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June 1983, Vol 40, No. 6 >
Article | June 1983

Predicting Response to Alcohol and Drug Abuse Treatments: Title and subTitle BreakRole of Psychiatric Severity

A. Thomas McLellan, PhD; Lester Luborsky, PhD; George E. Woody, MD; Charles P. O'Brien, MD, PhD; Keith A. Druley, PhD
[+] Author Affiliations

Accepted for publication June 9, 1982.

Reprint requests to Bldg 7, Drug Dependence Treatment Service, Philadelphia Veterans Administration Medical Center, Philadelphia, PA 19104 (Dr McLellan).


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

REFERENCES

1 +
McLellan AT, Luborsky L, O'Brien CP, et al:  Is treatment for substance abuse effective? JAMA 1982;;247:1423-1427.
2 +
Bale R, Van Stone W, Kuldau J, et al:  Therapeutic communities vs methadone maintenance . Arch Gen Psychiatry 1980;;37:179-193.
3 +
Armor DJ, Polich JM, Stambul HB: Alcoholism and Treatment. Santa Monica, Calif, Rand Corp, 1978;.
4 +
Stinson DJ, Smith WG, Amidjoya I, et al:  Systems of care and treatment outcomes for alcoholic patients . Arch Gen Psychiatry 1979;;36: 107-113.
5 +
Edwards G, Orford Egerts S, et al:  Alcoholism: A controlled trial of treatment and advice . J Stud Alcohol 1977;;38:1004-1031.
6 +
Cummings NA:  Turning bread into stones: Our modern anti-miracle . Am Psychologist 1979;;34:26-39.
7 +
Newton J:  Methadone promise is unfulfilled . J Drug Alcohol Abuse , (Dec 1) , 1979;, pp 1-2.
8 +
Goldschmidt PG:  A cost-effectiveness model for evaluating drug abuse treatment . Inquiry 1976;;13:29-47.
9 +
Burt MR, Pines S, Glynn TJ: Drug Abuse: Its Natural History and the Effectiveness of Current Treatments . Cambridge, Mass, Schenkman, 1979;.
10 +
Emrick CD:  A review of psychologically oriented treatment of alcoholism: II. The relative effectiveness of different treatment approaches and the effectiveness of treatment versus no treatment . J Stud Alcohol 1975;;36:88-108.
11 +
Baeklund F:  Evaluation of treatment methods in chronic alcoholism , in Kissin B, Bigleiter H (eds): The Biology of Alcoholism: Treatment and Rehabilitation of the Chronic Alcoholic . New York, Plenum Press, 1977;, vol 5, pp 385-440.
12 +
Baker SL, Lorei T, McKnight H, et al:  The Veterans Administration's comparison study: Alcoholism and drug abous—combined and conventional treatment settings . Alcoholism: Clin Exp Res 1977;;1:18-34.
13 +
Gottheil E, McLellan AT. Druley KA:  Reasonable and unreasonable standards in evaluation of substance abuse treatments , in Gottheil E, Methods in Substance Abuse . New York, Pergamon Press, 1981;, pp 371-388.
14 +
McLellan AT, O'Brien CP, Kron R, Druley et al:  Matching substance abuse patients to appropriate treatments: A conceptual and methodological approach . Drug Alcohol Depend 1980;;5:189-195.
15 +
Gottheil E, McLellan AT, Druley KA (eds): Addiction Research and Treatment: Converging Trends . New York, Pergamon Press, 1979;.
16 +
McLellan AT, Luborsky L, O'Brien CP, et al:  An improved evaluation instrument for substance abuse patients . J Nerv Ment Dis 1980;;168:26-33.
17 +
McLellan AT, Luborsky L, Erdlen F, et al:  The addiction severity index , in Gottheil E, McLellan AT, Druley KA (eds): Substance Abuse and Psychiatric Illness . New York, Pergamon Press, 1980;, pp 178-194.
18 +
Sobell LC, Sobell MB:  Outpatient alcoholics give valid self-reports . J Nerv Ment Dis 1975;;161:32-42.
19 +
Bale RN, Cabrera LS, Brown JD:  Follow-up evaluation of drug abuse treatment . Am J Drug Alcohol Abuse 1977;;4:233-249.
20 +
Dixon WJ, Brown MB (eds): BMDP-79: Biomedical Computer Programs . Los Angeles, University of California Press, 1979;.
21 +
Cohen J, Cohen P: Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences . New York, Lawrence Erlbaum Assoc Inc, 1975;.
22 +
Luborsky L:  Clinicians' judgments of mental health: Specimen case descriptions and forms for the Health-Sickness Rating Scale . Bull Menninger Clin 1975;;35:462-488.
23 +
Endicott J, Spitzer R, Fleiss J, et al:  The global assessment scale: A procedure for measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry 1976;;33:766-771.
24 +
McLellan AT, Woody G, O'Brien CP:  Development of psychiatric illness in drug abusers: Possible role of drug preference . N Engl J Med 1979;;301:1310-1314.
25 +
McLellan AT, Erdlen FR, O'Brien CP:  Psychological severity and response to alcoholism rehabilitation . Drug Alcohol Depend 1981;;8:23-35.
26 +
Woody GE, McLellan AT, O'Brien CP, et al:  Personality factors in methadone self-administration by heroin addicts , in Thompson J, Johanson C (eds): Behavioral Pharmacology of Human Drug Dependence . US Dept of Health, Education, and Welfare, 1982;, vol 37, pp 63-75.
27 +
McLellan AT, Luborsky L, Woody GE, et al:  Are the 'addictionrelated' problems of substance abusers really related? J Nerv Ment Dis 1981;;169:68-74.

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1 +
McLellan AT, Luborsky L, O'Brien CP, et al:  Is treatment for substance abuse effective? JAMA 1982;;247:1423-1427.
2 +
Bale R, Van Stone W, Kuldau J, et al:  Therapeutic communities vs methadone maintenance . Arch Gen Psychiatry 1980;;37:179-193.
3 +
Armor DJ, Polich JM, Stambul HB: Alcoholism and Treatment. Santa Monica, Calif, Rand Corp, 1978;.
4 +
Stinson DJ, Smith WG, Amidjoya I, et al:  Systems of care and treatment outcomes for alcoholic patients . Arch Gen Psychiatry 1979;;36: 107-113.
5 +
Edwards G, Orford Egerts S, et al:  Alcoholism: A controlled trial of treatment and advice . J Stud Alcohol 1977;;38:1004-1031.
6 +
Cummings NA:  Turning bread into stones: Our modern anti-miracle . Am Psychologist 1979;;34:26-39.
7 +
Newton J:  Methadone promise is unfulfilled . J Drug Alcohol Abuse , (Dec 1) , 1979;, pp 1-2.
8 +
Goldschmidt PG:  A cost-effectiveness model for evaluating drug abuse treatment . Inquiry 1976;;13:29-47.
9 +
Burt MR, Pines S, Glynn TJ: Drug Abuse: Its Natural History and the Effectiveness of Current Treatments . Cambridge, Mass, Schenkman, 1979;.
10 +
Emrick CD:  A review of psychologically oriented treatment of alcoholism: II. The relative effectiveness of different treatment approaches and the effectiveness of treatment versus no treatment . J Stud Alcohol 1975;;36:88-108.
11 +
Baeklund F:  Evaluation of treatment methods in chronic alcoholism , in Kissin B, Bigleiter H (eds): The Biology of Alcoholism: Treatment and Rehabilitation of the Chronic Alcoholic . New York, Plenum Press, 1977;, vol 5, pp 385-440.
12 +
Baker SL, Lorei T, McKnight H, et al:  The Veterans Administration's comparison study: Alcoholism and drug abous—combined and conventional treatment settings . Alcoholism: Clin Exp Res 1977;;1:18-34.
13 +
Gottheil E, McLellan AT. Druley KA:  Reasonable and unreasonable standards in evaluation of substance abuse treatments , in Gottheil E, Methods in Substance Abuse . New York, Pergamon Press, 1981;, pp 371-388.
14 +
McLellan AT, O'Brien CP, Kron R, Druley et al:  Matching substance abuse patients to appropriate treatments: A conceptual and methodological approach . Drug Alcohol Depend 1980;;5:189-195.
15 +
Gottheil E, McLellan AT, Druley KA (eds): Addiction Research and Treatment: Converging Trends . New York, Pergamon Press, 1979;.
16 +
McLellan AT, Luborsky L, O'Brien CP, et al:  An improved evaluation instrument for substance abuse patients . J Nerv Ment Dis 1980;;168:26-33.
17 +
McLellan AT, Luborsky L, Erdlen F, et al:  The addiction severity index , in Gottheil E, McLellan AT, Druley KA (eds): Substance Abuse and Psychiatric Illness . New York, Pergamon Press, 1980;, pp 178-194.
18 +
Sobell LC, Sobell MB:  Outpatient alcoholics give valid self-reports . J Nerv Ment Dis 1975;;161:32-42.
19 +
Bale RN, Cabrera LS, Brown JD:  Follow-up evaluation of drug abuse treatment . Am J Drug Alcohol Abuse 1977;;4:233-249.
20 +
Dixon WJ, Brown MB (eds): BMDP-79: Biomedical Computer Programs . Los Angeles, University of California Press, 1979;.
21 +
Cohen J, Cohen P: Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences . New York, Lawrence Erlbaum Assoc Inc, 1975;.
22 +
Luborsky L:  Clinicians' judgments of mental health: Specimen case descriptions and forms for the Health-Sickness Rating Scale . Bull Menninger Clin 1975;;35:462-488.
23 +
Endicott J, Spitzer R, Fleiss J, et al:  The global assessment scale: A procedure for measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry 1976;;33:766-771.
24 +
McLellan AT, Woody G, O'Brien CP:  Development of psychiatric illness in drug abusers: Possible role of drug preference . N Engl J Med 1979;;301:1310-1314.
25 +
McLellan AT, Erdlen FR, O'Brien CP:  Psychological severity and response to alcoholism rehabilitation . Drug Alcohol Depend 1981;;8:23-35.
26 +
Woody GE, McLellan AT, O'Brien CP, et al:  Personality factors in methadone self-administration by heroin addicts , in Thompson J, Johanson C (eds): Behavioral Pharmacology of Human Drug Dependence . US Dept of Health, Education, and Welfare, 1982;, vol 37, pp 63-75.
27 +
McLellan AT, Luborsky L, Woody GE, et al:  Are the 'addictionrelated' problems of substance abusers really related? J Nerv Ment Dis 1981;;169:68-74.

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