Factors associated with patient dropout from an outpatient alcoholism treatment service

A novel telehealth platform for alcohol use disorder treatment: preliminary evidence of reductions in drinking

BACKGROUND

Alcohol use disorder (AUD) treatment remains greatly underutilized. Innovative strategies are needed to improve AUD treatment access and patient engagement. The Ria Treatment Platform (RTP) is a patient-centered telemedicine AUD treatment program accessed through a smartphone application (app) that includes a package of physician visits (with AUD prescriptions as appropriate), text- and phone-based support from a recovery coach, video monitoring of medication adherence, and Bluetooth-linked breathalyzer tracking of alcohol intake.

OBJECTIVES

The purpose of the current study is to examine changes in alcohol use among patients utilizing the RTP.

METHODS

This study examines daily breathalyzer blood alcohol content (BAC) readings collected from 77 adult patients (50.7% male) over the first 90 days in treatment with the RTP. Data were analyzed using dynamic structural equation modeling.

RESULTS

The treatment retention rate at 90 days was 55%. The best fit for the BAC data was given by a cubic curve, which showed that among patients who remained engaged for 90 days average BAC levels declined approximately 50% (from .091 to .045) from baseline to day 90.

CONCLUSION

This study provides preliminary evidence of substantial alcohol use reductions among patients utilizing the RTP, an innovative telemedicine program accessed via smartphone. Although other alcohol-reduction apps have shown promise from scientific evaluations, the RTP appears to be the only app that incorporates physician-prescribed medication and a recovery coach. Research incorporating random assignment and meaningful comparison groups is needed to further evaluate this promising strategy.

Reducing appointment no-shows: going from theory to practice

Addiction appointment no-shows adversely impact clinical outcomes and healthcare productivity. During 2007-2010, 67 treatment organizations in the Strengthening Treatment Access and Retention program were asked to reduce their no-show rates by using practices taken from no-show research and theory. These treatment organizations reduced outpatient no-show rates from 37.4% to 19.9% (p = .000), demonstrated which practices they preferred to implement, and which practices were most effective in reducing no-show rates. This study provides an applied synthesis of addiction treatment no-show research and suggests future directions for no-show research and practice.

Improving substance abuse data systems to measure 'waiting time to treatment': lessons learned from a quality improvement initiative

Robust data measurement systems assess health care performance and monitor population-level treatment trends. A key challenge in the assessment of substance abuse treatment is the development of systems to accurately monitor service delivery indicators. Wait time to treatment, as defined by the days between first request for service and first treatment, is an important measure of organizational process and delivery of care. The Network for the Improvement of Addiction Treatment emphasizes wait time as a primary outcome in their study of 201 addiction treatment agencies in the USA. This article describes the changes made in five state data systems to monitor wait times and outlines lessons learned that could be applied to other health data tracking systems.

Days to treatment and early retention among patients in treatment for alcohol and drug disorders

OBJECTIVES

Drug and alcohol treatment programs often have long delays between assessment and treatment admission. The study examined the impact of days to treatment admission on the probability of completing four sessions of care within an addiction treatment program implementing improvements in their admission process.

METHODS

Mixed-effects logistic regression was used to test the effect of wait time on retention in care.

RESULTS

Findings demonstrate a strong decrement in the probability of completing four sessions of treatment with increasing time between the clinical assessment and first treatment session.

Nurse-led detoxification in primary care. Can it be done?

This paper describes the community alcohol detoxifications (detox) carried out in primary care by the nurse specialist for alcohol in Islington, as an independent prescriber. It is argued that this service is a valuable resource and can enable a better space for preparation for the client, who can then be more insightful and motivated before entering the detox in primary care. It also shows that the guidelines for the assessment and detoxification of patients entering this modality are important in ensuring a potentially good outcome. This is beneficial for the patient and can ensure a break from dependent drinking for 6 months to 1 year. Importantly, it also shows the crucial and beneficial role a nurse specialist can play in treating patients in the clinical speciality of alcohol misuse. The role of the nurse has changed over time, and can now initiate services in primary care. One such role has set up a service that supports GPs and practice staff in the area of alcohol. Often this is seen as specialist area crossing over into mental health. However, many patients can be managed and prescribed for in primary care with the support of an experienced and knowledgeable specialist nurse. This paper illustrates that through basic audit and research, good outcomes are possible for nurses working on the clinical ‘frontline’. Also, nurses are capable of producing excellent prescribing guidelines in the field of substance misuse.

Planned and unplanned discharge from alcohol services in Scotland, 2004-2008

AIMS

Available data suggests that the rate of unplanned discharge from alcohol treatment services is an international problem reflective, perhaps, of ambivalence surrounding treatment in general. Given Scotland's escalating prevalence of alcohol misuse, a preliminary study of Scottish dropout rates would make a useful contribution to the international scene.

METHODS

A retrospective analysis of discharge statuses (planned/unplanned/disciplinary) of entries to alcohol treatment services between 1 April 2004 and 31 March 2008 was conducted on data provided by 10 regional Drug and Alcohol Action Teams (DAATs) and three individual treatment providers.

RESULTS

Of 48,299 cases, 52.23% (n = 25,231) were unplanned discharges. Data showed a general increasing trend in the rate of planned discharges across the examined 4-year period, from 41.66% in 2004-2005 to 51.94% in 2007-2008. Inspection of the data revealed marked regional variations in ratios of planned to unplanned discharge, with only four of the 10 regions examined reporting a planned discharge rate >50%.

CONCLUSION

More than one of every two entries to alcohol misuse services between 2004 and 2008 resulted in an unplanned discharge. The trend of improvement over the examined 4-year period was not consistent for all regions. A comparison of this figure with available US and Welsh data is made. The importance of these data in assessing the cost-effectiveness of alcohol treatment services and implications for policy making is discussed.

Pretreatment and during treatment risk factors for dropout among patients with substance use disorders

OBJECTIVE

The aim of this study was to use pretreatment and treatment factors to predict dropout from residential substance use disorder program and to examine how the treatment environment modifies the risk for dropout.

METHOD

This study assessed 3649 male patients at entry to residential substance use disorder treatment and obtained information about their perceptions of the treatment environment.

RESULTS

Baseline factors that predicted dropout included younger age, greater cognitive dysfunction, more drug use, and lower severity of alcohol dependence. Patients in treatment environments appraised as low in support or high in control also were more likely to drop out. Further, patients at high risk of dropout were especially likely to dropout when treated in a highly controlling treatment environment.

CONCLUSION

Better screening of risk factors for dropout and efforts to create a less controlling treatment environment may result in increased retention in substance use disorder treatment.

Jail-based substance user treatment: an analysis of retention

Many jail inmates have a history of substance use and "abuse"; few, however, receive comprehensive treatment for substance use disorders while in jail. The authors offer a longitudinal reanalysis of data from five jail-based substance user treatment programs. Survival analysis was used to identify client characteristics associated with length of time in treatment. Survival curves for the five programs were compared, indicating which ones retained inmates the longest. Results from a model stratified by jail site revealed that inmates over 25 years of age and those already sentenced had significantly longer treatment stays. The Substance Abuse Intervention Division (SAID) program, a modified therapeutic community in a New York jail, and the Deciding, Educating, Understanding, Counseling, and Evaluation (DEUCE) program, a curriculum-based intervention, had the longest survival curves and were, therefore, most effective at retaining inmates in treatment.

Dropout from 12-step self-help groups: prevalence, predictors, and counteracting treatment influences

Attendance at 12-step self-help groups is frequently recommended as an adjunct to professional substance use disorder (SUD) treatment, yet patient dropout from these groups is common. This study assessed the prevalence, predictors, and treatment-related factors affecting dropout in the first year following treatment for 2,778 male patients. Of these, 91% (2,518) were identified as having attended 12-step groups either in the 90 days prior to, or during, treatment. At 1-year followup 40% had dropped out. A number of baseline factors predicted dropout. Importantly, patients who initiated 12-step behaviors during treatment were less likely to drop out. Further findings suggest patients at highest risk for dropout may be at lower risk if treated in a more supportive environment. Clinicians may decrease the likelihood of dropout directly, by screening for risk factors and focusing facilitation efforts accordingly, and indirectly, by increasing the supportiveness of the treatment environment, and facilitating 12-step involvement during treatment.

Preparing clients for alcoholism treatment: effects on treatment participation and outcomes

In this study, 126 clients (87 men, 39 women) entering outpatient alcoholism treatment were assigned randomly to 1 of 3 preparatory conditions: a role induction (RI) session, a motivational interview (MI) session, or a no-preparatory session control group (CG). Clients assigned to the MI preparatory condition attended more treatment sessions and had fewer heavy drinking days during and 12 months after treatment relative to CG clients. Clients assigned to MI, relative to CG clients, also had more abstinent days during treatment and during the first 3 months posttreatment, although this difference was not maintained through the remainder of the 12-month follow-up period. Clients assigned to the RI condition showed no significant advantage over those in the CG condition.

The relative impact of waiting time and treatment entry on drug and alcohol use

One hundred and twenty-three treatment-seeking substance misusers were recruited to a study assessing the early impact of treatment. Participants were interviewed at treatment entry and 3 and 6 months later, regardless of their treatment status (i.e. including those who had dropped out of treatment), while additional data were obtained from the two assessment interviews carried out prior to the initiation of treatment. Three consistent observations can be applied to both the opiate misuser (n = 61) and problem drinker samples (n = 62): (1) the period of pre-treatment wait (mean of 8 weeks) was characterized by stable patterns of substance misuse with no significant 'spontaneous' improvement in indices of severity of drug or alcohol problems; (2) the period immediately following initiation of treatment was associated with substantial reductions in the quantity and frequency of substance use, an effect not influenced by the length of time for treatment initiation; (3) these benefits are maintained to 6 months after treatment initiation. The waiting period for treatment initiation does not seem to be characterized by significant changes in drug or alcohol use patterns, at least among those who made it into treatment, with clear and sustained improvements irrespective of the length of treatment wait.

Engaging substance abusers after centralized assessment: predictors of treatment entry and dropout

High attrition continues to be an important issue for substance abuse treatment providers. This study examined factors contributing to treatment entry and dropout after referral from centralized assessment. Univariate analysis showed that individuals with a shorter wait after assessment were more likely to attend an initial treatment appointment, while those who reported a history of physical or sexual abuse or were on probation were significantly more likely to drop out of treatment early. Multivariate analysis revealed, first, that persons with a comorbid psychiatric diagnosis and those referred to outpatient rather than residential care were less likely to enter treatment; and, second, that persons on probation and with a history of physical or sexual abuse were more likely to be early treatment dropouts. Findings suggest that decisions to seek help and to accept help are distinct, and that program factors play a substantial role in treatment engagement and retention.

The impact of women's family status on completion of substance abuse treatment

This study examines the role of family status and demographic characteristics in explaining the nearly 60% dropout rate for women in substance abuse treatment. Data from the administrative record files of the Illinois Office of Alcoholism and Substance Abuse (OASA) for the fiscal year 1996-97 were analyzed for women age 12 or older who completed intake for publicly funded substance abuse treatment and whose outpatient treatment records were closed at year-end. Multivariate logistic regression models found that the likelihood of not completing treatment was greatest for women who were African American, pregnant, had custody of minor children, or were younger than age 21. However, African American women who had children in foster care were more likely to complete treatment. Implications for treatment and research are discussed.

Predictors of homeless veterans' irregular discharge status from a domiciliary care program

This study addresses the relationship of homeless veterans' discharge status from a domiciliary care program to biopsychosocial characteristics presented at admission into the program. Hypotheses were that younger age, less education, and substance abuse or psychiatric disorder would predict an irregular discharge. Research participants were 367 homeless male veterans who had been admitted to a domiciliary care program at the West Los Angeles Veterans Affairs Medical Center for treatment of medical, psychiatric, or substance disorders. Status of veterans' program discharge (regular or irregular) served as the outcome measure. Logistic regression analysis revealed that irregular discharge from the program was more likely among veterans who were black, who had poor employment histories, or who had problems with alcohol. Results are discussed in light of the need to maintain homeless veterans in treatment programs so that they can achieve maximum benefit from available programs.

Pretreatment dropouts: characteristics and outcomes

The characteristics and outcome results of 123 cocaine dependent patients who dropped out following intake without returning for even one treatment visit were compared with those of 324 who did return and received at least one treatment service and 118 who remained on the program for two months or more. The pre-treatment dropouts were more often positive for cocaine on admission drug screens and less often employed. They reported fewer psychological symptoms on the scales of the SCL-90 and received lower scores on the medical problem severity scale of the ASI. At 9-month follow-up they were found to have less often attended self-help meetings or continued in outpatient treatment, more often to have been admitted for inpatient treatment or been in jail, less often returned to school and were more often using cocaine. Clearly, clinicians and researchers need a better understanding of these patients who account for significant attrition, have distinguishing characteristics, and do much more poorly than those who remain in treatment.

Substance user MMPI-2 profiles: predicting failure in completing treatment

Minnesota Multiphasic Personality Inventory-2 protocols were examined in an attempt to develop a model able to identify chemically-dependent patients likely not to complete treatment. MMPI-2 profiles of 173 patients (142 male) were analyzed using profile code types and a multiple analysis of variance. A chi-square showed that patients classified as neurotic were more likely to fail treatment. A MANOVA indicated that elevated T-scores on Scales 7 and 8 (p < .05) were related to noncompletion. Comparing these results with similar studies indicates that attempting to construct a predictive model based on a single objective measure may not be sufficient to determine outcome.

Attitude toward recovery and completion of a substance abuse treatment program

This study tested the ability of the Recovery Attitude and Treatment Evaluator (RAATE; Mee-Lee, Hoffmann, & Smith, 1992) to predict attrition from treatment for pregnant and postpartum substance abusing women. During the first month of treatment, the RAATE was completed by both the clinician and the patient. Three types of discharge status were considered: completion of the treatment program, dropping out of the program, and being administratively discharged. No group differences were found concerning the clinician version of the RAATE. Initial analyses of the patient version revealed that subjects who completed the program had lower ratings of resistance to treatment and continuing care compared to those who dropped out; further analysis suggested that those who completed less than 1 month of treatment exhibited the highest resistance. These results suggest the RAATE is a potentially effective tool for predicting early attrition from substance abuse treatment in this population.

Presenting problems of substance abusers in treatment: implications for service delivery and attrition

This study used the Addiction Severity Index (ASI) to identify the various problems substance abuse clients present when seeking treatment at a Department of Veterans Affairs Medical Center. The sample was 98% male and 73% African-American, with a mean age of 37 years. Cluster analysis was used to identify commonalities and divergences in self-reported employment, legal, family, substance abuse, psychological, and medical problems. Four distinct clusters emerged, each of which could be characterized by a dysfunctional pattern. The utility of this approach in designing treatment regimens, addressing client problems in addition to their substance abuse, increasing client satisfaction with service provided, and decreasing treatment attrition is discussed.

Personality-based subtypes of chemically dependent patients

Jackson's Personality Research Form E (PRF) was administered to a large, heterogeneous group of adult inpatients with diagnoses of alcohol and/or drug dependence. Cluster analysis of PRF factor scores yielded five distinct patient subtypes: hostile-dependent, cooperative-nonreflective, socially uninvolved, impulsive-unsociable, and hostile-overcontrolled. The subtypes differed on two MMPI canonical variables and on self-reported high risk factors for substance usage. Implications of the findings for more appropriate matching of patients to chemical dependency interventions are offered.

Completion rates of clients discharged from drug and alcohol treatment programs in Washington State

OBJECTIVES

The primary goal of this study was to analyze completion rates of clients in drug and alcohol abuse treatment programs in Washington State and to assess the factors associated with treatment completion. A secondary goal was to examine the utility of a state information system as a source of evaluative data.

METHODS

Analyses were conducted of 5827 client records contained in the Washington State Substance Abuse Monitoring System, representing a census of public clients discharged during the last quarter of 1990 from all state-funded alcohol and drug treatment programs in four treatment modalities. Logistic regression was performed to determine the independent predictors of treatment completion.

RESULTS

Completion rates were highest for intensive inpatient alcohol treatment (75%) and lowest for intensive outpatient drug programs (18%). Factors associated with treatment completion included screening at a referral assessment center, education, age, ethnicity, and existence of a secondary drug problem.

CONCLUSIONS

The fit between clients and treatment programs may be an important factor explaining why some clients complete treatment and others drop out. State client information systems are an important source of data for analyzing treatment completion and other outcomes.

Attrition from conjoint alcoholism treatment: do dropouts differ from completers?

This study addresses patient attrition in order to identify variables associated with retention in conjoint treatment for alcohol abuse and dependence. Subjects were 105 male alcoholics and their partners who participated in a randomized clinical trial of three approaches to conjoint treatment of alcoholism: (a) alcohol and behavioral marital therapy (ABMT); (b) ABMT plus Alcoholics Anonymous and Alanon (AA/ABMT); and (c) ABMT plus relapse prevention (RP/ABMT). Completers (n = 45) attended two assessment and 15-17 treatment sessions. Partial completers (n = 23) left treatment between the 5th and 15th treatment session. Thirty-seven dropouts left treatment between the first assessment session and the 5th treatment session; of these, 22 dropouts completed at least one treatment session (called early treatment dropouts). Of subjects who entered treatment, dropouts from early treatment were least compliant with treatment requirements in the first few sessions, less educated, and less committed to their relationship. Data indicate that therapists with more clinical experience were more likely to retain clients in treatment, regardless of treatment condition. The data do not reflect a linear relationship between most variables studied and a continuum of attrition status from assessment to completion of the program.

Predicting attrition from substance misuse treatment using the Inventory of Interpersonal Problems

A simple, self-report scale to predict who would leave substance misuse treatment against medical advice was developed and tested. Scale items were drawn from the Inventory of Interpersonal Problems which measures interpersonal distress in the same format that the SCL-90-R uses to measure personal distress. Potential items were selected using data from an initial sample of 66 patients at a substance misuse clinic. Factor analytic techniques were then used to decide which of these items to include in the scale. It was tested using 98 patients not included in the initial sample. Logistic regression analysis confirmed that patients with high scores on the scale were significantly more likely to leave treatment than were patients with low scores.

Reducing waiting time for substance abuse treatment does not reduce attrition

Attrition rates from substance abuse treatment are high. In an attempt to cut down on the attrition rate in our clinic we instituted an "Orientation Group" to cut down on the time patients spent waiting to enter treatment. An evaluation of the results of this intervention reveals that contrary to the impressions of the clinical staff, the attrition rate was not reduced.

Predictors of marijuana treatment outcomes: the role of self-efficacy

This study tested the ability of sets of demographic, socioeconomic, marijuana use/abuse, psychological distress, and self-efficacy variables to predict posttreatment indices of marijuana intake and problems related to use. Subjects were 167 adults who participated in one of two outpatient treatments for marijuana dependence and completed the 3-, 6-, and 12-month posttreatment follow-ups. Only pretreatment marijuana quantity-frequency of intake and self-efficacy variables made significant and consistent contributions to the regression equations predicting posttreatment frequency of use. In contrast, socioeconomic and severity of abuse indicators predicted posttreatment marijuana-related problems. Contrary to social cognitive theory (Bandura, 1986), there was no evidence that self-efficacy mediated the effects of other predictors. Results are discussed in terms of the specificity of predictor-outcome relationships and the need for improvements in self-efficacy measurement.

The process of treatment selection among previously untreated help-seeking problem drinkers

A sample of 515 untreated problem drinkers was followed up for 1 year after contacting alcohol information and referral or detoxification services. At the 1-year follow-up, participants were placed into one of four treatment status groups: no treatment (24%), Alcoholics Anonymous only (18%), outpatient (25%), and inpatient or residential (32%). Participants with fewer financial resources, more serious drinking problems, and poorer functioning at baseline were more likely to enter inpatient or residential programs than outpatient treatment. Persons who selected AA only for treatment were of lower socioeconomic status than outpatients, and were functioning better than those who opted for treatment in inpatient or residential settings. In general, individuals who entered treatment received a considerable amount of treatment. Poorer baseline functioning was related to attending more AA meetings or outpatient sessions, and to staying longer in inpatient or residential treatment. The results are discussed in the context of a conceptual model of selection into alcoholism treatment.

The effect of a 'recall-system' in the treatment of alcoholic patients

In a service specializing in alcohol and drug abuse in Brazil, a 'recall system' was developed in order to decrease the drop out level, which is high in this kind of treatment. The effect of this procedure was measured in two groups: in the 82 patients with the 'recall system', the drop out rate after 12 months was 45%. In 227 patients without this system the drop out rate was 84%. The difference in drop out rate was significant (p less than 0.01) only during the first 6 months of treatment.

A comparison of predictors of treatment drop-out of women seeking drug and alcohol treatment in a specialist women's and two traditional mixed-sex treatment services

The problem of high levels of client drop-out in drug and alcohol treatment is frequently reported in the literature. In the course of conducting an evaluation of a specialist women's treatment service, the inadequacy of the data on women-specific predictors of treatment drop-out was highlighted. Using a retrospective design, the characteristics of 160 women who left treatment less than 5 days after admission were compared to the 160 women who stayed longer than 5 days and were enrolled in the evaluation study. The findings of this study suggested that women who were employed, had a history of sexual assault (especially in adulthood), nominated alcohol as their drug of choice, were not married, older than 25 years of age and had demonstrated a sympathy with the agency's treatment philosophy were less likely to drop-out of treatment. In addition, for lesbian women, women with a history of sexual assault in childhood, and those with dependent children, attendance at a specialist women's service reduced the incidence of treatment drop-out.

Relation of client variables to continuance in five types of alcohol treatment settings

Multiple regression analyses were used to assess the relationship of 29 client variables to continuance in five types of alcohol treatment settings (outpatient, inpatient, social detoxification, halfway houses with highly structured treatment regimens, and halfway houses with minimal structured treatment; N = 3,240). Socioeconomic variables were most often related to continuance; however, the pattern of the relationship between predictor variables and continuance varied greatly from setting to setting. The strongest multiple regression coefficients were found for outpatient and inpatient settings and the weakest were found for the two types of halfway house settings. It was concluded that archive-derived variables had significant, but limited, power to predict continuance and that other approaches to investigating continuance are needed.

Retention of cocaine abusers in outpatient psychotherapy

Retention in outpatient psychotherapy of 148 crack and cocaine abusers was examined. The clients were predominantly Black (63%) and Hispanic (21%), predominantly male (87%), and the majority (66%) had completed no more than 12 years of high school. Clients entered treatment in a low-cost treatment center in New York City between June 1987 and November 1988. Forty-two percent (62) of the subjects were seen for one or two research interviews only, and did not return to begin therapy. Of the 86 persons who came to at least one therapy session, 30% (26) dropped out before the third session, 28% (24) dropped out between the third and fifth sessions, and 42% (36) were retained for six or more sessions. Short-term and longer-term retentions were analyzed separately, using a battery including sociodemographic variables, treatment history, psychiatric symptomatology, number of arrests, and drug use variables. None of the variables considered was significantly related to short-term retention. There were large although not significant differences in longer term retention by therapist. Longer-term retention was associated significantly with being White (contrasted with being Black) and being young. Nonsignificant but large associations were found between longer-term retention and having few arrests, being Hispanic (contrasted with being Black), and having low SCL-90 scores. Results are compared with previous findings about retention in drug and alcohol treatment. It is suggested that future research on retention in treatment focus less on client variables and more on therapist and program variables.

Abstinence expectancy and abstinence among men undergoing inpatient treatment for alcoholism

Several personal and situational variables were examined as possible predictors of renewed drinking before completion of an inpatient alcoholism treatment program: either drinking surreptitiously while remaining in the program or leaving the program to return to alcohol. Male alcoholics were interviewed shortly after entering the program and again as they finished treatment. The first interview assessed predictor variables, the second interview assessed drinking during treatment. Treatment dropouts were pursued to determine their drinking status. Discriminant analyses revealed that renewed drinking was inversely related to subjects' reported expectancies of remaining abstinent during the next 6 months, positively related to employment instability, and also related to racial group. Analysis of premature termination of treatment as an alternative outcome variable suggested that these effects were specific to renewed drinking per se. Discussion centers on the potential relevance of expectancy-based theories of self-regulation to behavior during the period of treatment.

"Hello, may we help you?" A study of attrition prevention at the time of the first phone contact with substance-abusing clients

The problem of early attrition from treatment is pervasive throughout community mental health and is particularly high for substance-abusing clients. In spite of the severity of this problem and the potential for successful interventions, there have not been many studies that attempt to reduce the dropout rate of drug abusers. The purpose of this research was to test the effectiveness of attrition prevention procedures at the time of the client's first phone contact with the clinic. Callers were either given an appointment or told to come to the clinic the same day. A second variable was the presence or absence of an experimenter-initiated dialogue designed to help subjects predict possible obstacles to attendance and to generate potential solutions to those barriers. Subjects in the same day conditions showed at a higher rate than those given appointments, but the addition of the dialogue had no effect on client behavior. The results are discussed in terms of how mental health professionals can find cost effective interventions that prevent drug abuse treatment dropout.

Generalizing a predictor of male alcoholic treatment outcomes

A predictive index was developed using 34 intake variables from 416 alcoholic inpatient program participants at a Veterans Administration Medical Center (VAMC). Using drinking behavior as the outcome criteria, an R-squared value of 0.562 was achieved and 65% of the index-generating sample was correctly classified. The index was cross-validated on 61 inpatients at 4 months posttreatment. It achieved a point biserial correlation of 0.389 and correctly classified 66% of the sample. The index, unprecedentedly, was generalized to three other VAMCs and achieved an overall r of 0.393 and correctly classified 61% of the generalization subjects.

Personality, drug use, and early attrition from substance abuse treatment

This study examined the relationships among demographics, personality variables, drug use, and early attrition from substance abuse treatment. Attrition was considered at two time intervals; immediately (after one visit) and after 2 months. One hundred consecutive admissions to a community drug-abuse treatment center were given the MCMI and the SCL-90R following a standard intake interview. Subjects were classified according to their primary drug of abuse, yielding 16 opiate, 16 amphetamine, 34 cocaine, and 29 marijuana abusers. ANOVA's, ANCOVA's, and chi-squares were performed to compare characteristics of the different groups. Immediate Dropouts were less likely to be court mandated than Remainers, but were not different on any other demographic or drug use variable. Remainers had higher scores than Immediate Dropouts on 7 MCMI scales. A significant interaction between drug type, symptom severity, and early attrition was found for amphetamine abusers with high levels of subjective distress as measured by the SCL-90R. These clients dropped out earlier than amphetamine abusers without elevated SCL-90R scores. Analysis also indicated that Long-Term Remainers were less likely to be employed than Dropouts. All other comparisons between these groups failed to produce significant differences. This study confirms earlier research which found a high rate of early attrition from treatment with substance-abusing clients. Results also indicate that severity of psychopathology is not key in predicting attrition; it is more the nature of the disorder that influences client dropout. It is argued that continuation in community treatment is problematic for most substances abusers, and treatment facilities should routinely employ attrition prevention procedures.