Drug use and treatment success among gang and non-gang members in El Salvador: a prospective cohort study

Knowlton W Johnson,Melissa H Abadi,Thom Browne,Matthew W Courser,Linda Young,Stephen R Shamblen

doi:10.1186/1747-597x-8-20

Abstract

BackgroundThis article focuses on examining drug abuse treatment (DAT) in El Salvador highlighting gang vs. non-gang membership differences in drug use and treatment outcomes.MethodsCross-sectional and prospective cohort designs were employed to examine the study aims. The 19 centers that met the study’s inclusion criteria of one year or less in planned treatment offered varying treatment services: individual, group, family, and vocational therapy, dual diagnosis treatment, psychological testing, 12-step program, and outreach and re-entry aftercare. Most directors describe their treatment approach as “spiritual.” Data were collected from 625 patients, directors, and staff from the 19 centers at baseline, of which 34 patients were former gang members. Seventy-two percent (72%) of the former patients (448) were re-interviewed six-months after leaving treatment and 48% were randomly tested for drug use.ResultsEighty-nine percent (89%) of the DAT patients at baseline were classified as heavy alcohol users and 40% were using illegal drugs, i.e., crack, marijuana, cocaine, tranquilizers, opiates, and amphetamines. There were large decreases after treatment in heavy alcohol and illegal drug use, crime, and gang related risk activities. Gang members reported illegal drug use, crime, and gang related risk activity more than non-gang members, yet only 5% of the study participants were gang members; further, positive change in treatment outcomes among gang members were the same or larger as compared to non-gang members.ConclusionsAlcohol use is the drug of choice among DAT patients in El Salvador with gang member patients having used illegal drugs more than non-gang members. The study shows that DAT centers successfully reduced the use of illegal drugs and alcohol among gang and non-gang members. Although our study could not include a control group, we believe that the DAT treatment centers in El Salvador contributed to producing this treatment success among former patients. These efforts should be continued and complemented by funding support from the Salvadoran government for DAT centers that obtain certification. In addition, tailored/alternative treatment modalities are needed for gang members in treatment for heavy drinking.

Highlights

This article focuses on examining drug abuse treatment (DAT) in El Salvador highlighting gang vs. non-gang membership differences in drug use and treatment outcomes
DAT centers in El Salvador have been successful in treating both gang and non-gang members. These outcome results show large, positive, statistically significant, changes in alcohol and drug use, crime, and gang risk activity for both gang and non-gang members. These results suggest that the gang members in El Salvador who enter DAT treatment benefit more from the existing combination of treatment strategies than non-gang members do as it pertains to criminal behavior, but not as it pertains to substance use
Since treatment success was measured by reductions in the prevalence of illegal drug use, frequency of heavy alcohol use, crime, and gang related risk activities was proven to be substantial, we believe that the DAT treatment centers in El Salvador contributed to producing this treatment success

Summary

Introduction

This article focuses on examining drug abuse treatment (DAT) in El Salvador highlighting gang vs. non-gang membership differences in drug use and treatment outcomes. Illicit drug use has increased dramatically in the past decade in the developing countries of Central America including El Salvador with a concomitant rise in substance use [1,2,3,4]. Like many middleand low-income countries, El Salvador has served as a staging point for illegal drugs like crack that are destined for the United States. El Salvador, a country of 7.2 million people which is bordered by Guatemala and Honduras, can be considered a developing nation that is struggling with very high unemployment rates, slow recovery from natural disasters such as a 1998 hurricane that ravaged parts of the country, a series of earthquakes in 2001 that killed over 1,000 people and destroyed over a quarter-million homes, and floods that left thousands homeless in 2009 (http://www.state.gov/r/pa/ei/bgn/2033.htm). Deterioration of democratic institutions in the 1970s led to armed conflict from 1980 to 1992, during which 75,000 are estimated to have died (http://www.state.gov/ r/pa/ei/bgn/2033.htm)

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