June 1983

Predicting Response to Alcohol and Drug Abuse TreatmentsRole of Psychiatric Severity

Author Affiliations

From the Department of Psychiatry, University of Pennsylvania, Philadelphia, and the Drug Dependence Treatment Service, Philadelphia Veterans Administration Medical Center (Drs McLellan, Luborsky, Woody, and O'Brien); the Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia (Dr Druley); and the Substance Abuse Treatment Unit, Coatesville (Pa) Veterans Administration Medical Center (Dr Druley).

Arch Gen Psychiatry. 1983;40(6):620-625. doi:10.1001/archpsyc.1983.04390010030004

• Male alcoholics (n=460) and drug addicts (n=282) were evaluated at six-month follow-up after treatment in six rehabilitation programs. Initial analyses of the unstratified samples showed significant patient improvement, but no evidence of differential effectiveness from different treatments or from "matching" patients to treatments. The two samples were then divided into groups based on the number, duration, and intensity of their psychiatric symptoms at admission, ie, their overall "psychiatric severity." Patients with low psychiatric severity improved in every treatment program. Patients with high psychiatric severity showed virtually no improvement in any treatment. Patients with midrange psychiatric severity (60% of the samples) showed outcome differences from different treatments and especially from specific patient-program matches. These findings support the effectiveness and specificity of different substance abuse treatments, suggest methodologic reasons for the lack of similar findings in previous studies, and demonstrate the importance of psychiatric factors in substance abuse treatment.

(Arch Gen Psychiatry 1983;40:620-625)