Modeling the Therapeutic Process of Patients with Cocaine Use Disorders: The Texas Christian University Process Model as a Guidance to Predict Readmission

Background Patients readmitted for Cocaine Use Disorders are, along with Opiates Use Disorder, one of the group of patients with highest demand of treatment in specialized centers of addiction and with greater therapeutic failure. Objective Our aim is to apply the Texas Christian University Process Model to modeling the relationships between patient’s attributes at intake of treatment, treatment progress indicators and outcomes, including treatment success and readmissions. Method A retrospective observational design was used with 10,298 Cocaine Use Disorder patients. Electronic health records were used for statistical analysis of the data. Randomized subsample 1 (n= 5,150) was used for exploratory analysis and subsample 2 (n = 5,148) to modeling variables relations. Results Patients attributes at intake have limited relevance in explaining the treatment progress indicators and outcomes. Time on treatment and patient’s adherence are relevant to explain treatment success. Readmissions are mainly explained by time in treatment and therapeutic success. Been referred to addiction centers by health of services also appear to be relevant. Discussion and conclusion Our study reflects that the therapeutic process is important in order to have and adequate therapeutic adherence and to stay longer in treatment. Patients with a successful treatment and longer stay in treatment are less likely to have future readmissions. Through this study we highlight, therefore, the value of an adequate therapeutic adherence to obtain successful short- and medium-term results. This would make the treatment of these patients more efficient, and alleviate suffering for the patients and their families. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the grant 'COMPARA: Comorbilidad Psiquiatrica en Adicciones y Resultados en Andalucia. Modelizacion a traves de Big Data', project P20_00735 on Andalusian Research, Development and Innovation Plan, provided by Fondo Europeo de Desarrollo Regional (EU) and Junta de Andalucia (Spain). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The storage and encoding of this data comply with the General Health Law of April 25, 1986 (Spain) and Law 41/2002 of November 14 on patient autonomy, rights, and obligations regarding clinical information and documentation. Furthermore, according to European regulations, the procedures comply with the Organic Law 3/2018 of December 5, 2018, on protecting personal data and guaranteeing digital rights. The Research Ethics Committee of the Andalusian Ministry of Health certified compliance with the ethical handling of the information. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors