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 naturali stic, multisite evaluation of Department of Veterans Affairs (VA) substance abuse treatment programs. It then examines the effectiveness of an index e pisode of inpatient treatment and the effectiveness of continuing outpatien t care and participation in self-help groups. The study was conducted among 3018 patients from 15 VA programs that emphasized 12-Step, cognitive-behav ioral (CB), or eclectic treatment. Casemix-adjusted 1-year outcomes showed that patients in 12-Step programs were the most likely to be abstinent, fre e of substance abuse problems, and employed at the 1-year follow-up. Patien ts who obtained more regular and mom intensive outpatient mental health car e, and those who participated more in 12-Step self-help groups, were more l ikely to be abstinent and free of substance use problems at the 1-year foll ow-up. These findings support the effectiveness of 12-Step treatment and sh ow that patients with substance use disorders who become more involved in o utpatient care and self-help groups tend to experience better short-term su bstance use outcomes. Subsequent papers in this section focus on the proxim al outcomes of treatment, patients with psychiatric as well as substance us e disorders, patient-treatment matching effects, and the link between progr am treatment orientation end patients' involvement in and the influence of 12-Step self-help groups.