A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed.

This study investigated the relationship between duration of most recent drug and alcohol abstinence attempt and psychological distress tolerance, as indexed by persistence on a mental arithmetic task (the Paced Auditory Serial Addition Task; D. M. A. Gronwall, 1977), in 89 individuals in an inner-city residential substance abuse treatment facility. Results indicated that most recent abstinence duration was related to persistence on the psychological stressor, beyond the influence of demographics, substance use level, and negative affect. These findings extend previous work (T. H. Brandon et al., 2003; R. A. Brown, C. W. Lejuez, C. W. Kahler, & D. Strong, 2002) reporting significant relationships between persistence on laboratory challenge procedures and duration of abstinence following a quit attempt in smokers, suggesting that common processes account for relapse across addictions. Systematic replications including a prospective design are recommended.

Depression is highly prevalent among illicit drug users, and this co-occurrence is associated with poorer treatment outcomes. However, there has been limited empirical attention toward developing and assessing behavioral interventions for depression among illicit drug users. The objective of the current study was to test the efficacy of integrating a brief behavioral intervention for depression into standard inpatient substance abuse treatment. Forty-four adult illicit drug users with mild to moderate depressive symptoms (Beck Depression Inventory-II [BDI-II] score >or= 10) who were receiving inpatient substance abuse treatment were randomly assigned to either treatment as usual (TAU) alone or TAU plus brief behavioral therapy for depression (i.e., Life Enhancement Treatment for Substance Use [LETS Act!]). Patients were assessed at baseline for DSM-IV psychiatric diagnoses, depressive symptoms (Hamilton Rating Scale for Depression, BDI-II), anxiety symptoms (Beck Anxiety Inventory), and enjoyment and reward value of activities (Environmental Reward Observation Scale). Patients were again assessed at posttreatment and at 2-week follow-up. Treatment satisfaction and attrition rates also were assessed at posttreatment. Data were collected from November 2005 to March 2006. Patients who received the LETS Act! intervention (N = 22) evidenced significantly greater improvements than the TAU group (N = 22) in severity of depression, anxiety symptoms, and enjoyment and reward value of activities at posttreatment and in depressive symptoms at 2-week follow-up. The LETS Act! group also reported significantly higher treatment satisfaction ratings. This study supports the efficacy of LETS Act! in treating depressive symptoms and improving the enjoyment and reward value of activities among illicit drug users currently receiving inpatient substance use treatment. Data also indicate the intervention may help prevent treatment attrition. LETS Act! appears to be a feasible and parsimonious intervention to improve the treatment of depression and overall quality of care within inpatient substance abuse treatment settings.