Treatment Research Volume 12, Number 5 September/October 1997 |
The four most common forms of drug abuse treatment are all effective in reducing drug use. That is the major finding from a NIDA-sponsored nationwide study of drug abuse treatment outcomes. The Drug Abuse Treatment Outcome Study (DATOS) tracked 10,010 drug abusers in nearly 100 treatment programs in 11 cities who entered treatment be-tween 1991 and 1993.
"DATOS is the largest study of drug abuse treatment outcomes since the early 1980s and the most important in the last 10 years in terms of telling us how treatment programs are doing", says Dr. Bennett Fletcher, chief of NIDA's Services Research Branch.
DATOS investigators measured treatment outcomes using a random sample of approximately 3,000 patients. The researchers compared patients weekly and daily drug use for the 12 months before they entered treatment with their weekly and daily drug use 12 months after they stopped treatment. Patients in outpatient methadone treatment who were still in treatment were interviewed approximately 24 months after admission. Other outcomes that the researchers measured included:
The four types of programswith the number of programs that DATOS studied in parentheseswere outpatient methadone (29), outpatient drug-free (32), long-term residential (21), and short-term inpatient (14). (For descriptions of the program types, see "Four Common Types of Drug Abuse Treatment") Three of the four types were also studied in DATOS's two predecessors: the Drug Abuse Reporting Program (DARP), which included admissions to treatment from 1969 to 1973, and the Treatment Outcome Prospective Study (TOPS), which covered admissions from 1979 to 1981. The short-term inpatient treatment programs, originally developed to treat alcohol abuse but admitting increasing numbers of cocaine abusers during the 1990s, were studied in DATOS but not in the two earlier projects.
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* Outpatient methadone patients still in treatment were interviewed approximately 24 months after admission. In all four types of treatment programs that the Drug Abuse Treatment Outcome Study examined, the percentage of patients reporting frequent use of cocaine dropped dramatically after treatment. |
Highlights From the Study
For the four treatment types, DATOS investigators found reductions almost without exception in the use of all drugsincluding cocaine, heroin, and marijuanaafter treatment. (See "Percentage of Patients Reporting Weekly or More Frequent Substance Use Before and After Treatment") Likewise, after treatment a smaller percentage of patients reported committing illegal acts, working less than full time, and thinking about or attempting suicide. (See "Percentage of Patients Reporting These Behaviors Before and After Treatment"). The data also revealed that:
The Drug Abuse Treatment Outcome Study found reductions in the use of all drugs including cocaine, heroin, and marijuana after treatment. |
New Demographics
Demographic characteristics of patients studied in DATOS had changed since the earlier study. For example, DATOS patients were older and had more years of schooling than TOPS patients, and a greater percentage of them were women.
In DATOS, 39 percent of patients admitted to outpatient methadone programs were women compared to approximately 31 percent in TOPS. Women made up approximately 33 percent of the patients admitted to long-term residential programs, as opposed to 22 percent for TOPS. Outpatient drug-free programs saw little change from TOPS to DATOS, with women accounting for approximately 33 percent of patients in these programs in both studies. In DATOS, about 37 percent of patients admitted to short-term inpatient programs, which were not included in TOPS, were women. The researchers are conducting additional analyses to further explore the characteristics and outcomes for women in DATOS.
Four Common Types of Drug Abuse TreatmentInvestigators with the Drug Abuse Treatment Outcome Study (DATOS) studied patients in the four most common kinds of treatment programs:
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Substance Abuse and Psychological Disorders
DATOS researchers looked at co-occurring psychological disorders and dependencies in 7,402 patients in the DATOS programs who were diagnosed as substance dependent. They found that 32.1 percent of those patients were dependent on cocaine alone. Of that 32.1 percent, 59.1 percent were male. Another 26.3 percent of the patients were dependent on both cocaine and alcohol, and, of those, 69.8 percent were male. In addition, 10.6 percent of the patients were dependent on heroin alone, and 64.2 percent of those were male.
The prevalence of co-occurring psychological disorders among the group was high, especially for antisocial personality disorder (APD) and major depression. APD was characterized as a pattern of disregard for the rights of others, irresponsibility, and lack of remorse. Major depression was characterized as either a depressed mood or a loss of interest or pleasure for 2 weeks or more.
When the researchers looked at retention rates, they found big differences within each of the four treatment types and among individual programs. |
The prevalence of those two disorders differed widely among men and women. Approximately 40 percent of the group was diagnosed with APD, and males were twice as likely as females to be diagnosed with the disorder. While 12 percent of the group had experienced a major depression, female patients were twice as likely as male patients to have done so.
Keeping Patients in Treatment
When the researchers looked at retention rates, they found big differences within each of the four treatment types and among individual programs. "We found a lot of diversity in how well they're doing at keeping patients in treatment, and we wanted to know why," says Dr. Dwayne Simpson of Texas Christian University in Fort Worth.
The investigators found that programs with low retention rates tended to have patients with the most problems, particularly antisocial personality disorder, cocaine addiction, or alcohol dependence. In addition, heroin abusers who also abused crack cocaine but not powder cocaine had significantly lower retention rates than other heroin abusers did. "These programs are dealing with some tough people. Programs with the highest concentration of these problem patients naturally tend to have low retention," Dr. Simpson says.
What makes patients stay in treatment? The researchers found that the major predictors were:
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Lessons From DATOS
What were the overall conclusions? "Clearly there were significant changes from before to after treatment in each of the four modalities," says Dr. Fletcher. That finding raises some interesting questions, he adds. "For example, retention has been our most powerful and consistent predictor of treatment outcomes - yet even people in short-term inpatient treatment for 30 days or less improved significantly." Although DATOS replicated the finding from DARP and TOPS that time in treatment is important, the relationship to retention of other factors such as motivation, psychiatric comorbidity, and treatment process needs to be studied more, he says.
One would also expect worse outcomes from DATOS compared to TOPS because of the steady decline in availability of support services, says Dr. Fletcher. A possible explanation for the better DATOS outcomes is that although support services have decreased, core treatment services have improved. "Core services - basic treatment techniques such as drug abuse counseling, mutual-help groups, and patient participation in devising treatment plansmay have improved over the past 10 years. What we're seeing may be a result of this improvement, even though availability and use of noncore support services have declined," Dr. Fletcher says.
The study's encouraging results verify the effectiveness of drug abuse treatment no matter what its form, says NIDA Director Dr. Alan I. Leshner. "The service system has changed dramatically over the last two decades. This study gives us a unique opportunity to understand the effect of those changes and to have an impact on the way treatment is delivered," Dr. Leshner says.
Sources
Etheridge, R.M.; Hubbard, R.L.; Anderson, J.; Craddock, S.G.; and Flynn, P.M. Treatment structure and program services in DATOS. Psychology of Addictive Behavior, in press.
Flynn P.M.; Craddock, S.G.; Luckey, J.W.; Hubbard, R.L.; and Dunteman, G.H. Comorbidity of antisocial personality and mood disorders among psychoactive substance-dependent treatment clients. Journal of Personality Disorders 10(1):56-67, 1996.
Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; Anderson, J.; and Etheridge, R.M. Overview of one-year follow-up outcomes in DATOS. Psychology of Addictive Behavior, in press.
Simpson, D.D.; Joe, G.W.; Broome, K.M.; Hiller, M.L.; Knight, K.; and Rowan-Szal, G.A. Program diversity and treatment retention rates in DATOS. Psychology of Addictive Behavior, in press.
NIDA NOTES - September/October 1997 |