Long-Term Post-Discharge Follow-up in Addictions

Although recovery from addiction is recognised as a long-term process, most evaluations of factors associated with treatment outcomes have relied on short-term data collected shortly after discharge from addiction treatment.

This study aimed to examine the effect of personal, treatment-related and environmental factors on participants' situation with regard to their chemical dependency (addiction status) at follow-up during long-term post-treatment. Stratified random sampling by time since discharge was used to select 286 participants who had been discharged from addiction treatment at the Fundación Instituto Spiral (Spain) between 1993 and 2022. Demographic and treatment information was collected from medical records, while the DARP-M-2023 Post-Program Follow-Up Questionnaire was administered by telephone to collect information on personal and environmental factors. Addiction status was assessed by trained clinicians and the patients themselves at follow-up. Cumulative link models were used to analyze the effect of study factors on addiction status as assessed by observers at follow-up. Discrete-time survival analyses were used to study participants' risk of relapse after discharge.

Addiction status increased significantly after 10 years since the end of treatment (p < 0.001) and was positively related to better mental health (p < 0.001), occupational (p < 0.001), legal (p < 0.001), and social functioning (p = 0.003). Premature discharge (p = 0.044) and short treatment duration (p = 0.003) were associated with an increased and earlier risk of relapse.

Our findings support the need for a dynamic, broad and long-term approach to the recovery process and for dropout predictors to be monitored and relapse prevention strategies implemented according to the identified factors. However, the low response rate and differences between respondents and non-respondents may have led to an overestimation of participant's addiction status.