Espen Walderhaug | Oslo University Hospital (original) (raw)
Papers by Espen Walderhaug
Additional file 2. Consort checklist.
European Journal of Psychological Assessment, 2017
This study investigated psychometric properties of a dimensional measure of maladaptive core path... more This study investigated psychometric properties of a dimensional measure of maladaptive core pathology for personality disorders, the Severity Indices of Personality Problems (SIPP). The study analyzed data from 941 respondents in a community sample, 949 psychiatric patients with Personality disorders (PD), and 413 psychiatric patients without PD in Norway. The facets of SIPP had acceptable internal consistency, but the construct validity of some facets had potentials for improvement. The original SIPP domains (the factor structures of the facets) were not supported, and factor analysis gave different results across the three current study samples. All facets of SIPP have good discriminative properties with respect to differentiating between a nonclinical sample, a clinical sample without PD, and a clinical PD sample. Further research and improvements on SIPP are suggested.
Qualitative Social Work, 2016
Dropout from substance use disorder treatment is usually investigated and understood from a persp... more Dropout from substance use disorder treatment is usually investigated and understood from a perspective of quantitative patient-related factors. Patients’ own perspectives (user perspective) are rarely reported. This study, therefore, aimed to explore patients’ own understanding of their dropout from residential substance use disorder treatment. The participants were 15 males and females, aged 19–29 years, who had dropped out of residential substance use disorder treatment at the Department of Addiction Treatment, Oslo University Hospital, Norway. Qualitative methodology with semistructured interviews was used to explore how the participants described their dropout and their reasons for doing so. Thematic analysis was used as the framework for analyzing the data derived from the interviews. Dropout had different meanings for different participants. It was understood as a break from treatment, as an end to treatment, or as a means of reduced treatment intensity. Against that backgrou...
Addiction Science & Clinical Practice, 2015
Journal of Dual Diagnosis, 2019
Abstract Objective: Co-occurrence of substance use disorder and personality disorder (PD) is asso... more Abstract Objective: Co-occurrence of substance use disorder and personality disorder (PD) is associated with greater functional impairment and mutual deterioration of the prognosis. More information is needed about the extent of personality problems in substance use disorder patients and when these problems can be assessed in a reliable way. The aim of this study was to compare the levels and scale reliability of (mal)adaptive personality functioning in four different samples and to discuss the possible clinical implications. Methods: Personality problems were assessed using the self-report Severity Indices of Personality Problems (SIPP) questionnaire in four samples: (a) 136 patients in the detoxification phase, (b) 187 patients with substance use disorder in long-term inpatient treatment, (c) 1,399 patients with PD in day and outpatient treatment, and (d) a community population of 935 respondents. Scale reliability of the SIPP facets was computed for each sample and levels of personality problems were compared among samples. Results: The scale reliability was acceptable for most of the SIPP facets in both substance use disorder samples. The substance use disorder samples had scores on SIPP that reflected greater personality dysfunction compared with the general community population and at a level similar to the PD population. Conclusions: SIPP appears to be a promising instrument for assessing personality pathology in substance use disorder treatment. The finding of high levels of maladaptive personality functioning in substance use disorder populations challenges the clinical management of the substance use disorder patient group and supports the development of integrated treatment approaches.
Tidsskrift for Den norske legeforening, 2019
Substance Abuse: Research and Treatment, 2018
Journal of substance abuse treatment, 2017
Polysubstance use disorder is prevalent in treatment-seeking patients with substance use disorder... more Polysubstance use disorder is prevalent in treatment-seeking patients with substance use disorder (SUD), with a higher risk of developing comorbid psychiatric symptoms, more pervasive deficits in cognitive functions, and inferior treatment results. The present study investigates if individuals with polysubstance use disorder who achieve at least one year of abstinence show greater improvements in satisfaction with life, executive functions, and psychological distress, compared to relapsers and controls. The prospective recovery from polysubstance use disorder assessed with broad output indicators remains understudied. A better understanding of the pattern of recovery of the chosen output indicators could shed light on the recovery process for this group of patients. We investigated changes in satisfaction with life, executive functions and psychological distress over a period of 12months in patients who remained abstinent and in those who relapsed. Subjects with polysubstance use di...
Addictive Behaviors Reports, 2017
Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke, 2021
Quality of Life Research
Purpose The Severity Indices of Personality Problems 118 (SIPP-118) is a self-report questionnair... more Purpose The Severity Indices of Personality Problems 118 (SIPP-118) is a self-report questionnaire that aims to measure core components of (mal)adaptive personality functioning that can change over time. In this study, we aimed to assess the facet strength of the 16 facets across three large clinical samples. Methods Data from Norwegian and Dutch psychiatric patients were analyzed in this international multi-center study (N1 = 2814, N2 = 4751, N3 = 2217). Bi-factor modeling was used to assess to what degree the SIPP items tap into an overall general factor. The incremental value (distinctiveness) of the facets was studied using proportional reduction in mean squared error (PRMSE) based statistics. Results The estimated model showed adequate fit. The explained common variance (ECV) attributable to the general factor equaled 50% for all three samples. All but two facets (stable self-image and frustration tolerance) showed sufficient levels of distinctiveness. The findings were observe...
Journal of Patient-Reported Outcomes
Purpose There is a need to assess the quality of treatment for Substance Use Disorder (SUD), and ... more Purpose There is a need to assess the quality of treatment for Substance Use Disorder (SUD), and document SUD patients’ health-related quality of life (HRQoL). The study aims to describe Norwegian SUD patients’ HRQoL as measured by EQ-5D, compared to a general population sample, and discuss the potential usefulness of the EQ-5D to monitor HRQoL for SUD patients. Methods One hundred seventy eight SUD patients (66.3% male) were administered the EQ-5D-3L at treatment start. Patients and general population samples were compared in terms of reported EQ-5D-3L health states, problems by dimension, UK index values, and EQ VAS scores. We investigated specific drug dependence, mental health disorders, sex, age, and education as predictors of EQ-5D-3L values and EQ VAS scores. Anxiety/depression dimension scores were compared to Hopkins symptom Checklist (HSCL-25) scores. Results 91.6% of the patient sample reported problems on the EQ-5D-3L, with 29.8% reporting extreme problem, compared to 39...
Addiction Science & Clinical Practice
Background Treatment completion is the greatest challenge for the treatment of substance use diso... more Background Treatment completion is the greatest challenge for the treatment of substance use disorders (SUDs). A previous investigation showed that complementary horse-assisted therapy (cHAT) was associated with higher retention in treatment and completion than standard treatment alone. This randomized controlled trial further explored the benefits of cHAT for patients with SUDs. Methods Fifty patients in residential SUD treatment at the Department of Addiction Treatment, Oslo University Hospital, were randomly allocated to either cHAT (cHAT group) or treatment as usual alone (TAU-only group). The primary end-point was treatment completion. Secondary end-points were dropout, transfer to another treatment, and time in treatment. Results The multinomial logistic regression analysis found no statistically significant association between intervention (cHAT) and treatment outcome (completion, dropout, transferred) among the 37 participants who were ultimately recruited to the study. Some...
Biological …, 2010
Background-Although animal models suggest that alcohol dependence (AD) is associated with elevati... more Background-Although animal models suggest that alcohol dependence (AD) is associated with elevations in the number of serotonin-1B receptors (5HT 1B R), 5HT 1B R levels have not been investigated in people with AD. The selective 5HT 1B R antagonist radioligand, [ 11 C]P943, permits in vivo assessment of central 5HT 1B R binding potential (BP ND) using positron emission tomography (PET). Because of its central role in AD, we were particularly interested in ventral striatal 5HT 1B R BP ND values. Methods-Twelve medication-free, recently abstinent (at least 4 weeks) patients with AD (mean age 35.2±10.1 years, 5 women) and 12 healthy control subjects (HC) (mean age 30.6±9.2 years, 5 women) completed [ 11 C]P943 PET on a high resolution research tomograph (HRRT). Individual MRI scans were collected to exclude individuals with anatomical abnormalities and for coregistration. Imaging data were analyzed using a multilinear reference tissue model. Results-Ventral striatal 5-HT 1B R BP ND values (2.01±0.57 and 1.55±0.09, 29% between-group difference, p=.006) were increased in AD compared to HC subjects. No influence of demographic or clinical variables or amount of injected radiotracer was observed. Conclusions-This study provides the first evidence that AD in humans, like in rodent models, is associated with increased levels of ventral striatal 5HT 1B Rs.
Journal of Dual Diagnosis
Objective: Co-occurrence of substance use disorder and personality disorder (PD) is associated wi... more Objective: Co-occurrence of substance use disorder and personality disorder (PD) is associated with greater functional impairment and mutual deterioration of the prognosis. More information is needed about the extent of personality problems in substance use disorder
patients and when these problems can be assessed in a reliable way. The aim of this study was to compare the levels and scale reliability of (mal)adaptive personality functioning in four different samples and to discuss the possible clinical implications.
Methods: Personality problems were assessed using the self-report Severity Indices of Personality Problems (SIPP) questionnaire in four samples: (a) 136 patients in the detoxification phase, (b) 187 patients
with substance use disorder in long-term inpatient treatment, (c) 1,399 patients with PD in day and outpatient treatment, and (d) a community population of 935 respondents. Scale reliability of the SIPP facets was computed for each sample and levels of personality problems
were compared among samples.
Results: The scale reliability was acceptable for most of the SIPP facets in both substance use disorder samples. The substance use disorder samples had scores on SIPP that reflected greater personality dysfunction compared with the general community population and at a level similar to the PD population.
Conclusions: SIPP appears to be a promising instrument for assessing personality pathology in substance use disorder treatment. The finding of high levels of maladaptive personality functioning in substance use disorder populations challenges the clinical management of the substance use disorder patient group and supports the development of integrated treatment approaches.
Tidsskrift for Den norske legeforening, 2019
B A C K G R O U N D Combination of drugs is the main cause of fatal overdose, and polydrug use is... more B A C K G R O U N D
Combination of drugs is the main cause of fatal overdose, and polydrug use is associated with greater treatment needs. This study investigates the prevalence and registration of multiple substance dependence.
M A T E R I A L A N D M E T H O D
Substance dependence diagnoses for 147 inpatients at the Department of Addiction Treatment, Oslo University Hospital were registered and reassessed with a focus on the ICD-10 diagnosis F19 (chaotic intake of multiple substances). The resulting diagnoses were also assessed according to ICD-11.
R E S U L T S
Altogether 116 (79 %) out of 147 patients were addicted to two or more drugs. Only 22 (15 %) out of 147 were diagnosed with F19, but this figure increased to 52 (35 %) after reassessment. Using ICD-11 we found a prevalence of the diagnosis 6C4F (multiple substance dependence)
of 79 %.
I N T E R P R E T A T I O N
We found an underreporting of the ICD-10 diagnosis F19. It is important to use the F19 diagnosis, because polydrug use is underreported, even though it predicts overdose, prognosis and treatment needs.
European Journal of Psychological Assessment
This study investigated psychometric properties of a dimensional measure of maladaptive core path... more This study investigated psychometric properties of a dimensional measure of maladaptive core pathology for personality disorders,
the Severity Indices of Personality Problems (SIPP). The study analyzed data from 941 respondents in a community sample, 949 psychiatric
patients with Personality Disorders (PD), and 413 psychiatric patients without PD in Norway. The facets of SIPP had acceptable internal
consistency, but the construct validity of some facets had potentials for improvement. The original SIPP domains (the factor structures of the
facets) were not supported, and factor analysis gave different results across the three current study samples. All facets of SIPP have good
discriminative properties with respect to differentiating between a nonclinical sample, a clinical sample without PD, and a clinical PD sample. Further research and improvements in SIPP are suggested.
Substance Abuse: Research and Treatment, 2018
Introducti on: Dropout from inpatient treatment for substance use disorder (SUD) is an ongoing ch... more Introducti on: Dropout from inpatient treatment for substance use disorder (SUD) is an ongoing challenge. The aim of this study was to
identify demographic, substance use, and psychological factors that predict dropout from postdetoxification inpatient SUD treatment.
Materials and methods : A total of 454 patients from 5 inpatient SUD centers in Central Norway were consecutively included in this
naturalistic, prospective cohort study.
Results : A total of 132 patients (28%) did not complete the planned treatment stay (dropped out). Cox regression analysis showed that
higher levels of intrinsic motivation for changing personal substance use reduced the dropout risk (adjusted hazard ratio [adjHR]: 0.62, 95%
confidence interval [CI]: 0.48-0.79). Higher levels of mental distress were associated with an increased risk for dropout (adjHR: 1.48, 95%
CI: 1.11-1.97).
Conclusions: The role of mental health and motivation in reducing dropout risk from inpatient SUD treatment should be targeted in future
prospective intervention studies.
Additional file 2. Consort checklist.
European Journal of Psychological Assessment, 2017
This study investigated psychometric properties of a dimensional measure of maladaptive core path... more This study investigated psychometric properties of a dimensional measure of maladaptive core pathology for personality disorders, the Severity Indices of Personality Problems (SIPP). The study analyzed data from 941 respondents in a community sample, 949 psychiatric patients with Personality disorders (PD), and 413 psychiatric patients without PD in Norway. The facets of SIPP had acceptable internal consistency, but the construct validity of some facets had potentials for improvement. The original SIPP domains (the factor structures of the facets) were not supported, and factor analysis gave different results across the three current study samples. All facets of SIPP have good discriminative properties with respect to differentiating between a nonclinical sample, a clinical sample without PD, and a clinical PD sample. Further research and improvements on SIPP are suggested.
Qualitative Social Work, 2016
Dropout from substance use disorder treatment is usually investigated and understood from a persp... more Dropout from substance use disorder treatment is usually investigated and understood from a perspective of quantitative patient-related factors. Patients’ own perspectives (user perspective) are rarely reported. This study, therefore, aimed to explore patients’ own understanding of their dropout from residential substance use disorder treatment. The participants were 15 males and females, aged 19–29 years, who had dropped out of residential substance use disorder treatment at the Department of Addiction Treatment, Oslo University Hospital, Norway. Qualitative methodology with semistructured interviews was used to explore how the participants described their dropout and their reasons for doing so. Thematic analysis was used as the framework for analyzing the data derived from the interviews. Dropout had different meanings for different participants. It was understood as a break from treatment, as an end to treatment, or as a means of reduced treatment intensity. Against that backgrou...
Addiction Science & Clinical Practice, 2015
Journal of Dual Diagnosis, 2019
Abstract Objective: Co-occurrence of substance use disorder and personality disorder (PD) is asso... more Abstract Objective: Co-occurrence of substance use disorder and personality disorder (PD) is associated with greater functional impairment and mutual deterioration of the prognosis. More information is needed about the extent of personality problems in substance use disorder patients and when these problems can be assessed in a reliable way. The aim of this study was to compare the levels and scale reliability of (mal)adaptive personality functioning in four different samples and to discuss the possible clinical implications. Methods: Personality problems were assessed using the self-report Severity Indices of Personality Problems (SIPP) questionnaire in four samples: (a) 136 patients in the detoxification phase, (b) 187 patients with substance use disorder in long-term inpatient treatment, (c) 1,399 patients with PD in day and outpatient treatment, and (d) a community population of 935 respondents. Scale reliability of the SIPP facets was computed for each sample and levels of personality problems were compared among samples. Results: The scale reliability was acceptable for most of the SIPP facets in both substance use disorder samples. The substance use disorder samples had scores on SIPP that reflected greater personality dysfunction compared with the general community population and at a level similar to the PD population. Conclusions: SIPP appears to be a promising instrument for assessing personality pathology in substance use disorder treatment. The finding of high levels of maladaptive personality functioning in substance use disorder populations challenges the clinical management of the substance use disorder patient group and supports the development of integrated treatment approaches.
Tidsskrift for Den norske legeforening, 2019
Substance Abuse: Research and Treatment, 2018
Journal of substance abuse treatment, 2017
Polysubstance use disorder is prevalent in treatment-seeking patients with substance use disorder... more Polysubstance use disorder is prevalent in treatment-seeking patients with substance use disorder (SUD), with a higher risk of developing comorbid psychiatric symptoms, more pervasive deficits in cognitive functions, and inferior treatment results. The present study investigates if individuals with polysubstance use disorder who achieve at least one year of abstinence show greater improvements in satisfaction with life, executive functions, and psychological distress, compared to relapsers and controls. The prospective recovery from polysubstance use disorder assessed with broad output indicators remains understudied. A better understanding of the pattern of recovery of the chosen output indicators could shed light on the recovery process for this group of patients. We investigated changes in satisfaction with life, executive functions and psychological distress over a period of 12months in patients who remained abstinent and in those who relapsed. Subjects with polysubstance use di...
Addictive Behaviors Reports, 2017
Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke, 2021
Quality of Life Research
Purpose The Severity Indices of Personality Problems 118 (SIPP-118) is a self-report questionnair... more Purpose The Severity Indices of Personality Problems 118 (SIPP-118) is a self-report questionnaire that aims to measure core components of (mal)adaptive personality functioning that can change over time. In this study, we aimed to assess the facet strength of the 16 facets across three large clinical samples. Methods Data from Norwegian and Dutch psychiatric patients were analyzed in this international multi-center study (N1 = 2814, N2 = 4751, N3 = 2217). Bi-factor modeling was used to assess to what degree the SIPP items tap into an overall general factor. The incremental value (distinctiveness) of the facets was studied using proportional reduction in mean squared error (PRMSE) based statistics. Results The estimated model showed adequate fit. The explained common variance (ECV) attributable to the general factor equaled 50% for all three samples. All but two facets (stable self-image and frustration tolerance) showed sufficient levels of distinctiveness. The findings were observe...
Journal of Patient-Reported Outcomes
Purpose There is a need to assess the quality of treatment for Substance Use Disorder (SUD), and ... more Purpose There is a need to assess the quality of treatment for Substance Use Disorder (SUD), and document SUD patients’ health-related quality of life (HRQoL). The study aims to describe Norwegian SUD patients’ HRQoL as measured by EQ-5D, compared to a general population sample, and discuss the potential usefulness of the EQ-5D to monitor HRQoL for SUD patients. Methods One hundred seventy eight SUD patients (66.3% male) were administered the EQ-5D-3L at treatment start. Patients and general population samples were compared in terms of reported EQ-5D-3L health states, problems by dimension, UK index values, and EQ VAS scores. We investigated specific drug dependence, mental health disorders, sex, age, and education as predictors of EQ-5D-3L values and EQ VAS scores. Anxiety/depression dimension scores were compared to Hopkins symptom Checklist (HSCL-25) scores. Results 91.6% of the patient sample reported problems on the EQ-5D-3L, with 29.8% reporting extreme problem, compared to 39...
Addiction Science & Clinical Practice
Background Treatment completion is the greatest challenge for the treatment of substance use diso... more Background Treatment completion is the greatest challenge for the treatment of substance use disorders (SUDs). A previous investigation showed that complementary horse-assisted therapy (cHAT) was associated with higher retention in treatment and completion than standard treatment alone. This randomized controlled trial further explored the benefits of cHAT for patients with SUDs. Methods Fifty patients in residential SUD treatment at the Department of Addiction Treatment, Oslo University Hospital, were randomly allocated to either cHAT (cHAT group) or treatment as usual alone (TAU-only group). The primary end-point was treatment completion. Secondary end-points were dropout, transfer to another treatment, and time in treatment. Results The multinomial logistic regression analysis found no statistically significant association between intervention (cHAT) and treatment outcome (completion, dropout, transferred) among the 37 participants who were ultimately recruited to the study. Some...
Biological …, 2010
Background-Although animal models suggest that alcohol dependence (AD) is associated with elevati... more Background-Although animal models suggest that alcohol dependence (AD) is associated with elevations in the number of serotonin-1B receptors (5HT 1B R), 5HT 1B R levels have not been investigated in people with AD. The selective 5HT 1B R antagonist radioligand, [ 11 C]P943, permits in vivo assessment of central 5HT 1B R binding potential (BP ND) using positron emission tomography (PET). Because of its central role in AD, we were particularly interested in ventral striatal 5HT 1B R BP ND values. Methods-Twelve medication-free, recently abstinent (at least 4 weeks) patients with AD (mean age 35.2±10.1 years, 5 women) and 12 healthy control subjects (HC) (mean age 30.6±9.2 years, 5 women) completed [ 11 C]P943 PET on a high resolution research tomograph (HRRT). Individual MRI scans were collected to exclude individuals with anatomical abnormalities and for coregistration. Imaging data were analyzed using a multilinear reference tissue model. Results-Ventral striatal 5-HT 1B R BP ND values (2.01±0.57 and 1.55±0.09, 29% between-group difference, p=.006) were increased in AD compared to HC subjects. No influence of demographic or clinical variables or amount of injected radiotracer was observed. Conclusions-This study provides the first evidence that AD in humans, like in rodent models, is associated with increased levels of ventral striatal 5HT 1B Rs.
Journal of Dual Diagnosis
Objective: Co-occurrence of substance use disorder and personality disorder (PD) is associated wi... more Objective: Co-occurrence of substance use disorder and personality disorder (PD) is associated with greater functional impairment and mutual deterioration of the prognosis. More information is needed about the extent of personality problems in substance use disorder
patients and when these problems can be assessed in a reliable way. The aim of this study was to compare the levels and scale reliability of (mal)adaptive personality functioning in four different samples and to discuss the possible clinical implications.
Methods: Personality problems were assessed using the self-report Severity Indices of Personality Problems (SIPP) questionnaire in four samples: (a) 136 patients in the detoxification phase, (b) 187 patients
with substance use disorder in long-term inpatient treatment, (c) 1,399 patients with PD in day and outpatient treatment, and (d) a community population of 935 respondents. Scale reliability of the SIPP facets was computed for each sample and levels of personality problems
were compared among samples.
Results: The scale reliability was acceptable for most of the SIPP facets in both substance use disorder samples. The substance use disorder samples had scores on SIPP that reflected greater personality dysfunction compared with the general community population and at a level similar to the PD population.
Conclusions: SIPP appears to be a promising instrument for assessing personality pathology in substance use disorder treatment. The finding of high levels of maladaptive personality functioning in substance use disorder populations challenges the clinical management of the substance use disorder patient group and supports the development of integrated treatment approaches.
Tidsskrift for Den norske legeforening, 2019
B A C K G R O U N D Combination of drugs is the main cause of fatal overdose, and polydrug use is... more B A C K G R O U N D
Combination of drugs is the main cause of fatal overdose, and polydrug use is associated with greater treatment needs. This study investigates the prevalence and registration of multiple substance dependence.
M A T E R I A L A N D M E T H O D
Substance dependence diagnoses for 147 inpatients at the Department of Addiction Treatment, Oslo University Hospital were registered and reassessed with a focus on the ICD-10 diagnosis F19 (chaotic intake of multiple substances). The resulting diagnoses were also assessed according to ICD-11.
R E S U L T S
Altogether 116 (79 %) out of 147 patients were addicted to two or more drugs. Only 22 (15 %) out of 147 were diagnosed with F19, but this figure increased to 52 (35 %) after reassessment. Using ICD-11 we found a prevalence of the diagnosis 6C4F (multiple substance dependence)
of 79 %.
I N T E R P R E T A T I O N
We found an underreporting of the ICD-10 diagnosis F19. It is important to use the F19 diagnosis, because polydrug use is underreported, even though it predicts overdose, prognosis and treatment needs.
European Journal of Psychological Assessment
This study investigated psychometric properties of a dimensional measure of maladaptive core path... more This study investigated psychometric properties of a dimensional measure of maladaptive core pathology for personality disorders,
the Severity Indices of Personality Problems (SIPP). The study analyzed data from 941 respondents in a community sample, 949 psychiatric
patients with Personality Disorders (PD), and 413 psychiatric patients without PD in Norway. The facets of SIPP had acceptable internal
consistency, but the construct validity of some facets had potentials for improvement. The original SIPP domains (the factor structures of the
facets) were not supported, and factor analysis gave different results across the three current study samples. All facets of SIPP have good
discriminative properties with respect to differentiating between a nonclinical sample, a clinical sample without PD, and a clinical PD sample. Further research and improvements in SIPP are suggested.
Substance Abuse: Research and Treatment, 2018
Introducti on: Dropout from inpatient treatment for substance use disorder (SUD) is an ongoing ch... more Introducti on: Dropout from inpatient treatment for substance use disorder (SUD) is an ongoing challenge. The aim of this study was to
identify demographic, substance use, and psychological factors that predict dropout from postdetoxification inpatient SUD treatment.
Materials and methods : A total of 454 patients from 5 inpatient SUD centers in Central Norway were consecutively included in this
naturalistic, prospective cohort study.
Results : A total of 132 patients (28%) did not complete the planned treatment stay (dropped out). Cox regression analysis showed that
higher levels of intrinsic motivation for changing personal substance use reduced the dropout risk (adjusted hazard ratio [adjHR]: 0.62, 95%
confidence interval [CI]: 0.48-0.79). Higher levels of mental distress were associated with an increased risk for dropout (adjHR: 1.48, 95%
CI: 1.11-1.97).
Conclusions: The role of mental health and motivation in reducing dropout risk from inpatient SUD treatment should be targeted in future
prospective intervention studies.