Assessing outpatient drug abuse treatment programs

Abstract

Drug abuse is a major domestic health problem in the United States, and evaluators, policy makers, interest groups, and the general public are critically interested in knowing which treatments work best. Costs of drug abuse in America are conservatively estimated at 47 billion dollars per year (Harwood, 1984). It is estimated that over 27 million persons in households in the United States, or about one in every ten Americans, used illicit drugs in 1990 (National Institute on Drug Abuse, 1991). The Drug Abuse Reporting Program (DARP) and the Treatment Outcome Prospective Study (TOPS) represent two major drug abuse treatment outcome studies. The DARP study tracked over 44,000 drug users admitted to 52 drug abuse treatment programs during 1969-1973. DARP found that demographic and socioeconomic characteristics explained only a small amount of outcome variance (Sells and Simpson, 1980). Better predictors of treatment outcome were the length of time in treatment and the behavior during treatment (Simpson et al., 1982). TOPS included 11,750 drug users admitted to 41 drug abuse programs during 1979-l 98 1. A finding from this study was that drug abuse treatment reduced illicit drug use and criminal behavior (Hubbard et al., 1989). As in DARP, time in treatment was positively related to drug abuse treatment outcome. While the DARP and TOPS studies established the effectiveness of drug abuse treatment, many issues remain to be clarified. For example, more work is needed in efforts to match clients to treatment. The study of treatment process has remained tantalizingly difficult and little is known about the role that treatment structure and organization play in treatment outcome (Tims and Ludford, 1984). The purpose of this paper is to report data about outpatient treatment unit followup evaluations drawn from selected evaluation items in the recent National Drug Abuse Treatment Survey. A section of questions related to treatment evaluation activities was included in this national survey of drug abuse treatment programs. These