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Heroin Addiction and Related Clinical Problems: 2025, 27, 22

Predictors of engagement and dropout in the context of joint treatment for dual disorders: an exploratory analysis

Andrea Saverio Spagnuolo, Ottone Baccaredda Boy, Ilaria Noschese, Niccolò Porcinai, Ferdinando Elia, Giovanni Castellini, Francesco Rotella, Valdo Ricca, Cecilia Lanzi, Brunella Occupati, Icro Maremmani, Guido Mannaioni, and Andrea Ballerini

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-22

Summary: Introduction: Integrated care models between psychiatry and toxicology specialists are essential for the evaluation and management of patients affected by dual disorders, but their application across mental health and addiction services remains inconsistent. Observational studies on the outcomes of these collaborations are necessary to substantiate the rationale of this approach. Objective: This study aimed to evaluate the effects of an integrated treatment approach for patients with dual disorders in public healthcare, highlighting factors that could positively or negatively influence dropout rates. Methods: The research was conducted at the Joint Unit (Psychiatry-Toxicology) of A.O.U. Careggi on 56 patients. Baseline data (T0) included anamnestic, sociodemographic, and clinical information, as well as psychometric scores on several scales. Dropouts were recorded at 2 months (T1) and 6 months (T2). Logistic regression and stepwise forward conditional regression identified risk and protective factors for the interruption of the care pathway within the Joint Unit. Results: At T1, anxiety disorders and high scores in the positive and negative subscales of the Positive and Negative Syndrome Scale (PANSS) proved to be protective against dropout, while benzodiazepine use disorder and high PANSS general psychopathology scores increased risk. At T2, cannabinoid and benzodiazepine use disorders, as well as high PANSS general psychopathology scores, predicted discontinuation, whereas high positive/negative PANSS scores favoured engagement again. Substance-specific treatments, especially opioid agonists, were the strongest protective factor. Conclusions: Despite its limitations, this study emphasises the importance of early identification of risk and protective factors at the time of patient assessment in integrated care models. Public Significance Statement: This study offers valuable insights into the engagement and dropout patterns of individuals from a dual disorder-dedicated unit, one of the first of its kind in Italy.

Keywords: Dual Disorders; Dropout Predictors; Psychopathology; Substance Use