Profiles of substance use disorders in patients of therapeutic communities: link to social, medical and psychiatric characteristics.
BACKGROUND
Therapeutic community (TC) clients frequently display a pattern of multiple substance use disorders (SUDs) which is associated with poorer treatment outcomes. This study aimed to characterize multiple SUD profiles in patients enrolled in TCs, and examine the association of these profiles with social, medical and psychiatric outcomes.


METHODS
Observational study. We acquired substance use diagnoses and sociodemographic, medical and psychiatric comorbidity data for 4102 patients who had been admitted to six public TCs in Andalusia (Spain) from 2004 to 2012. Latent class analysis was applied to participants' substance use diagnoses, and the resulting classes were associated with social (i.e., education, employment, criminality), medical (i.e., infectious diseases) and psychiatric comorbidity.


RESULTS
We found four differentiated profiles of substance use diagnoses among TC patients: cocaine/opiates (Class 1: 37% of participants); cocaine/opiates/benzodiazepines (Class 2: 25.3%); alcohol (Class 3: 24.7%); and cocaine/cannabis/alcohol (Class 4: 12.9%). Classes 1 and 2 were associated with poorer social and medical characteristics. Class 2 was also associated with greater prevalence of impulsive spectrum mental disorders. Class 3 was associated with greater prevalence of mood and anxiety disorders and cognitive dysfunction, and Class 4 was associated with higher prevalence of psychotic illness.


CONCLUSIONS
Patients admitted to TCs have heterogeneous substance use diagnostic profiles. Profiles involving multiple use of heroin, cocaine, alcohol and benzodiazepines are associated with poorer social and medical function and impulse control disorders. Profiles involving alcohol use and cannabis/cocaine use are associated with cognitive dysfunction and psychotic illness respectively.
['Fernández-Calderón|David|D|', 'Fernández|Fermín|F|', 'Ruiz-Curado|Sofía|S|', 'Verdejo-García|Antonio|A|', 'Lozano|Óscar M|ÓM|']
D000328:Adult D001008:Anxiety Disorders D003072:Cognition Disorders D015897:Comorbidity D004194:Disease D005260:Female D006801:Humans D007175:Impulsive Behavior D008297:Male D001523:Mental Disorders D015995:Prevalence D011618:Psychotic Disorders D012959:Socioeconomic Factors D013030:Spain D019966:Substance-Related Disorders D013808:Therapeutic Community D016896:Treatment Outcome
Multiple substance use disorders Comorbidity Latent class analysis