Prediction of treatment outcomes: Lifetime depression versus the continuumof care

We sought to determine the impact of a lifetime diagnosis of major depressi on on addiction treatment outcome. Structured interviews were co;conducted upon admission, and consecutive structured interviews were conducted prospe ctively for treatment outcome at G and 12 month follow-up periods. A multis ite evaluation study of patients undergoing addiction treatment for alcohol and drug dependence was conducted in private outpatient facilities. Two th ousand twenty-nine subjects fr om 33 independent programs were enrolled in a national registry for addiction treatment outcomes. The patients received abstinence-based addiction treatment with referral to a 12-step recovery p rogram, often Alcoholics Anonymous, and continuing care in the treatment pr ograms. The outcome areas measured were treatment completion, posttreatment substance use exposure to psychosocial relapse risk factors, involvement w ith continuing care (formal aftercare and peer support groups) and posttrea tment vocational functioning, health care utilization, and legal involvemen t, The prevalence rate of depressive symptoms over at least a 2-week period (major depression) in our sample was 28%. Multivariate analysis with stepw ise multiple regression indicated that the most powerful predictors (relati vely) ofposttreatment alcohol/drug use were peel support group attendance a nd program continuing care involvement. Lifetime depression by itself and i n interaction with each of these factors accounted for less than 2% of the variance in outcome. Logistic regression yielded similar results in the pre diction of abstinence versus relapse. Posttreatment more than pretreatment factors appear to be mole decisive in predicting risk for relapse.