One-day dropouts from correctional drug treatment

The effect of anxiety and depression on completion/withdrawal status in patients admitted to substance abuse detoxification program

A large proportion of patients entering substance abuse treatment carry psychiatric diagnoses, and some studies have found that those with psychopathology are more likely to withdraw before treatment is completed. We performed a prospective study of patients entering an inpatient substance abuse detoxification program to determine if the degree of anxiety and/or depression correlated with higher dropout rates. On entry to the unit, all patients were administered the Hamilton Rating Scales for Depression and Anxiety. Of the 148 patients studied, 97 (65.5%) completed treatment and 51 (34.5%) withdrew prematurely. There were no significant differences in Hamilton Depression and Anxiety Rating Scale scores between completers and withdrawers. This was true for the total study population, as well as for subgroups of patients based on primary drug abused (heroin or cocaine). Although anxiety and depression are common in substance abusers, we were unable to detect differences on validated anxiety and depression rating scales between those completing and those withdrawing from substance abuse detoxification.

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.

"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.

Moral reconation therapy: a systematic step-by-step treatment system for treatment resistant clients

Moral Reconation Therapy is a systematic treatment strategy designed to enhance ego, social, moral, and positive behavioral growth in a progressive, step-by-step fashion. It is based upon the assumption that fully functioning, reasonably content, happy persons have a strong sense of identity and that their behavior and relationships are based upon relatively high moral judgment levels. The therapist strives to reeducate clients socially, morally, and behaviorally and to instill appropriate goals, motivation, and values. Moral Reconation Therapy has slowly evolved in response to the unique needs of particular client populations who are considered resistant to treatment. The therapy is an adaptable and utilitarian treatment system. This article is a review of the treatment system and relevant personality theory, and a description of how the system is applied to drug abusers and clients with antisocial personalities. In addition, the article presents preliminary research on the system.

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.