National Treatment Retention Findings from DATOS

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National National Treatment Treatment

Retention Findings Retention Findings from DATOSfrom DATOS

Charts Prepared & Released for Public Use by Charts Prepared & Released for Public Use by Dwayne Simpson (TCU), Robert Hubbard (NDRI-NC), Dwayne Simpson (TCU), Robert Hubbard (NDRI-NC),

Douglas Anglin (UCLA), & Bennett Fletcher (NIDA)Douglas Anglin (UCLA), & Bennett Fletcher (NIDA)

Drug Abuse Treatment Drug Abuse Treatment Outcome StudiesOutcome Studies(Funded by NIDA)(Funded by NIDA)

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DDrug rug AAbuse buse RReporting eporting PProgramrogramFirst National Evaluation of Treatment Effectiveness

Funded by the Funded by the National National

Institute on Institute on Drug AbuseDrug Abuse

Sells, Simpson, Demaree, & Joe Sells, Simpson, Demaree, & Joe 6 books & 150 papers published (funded 1970-19906 books & 150 papers published (funded 1970-1990))

1969-73

35 Cities

139 Programs

~44,000 Patients

All treatment types

Follow-ups: 1,3,6,12 Yrs

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53

64

52

29

53

33

43 42

30

0

20

40

60

80

100

Daily Opioid Use: Daily Opioid Use: % in Year 1 After Discharge% in Year 1 After Discharge

0Days

(IntakeOnly)

1-30Days inDetoxOnly

1-3 3+Mos in

TherapeuticCommunity*

1-3 3+Mos in

OutpatientDrug-Free*

1-3 3-12 12+Mos in

MethadoneMaintenance*

*p<.01

ComparisonGroups Same for criminality !

N=3,248; Simpson & Sells, 1982 (AASA)

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TTreatment reatment OOutcome utcome PProspective rospective SStudytudySecond National Evaluation of Treatment Effectiveness



Hubbard, Marsden, Rachal, Harwood, Cavanaugh, & Ginzburg, Hubbard, Marsden, Rachal, Harwood, Cavanaugh, & Ginzburg, Drug abuse treatment: A national study of effectivenessDrug abuse treatment: A national study of effectiveness (1989) (1989)

1979-81

10 Cities

37 Programs

~11,000 Patients

All treatment types

Follow-up: 1 year

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““Treatment Process” in Treatment Process” in TOPSTOPS

Comparisons between 21 MM programs

Programs with Longer Retention had -Better assessment & program planning

Higher MM dose & better UA monitoring

Comprehensive (“wrap-around”) services

Higher patient ratings for “meeting needs”

Similar findings for other modalitiesSimilar findings for other modalities

Joe, Simpson, & Hubbard, 1991 (J Sub Abuse)

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DDrug rug AAbuse buse TTreatment reatment OOutcome utcome SStudiestudiesThird National Evaluation of Treatment Effectiveness

Over Over 40 Studies Published40 Studies Published – – Psychology of Addictive BehaviorsPsychology of Addictive Behaviors (Dec 97) (Dec 97)Drug and Alcohol DependenceDrug and Alcohol Dependence (Dec 99) (Dec 99) Archives of General PsychiatryArchives of General Psychiatry (June 99) (June 99)



1991-93

11 Cities

96 Programs

~10,000 Patients

All treatment types

Follow-up: 1 & 5 Yrs

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Long-Term ResidentialLong-Term Residential (LTR)Treatment(LTR)Treatment

Changes from Before to After TreatmentChanges from Before to After Treatment

66

2217

6

40

19

41

16

88

77

24

13

0

20

40

60

80

100

Cocaine (Weekly)*

Heroin (Weekly)*

Heavy Alcohol*

Illegal Activity*

No FTWork*

SuicidalIdeation*

Pre Post

% of DATOS Sample (N=676)*p<.001

Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)

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Outpatient Drug-FreeOutpatient Drug-Free (ODF) (ODF) TreatmentTreatment


42

1825

9

31

1522

14

8276

19

11

0

20

40

60

80

100

Cocaine (Weekly)*

Marijuana (Weekly)*

Heavy Alcohol*

Illegal Activity*

No FTWork*

SuicidalIdeation*

Pre Post

% of DATOS Sample (N=764)*p<.001


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42

22

89

28

15 16

29

14

85 82

1713

0

20

40

60

80

100

Cocaine (Weekly)*

Heroin (Weekly)*

Heavy Alcohol

Illegal Activity*

No FTWork

SuicidalIdeation

Pre Post

% of DATOS Sample (N=727)

Outpatient Methadone TreatmentOutpatient Methadone Treatment (OMT)(OMT)


*p<.001


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Average Average ExpectedExpected vs vs ObservedObserved Length of Stay by Patients Length of Stay by Patients (in (in

months)months)

96

24

3 3

12

Long-TermResidential

(n=17)

Outpatient Drug-Free

(n=14)

OutpatientMethadone

(n=10)

Observed (Median)Expected (Median)

Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)

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Patient Retention Rates for Patient Retention Rates for ProgramsPrograms

(beyond minimum “thresholds”)(beyond minimum “thresholds”)

65%75% 76%

21% 16% 15%

3+ Mos inLong-TermResidential

(n=17)

3+ Mos in Outpatient Drug-Free

(n=14)

12+ Mos inOutpatient

Methadone (n=10)

BestProgram

PoorestProgram


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Program Retention Rates in Program Retention Rates in LTRLTR(for 90 days or longer)(for 90 days or longer)

21

3133

4043 43 43 44

50 50 50

56 56 5759

6165

% of Admissions to 17 LTR Programs (with 40+ patients)

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Program Retention Rates in Program Retention Rates in ODFODF(for 90 days or longer)(for 90 days or longer)

1619

31

40 4144

51

56 57 5861

6769

75

% of Admissions to 14 ODF Programs (with 40+ patients)

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Program Retention Rates in Program Retention Rates in OMTOMT(for 360 days or longer)(for 360 days or longer)

1520

4246 47 49

5255

63

76

% of Admissions to 10 OMT Programs (with 40+ patients)

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Example from LTR in DATOSExample from LTR in DATOSExample from LTR in DATOSExample from LTR in DATOS

Retention Predicts Retention Predicts OutcomesOutcomes

Findings Consistent from National Studies1970s (44,000 admissions in DARP)

1980s (11,000 admissions in TOPS)

1990s (10,000 admissions in DATOS)

Also in England’s NTORS !

Conclusions from Major ReviewsInstitute of Medicine (Gerstein & Harwood, ‘90)

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Comparison of Year 1 Comparison of Year 1 Outcomes Outcomes

by Length of Stay in by Length of Stay in LTRLTR

55

28

53

1915

9

54

24

0

20

40

60

80

100

Cocaine (Any Use)*

UA+ (Any Drug)*

Alcohol (Daily Use)*

Any Jail*

< 90 Days 90+ Days

% of Sample

*p<.001

N=342; Simpson, Joe, & Brown, 1997 (PAB)

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DATOS Programs with DATOS Programs with Lower Lower RetentionRetention had more “troubled” had more “troubled”

caseloads!caseloads!

Admissions to these programs had -

More cocaine & alcohol problems More previous treatments More psychological problems

But these patient problems did not explainall program differences in retention rates!


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Patient Problems in Patient Problems in LTRLTR Programs Programs

6782

9686 86

75

41

6

42 33 4429

Highest %

Lowest %

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Selected Studies

1-Year Outcomes

Treatment Services

& Process

CocaineTreatment

SelectedWeb Posters

AdolescentStudies

Cost Benefits ofMM Treatment

Readinessfor Treatment

News and FeaturesHome Page

About DATOS

Background

Highlights

Special Topics

Publications

Web Posters

What’s New

CONTENT

Cocaine Treatment Outcome Study is Released(in June 1999 issue of Archives of General Psychiatry)Findings emphasize the need for "adequate treatment stays," especially when problem severity is moderate-to-high. At least 90 days in intensive residential (TC) programs was indicated for high-severity cases. More information is provided in a new section of Highlights page, "Outcomes for Treatment of Cocaine Dependence.”

Latest DATOS studies have been published in Drug and Alcohol DependenceTreatment process (engagement and participation), retention, and outcomes are the focus of this series of studies, and our first cost-benefit analysis addresses cocaine treatment. The latest DATOS publications and "in press" are listed on the Publications page.

www.datos.orgwww.datos.org

National Treatment Retention Findings from DATOS

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