(PS1-2) A Latent Class Analysis of Psychopathology Among Adults in Residential Substance Use Treatment: Associations with Craving and Treatment Dropout

Abstract Text: Nearly 40% of adults with substance use disorders (SUDs) report comorbid psychopathology (Chan et al., 2018), yet residential treatment programs for SUDs often target substance use in isolation (de Andrade et al., 2019). This approach may hinder treatment outcomes for patients with comorbid psychopathology who are often referred to as patients with “dual diagnosis.” Patients with dual diagnosis face unique challenges in SUD treatment, including increased substance use craving and treatment dropout against medical advice (AMA; Medenblik et al., 2024; Nordheim et al., 2018). Prior studies have investigated associations between specific forms of psychopathology and these outcomes using variable-centered approaches. However, psychological disorders often co-occur and may cluster together to amplify risk for craving and treatment dropout AMA. Understanding which constellations of psychopathology are related to increased craving and treatment dropout could improve the identification of SUD patients who may benefit from tailored, evidence-based interventions.
This study used latent class analysis to identify patterns of psychopathology in 1046 adult patients receiving residential treatment for SUDs (73.7% men; Mage = 42.31, SD = 12.13). We analyzed medical record data to determine whether patients completed treatment or left AMA. Medical record data also contained patients’ responses to the Psychiatric Diagnostic Screening Questionnaire—a broadband measure of psychopathology—and the Penn Alcohol and Drug Craving Scale. We tested whether psychopathology latent classes differed in alcohol and drug cravings and treatment dropout AMA.
We identified four latent classes: 1) high psychopathology, 2) moderate anxiety/depression, 3) illness anxiety/somatic problems, and 4) low psychopathology. The high psychopathology class reported significantly more alcohol and drug cravings than all other classes. The moderate anxiety/depression class reported more alcohol cravings than the low psychopathology class. Additionally, the high psychopathology, illness anxiety/somatic problems, and moderate anxiety/depression classes had higher proportions of patients who dropped out of treatment AMA compared to the low psychopathology class.
These findings suggest that comorbid psychopathology significantly impacts treatment outcomes in residential SUD treatment programs, regardless of the type or amount of psychopathology that comprised each class. Results highlight the potential importance of screening for psychopathology and linking patients with dual diagnosis to evidence-based interventions to prevent concerns that may inhibit their recovery, including craving and treatment dropout AMA.