Introduction

1. Characteristics of Clients with Co-Occurring Disorders in Addiction Treatment: A Comparison by Gender Laurel Mangrum, Ph.D. University of Texas at Austin, Addiction Research Institute Introduction COPSD Client Characteristics Results and Conclusions The co-occurrence of psychiatric and substance use disorders (COD) and the effects of comorbidity on the clinical presentation and outcomes of addiction treatment are growing areas of study. Early studies in this area focused on severely mentally ill (SMI) populations and led to the development of specialized integrated treatment programs for these clients. As research progresses, studies are focusing on identifying client characteristics that may be associated with clinical features and outcomes. In this line of research, gender has been explored as a potential factor affecting symptom presentation and treatment response in COD clients with SMI. Studies to date suggest that women have a greater history of victimization and associated traumatic stress, more medical problems, and may be more willing or able to identify relationship and psychiatric problems, whereas men tend to have higher levels of legal involvement. Findings in the area of substance use and psychiatric severity are inconsistent but trends suggest that men may present more severe substance use symptoms and women greater psychiatric distress. These extant studies, however, are limited to COD clients with SMI and may not generalize to individuals with non-severe co-occurring psychiatric disorders. The current study examines gender differences in a sample of COD clients entering addiction treatment that includes both severe and non-severe psychiatric disorders. The purpose of the study was to determine if gender characteristics in this sample, containing a wider array of psychiatric disorders, are similar to those found in previous studies of SMI populations. . • Analyses of demographic and social variables revealed that males were more likely to be Hispanic and relatively older, whereas females were more often Black. Males were more likely to be employed; however, high levels of unemployment were found in both groups (approximately 85%). No differences were found between males and females in education level. The groups were similar in incidence of past year DWI and PI arrests, but females had a higher incidence of other substance related arrests. Males were more likely to be homeless; by contrast females were more often living in an institutional setting. In the area of client-reported problem days during the month prior to admission, females reported significantly more problem days related to physical health, employment, family, social, and psychological issues, whereas males reported greater problem days related to substance use. On psychiatric measures, males more often obtained the diagnoses of depression and generalized anxiety disorder; by contrast, females were more frequently diagnosed with posttraumatic stress disorder. No group differences were found on the total number of diagnoses on the MINI. Males reported greater psychiatric severity on 10 of the 11 BSI scales relative to females. Further, comparisons of clinician ratings on the BDPRS revealed that males had significantly higher severity ratings on the Somatization, Obsessive-Compulsive, Phobic Anxiety, Paranoid Ideation, Psychoticism, and Global Pathology Index scales. In the area of addiction treatment history and substance use patterns, males had a greater history of detox treatment, whereas females had a greater incidence of AA attendance during the month prior to admission. The groups did not differ in previous non-detox treatment or past year emergency room visits. Males were more likely to use alcohol and opiates as primary substances and females more often used crack cocaine. Females were more likely to engage in polysubstance use, whereas males had a higher history of IV drug use. Males reported greater days of primary substance use during the 30 days prior to admission; however, relatively equivalent percentages of both groups reported daily use during the past 6 months. At discharge, males had higher rates of treatment completion (79% vs. 71%; X2(1) = 10.18, p < .01), past month abstinence rates (89% vs. 74%; X2(1) = 34.20, p < .0001), and AA attendance during the 30 days prior to discharge (87% vs. 82%; X2(1) = 4.10, p < .05). Analyses of recovery support service utilization revealed that males were more likely to receive food assistance, peer mentoring, housing assistance, and transportation services, whereas higher proportions of females received vocational assistance and educational support. Males also received a greater number of voucher service types relative to females. • Consistent with previous findings in the SMI population, the current analyses revealed that women had greater rates of posttraumatic stress disorder, displayed higher medical problems, and reported more psychosocial problems compared to men. Contrary to past results, however, women were more likely to have substance related arrests relative to men and reported comparable rates of DWI and PI arrests during the past year. Further, the results of this study did not support trends noted in other studies in which women tended to display greater psychiatric symptom severity. In this sample, men displayed greater severity on psychiatric measures and received a wider array of recovery support services, yet reported less social and psychological problem days at admission to treatment compared to women. Conversely, women reported higher levels of psychosocial distress and less problems related to substance use. These findings suggest that a differential pattern of awareness may exist regarding the effects of psychiatric and substance use severity on life functioning, with males more readily admitting to problems related to substance use and females more open to acknowledging the effects of social and psychiatric problems. The possible presence of differential gender effects on client reporting has significant clinical implications for the assessment process and highlights the importance of using a variety of measures and informant sources to corroborate the client’s problem presentation. In addition, gender differences in problem awareness may also indicate the need for treatment programming and interventions tailored toward increasing recognition of the broader and interactive effects of substance use and psychiatric problems on social functioning. Demographic and Social Characteristics Problem Days Past Month at Admission Recovery Support Services Received Treatment History and Substance Use Sample and Method The sample consisted of 1,224 clients entering addiction treatment who subsequently qualified for the Texas Co-Occurring State Incentive Grant (COSIG) based on the presence of a comorbid non-substance use disorder determined though the Mini International Neuropsychiatric Interview (MINI). The sample was recruited between February 2005 and September 2007 from ten state-funded addiction treatment programs participating in the COSIG project. The total sample was 63% female, 43% White, 31% Hispanic, and 21% Black. Males and females were compared on demographic variables, MINI psychiatric diagnoses, substance use characteristics, psychiatric severity, recovery support service utilization, and treatment characteristics. Psychiatric severity measures included the Brief Symptom Inventory (BSI; client report) and the Brief Derogatis Psychiatric Rating Scale (BDPRS; clinician rating). Demographic, substance use, and treatment characteristics data were obtained from the Behavioral Health Integrated Provider System (BHIPS), which is the mandatory data collection and outcomes monitoring system for state-funded addiction treatment providers in the state of Texas. One component of the COSIG project consisted of a voucher program designed to provide recovery support services to clients with COD to support the treatment and recovery process. Data regarding COSIG voucher services received were also available from BHIPS. Psychiatric Severity Co-Occurring Disorders Acknowledgements The author acknowledges the Texas Department of State Health Services (TDSHS), Mental Health and Substance Abuse Services Division for their assistance in providing data for this study. I also acknowledge the treatment providers participating in the COSIG project for contributing client data and recognize their continuing efforts to enhance services for clients with co-occurring disorders. The findings and conclusions of this in this presentation are the opinions of the author and do not necessarily reflect the official position of TDSHS. This project was funded by the SAMHSA Co-Occurring State Incentive Grant. Presented at the College on Problems of Drug Dependence Conference, Reno, Nevada, June 22, 2009