(PS6-D77) Retention in Residential Substance Use Disorder Treatment: The Roles of PTSD Symptomatology and Emotion Regulation

Dropout rates from substance use disorder (SUD) treatment are high and substantially hamper the potential therapeutic benefit of such programs (Lappan et al., 2020). Posttraumatic stress disorder (PTSD) is common among individuals with SUD and is associated with poor clinical outcomes, relapse, and treatment dropout (Goldstein et al., 2016; Schäfer & Najavits, 2007). However, studies examining PTSD as a predictor of dropout from SUD-only treatment are limited and have demonstrated conflicting results (Brorson et al., 2013; Syan et al., 2020). Some data suggest that PTSD is predictive of SUD treatment dropout, whereas other data have found no relationship between PTSD and SUD treatment dropout (Brorson et al., 2013; Syan et al., 2020). Additionally, most research on treatment dropout in individuals with co-occurring PTSD-SUD has focused on risk factors for dropout; less attention has been given to factors that might contribute to retention. Preliminary evidence indicates that strong emotion regulation abilities are associated with persistence in SUD treatment (Hopwood et al., 2015; Lejuez et al., 2008). Thus, emotion regulation may be protective against SUD treatment dropout among individuals with PTSD. The current study seeks to a) address whether PTSD symptomatology is associated with leaving residential SUD treatment against medical advice (AMA) and b) identify factors associated with staying in residential SUD treatment among individuals with co-occurring PTSD. 

This prospective analysis will use data from an ongoing cross-sectional study of adults receiving residential treatment for SUDs (N = 71 to date). Participants complete a demographic questionnaire, revised version of the Trauma History Questionnaire, PTSD Checklist for DSM-5 (PCL-5), and Difficulties in Emotion Regulation-Short Form (Blevins et al., 2015; Hooper et al., 2011; Kaufman et al., 2016). Medical chart review is used to determine whether participants leave treatment AMA. The sample is majority male (73.2%) and racially and ethnically diverse (46.5% White; 31.0% Black; 15.5% Multiracial; 2.8% Asian; 2.8% Hispanic/Latinx; 1.4% American Indian/Alaskan Native), with a mean age of 38.3 years (SD = 12.9). The average PCL-5 score is 39.4 (SD = 23.7), and 64.8% of participants’ PCL scores are 31 or above, consistent with a provisional diagnosis of PTSD. Logistic regression will assess whether PTSD symptom severity among trauma-exposed individuals is associated with leaving treatment AMA. Moderation analysis will test for an interaction between PTSD and emotion regulation on SUD treatment retention. It is hypothesized that more severe PTSD symptoms will be associated with increased likelihood of leaving treatment AMA and that emotion regulation capabilities will attenuate this relationship. These findings will help clarify whether PTSD is predictive of SUD treatment dropout and possibly inform interventions for enhancing treatment retention in this population.