RESUMEN
BACKGROUND: Prior reviews of substance use disorder (SUD) treatment have found mixed support for residential level of care but are limited by methodology problems and the ethical concerns of randomizing patients with severe SUD to lower levels of care. METHODS: The present study is the first to use a large archival SUD residential sample with a matched comparison group and one-year follow-up period to examine the benefits of residential treatment provided to adults clinically assessed as warranting SUD residential care. We used propensity score matching in our sample (N = 6177) of veterans with a SUD who were screened and accepted for Veterans Affairs (VA) SUD residential treatment between January 1st, 2019 and June 30th, 2019. RESULTS: We found evidence that VA SUD residential treatment saves veteran lives with an average 66% all-cause mortality risk reduction during the study period (b = -1.09, exp(b) = 0.34, p <0.001). Medium-to-large residential pre- to post-treatment self-reported mental health and SUD symptom improvements (|SMDrobust| = 0.54-0.93) were sustained by one-year post-screening. These residential treatment improvements were significantly larger than estimated counterfactual outcomes across self-reported SUD and stress disorder symptoms at one-year post-screening (ps <0.001). We found mixed behavioral, service utilization, and other self-reported mental health outcomes. CONCLUSIONS: We conclude that VA SUD residential treatment is an effective level of care for veterans warranting residential care particularly for SUD symptom improvements and reductions in mortality risk.
Asunto(s)
Trastornos Relacionados con Sustancias , Veteranos , Adulto , Estados Unidos/epidemiología , Humanos , Veteranos/psicología , Tratamiento Domiciliario/métodos , Puntaje de Propensión , United States Department of Veterans Affairs , Trastornos Relacionados con Sustancias/terapiaRESUMEN
OBJECTIVE: Tic disorders are the most common movement disorder diagnosed in children and have symptoms that fluctuate in frequency and intensity over time. We conducted an 8-month longitudinal observational study to determine the variations in frequency of motor tics and associated problem behaviors. METHODS: A total of 553 children, kindergarten through sixth grade, were observed monthly from November 1999 to June 2000 by 3 raters. Motor tics were recorded by location and rated for severity as none (0), mild (1), moderate (2), or severe (3). Problem behaviors were rated as absent (0), subclinical (1), or clinical (2) in each of 6 categories: disruptive, hyperactive, impulsive, aggressive, anxious, and distracted. RESULTS: The monthly point prevalence of motor tics ranged from 3.2% to 9.6%, with an overall frequency of 24.4%. The monthly point prevalence of problem behaviors ranged from 2.6% to 11.0%, with an overall frequency of 25.7%. The incidence of motor tics and problem behaviors was significantly higher during the winter months of November through February, compared with the spring months of March through June (motor tics: z = 4.97; problem behaviors: z = 3.79). Motor tics were observed in 2 distinct patterns (isolated and persistent), which varied by the number of months present, gender ratio of affected children, severity of tic symptoms, and association with problem behaviors. CONCLUSIONS: Motor tics and problem behaviors are frequent occurrences among schoolchildren and seem to occur more frequently during the winter months. For most children, the tics were mild, observed on only 1 occasion, and were not accompanied by problem behaviors.