Factors associated with the successful completion of a substance rehabilitation programme at a psychiatric training hospital

Abstract

BACKGROUND : Comorbid psychiatric and substance use disorders are common and present several treatment challenges. AIM : The aim of this study was to determine which patient and substance factors are associated with the completion of a substance rehabilitation programme in psychiatric inpatients. SETTING : The study was conducted at the Substance Rehabilitation Unit (SRU) at Weskoppies Hospital, a psychiatric training hospital in South Africa, which offers a 6-week programme at the hospital for psychiatric inpatients. METHODS : This descriptive, retrospective hospital-based study was carried out comparing completers and non-completers of the SRU programme with respect to patient and substance factors. All patients accepted into the SRU during 2013–2014 were included (n = 119). Data were collected over a year (2016–2017) from the clinical files, SRU referral forms, SRU attendance register, hospital computerised demographic records, nursing notes and administration files using a data collection sheet designed by the researchers for this study. Comparison between completers and non-completers was performed using Chi-Square or Fisher’s Exact tests. RESULTS : The SRU accepted 119 patients from January 2013 to December 2014. The majority of the sample were involuntary patients (n = 39), 30–49 years old (n = 57), male (n = 89), unmarried (n = 112), never having received a disability grant (n = 27), unemployed (n = 96) and with a Grade 8–11 education (n = 49). Substance-induced psychotic disorders (n = 39), schizophrenia (n = 29) and bipolar disorders (n = 22) were found to be common. Frequent medical comorbidities included head injury (n = 27), cardiovascular disease (n = 18) and HIV reactivity (n = 7). Cannabis (n = 98), alcohol (n = 94) and nicotine (n = 90) were the most frequently us substances. Level of education (p = 0.004), disability grant status (p = 0.004), Nyaope use (p = 0.001) and nicotine use (p = 0.049) were statistically seen to be significantly associated with completion. Psychiatric diagnoses and general medical comorbidity were not associated with completion. CONCLUSIONS : This study has yielded several results in areas that have not yet been well researched in South Africa. Risk factors for non-completion may include lower levels of education, being on a disability grant and using Nyaope or nicotine, but may vary in different settings. Future research should focus on identifying further factors that may affect completion of substance rehabilitation in psychiatric inpatients, the role of disability grants in patients with co-occurring disorders and the effect of Nyaope and nicotine use on treatment outcomes in this population. Effective and accessible interventions to assist vulnerable patients also need to be identified.