Abstract

Investigation into matching substance abusers attributes to aftercare treatment has yielded mixed results. The notion that substance abusers with greater psychiatric distress and sociopathy will benefit more from relapse prevention oriented aftercare remains uncertain. Moreover, indices of psychiatric distress during the early stages of intensive substance abuse treatment are suspect as withdrawal symptoms often complicate psychiatric symptom presentation. The present study examined these attributes as aftercare matching variables, including posttreatment degree of psychiatric distress. Additionally, the utility of qualitative appraisals of psychiatric severity and needs in predicting treatment outcome was investigated. Substance abusers (N = 125; 66% male) were randomly assigned posttreatment to either 10-weekly sessions of Structured Relapse Prevention (SRP) or Twelve-Step Facilitation (TSF) aftercare treatment groups and followed-up over a six-month period. Post-intensive treatment degree of psychiatric distress and sociopathy were measured by the revised Symptoms Checklist-90 (SCL-90-R: Derogatis, 1983) and California Psychological Inventory, Socialization subscale (CPI-So: Gough, 1987), respectively. The Addiction Severity Index (ASI: McLellan et al., 1980) participant severity ratings were used to predict substance use and psychosocial functioning at follow-up. The results indicated that although greater psychiatric distress and sociopathy contributed to poorer substance use and psychosocial functioning throughout the follow-up period, few interactions with aftercare treatment were noted. In fact, the few interactions noted contradicted the hypothesized effect. Participants with greater psychiatric distress benefited more (i.e., longer latency to lapse) from TSF than SRP. Participants with greater sociopathy reported less legal problems when assigned to TSF than those assigned to SRP. Both of these findings failed to support previous aftercare matching findings (R. Kadden et al., 1989). The ASI participant severity rating (i.e., patient importance of treatment) for psychiatric status significantly predicted family/social adjustment at follow-up. Moreover, the qualitative appraisals of psychiatric needs were significantly correlated with quantitative psychiatric distress indices (i.e., SCL-90-R), thus contributing to the validity and utility of the ASI patient rating scales. These qualitative appraisals hold both empirical and clinical appeal.