Persistence in Residential Substance Use Disorder Treatment: The Roles of PTSD, Grit, and Emotion Regulation

Abstract

Dropout rates from substance use disorder (SUD) treatment are high and substantially hamper the potential therapeutic benefit of such programs. Posttraumatic stress disorder (PTSD) is common among individuals with SUD and is associated with poor clinical outcomes, relapse, and treatment dropout. However, studies examining PTSD as a predictor of dropout from SUD treatment are limited and have demonstrated conflicting results. Additionally, most research on treatment dropout in individuals with co-occurring PTSD-SUD has focused on risk factors for dropout; less attention has been given to factors that might contribute to persistence in treatment, such as self-regulatory abilities. The current study used Temporal Self-Regulation Theory as a framework to examine whether PTSD symptomology (representing behavioral prepotency) predicted premature termination from residential SUD treatment. The study also examined whether grit and emotion regulation (representing self-regulatory capacity) were associated with treatment persistence among individuals with co-occurring PTSD. This analysis used data from 146 adults receiving residential treatment for SUDs. Participants completed self-report measures of PTSD symptomology, grit, and emotion regulation. Chart data was reviewed to determine treatment termination status. PTSD symptomology did not predict premature termination, and there were no main or interactive effects of grit or emotion regulation. Consistent with previous research on predictors of SUD treatment dropout, exploratory analyses revealed that younger age and a dual diagnosis of an alcohol and drug use disorder predicted premature treatment termination. Clinical and theoretical implications of these findings are discussed.