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Abstract
BackgroundAddiction treatment faces high pretreatment and treatment dropout rates, especially among Aboriginals. In this study we examined characteristic differences between Aboriginal and non-Aboriginal clients accessing an inpatient medical withdrawal management program, and identified risk factors associated with the probabilities of pretreatment and treatment dropouts, respectively.Methods2231 unique clients (Aboriginal = 451; 20%) referred to Vancouver Detox over a two-year period were assessed. For both Aboriginal and non-Aboriginal groups, multivariate logistic regression analyses were conducted with pretreatment dropout and treatment dropout as dependent variables, respectively.ResultsAboriginal clients had higher pretreatment and treatment dropout rates compared to non-Aboriginal clients (41.0% vs. 32.7% and 25.9% vs. 20.0%, respectively). For Aboriginal people, no fixed address (NFA) was the only predictor of pretreatment dropout. For treatment dropout, significant predictors were: being female, having HCV infection, and being discharged on welfare check issue days or weekends. For non-Aboriginal clients, being male, NFA, alcohol as a preferred substance, and being on methadone maintenance treatment (MMT) at referral were associated with pretreatment dropout. Significant risk factors for treatment dropout were: being younger, having a preferred substance other than alcohol, having opiates as a preferred substance, and being discharged on weekends.ConclusionsOur results highlight the importance of social factors for the Aboriginal population compared to substance-specific factors for the non-Aboriginal population. These findings should help clinicians and decision-makers to recognize the importance of social supports especially housing and initiate appropriate services to improve treatment intake and subsequent retention, physical and mental health outcomes and the cost-effectiveness of treatment.
Highlights
Addiction treatment faces high pretreatment and treatment dropout rates, especially among Aboriginals
Previous studies on Vancouver have shown that Aboriginal people are overrepresented among injection drug users (IDUs) in Downtown Eastside (DTES), are becoming HIV positive at twice the rate of non-Aboriginal IDUs, have a six-fold higher incidence of acute hepatitis C infection (HCV) and are more likely to be co-infected with HIV and HCV compared to the non-Aboriginal population
Among 2231 unique clients who were referred by ACCESS1 to Vancouver Detox (VD) during the study period, 451 (20%) clients self identified as Aboriginal
Summary
Addiction treatment faces high pretreatment and treatment dropout rates, especially among Aboriginals. Aboriginal people are overrepresented among HIV and AIDS cases in Canada. Previous studies on Vancouver have shown that Aboriginal people are overrepresented among injection drug users (IDUs) in DTES, are becoming HIV positive at twice the rate of non-Aboriginal IDUs, have a six-fold higher incidence of acute hepatitis C infection (HCV) and are more likely to be co-infected with HIV and HCV compared to the non-Aboriginal population. They have higher rates of drug-induced deaths [5]
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