Family discord after completion of an outpatient community treatment program predicts greater substance use during follow-up.

It is reasonable to consider family discord after treatment as a potential target for a next-step intervention, since family discord is often comorbid with substance use disorders. This study evaluated family discord after completing an initial course of treatment as a predictor of substance use and retention in the community treatment program during follow-up. Patients were from two multisite randomized clinical trials implemented through the NIDA Clinical Trials Network (CTN-0004 and CTN-0005). There were 315 participants from Study 1 (12-week posttreatment follow-up) and 295 participants from Study 2 (8-week posttreatment follow-up). Negative binomial and logistic regression were used to estimate days of substance use and odds of retention in the community treatment program at follow-up, respectively, from family discord status.

Results found that participants experiencing family discord reported significantly more days of substance use during the posttreatment follow-up period than those who did not experience family discord in both Study 1 (9.12 vs. 2.89 days, p=.0001) and Study 2 (5.58 vs. 2.83 days, p=.0062). Family discord was significantly associated with lower retention in the community treatment program at follow-up in Study 1 (47.6% vs. 60.6%; p=.03), but not in Study 2 (55.3% vs. 64.9%; p=.11).

Conclusions: Family discord after an initial course of treatment might be a clinically relevant predictor of substance use. There is mixed support for a conclusion that family discord is associated with lower retention in the community treatment program at follow-up. Family discord warrants assessment after an initial course of treatment and may be a useful target for adaptive treatment intervention.

Related protocols: CTN-0004, CTN-0005