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Biomedical subjects

R H Moos

Publications and source records attributed to R H Moos.

At least 91 records · Page 5Linked to original sources
PubMed1995

Inpatient treatment for substance abuse patients with psychiatric disorders: a national study of determinants of readmission.

This study examined the patient case mix and program determinants of 6-month readmission rates and early treatment dropout for 7,711 VA inpatients with both substance abuse and major psychiatric disorders treated in one of 104 substance abuse programs. Patients were treated in one of three types of inpatient programs: explicitly designed dual diagnosis specialty programs, substance abuse programs with a dual diagnosis psychotherapy group or standard substance abuse programs. Dual diagnosis specialty programs differed from regular substance abuse programs in that they had a more severe case mix, a higher 180-day readmission rate, greater dual diagnosis treatment orientation, used more psychotropic medication, had longer lengths of stay, had greater tolerance of relapse and medication noncompliance, and a higher rate of psychiatric aftercare in the 30 days after discharged. Programs with less severe case mix, longer intended and actual length of stay, lower 7-day dropout rates, greater tolerance of problem behavior, 12-step groups, and higher immediate postdischarge utilization of outpatient mental health treatment lower 180-day readmission rates. Programs with less severe patient case mix, more use of psychotropic medications but less of methadone and antabuse, less varied and diverse treatment activities, and low use of patient-led groups had lower dropout rates.

Adolescent↗
PubMed1995

Characteristics and outcomes of three models of community residential care for abuse patients.

Three models of transitional residential community care for substance abuse patients are defined on the basis of the differential provision of health and treatment services: a psychosocial model, a supportive rehabilitation model, and an intensive treatment model. Facilities that provided a high level of on-site health and treatment services were categorized as following an intensive treatment model; these facilities had the strongest emphasis on medical, dual diagnosis, and family treatment orientations. These facilities also had clearer policies and provided their residents more opportunities to participate in setting policies; however, staff were not more accepting of patient impairment or problem behavior. Patients in facilities with intensive treatment programs obtained more outpatient mental health after care. In each of the three types of facilities, a longer length of care was associated with a lower readmission rate; patients who dropped out of psychosocial model facilities had especially high readmission rates. Overall, the findings identify substantial variations among community residential facilities for substance abuse patients, but show relatively little matching of patients' needs with facility services and programs.

Adult↗
PubMed1995

Depression and drinking behavior among women and men: a three-wave longitudinal study of older adults.

This 3-wave longitudinal study analyzed latent variable cross-lagged models of the relation between depressive symptoms and drinking behavior separately for 621 late-middle-aged women and 951 late-middle-aged men. Time lags of 1 and 3 years were used. Among women, heavier alcohol consumption predicted less depressive symptomatology 1 and 3 years later, whereas among men, having more depressive symptoms predicted less alcohol consumption later on. Including cross-temporal paths in the women's depression-drinking problems model did not provide a significant improvement over hypothesizing no cross-temporal effects. Among men, however, having more drinking problems was associated with fewer depressive symptoms 3 years later. These findings were robust in follow-up analyses controlling for the effects of socioeconomic and health status.

Aged↗
PubMed1995

Social support, coping, and depressive symptoms in a late-middle-aged sample of patients reporting cardiac illness.

This study tests a 1-year predictive model of depressive symptoms in a late-middle-aged sample of patients reporting diagnoses of cardiac illness. Results based on 325 individuals (248 men and 77 women) diagnosed with chronic cardiac illness, 71 individuals (52 men and 19 women) diagnosed with acute cardiac illness, and 219 healthy controls (129 men and 90 women) strongly supported the hypotheses. Compared with healthy persons, individuals with chronic and those with acute cardiac illness reported more depressive symptoms at follow-up. Women overall showed more depressive symptoms than did men, and women with cardiac illness were particularly vulnerable to behavioral manifestations of depressive symptoms. Integrative time-lag and prospective structural equation models indicated that, for individuals with cardiac illness, social support and adaptive coping strategies predicted fewer depressive symptoms.

Adaptation, Psychological↗
PubMed1995

Entering treatment for alcohol abuse: a stress and coping model.

This study used a stress and coping model to examine the process of entering treatment among 515 problem drinkers without prior formal treatment for alcohol abuse who were recruited at alcoholism information/referral (I&R) and detoxification centers. Over a 1-year follow-up period, 76% of the individuals in the sample entered some form of treatment, including Alcoholics Anonymous. People were more likely to enter treatment if they perceived their drinking problem as more severe, had more dependence symptoms, experienced more adverse consequences as a result of drinking, had more symptoms of depression, were more self-derogating, experienced more negative life events in the past year, and/or experienced more stressors in various life domains. Facilitative factors also related positively to treatment entry: people who had sought help from non-formal treatment sources before, who recalled being referred to treatment programs by an I&R center, and/or who received detoxification at a center that had treatment services available on-site, also were more likely to enter treatment. For people with greater resources in multiple life domains the positive effects of days intoxicated, dependence symptoms and stressors on help-seeking were intensified. Overall, the findings suggest that perceived severity of drinking problem plays a central role in the treatment entry process and mediates the effects of many other intrapersonal and environmental variables in generating an impetus or readiness to seek treatment.

Adaptation, Psychological↗
PubMed1995

Stay in residential facilities and mental health care as predictors of readmission for patients with substance use disorders.

OBJECTIVES: This study examined the relationship between substance abuse patients' length of stay in community residential facilities and their outpatient mental health aftercare and readmission for inpatient care. METHODS: A national sample of 1,070 substance abuse patients referred to community residential facilities after an episode of inpatient care was assessed and followed over four years. Patients were divided into three groups: those with only alcohol-related diagnoses; those with drug-related diagnoses, most of whom also had alcohol diagnoses; and those with concomitant psychiatric diagnoses. RESULTS: Patients who had longer episodes of care in residential facilities were more likely to obtain outpatient mental health aftercare and were less likely to be readmitted for additional substance abuse or psychiatric care in six-month, one-year, and four-year follow-up intervals. Readmission rates among substance abuse patients with psychiatric diagnoses were much higher than rates among patients who had only substance abuse diagnoses. Length of stay in the community residential facility and postdischarge outpatient mental health care remained significant independent predictors of lower readmission after other risk factors for readmission were considered. CONCLUSIONS: Transitional community residential care can contribute to substance abuse patients' treatment outcome; however, longer-term supportive care is needed for substance abuse patients with more severe and chronic disorders.

Adult↗
PubMed1995

Longer episodes of community residential care reduce substance abuse patients' readmission rates.

OBJECTIVE: The study focuses on whether substance abuse patients who enter a community residential facility (CRF) after discharge from inpatient care obtain more outpatient mental health care and have lower readmission rates than comparable patients discharged directly to the community. METHOD: A national sample of substance abuse patients (N = 5,176; 99% men) referred to CRFs after inpatient substance abuse care is compared to a matched sample of patients (N = 5,176; 99% men) discharged to the community. RESULTS: Compared with controls, CRF patients were more likely to obtain outpatient mental health aftercare and obtained more intensive care. Patients with longer episodes of CRF care had lower 6-month and 1-year readmission rates than patients who dropped out of CRFs and than matched controls. These findings held for patients who had only alcohol diagnoses, patients who had drug diagnoses and patients who had psychiatric diagnoses in addition to their substance abuse disorders. Longer length of CRF care and more outpatient mental health care were significant predictors of lower readmission rates after other risk factors for readmission were controlled. CONCLUSIONS: Longer episodes of community residential care can contribute to better outcomes for substance abuse patients, in part by maintaining patients' involvement in outpatient mental health care. CRFs may play an important role in the continuum of substance abuse patients' care.

Activities of Daily Living↗
PubMed1995

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

OBJECTIVE: To describe treatment selection and outcomes over a 3-year follow-up period for 439 individuals who had drinking problems and had not yet received formal treatment at baseline. METHOD: By the 3-year follow-up, individuals had self-selected into one of four groups: no-treatment (n = 70), completed treatment (i.e., help was received only in Year 1 of follow-up: n = 109), additional treatment (i.e., help was received in Year 1, with more help in Years 2 and 3; n = 233), and delayed treatment (i.e., no help was received until Years 2 and 3 of follow-up; n = 27). RESULTS: Compared with individuals who remained untreated, individuals who sought help during Year 1 had more severe drinking problems, poorer psychosocial functioning and more negative life events at baseline; however, treated individuals had better drinking outcomes than untreated persons at the 1- and 3-year follow-ups. Compared to individuals who completed treatment in Year 1, additional treatment group members had more severe drinking problems at baseline and 1 year later, but better drinking outcomes at the 3-year follow-up. Formal treatment in conjunction with Alcoholics Anonymous (AA) was associated with better drinking outcomes than formal treatment alone. In addition, more involvement with formal inpatient or outpatient treatment, or AA, was associated with more improvement on drinking indices. CONCLUSION: Overall, the findings suggest a reciprocal relationship between individuals' functioning and their participation in alcohol abuse interventions.

Adult↗
PubMed1994

Outcome of treatment for alcohol abuse and involvement in Alcoholics Anonymous among previously untreated problem drinkers.

A sample of 515 initially untreated problem drinkers was followed for one year after contacting alcohol information and referral or detoxification services. At a one-year follow-up, participants had self-selected into one of four groups: no treatment (24%), Alcoholics Anonymous (AA) only (18%), outpatient treatment (25%), and residential or inpatient treatment (32%); some outpatients also attended AA, and some inpatients also attended AA and/or outpatient programs. These four groups were compared on changes in drinking-related variables, other aspects of functioning, and stressors and resources over the follow-up year. Also examined were associations between amount of treatment and outcomes at one year. All four groups improved on drinking and functioning outcomes but changed less on stressors and resources. Although individuals who received no help improved, persons in the two treatment and the AA-only groups improved more, particularly on drinking-related outcomes. Inpatients were more likely than outpatients or AA-only participants to be abstinent; otherwise, type of intervention had few differential effects. More AA attendance was associated with abstinence among AA-only, outpatient, and inpatient group members. Among outpatients and inpatients, more formal treatment was associated with abstinence and improvement on other drinking-related outcomes.

Alcoholics Anonymous↗
PubMed1994

Personal and environmental risk factors as predictors of alcohol use, depression, and treatment-seeking: a longitudinal analysis of late-life problem drinkers.

We examined how personal risk factors (prior functioning, male, unmarried, early onset of drinking problems, and avoidance coping) and environmental risk factors (negative life events, chronic stressors, and friends' approval of drinking) predicted changes in older problem drinkers' (N = 659) adaptation over a 1-year interval. Personal risk factors independently predictive of poorer outcomes included poorer prior functioning, being male, and more use of avoidance coping strategies. Of environmental risk factors, negative life events, chronic health and spouse stressors, and having more friends who approved of drinking were independent predictors of poorer follow-up functioning and treatment seeking. Interactions between personal and environmental risk factors helped predict subsequent alcohol consumption and treatment seeking. For example, lighter drinkers were more likely than heavier drinkers to curtail alcohol use in response to new health events; friends more strongly influenced the treatment seeking of unmarried problem drinkers and individuals who used more avoidance coping strategies.

Adaptation, Psychological↗
PubMed1994

Determinants of readmission following inpatient substance abuse treatment: a national study of VA programs.

This study examines program determinants of one aspect of VA inpatient substance abuse treatment program performance. Performance was measured by the ratio of a program's readmission rate to the expected rate for programs with similar patients. Six-month readmission rates in 101 VA treatment programs were analyzed. Preliminary analyses indicated that patient differences across programs accounted for 36% of the variance in readmission rates. Program differences accounted for 47% of the variance in case-mix-adjusted readmission rate. Among program factors selected through a literature review, better than expected readmission performance was associated with having fewer early discharges, a longer intended treatment duration, more patient participation in aftercare, more family or friend assessment interviews, and treating more patients on a compulsory basis. Performance was not related to stress management training, patient attendance at more self-help meetings during treatment, staff characteristics, or average staff costs per patient day. The findings indicate that treatment retention, duration, and increased aftercare may be targeted to reduce high readmission rates. Last, there were only small differences in the model over 30, 60, 90, and 365 day follow-up intervals, suggesting substantial stability of the findings.

Aftercare↗
PubMed1994

Why do some people recover from alcohol dependence, whereas others continue to drink and become worse over time?

For more than three decades, my colleagues and I have examined factors that help people overcome adversity, in particular how personal and treatment factors and the broader social context influence recovery from alcoholism. Guided by a demanding Guardian Angel, we have formulated conceptual models that raise key issues, developed tentative measures of key constructs, and conducted long-term naturalistic studies. In an ongoing odyssey of quest and discovery, we have identified interrelated factors that are important to predicting outcomes. These factors include personal resources and specific aspects of treatment, life context, and appraisal and coping. Such basic processes are also broadly relevant to remission and recovery from depression and other disorders. The answers to each question we have addressed point to more intriguing and complex issues to consider before we will grasp the essence of why some people adapt to adversity so much better than others do.

Adaptation, Psychological↗
PubMed1994

Remission of late-life drinking problems: a 4-year follow-up.

This 4-year follow-up study compared stably remitted late-life problem drinkers to nonremitted problem drinkers and nonproblem drinkers. At time 1, to-be-remitted drinkers reported less alcohol consumption and fewer drinking problems, more depression and less self-confidence, less spousal support and approval of drinking from friends, and more help-seeking than did to-be-nonremitted drinkers. Remitted drinkers showed improvement in functioning and life context at the 4-year follow-up, but compared with nonproblem drinkers some deficits persisted. Stable remission and abstinence among late-onset drinkers were closely tied to receiving less spousal support and approval from friends for drinking at time 1, whereas help-seeking was a strong predictor of stable remission and abstinence among early-onset problem drinkers. For both late- and early-onset drinkers, abstinence was predicted by initially having more drinking problems, depression, and health stressors.

Adaptation, Psychological↗
PubMed1994

Mortality rates and predictors of mortality among late-middle-aged and older substance abuse patients.

This study describes mortality rates and predictors of mortality among late-middle-aged and older (55+) substance abuse inpatients (n = 21,139) in Department of Veterans Affairs (VA) Medical Centers in the 4 years after an index episode of care. A total of 24% of the patients died; this mortality rate was 2.64 times higher than expected. Predictors of earlier mortality included older age and nonmarried status, alcohol psychosis and organic brain disorder diagnoses, and several medical diagnoses, including neoplasms, liver cirrhosis, respiratory, endocrine and metabolic, and blood system disorders. Three proxy indicators of illness severity also predicted mortality: more prior inpatient and outpatient medical care and an index episode in an extended care unit. In contrast, more prior outpatient mental health care and remitted status predicted lower mortality. These diagnostic and treatment indicators can be used to identify patients at heightened risk for premature mortality. Moreover, they show that intensive mental health aftercare and remission of substance abuse may delay mortality, even among older patients who have longstanding substance abuse problems.

Aged↗
PubMed1994

Diagnostic subgroups and predictors of one-year re-admission among late-middle-aged and older substance abuse patients.

This naturalistic study uses data based on clinical records to examine treatment utilization and 1-year re-admission rates among three diagnostic subgroups of late-middle-aged and older substance abuse inpatients in Department of Veterans Affairs (VA) Medical Centers: inpatients with only an alcohol or drug dependence diagnosis (n = 11,652); inpatients with an alcohol or drug psychosis (n = 3,510); and inpatients with an alcohol or drug disorder and a concomitant psychiatric disorder (n = 5,977). As expected, substance abuse patients in the latter two subgroups received more treatment before, during and following an index episode of care than did patients with only an alcohol or drug dependence diagnosis. From a broad perspective, these results indicate a match between treatment services and patient needs. However, relatively few older substance abuse patients received outpatient mental health aftercare; this was true especially of patients with alcohol or drug psychosis diagnoses. The 1-year re-admission rate in the group overall was higher than that usually reported in younger and mixed-age groups of substance abuse patients. Re-admission was predicted by unmarried status (a predisposing factor) and need, as indexed by several diagnostic and treatment characteristics.

Aged↗
PubMed1994

Rates and predictors of four-year readmission among late-middle-aged and older substance abuse patients.

This naturalistic study examines treatment, diagnoses and readmission among late-middle-aged and older (age 55+) substance abuse inpatients (N = 16,066) in Department of Veterans Affairs Medical Centers. Over an interval extending from 4 years before to 4 years after an index episode of care, older substance abuse patients used substantial amounts of inpatient and outpatient treatment. Service use was heaviest among patients with a concomitant psychiatric disorder, and there was no evidence that it declined over time in the overall group. Four-year readmission rates in three diagnostic subgroups (alcohol or drug dependence diagnosis only, alcohol or drug psychoses, substance dependence and/or psychoses with one or more psychiatric diagnoses) were very high (57% to 70%); however, they were somewhat lower among patients with less chronic substance abuse problems. Readmission and multiple readmission were predicted by younger age, unmarried status, more prior service use, alcohol psychosis or psychiatric diagnoses, treatment in a psychiatric unit, and shorter hospital stay. These factors may be used at admission and discharge to identify patients at risk for rehospitalization; inpatient treatment and aftercare can be planned accordingly.

Age Factors↗
PubMed1993

Parental risk and resistance factors among children with juvenile rheumatic disease: a four-year predictive study.

Examined the extent to which baseline functioning and parental risk and resistance factors predicted disease-related (functional disability and pain) and psychosocial functioning (social competence and behavior problems) 4 years later among 172 children with juvenile rheumatic disease. The study also examined the extent to which fathers' risk and resistance factors explained patients' adaptation, above and beyond maternal factors. Poorer baseline functioning was a strong risk factor that predicted poorer functioning 4 years later. In addition, parental risk and resistance factors at baseline predicted patients' adjustment after patients' age and baseline functioning were controlled. Mothers' and fathers' personal strain and depressed mood, and fathers' drinking problems, were associated with poorer patient adjustment; mothers' and fathers' social functioning appeared to aid patients' adjustment. Fathers' risk and resistance factors contributed independently from those of mother, to predict patients' outcome.

Adaptation, Psychological↗