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Aftercare Attendance Partially Moderated by History of
Physical Abuse and Gender
1
Haynes ;
1
Herrin ;
1
Carter ;
1;
Back Robert
2
Hubbard
Louise F.
Amy E.
Rickey E.
Sudie E.
L.
1Medical University of South Carolina, Charleston, SC; 2University Medical Center, Clinical Research Institute, Duke University, Durham, NC
Introduction
Results
Introduction:
Substance use relapse rates are often high in the first months
after discharge from inpatient substance abuse treatment, and
patient adherence to aftercare plans is often low. Exposure to
traumatic events is also high among substance abuse patients
and may affect outcome. This secondary analysis examines
the relationship of participant gender on aftercare attendance
and the moderating effects of a history of abuse.
Results:
The findings revealed that the odds of attending aftercare
were 1.91 times higher in women than men (95% CI: [1.2,
3.2]; p<0.01)1. Women were also more likely to report
higher rates of physical abuse (PA; 78% women vs. 45%
men, p<0.01) and sexual abuse (SA; 67% women vs. 20%
men, p<0.01). (Table 1)
Methods:
Four residential addiction treatment centers participated in a
NIDA-sponsored Clinical Trials Network feasibility study
designed to estimate the efficacy of a post-discharge
telephone intervention intended to encourage compliance with
aftercare. Participants were 282 outpatients (100 women, 182
men) with substance use disorders. In order to determine
whether prior physical abuse (PA) or sexual abuse (SA)
confounded the gender effect observed, separate logistic
regression models were used to test each interaction.
Exclusion Criteria: current suicide intention or a recent (< 30
days prior to admission) suicide attempt
Subjects randomized into two groups: Telephone care group
(TCG) and Standard care group (SCG)
For the PA by gender interaction, women without PA were
more likely to return for aftercare when compared to men
with PA (OR=12.25, p<0.01) or men without PA (OR=12.59,
p<0.01); however, the odds of aftercare for women with PA
were one-tenth times that of females without PA (OR=0.1,
p<0.01) (Figure 3). Women with PA were no more likely to
attend aftercare than either males with (p=0.27) or without
PA (p=0.21). These results are adjusted for the intervention
group.
Verified attendance was used as the primary outcome. This
differed from self-reported attendance.
Statistical Analyses:
Separate logistic regression models were used to test the
interaction between gender and history of SA and gender and
history of PA to see if previous SA or PA moderated the effect
that gender had on attending aftercare visits.
Figure 3: Odds ratios & 95% Confidence Interval for attending aftercare (N=281) with regard to gender and history of PA, after
adjusting for intervention group
Table 1. Demographics
N
History of PA (%)
History of SA (%)
Aftercare Attendance (%)
Overall
282
56%
36%
51%
Males
182
45%
20%
45%
Females p-value
100
78%
< 0.01
67%
< 0.01
61%
< 0.01
Figure 1: Percent of Males and Females who reported PA or
SA that attended aftercare
100
After the follow-up visit, attempts were made to verify the
client’s attendance/participation in the assigned program
identified on the discharge plan.
Figure 2: Odds Ratios & 95% Confidence Intervals for attending aftercare (N=281) with regard to gender and history of SA, after
adjusting for intervention group
A significant gender by PA interaction was found (p<0.01)
but no interaction between SA and gender (p=0.68). While
the interaction between SA and gender was not significant,
the gender effect persisted after adjustment for history of
SA.
Methods
Study Design:
Four residential treatment centers enrolled men and women
18 years of age or older who voluntarily admitted to a
residential program for rehabilitation treatment, not solely for
detoxification
Results
Female
Male
90
Note: In Figures 2 and 3, M=Male, F=Female, PA=Physical Abuse, NoPA=No Physical Abuse, SA=Sexual Abuse, NoSA=No Sexual Abuse
Conclusions
History of Sexual Abuse:
The gender effect of aftercare attendance persisted after
adjusting for history of SA. Women were more likely to
attend aftercare than men, but there was no statistical
difference in attendance rates between subjects with and
without a history of SA.
80
History of Physical Abuse:
Women without a history of PA were more likely to return for
aftercare visits than men with and without a history of PA.
The odds of attending aftercare for women with a history of
PA were 1/10 times that of females without a history of PA.
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References
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Gender
Women reported significantly more physical and sexual
abuse than men. Women’s odds of attendance were 1.91
times higher than the odds of men attending aftercare.
Individuals with the lowest level of aftercare attendance
were men, and women with a history of PA.
Interventions to help increase aftercare attendance among
men and among women with a history of PA are needed.
In addition, future research to help increase understanding
of decreased participation among men would be beneficial.
Acknowledgements
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10
0
Physical Abuse
Sexual Abuse
No Physical Abuse
No Sexual Abuse
1.Haynes, L.F.; Back, S.E.; Leimberger, J.D.; Hubbard, R.L.
Improving the transition from residential to outpatient addiction
treatment: Gender differences in response to supportive
telephone calls. In College on Problems of Drug Dependence:
Orlando, FL, 2005.
This study is funded by the following grants from the National
Institutes of Health: DA0013727, DA013711, DA013045, and
DA013710. The consortium performing this study was a part of the
Clinical Trials Network (CTN) established by the National Institute
on Drug Abuse (NIDA).