Clinical Characteristics of Early Leavers From a Private Dual-Diagnosis Program

Objective: Early leaving in substance use disorder treatment may be the single largest variable undermining treatment success. Existing work on early leaving tends to explore either client factors, which include age, race, gender, and diagnoses, or treatment factors, which include the type of treatment activities offered, treatment experiences of clients and staff, treatment amenities, and environmental factors in the residential treatment program. However, existing work on both client factors and treatment factors provides mixed results on what contributes to early leaving. Further, there has been very little research in the private residential treatment setting. This study aims to explore the factors influencing early leaving in a private residential treatment setting. Methods: The study analyzed admission and treatment records from 247 consecutive clients at a private treatment facility in Southern California to identify factors related to shorter retention. The program employs a biopsychosocial approach and evidence-based practices to assist clients in recovery from substance use disorders and mental health conditions. We utilize a battery of client measures, including the Outcome Questionnaire 45.2, Trauma History Questionnaire, as well as demographic and psychiatric variables in our analyses. Results: Findings challenge previous research by showing that age and gender do not predict shorter retention, contrary to findings in the extant literature on public treatment centers. Instead, clients with higher symptoms of distress stay longer, as indicated by scores on the Outcome Questionnaire 45.2. Additionally, we find the majority of the cohort stayed in residential treatment for more than 30 days, with the average length of stay being 47.92 days, indicating that treatment completion of clients with severe symptomatology for an extended time in treatment (30 days or more) is achievable. Conclusions: The study underscores the importance of considering client symptomologies and severities in understanding and improving retention in substance use disorder treatment programs. This study highlights the potential impact of treatment services offered in private settings on client retention.