Veterans returning to civilian life are at greater risk than the average person of substance use and other mental health disorders. This large research study offers evidence that residential treatment programs can address this burden, showing promising results for recovery and long-term health.
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Veterans are particularly susceptible to the adverse outcomes of substance use disorder, such as increased risk of various medical conditions, mental health diagnoses, and higher mortality rates. In comparison to the general population, veterans with substance use disorder face greater clinical complexity and have heightened treatment needs. The current residential treatment models provide comprehensive 24/7 services for severe substance use disorder, but questions remain regarding their efficacy, especially concerning mortality risk and mental health symptom reduction. Studies of residential and other treatments for veterans can help to guiding future care practices and policy for this at-risk group.
This study used a rigorous quasi-experimental analysis called propensity score matching to compare outcomes of VA patients that were referred to, and attended residential treatment to those who were referred to, but did not attend residential treatment.
This study included 6177 veterans across more than 60 different residential treatment programs within the VA system matching patients who were referred and attended residential treatment for substance use disorders with a group who were referred but did not attend residential treatment at baseline (i.e., time of referral), 3-, 6-, and 12-months after referral.
The propensity score matching strategy creates a single score from several factors, based on an individual’s likelihood of attending vs. not attending residential treatment – helping to control for the factors associated with selecting into one treatment or another. This is done when randomization to study conditions may not be possible or desirable, but the method helps to build confidence that any observed differences are truly due to the different types of treatments.
The propensity scores were derived from the most recent assessment during the 3 months prior to referral of variables including substance use disorder and other mental health treatment visits, measures of substance use, mental health symptoms (depression, posttraumatic stress and other anxiety, etc.), trauma history, and marital status. The residential vs. comparison group outcomes at 3-, 6-, and 12-month follow-ups included naturalistic observations of health services (i.e., from VA medical record data) and patient reported outcome measures, where analyses used the outcome measures closest in time to each retrospective follow-up point. For the patient reported outcomes, the Brief Addiction Monitor used in this study includes 3 scales: substance use (3 items; 0-90), risk factors (6 items; 0-180), and protective factors (6 items; 0-180) each based on number of days between 0 and 30 for a given item. Of note, the substance use factor captures alcohol use generally, heavy alcohol use days, and other drug use days.
Participants had varying durations of stay in the residential program, but the average time to treatment entry was 24 days after referral and 80% had been discharged by 3 months after referral, suggesting 2-month residential stays were typical. The comparison group did not attend residential treatment during the 12-month study window, but could have attended any combination of standard outpatient services, intensive outpatient programming, acute inpatient or emergency services, primary care or other medical services, or may have also disengaged from care entirely. The comparison group had 9 outpatient substance use disorder visits on average between baseline and 6-months and 15 visits for other mental health concerns.
Participants were 50 years old, on average and 94% male (consistent with the gender make-up at many VAs). With respect to race/ethnicity, 55% were “European American” (White), 34% were “African/Caribbean American” (Black), and 6% were “Latino American” (Hispanic/Latino). Three-quarters were living in urban areas while 20% were married, 39% divorced, and 29% never married.
Residential patients with advantage on substance use outcomes
Residential treatment participants had improved substance use, relapse risk, and protective factors relative to the comparison group at 3-, 6-, and 12-month follow-ups.
Residential patients with advantage on behavioral and mental health outcomes too
The residential and comparison groups had similar numbers of emergency room visits, acute inpatient stays, and a measure combining suicide and overdose events. Their depression, posttraumatic stress, and generalized anxiety symptoms, on average, were as good, or better than the comparison group. Notably, at the 12-month follow-up, they had lower posttraumatic stress symptoms, and at the 6-month follow-up lower depressive and generalized anxiety symptoms. Finally, the residential treatment group had 66% lower risk of death during the 12-month follow-up, though the article did not report exact number of participants who died in each group.
Pre- to post-treatment improvements retained over time
In the entire group of participants that attended residential treatment (not only those with a matched participant in the comparison group), there were medium-to-large improvements in substance use disorder and mental health symptoms observed from pre- to post-residential treatment which were sustained out to 12-month follow-up. This suggests that in this sample of VA residential patients, their gains during residential treatment were maintained over a substantial period.
The findings from this quasi-experimental study suggest that veterans recommended to attend residential substance use disorder treatment had better substance use and related outcomes over 12-month follow-up relative to a matched comparison group that did not attend residential treatment, many of whom attend outpatient services instead.
One of the most striking outcomes was the significant drop in mortality risk for those in residential care, underscoring the importance of these treatment programs in potentially saving lives for those whose clinical profiles are severe enough to warrant a referral for residential level of care. There were also increases for the residential treatment group in number of mental health treatment sessions attended as well as improvements in anxiety and PTSD. It is possible that the residential treatment program (and its corresponding environmental protections against recurrence of use) allowed for more accurate assessment of co-occurring mental health disorders and, consequently, more targeted recommendations for their treatment. Future studies should see if they replicate this apparent benefit of residential versus outpatient treatment for co-occurring mental health conditions given how commonly substance use and mental health disorders co-occur in veteran populations. Overall, the study’s rigorous quasi-experimental design, particularly its use of propensity score matching, adds a level of confidence in these findings, highlighting the method’s strength in accurately assessing the treatment’s effects.
By examining a diverse group of 6177 participants from more than 60 treatment locations, the study also allows these findings to be applied more broadly, potentially with implications for other community-based health care systems. The VA offers ongoing access to an expansive continuum of substance use disorder and mental health treatment, including the use of measurement-based practices that track patient outcomes while identifying the potential need for re-engagement with care once someone has completed treatment. Recovery management approaches like these consistently outperform approaches that consist primarily of discrete episodes of care while simultaneously saving costs.
This study suggests that, among veterans who are recommended to attend residential treatment, this level of care improves substance use outcomes and reduces mortality risk compared to lower levels of care.
Dams, G. M., Ketchen, B. R., Burden, J. L., & Smith, N. B. (2024). Effectiveness of residential treatment services for veterans with substance use disorders: A propensity score matching evaluation. Drug and Alcohol Dependence, 255. doi: 10.1016/j.drugalcdep.2024.111081
l
Veterans are particularly susceptible to the adverse outcomes of substance use disorder, such as increased risk of various medical conditions, mental health diagnoses, and higher mortality rates. In comparison to the general population, veterans with substance use disorder face greater clinical complexity and have heightened treatment needs. The current residential treatment models provide comprehensive 24/7 services for severe substance use disorder, but questions remain regarding their efficacy, especially concerning mortality risk and mental health symptom reduction. Studies of residential and other treatments for veterans can help to guiding future care practices and policy for this at-risk group.
This study used a rigorous quasi-experimental analysis called propensity score matching to compare outcomes of VA patients that were referred to, and attended residential treatment to those who were referred to, but did not attend residential treatment.
This study included 6177 veterans across more than 60 different residential treatment programs within the VA system matching patients who were referred and attended residential treatment for substance use disorders with a group who were referred but did not attend residential treatment at baseline (i.e., time of referral), 3-, 6-, and 12-months after referral.
The propensity score matching strategy creates a single score from several factors, based on an individual’s likelihood of attending vs. not attending residential treatment – helping to control for the factors associated with selecting into one treatment or another. This is done when randomization to study conditions may not be possible or desirable, but the method helps to build confidence that any observed differences are truly due to the different types of treatments.
The propensity scores were derived from the most recent assessment during the 3 months prior to referral of variables including substance use disorder and other mental health treatment visits, measures of substance use, mental health symptoms (depression, posttraumatic stress and other anxiety, etc.), trauma history, and marital status. The residential vs. comparison group outcomes at 3-, 6-, and 12-month follow-ups included naturalistic observations of health services (i.e., from VA medical record data) and patient reported outcome measures, where analyses used the outcome measures closest in time to each retrospective follow-up point. For the patient reported outcomes, the Brief Addiction Monitor used in this study includes 3 scales: substance use (3 items; 0-90), risk factors (6 items; 0-180), and protective factors (6 items; 0-180) each based on number of days between 0 and 30 for a given item. Of note, the substance use factor captures alcohol use generally, heavy alcohol use days, and other drug use days.
Participants had varying durations of stay in the residential program, but the average time to treatment entry was 24 days after referral and 80% had been discharged by 3 months after referral, suggesting 2-month residential stays were typical. The comparison group did not attend residential treatment during the 12-month study window, but could have attended any combination of standard outpatient services, intensive outpatient programming, acute inpatient or emergency services, primary care or other medical services, or may have also disengaged from care entirely. The comparison group had 9 outpatient substance use disorder visits on average between baseline and 6-months and 15 visits for other mental health concerns.
Participants were 50 years old, on average and 94% male (consistent with the gender make-up at many VAs). With respect to race/ethnicity, 55% were “European American” (White), 34% were “African/Caribbean American” (Black), and 6% were “Latino American” (Hispanic/Latino). Three-quarters were living in urban areas while 20% were married, 39% divorced, and 29% never married.
Residential patients with advantage on substance use outcomes
Residential treatment participants had improved substance use, relapse risk, and protective factors relative to the comparison group at 3-, 6-, and 12-month follow-ups.
Residential patients with advantage on behavioral and mental health outcomes too
The residential and comparison groups had similar numbers of emergency room visits, acute inpatient stays, and a measure combining suicide and overdose events. Their depression, posttraumatic stress, and generalized anxiety symptoms, on average, were as good, or better than the comparison group. Notably, at the 12-month follow-up, they had lower posttraumatic stress symptoms, and at the 6-month follow-up lower depressive and generalized anxiety symptoms. Finally, the residential treatment group had 66% lower risk of death during the 12-month follow-up, though the article did not report exact number of participants who died in each group.
Pre- to post-treatment improvements retained over time
In the entire group of participants that attended residential treatment (not only those with a matched participant in the comparison group), there were medium-to-large improvements in substance use disorder and mental health symptoms observed from pre- to post-residential treatment which were sustained out to 12-month follow-up. This suggests that in this sample of VA residential patients, their gains during residential treatment were maintained over a substantial period.
The findings from this quasi-experimental study suggest that veterans recommended to attend residential substance use disorder treatment had better substance use and related outcomes over 12-month follow-up relative to a matched comparison group that did not attend residential treatment, many of whom attend outpatient services instead.
One of the most striking outcomes was the significant drop in mortality risk for those in residential care, underscoring the importance of these treatment programs in potentially saving lives for those whose clinical profiles are severe enough to warrant a referral for residential level of care. There were also increases for the residential treatment group in number of mental health treatment sessions attended as well as improvements in anxiety and PTSD. It is possible that the residential treatment program (and its corresponding environmental protections against recurrence of use) allowed for more accurate assessment of co-occurring mental health disorders and, consequently, more targeted recommendations for their treatment. Future studies should see if they replicate this apparent benefit of residential versus outpatient treatment for co-occurring mental health conditions given how commonly substance use and mental health disorders co-occur in veteran populations. Overall, the study’s rigorous quasi-experimental design, particularly its use of propensity score matching, adds a level of confidence in these findings, highlighting the method’s strength in accurately assessing the treatment’s effects.
By examining a diverse group of 6177 participants from more than 60 treatment locations, the study also allows these findings to be applied more broadly, potentially with implications for other community-based health care systems. The VA offers ongoing access to an expansive continuum of substance use disorder and mental health treatment, including the use of measurement-based practices that track patient outcomes while identifying the potential need for re-engagement with care once someone has completed treatment. Recovery management approaches like these consistently outperform approaches that consist primarily of discrete episodes of care while simultaneously saving costs.
This study suggests that, among veterans who are recommended to attend residential treatment, this level of care improves substance use outcomes and reduces mortality risk compared to lower levels of care.
Dams, G. M., Ketchen, B. R., Burden, J. L., & Smith, N. B. (2024). Effectiveness of residential treatment services for veterans with substance use disorders: A propensity score matching evaluation. Drug and Alcohol Dependence, 255. doi: 10.1016/j.drugalcdep.2024.111081
l
Veterans are particularly susceptible to the adverse outcomes of substance use disorder, such as increased risk of various medical conditions, mental health diagnoses, and higher mortality rates. In comparison to the general population, veterans with substance use disorder face greater clinical complexity and have heightened treatment needs. The current residential treatment models provide comprehensive 24/7 services for severe substance use disorder, but questions remain regarding their efficacy, especially concerning mortality risk and mental health symptom reduction. Studies of residential and other treatments for veterans can help to guiding future care practices and policy for this at-risk group.
This study used a rigorous quasi-experimental analysis called propensity score matching to compare outcomes of VA patients that were referred to, and attended residential treatment to those who were referred to, but did not attend residential treatment.
This study included 6177 veterans across more than 60 different residential treatment programs within the VA system matching patients who were referred and attended residential treatment for substance use disorders with a group who were referred but did not attend residential treatment at baseline (i.e., time of referral), 3-, 6-, and 12-months after referral.
The propensity score matching strategy creates a single score from several factors, based on an individual’s likelihood of attending vs. not attending residential treatment – helping to control for the factors associated with selecting into one treatment or another. This is done when randomization to study conditions may not be possible or desirable, but the method helps to build confidence that any observed differences are truly due to the different types of treatments.
The propensity scores were derived from the most recent assessment during the 3 months prior to referral of variables including substance use disorder and other mental health treatment visits, measures of substance use, mental health symptoms (depression, posttraumatic stress and other anxiety, etc.), trauma history, and marital status. The residential vs. comparison group outcomes at 3-, 6-, and 12-month follow-ups included naturalistic observations of health services (i.e., from VA medical record data) and patient reported outcome measures, where analyses used the outcome measures closest in time to each retrospective follow-up point. For the patient reported outcomes, the Brief Addiction Monitor used in this study includes 3 scales: substance use (3 items; 0-90), risk factors (6 items; 0-180), and protective factors (6 items; 0-180) each based on number of days between 0 and 30 for a given item. Of note, the substance use factor captures alcohol use generally, heavy alcohol use days, and other drug use days.
Participants had varying durations of stay in the residential program, but the average time to treatment entry was 24 days after referral and 80% had been discharged by 3 months after referral, suggesting 2-month residential stays were typical. The comparison group did not attend residential treatment during the 12-month study window, but could have attended any combination of standard outpatient services, intensive outpatient programming, acute inpatient or emergency services, primary care or other medical services, or may have also disengaged from care entirely. The comparison group had 9 outpatient substance use disorder visits on average between baseline and 6-months and 15 visits for other mental health concerns.
Participants were 50 years old, on average and 94% male (consistent with the gender make-up at many VAs). With respect to race/ethnicity, 55% were “European American” (White), 34% were “African/Caribbean American” (Black), and 6% were “Latino American” (Hispanic/Latino). Three-quarters were living in urban areas while 20% were married, 39% divorced, and 29% never married.
Residential patients with advantage on substance use outcomes
Residential treatment participants had improved substance use, relapse risk, and protective factors relative to the comparison group at 3-, 6-, and 12-month follow-ups.
Residential patients with advantage on behavioral and mental health outcomes too
The residential and comparison groups had similar numbers of emergency room visits, acute inpatient stays, and a measure combining suicide and overdose events. Their depression, posttraumatic stress, and generalized anxiety symptoms, on average, were as good, or better than the comparison group. Notably, at the 12-month follow-up, they had lower posttraumatic stress symptoms, and at the 6-month follow-up lower depressive and generalized anxiety symptoms. Finally, the residential treatment group had 66% lower risk of death during the 12-month follow-up, though the article did not report exact number of participants who died in each group.
Pre- to post-treatment improvements retained over time
In the entire group of participants that attended residential treatment (not only those with a matched participant in the comparison group), there were medium-to-large improvements in substance use disorder and mental health symptoms observed from pre- to post-residential treatment which were sustained out to 12-month follow-up. This suggests that in this sample of VA residential patients, their gains during residential treatment were maintained over a substantial period.
The findings from this quasi-experimental study suggest that veterans recommended to attend residential substance use disorder treatment had better substance use and related outcomes over 12-month follow-up relative to a matched comparison group that did not attend residential treatment, many of whom attend outpatient services instead.
One of the most striking outcomes was the significant drop in mortality risk for those in residential care, underscoring the importance of these treatment programs in potentially saving lives for those whose clinical profiles are severe enough to warrant a referral for residential level of care. There were also increases for the residential treatment group in number of mental health treatment sessions attended as well as improvements in anxiety and PTSD. It is possible that the residential treatment program (and its corresponding environmental protections against recurrence of use) allowed for more accurate assessment of co-occurring mental health disorders and, consequently, more targeted recommendations for their treatment. Future studies should see if they replicate this apparent benefit of residential versus outpatient treatment for co-occurring mental health conditions given how commonly substance use and mental health disorders co-occur in veteran populations. Overall, the study’s rigorous quasi-experimental design, particularly its use of propensity score matching, adds a level of confidence in these findings, highlighting the method’s strength in accurately assessing the treatment’s effects.
By examining a diverse group of 6177 participants from more than 60 treatment locations, the study also allows these findings to be applied more broadly, potentially with implications for other community-based health care systems. The VA offers ongoing access to an expansive continuum of substance use disorder and mental health treatment, including the use of measurement-based practices that track patient outcomes while identifying the potential need for re-engagement with care once someone has completed treatment. Recovery management approaches like these consistently outperform approaches that consist primarily of discrete episodes of care while simultaneously saving costs.
This study suggests that, among veterans who are recommended to attend residential treatment, this level of care improves substance use outcomes and reduces mortality risk compared to lower levels of care.
Dams, G. M., Ketchen, B. R., Burden, J. L., & Smith, N. B. (2024). Effectiveness of residential treatment services for veterans with substance use disorders: A propensity score matching evaluation. Drug and Alcohol Dependence, 255. doi: 10.1016/j.drugalcdep.2024.111081
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