Substance Abuse and Rehabilitation (Jul 2023)
A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment
Abstract
Kari Bøhle,1– 3 Eli Otterholt,1,2 Stål Kapstø Bjørkly1,4 1Faculty of Health and Social Science, Molde University College, Molde, Norway; 2Clinic of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Molde, Norway; 3Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; 4Regional Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, NorwayCorrespondence: Kari Bøhle, Molde University College, Britvegen 2, Molde, 6412, Norway, Tel +47 911 09 321 ; +47 71 21 40 00, Email [email protected]: This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions.Materials and Methods: Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUCG). A multivariate logistic regression analysis was performed to find an association between dropout rates and the biopsychosocial variables.Results: The results suggest a lower dropout odds for patients with high motivation (OR = 0.76, p = 0.022) and patients admitted to short-term treatment (OR = 0.06, p = 0.005). An interaction with stimulant SUD and DCS (OR = 13.74, p = 0.024) also revealed higher dropout odds. No statistical significance was found for psychological distress, WAS, and cortisol AUCG.Conclusion: The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.Keywords: cortisol, psychological distress, ward atmosphere, retention, drug abstinence
