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Biomedical subjects

R H Moos

Publications and source records attributed to R H Moos.

At least 37 records · Page 2Linked to original sources
PubMed2000

Changes in services and structure in community residential treatment facilities for substance abuse patients.

OBJECTIVE: This study examined the extent to which community residential facilities that contract with the Department of Veterans Affairs (VA) to treat substance abuse patients are providing more services and structure to meet the needs of a client population with increasingly severe problems. METHODS: A nationwide sample of 249 community residential facilities with VA contracts was surveyed in 1995 and again in 1998. RESULTS: In 1998 facilities were more likely than they were in 1995 to have psychiatrists and psychologists available to patients as well as specialized counseling and psychoeducational, rehabilitation, and medical services. Facilities also provided more social and recreational activities, and more structure was provided by discouraging patients' choice of individual daily living patterns. In 1998 the facilities were more likely to admit dual diagnosis patients, those with substance use disorders and psychiatric disorders. Programs that changed toward accepting dual diagnosis patients had more services and structure than programs that consistently accepted only substance abuse patients. CONCLUSIONS: Community residential facilities that contract with VA are responding appropriately to an increasingly ill patient population by providing more services and structure.

Adolescent↗
PubMed2000

Six- and ten-item indexes of psychological distress based on the Symptom Checklist-90.

Clinicians, provider organizations, and researchers need simple and valid measures to monitor mental health treatment outcomes. This article describes development of 6- and 10-item indexes of psychological distress based on the Symptom Checklist-90 (SCL-90). A review of eight factor-analytic studies identified SCL-90 items most indicative of overall distress. Convergent validity of two new indexes and the previously developed SCL-10 were compared in an archival sample of posttraumatic stress disorder patients (n = 323). One index, the SCL-6, was further validated with archival data on substance abuse patients (n = 3,014 and n = 316) and hospital staff (n = 542). The three brief indexes had similar convergent validity, correlating .87 to .97 with the SCL-90 and Brief Symptom Inventory, .49 to .76 with other symptom scales, and .46 to .73 with changes in other symptom measures over time. These results indicate the concise, easily administered indexes are valid indicators of psychological distress.

Adult↗
PubMed2000

Two-year mental health service use and course of remission in patients with substance use and posttraumatic stress disorders.

OBJECTIVE: Comorbid diagnoses of substance abuse/dependence and posttraumatic stress disorder (SUD-PTSD) adversely affect substance abuse patients' treatment outcomes. Recently, several practices have been recommended for the treatment of SUD-PTSD patients based on empirical findings, including providing PTSD-specific care. Accordingly, this study examines the association between outpatient PTSD treatment and the long-term course of SUD-PTSD patients. METHOD: Male substance abuse/dependence patients (N = 125) with a comorbid diagnosis of PTSD completed 1-and 2-year follow-ups. Based on these reports, 26 patients were stably remitted from substance abuse, 39 were partially remitted and 60 were not remitted at either follow-up. These three groups were compared on mental health service use indices gathered from patients' self-reports of inpatient treatment and nationwide Veterans Affairs (VA) databases abstracting outpatient visits. RESULTS: SUD-PTSD patients who attended more outpatient substance abuse, psychiatric and PTSD services in the first year following treatment (and cumulatively over the 2-year follow-up) were more likely to maintain a stable course of remission from substance use in the 2 years following inpatient SUD treatment. When the three types of sessions were examined in regression analyses, PTSD sessions in the second year and the total number of PTSD sessions over the 2 years following the index treatment episode emerged as the most significant predictors of remission. Self-help group participation was also associated with a remitted course for SUD-PTSD patients. CONCLUSIONS: These data suggest that PTSD-focused treatment services are an essential treatment component for substance abuse/dependence patients with PTSD.

Adult↗
PubMed2000

Long-term outcomes of alcohol use disorders: comparing untreated individuals with those in alcoholics anonymous and formal treatment.

OBJECTIVE: The aim of this study was to examine how the type and timing of help received over 8 years by previously untreated problem drinking individuals were linked to drinking and functioning outcomes. METHOD: At the time of the 8-year follow-up, individuals (N= 466, 51% male) had self-selected into four groups: no treatment (n = 78), Alcoholics Anonymous (AA) only (n = 66), formal treatment only (n = 74), or formal treatment plus AA (n = 248). RESULTS: Individuals who received some type of help--AA, formal treatment or both--were more likely to be abstinent at 8 years than were untreated individuals. Although the AA only group was better off than the formal treatment only group at 1 and 3 years, the informally and formally treated groups were equivalent on drinking outcomes at 8 years. Similarly, despite the formal treatment plus AA group having been better off at 1 and 3 years than the formal treatment only group, the two formal treatment groups were comparable on drinking at 8 years. Both helped and untreated individuals improved between baseline and 1 year on drinking outcomes, but only formally treated individuals showed continued improvement over 8 years on drinking indices. Participation in AA or formal treatment during Year 1 of follow-up was associated with better drinking outcomes at 8 years. CONCLUSIONS: Individuals who obtain help for a drinking problem, especially relatively quickly, do somewhat better on drinking outcomes over 8 years than those who do not receive help, but there is little difference between types of help on long-term drinking outcomes.

Adult↗
PubMed2000

Specialty mental health care improves patients' outcomes: findings from a nationwide program to monitor the quality of care for patients with substance use disorders.

OBJECTIVE: To describe the implementation of a nationwide program to monitor the quality of treatment for substance use disorders in the Department of Veterans Affairs, and to examine how the provision of outpatient mental health care, and the duration and intensity of care, relate to patients' outcomes. METHOD: Clinicians completed a baseline Addiction Severity Index (ASI) on more than 34,000 patients with substance use disorders; more than 21,000 (63%) were reassessed with the ASI an average of 12 months later. Nationwide health service utilization databases were used to obtain information about patients' diagnoses and their use of services during an index episode of care. RESULTS: On average, patients who received specialty outpatient mental health care experienced better risk-adjusted outcomes than did patients who did not receive such care. Patients who had longer index episodes of mental health care improved more than did those who had shorter episodes. There was some evidence that the duration of care contributed more to better outcomes among patients with only substance use disorders, whereas the intensity of care was more important for patients with both substance use and psychiatric disorders. CONCLUSIONS: The provision of specialty outpatient mental health care, and longer episodes of specialty care, were associated with better risk-adjusted substance use, symptom and social functioning outcomes for patients with substance use disorders. More emphasis should be placed on ensuring that these patients enter specialty care and on keeping them in treatment.

Adult↗
PubMed2000

Elderly Medicare inpatients with substance use disorders: characteristics and predictors of hospital readmissions over a four-year interval.

OBJECTIVE: (1) To describe the characteristics and 4-year readmissions of elderly Medicare inpatients with substance use disorders; (2) to determine whether their readmissions are elevated relative to case controls'; and (3) to examine gender differences in characteristics and predictors of readmissions among elderly inpatients with substance use disorders. METHOD: Health Care Financing Administration Medicare Provider Analysis and Review data were used to identify elderly patients with substance use disorders and their case controls, and to determine patient characteristics and readmissions over a 4-year interval following hospital discharge. RESULTS: Of elderly inpatients with substance use disorders (N = 22,768), 37% were women, 11% were black, 22% had previous, substance-related hospitalizations, 14% had concomitant psychiatric disorders and 9% had accident-related diagnoses. Among surviving patients with substance use disorders (N = 12,417), 73% were rehospitalized, a higher rate than among case controls (69%). Women with substance use disorders were more likely to have a psychiatric or accident diagnosis at the index episode than were men with substance use disorders. CONCLUSIONS: Many women and a disproportionate number of blacks constitute elderly Medicare inpatients with substance use disorders. These patients often have prior substance-related hospitalizations, psychiatric comorbidities, and accidents involving poisoning, adverse drug reactions and falls. They make costly, relatively heavy use of inpatient health services. Elderly women with substance use disorders may benefit from treatment that focuses on their psychiatric disorders and accident risk. Diagnostic information available at discharge can be used to identify patients at higher risk for subsequent rehospitalization and to plan treatment accordingly.

Aged↗
PubMed1999

Depression and outpatient medical utilization: a naturalistic 10-year follow-up.

The current investigation described the relationship between depression and outpatient medical utilization in a sample of 424 treatment-seeking individuals diagnosed with a depressive disorder and a demographically matched community sample of 424 men and women. This relationship was assessed longitudinally from baseline (intake for the patient sample) to 1-, 4-, and 10-year follow-ups. Patients and community individuals demonstrated distinct patterns of depressive symptoms and outpatient medical utilization: patients declined in symptoms and medical utilization following treatment, although they continued to have higher levels of depressive symptoms and outpatient utilization than controls at each follow-up period. Community controls demonstrated no change from baseline in symptoms or utilization at any follow-up. Higher levels of depressive symptoms was associated with increased outpatient medical utilization over the 10 years, even when age, sex, marital status, medical comorbidity, and patient status were controlled. Results add further evidence for a relationship between symptoms of depression and outpatient utilization by documenting this relationship in a posttreatment sample. Furthermore, the findings underscore the need for long-term follow-ups in investigations of the association between treatment for depression and the outpatient medical utilization of depressed individuals.

Adult↗
PubMed1999

Gender differences in problem drinking and depression: different "vulnerabilities?".

This study examines the relationship between stressors and resources and the functioning of a sample of 515 men and women who had a drinking problem. At a one-year follow-up, both women and men had improved on three functioning measures: alcohol consumption, days intoxicated, and depression. There were no gender differences at Time 2 on alcohol consumption, but men had more days intoxicated and women had more symptoms of depression. The impact of stressors and resources varied by life domain, functioning criterion, and gender. Although the predictors varied, the amount of variance in depression accounted for was the same for women and men. The most striking gender difference was the stronger impact of friendships for women on all aspects of functioning. This study provides support for reconsideration of the stress vulnerability of women and men.

Adult↗
PubMed1999

Resource loss, resource gain, and depressive symptoms: a 10-year model.

This study examined a broadened conceptualization of the stress and coping process that incorporated a more dynamic approach to understanding the role of psychosocial resources in 326 adults studied over a 10-year period. Resource loss across 10 years was significantly associated with an increase in depressive symptoms, whereas resource gain across 10 years was significantly associated with a decrease in depressive symptoms. In addition, change in the preponderance of negative over positive events across 10 years was inversely associated with change in resources during the period. Finally, in an integrative structural equation model, the association between change in life events and depressive symptoms at follow-up was completely mediated through resource change.

Adaptation, Psychological↗
PubMed1999

Dual diagnosis patients in substance abuse treatment: relationship of general coping and substance-specific coping to 1-year outcomes.

AIMS: This study examined general and substance-specific coping skills and their relationship to treatment climate, continuing care and 1-year post-treatment functioning among dual diagnosis patients (i.e. co-occurrence of substance use and psychiatric disorders). DESIGN: In a prospective multi-site study, dual diagnosis patients participating in substance abuse treatment were assessed at intake, discharge and at a 1-year follow-up. SETTING: Patients were recruited from 15 substance abuse treatment programs, which were selected from a larger pool of 174 inpatient treatment programs in the Department of Veterans Affairs Health Care System. PARTICIPANTS: A total of 981 male dual diagnosis patients participated in the study. MEASUREMENTS: Assessments included general and substance-specific coping skills, treatment climate, continuing outpatient care, abstinence and clinically significant psychiatric symptoms. FINDINGS: Dual diagnosis patients modestly improved on general and substance-specific coping skills over the 1-year follow-up period. Patients who were in programs with a 'dual diagnosis treatment climate' and who participated in more 12-Step self-help groups showed slightly more gains in adaptive coping. Both general and substance-specific coping were associated with abstinence, but only general coping was associated with freedom from significant psychiatric symptoms. CONCLUSIONS: Enhancing general and substance-specific coping skills in substance abuse treatment may reduce dual diagnosis patients' post-treatment substance use and improve their psychological functioning.

Adaptation, Psychological↗
PubMed1999

Reciprocal relations between stressors and drinking behavior: a three-wave panel study of late middle-aged and older women and men.

AIM: To examine reciprocal relations between stressors and drinking behavior among late-middle-aged and older women and men. DESIGN, SETTING, AND PARTICIPANTS: A community sample of 621 women and 941 men (mean age = 61) provided information about their life stressors and drinking behavior at three times: initial assessment, 1 year later and 4 years later. Structural equation modeling with manifest variables was used to examine cross-temporal relations between stressors and drinking behavior. FINDINGS: Stressors did not predict heavier or more frequent drinking. In fact, among women, increased health stressors predicted a reduction of alcohol consumption; among men, increased financial stressors suppressed alcohol consumption. Higher stressor levels in some life domains did foreshadow later drinking problems. More initial drinking problems resulted in more subsequent financial and spouse stressors for both women and men. Contrary to expectation, more frequent alcohol consumption presaged fewer negative life events, health stressors, and financial stressors for women, and fewer health stressors for men. CONCLUSIONS: The findings suggest that among older adults there may be a harmful feedback cycle whereby problematic drinking and life stressors exacerbate each other, but also a benign feedback cycle in which moderate alcohol consumption and life stressors reduce each other.

Age Factors↗
PubMed1999

Symptom-based predictors of a 10-year chronic course of treated depression.

The high likelihood of a chronic course of depression underscores the need to identify at intake patients most at risk for long-term nonremission. In a naturalistic study of 313 unipolar depressed patients, potential symptom-based risk factors were assessed at treatment intake and were used to predict a chronic course of treated depression over a 10-year interval. The prototypic chronically depressed patient was an individual who at baseline experienced more severe symptoms of fatigue, loss of interest in usual activities, trouble sleeping, and thoughts about death or suicide; was not calm, successful, or self-confident; and did not socialize with friends outside the home, and frequently coped with stressors by avoiding other people. A larger number of risk factors was associated with a higher likelihood of experiencing a chronic course. High-risk patients who received more psychological treatment during the index episode were more likely to experience a long-term course of remission or partial remission.

Adaptation, Psychological↗
PubMed1999

A comparative evaluation of substance abuse treatment: II. Linking proximal outcomes of 12-step and cognitive-behavioral treatment to substance use outcomes.

This study examines the linkages in the treatment process chains that are thought to underlie two prevalent approaches to substance abuse treatment, traditional 12-Step treatment and cognitive-behavioral treatment. The focus is on the "proximal outcomes" specified by the two treatment approaches and their relation to "ultimate" substance use outcomes assessed at a 1-year follow-up. A total of 2687 men who received treatment in 15 Department of Veterans Affairs substance abuse treatment programs were assessed at treatment entry, at or near discharge, and at a 1-year follow-up. Based on the results of factor analyses, composite proximal outcomes variables were constructed to assess 12-Step cognitions, 12-Step behaviors, cognitive-behavioral beliefs, substance-specific coping, and general coping. Correlation analyses indicated that some of the proximal outcome composites assessed at treatment discharge were linked to 1-year outcomes, but the relationships were weak (r = .09 to .15). At follow-up, the cross-sectional relationships between the proximal outcome composites and two substance use outcomes were stronger, but still modest in magnitude (r = .16 to .39). The weak predictive findings suggest some mechanism is needed to sustain treatment-induced change on proximal outcomes so that positive ultimate outcomes can be achieved more frequently. In this regard, participation in continuing care was associated with enhanced maintenance of treatment gains on proximal outcomes. However, the modest cross-sectional relationships between proximal and substance use outcomes at follow-up suggest that the theories on which 12-Step and cognitive-behavioral substance abuse treatments are based are not sufficiently comprehensive.

Adaptation, Psychological↗
PubMed1999

Outcomes of four treatment approaches in community residential programs for patients with substance use disorders.

OBJECTIVE: Treatment approaches used in community residential facilities for patients with substance use disorders were identified, and patients' participation in treatment and case-mix-adjusted one-year outcomes for substance use, symptoms, and functioning in facilities with different treatment approaches were examined. METHODS: A total of 2,376 patients with substance use disorders treated in a representative sample of 88 community residential facilities were assessed at entry to and discharge from the facility and at one-year follow-up. The community residential facilities were classified into four types based on the major emphasis of the treatment program: therapeutic community, psychosocial rehabilitation, 12-step, and undifferentiated. RESULTS: Patients in programs that used the therapeutic community, psychosocial rehabilitation, and 12-step approaches had comparable one-year outcomes in symptoms and functioning that were better than those of patients in undifferentiated programs. A more directed treatment orientation, a longer episode of care, and completion of care were independently related to better one-year outcomes. These findings held for patients with only substance use disorders and for patients with both substance use and psychiatric disorders. CONCLUSIONS: Community residential programs that have a more directed treatment orientation and that motivate patients to complete treatment have better substance use outcomes. As an increasingly important locus of specialized care, community residential facilities need to develop and maintain more differentiated and distinctive treatment orientations.

Adult↗
PubMed1999

Long-term treatment careers and outcomes of previously untreated alcoholics.

OBJECTIVE: The aim of this project was to describe treatment selection and outcomes over an 8-year follow-up period for 466 individuals who had drinking problems and had not yet received formal treatment at baseline. METHOD: By the 8-year follow-up, individuals had self-selected into one of four groups: no-treatment (n = 78); completed treatment (help was received only in Years 1-3 of follow-up; n = 230); additional treatment (help was received in Years 1-3, with more help in Years 4-8; n = 134); and delayed treatment (no help was received until Years 4-8 of follow-up; n = 24). RESULTS: Compared with individuals who remained untreated, the completed treatment group had more severe drinking problems and depression at baseline, but better drinking outcomes at both the 3- and 8-year follow-ups. At 3 years, the additional treatment group perceived their drinking problem as being more serious than did the untreated group and was more likely to have drinking-related problems; by 8 years, individuals who had obtained additional treatment were more likely to be abstinent, but still perceived their drinking problems as being more serious. Compared to individuals who completed treatment in Years 1-3, additional treatment group members had more severe drinking and functioning problems at 3 and 8 years. More involvement with formal outpatient treatment or AA was associated with more improvement on drinking indices. CONCLUSIONS: Persons with alcohol use disorders who elect to enter formal treatment or AA relatively soon after acknowledging their drinking problems experience better drinking-related outcomes than do those who receive no help or who delay receiving help. Accordingly, referral processes should ensure that problem drinkers enter self-help or formal treatment quickly.

Adult↗
PubMed1999

Effectiveness of treatment for substance abuse and dependence for dual diagnosis patients: a model of treatment factors associated with one-year outcomes.

OBJECTIVE: This study examines a model of treatment for substance abuse and dependence for patients with substance use disorders and concomitant psychiatric disorders. The model focuses on five interrelated sets of variables (social background, intake functioning. dual diagnosis treatment orientation, patients' change on proximal outcomes, and aftercare participation) that are hypothesized to affect dual diagnosis patients' 1-year posttreatment outcomes. METHOD: A total of 981 male dual diagnosis patients completed assessment at intake, discharge and 1-year follow-up. The relative importance of each set of variables as predictors of outcome was estimated by constructing block variables and conducting path analyses. RESULTS: Dual diagnosis patients had a higher abstinence rate at follow-up (39%) than at intake (2%); they also improved on freedom from psychiatric symptoms (from 60% to 68%) and employment (from 20% to 29%). At follow-up, patients in programs with a stronger dual diagnosis treatment orientation showed a higher rate of freedom from psychiatric symptoms (71%) than did patients in weaker dual diagnosis treatment oriented programs (65%); they also were more likely to be employed (34% vs 25%). More change on proximal outcomes and more aftercare participation were also associated with better 1-year outcomes. Patients with less severe psychiatric disorders improved more and responded better to dual diagnosis oriented treatments than did patients with more severe psychiatric disorders. CONCLUSION: Treatment programs for substance use disorders that adhere to principles of dual diagnosis treatment obtain better outcomes for dual diagnosis patients, especially for patients with less severe psychiatric disorders.

Adult↗
PubMed1999

A comparative evaluation of substance abuse treatment: I. Treatment orientation, amount of care, and 1-year outcomes.

This article first explains the conceptual framework and plan of a naturalistic, multisite evaluation of Department of Veterans Affairs (VA) substance abuse treatment programs. It then examines the effectiveness of an index episode of inpatient treatment and the effectiveness of continuing outpatient care and participation in self-help groups. The study was conducted among 3018 patients from 15 VA programs that emphasized 12-Step, cognitive-behavioral (CB), or eclectic treatment. Casemix-adjusted 1-year outcomes showed that patients in 12-Step programs were the most likely to be abstinent, free of substance abuse problems, and employed at the 1-year follow-up. Patients who obtained more regular and more intensive outpatient mental health care, and those who participated more in 12-Step self-help groups, were more likely to be abstinent and free of substance use problems at the 1-year follow-up. These findings support the effectiveness of 12-Step treatment and show that patients with substance use disorders who become more involved in outpatient care and self-help groups tend to experience better short-term substance use outcomes. Subsequent papers in this section focus on the proximal outcomes of treatment, patients with psychiatric as well as substance use disorders, patient-treatment matching effects, and the link between program treatment orientation and patients' involvement in and the influence of 12-Step self-help groups.

Adult↗