Outpatient Versus Residential Treatment Comparison for Pregnant Substance Abusers

Addictive disorders are chronic conditions for many women. Substance use during pregnancy is especially worrisome. Moreover, major depressive disorder often co-occurs with substance abuse among women. Therefore, pregnant women with substance abuse are complex patients. Priority populations (e.g., minority group members) are greatly over-represented among pregnant substance abusers. Treatment can be effective for female substance abusers but few (if any) data are available regarding comparative effectiveness of residential versus outpatient treatment for pregnant women with addictions. Residential treatment, by definition, provides shelter and reduces availability of substances in addition to delivering care for chemical dependency. However, residential treatment removes patients from their usual home and work environments and is more expensive than outpatient care. Although not focusing on pregnant substance abusers, studies have generally found little difference in outcomes for residential versus outpatient chemical dependency treatment. On the other hand, research has also suggested patient factors may moderate treatment impact so that sub-groups of substance abusers differentially benefit from residential (versus outpatient) care. To address these issues, this analytic epidemiologic study addresses "the benefits and harms of preventive or therapeutic interventions in 'real world' settings for patients who have multiple chronic co-morbid conditions." The chief focus is pregnant women (many of whom also have major depressive disorder) obtaining treatment for chemical dependency. The intervention is specialty sector substance abuse treatment. The "real world" settings are publicly financed substance abuse treatment programs. Among several data sets, the project employs newly available information from the nation-wide Treatment Episode Data Set (TEDS) discharge database. The project utilizes innovative statistical techniques (including non-linear instrumental variables approaches) to examine the comparative effectiveness of outpatient versus residential substance abuse treatment.​