Association Between Psychiatric Comorbidity and Retention in Substance Use Disorder Treatment: Results From Multi-Site Randomized Controlled Trials of Pharmacological and Behavioral Interventions

Objective: To examine the association of comorbid mood and/or anxiety disorders (M/AD) and psychological distress (PD) with treatment retention in substance use disorder (SUD) trials. Methods: Data are from 21 NIDA-sponsored randomized controlled trials (RCTs) for SUDs (n = 5,404). M/AD was assessed using the DSM-IV criteria and PD was assessed using the Addiction Severity Index. Treatment retention was defined as trial completion based on last visit attendance. Analyses used doubly-robust multivariable logistic regression with propensity score weighting. Results: Average treatment retention was 71.8%. Comorbid M/AD was associated with higher odds of treatment retention in pharmacological trials of cocaine and methamphetamine use disorder. However, comorbid PD was associated with lower treatment retention in behavioral trials of any stimulant use disorders and higher retention in pharmacological trials of methamphetamine use disorder. Conclusion: M/AD is associated with better treatment retention in SUD trials, while PD’s effects depend on treatment type and trial target substance.