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Longer Length of Stay Is Not Associated with Better Outcomes in VHA’s Substance Abuse Residential Rehabilitation Treatment Programs

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Abstract

Are longer stays in Veterans Health Administration (VHA) substance abuse residential rehabilitation treatment programs (SARRTPs) associated with better substance-related outcomes? To investigate, up to 50 new patients were randomly selected from each of 28 randomly selected programs (1,307 patients). The goal was to examine if patient and program average length of stay (ALOS) were associated with improvement on Addiction Severity Index (ASI) Alcohol and Drug composite scores in covariate-adjusted, multi-level regression models. Patients in programs with ALOS greater than 90 days tended to have more mental health treatment prior to the index episode and less severe substance-related symptoms, but more homelessness. At follow-up, programs longer than 90 days had the least improvement in the ASI Alcohol composite and significantly less improvement than programs with ALOSs of 15 to 30 and 31 to 45 days (both p < 0.05). Therefore, in VHA SARRTPs, ALOS greater than 90 days cannot be justified by the substance use disorder severity of the patients served or the magnitude of the clinical improvement observed.

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Acknowledgments

This study was funded by the VA Substance Use Disorders Quality Enhancement Research Initiative and Health Service Research and Development Service (grants nos. RRP 09-393 and SUS 99-015).

Conflict of interest

None of the authors has any conflict of interest related to this work. The views expressed herein are not necessarily those of the Department of Veteran Affairs.

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Authors and Affiliations

  1. Center for Health Care Evaluation, VA Palo Alto Health Care System, Stanford University School of Medicine, 795 Willow Road (MC152), Menlo Park, CA, 94025, USA

    Alex H. S. Harris PhD & John W. Finney PhD

  2. VA Puget Sound Health Care System, University of Washington School of Medicine, 1660 S. Columbian Way, Seattle, WA, 98108, USA

    Daniel Kivlahan PhD

  3. Health Economics Resource Center and Center for Health Care Evaluation, VA Palo Alto Health Care System, Stanford University School of Medicine, 795 Willow Road (MC152), Menlo Park, CA, 94025, USA

    Paul G. Barnett PhD

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  1. Alex H. S. Harris PhD
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  2. Daniel Kivlahan PhD
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  4. John W. Finney PhD
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Correspondence to Alex H. S. Harris PhD.

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Harris, A.H.S., Kivlahan, D., Barnett, P.G. et al. Longer Length of Stay Is Not Associated with Better Outcomes in VHA’s Substance Abuse Residential Rehabilitation Treatment Programs. J Behav Health Serv Res 39, 68–79 (2012). https://doi.org/10.1007/s11414-011-9250-2

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  • DOI: https://doi.org/10.1007/s11414-011-9250-2

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