Drug Treatment Clients Research Articles

Comparisons of self-report data and oral fluid testing in detecting drug use amongst new treatment clients

Drug testing is widely used and employed in diverse contexts, including drug treatment clinics. Building on previous research, this paper aims to (i) compare self-report data and oral fluid (OMT) testing in detecting drug use amongst individuals beginning a new episode of drug treatment and (ii) identify factors that may predict drug users who have discordant self-report and OMT test results. Two hundred and seventy-one new drug treatment clients completed a structured questionnaire that included questions relating to drug use during the preceding 3 days and provided an oral fluid sample that was independently tested for opiates, benzodiazepines, methadone and cannabis. Data were analysed using kappa statistics (Cohen, 1960) and univariate and multivariate logistic regression. Findings indicated a high level of consistency between self-reported drug use and OMT testing. However, agreement varied by drug type and respondents commonly reported consumption that screening failed to identify. Inconsistencies appeared to relate to a number of factors and were not necessarily a function of deliberate distortion by the drug user. Overall, it is concluded that OMT testing is a good indicator of the validity and reliability of drug users’ self-report data. Nonetheless, its accuracy might be greater for some drug categories than for others. Equally, further study comparing test results and self-reported drug use amongst different populations and in different contexts is required.

EFFECTIVENESS OF DRUG TREATMENT COURTS: EVIDENCE FROM A RANDOMIZED TRIAL*

Research Summary: Study randomly assigned 235 offenders to drug treatment court (DTC) or “treatment as usual.” Analyses of official records collected over a two‐year follow‐up period show that DTC is reducing crime in a population of drug‐addicted offenders. DTC subjects who participated in treatment were significantly less likely to recidivate than were both untreated drug court subjects and control subjects.Policy Implications: Continued enthusiasm for DTCs is warranted. Both sanctions and treatment are important elements of the DTC model. However, DTCs will not necessarily result in cost reductions because DTC and control cases are incarcerated for approximately equal numbers of days. Implementation fidelity is important, and DTCs can be strengthened if they engage a higher percentage of their clients in drug treatment.

Substance Use, Mental Disorders, Abuse, and Crime: Gender Comparisons Among a National Sample of Adolescent Drug Treatment Clients

ABSTRACT This paper describes important gender comparisons in drug and alcohol use, illegal activity, physical and sexual abuse, and mental health problems among a large sample of adolescents (N = 3,382) who were treated from 1993 to 1995 in adolescent-oriented drug programs that participated in the Drug Abuse Treatment Outcome Study of Adolescents. Most of the adolescents reported regular use of marijuana and alcohol; males had higher rates of illegal activity and involvement with the juvenile justice system; females reported more sexual abuse, while males reported more physical abuse; and males and females had equal rates of conduct disorder and attention deficit hyperactivity disorder.

Exploring the nature of the relationship between child sexual abuse and substance use among women.

This study investigated whether child abuse (CSA) was associated with earlier substance use and greater severity of substance dependence and what aspects of CSA might predict substance abuse. The study compared (a) drug and alcohol treatment clients with and without a history of CSA and (b) CSA survivors outside drug and alcohol treatment who did or did not have current substance abuse. Semi-structured interviews took place at participants' homes, treatment agencies or the research centre. Volunteer participants included 100 women recruited from drug and alcohol treatment programmes and 80 CSA survivors recruited through CSA counseling services and medial advertising. The results focus on data from the Opiate Treatment Index, Severity of Alcohol Dependence Questionnaire, Substance Dependence Scale, Self-Esteem Inventory and self-reported histories of CSA. There were no differences between CSA survivors and other drug and alcohol treatment clients in their severity of dependence. Women with a history of CSA more frequently identified stimulants as their main problem drug and reported an earlier age of first intoxication and earlier use of inhalants. Among abused CSA survivors outside drug and alcohol treatment, women with current substance abuse had typically been abused during adolescence by someone outside the family, whereas those without current substance abuse were typically abused by family members before adolescence. The results suggest that adolescence is a crucial time for the influence of CSA experiences on substance abuse.

Crack Mothers at 6

This study examines ABC, CBS, and NBC evening news programs from 1983 to 1994 to understand the images associated with crack mothers (i.e., women who used crack or cocaine during pregnancy). Qualitative analysis shows that over time, news framed maternal crack/cocaine use in at least three ways. First, White middle-class women were presented as psychologically addicted, as guilt-ridden for having exposed their babies to cocaine, and as motivated to succeed in treatment. Second, Black poor women were represented as mindlessly addicted, as knowingly having exposed their fetuses to the adversity of crack, and as unwilling to enter treatment. Third, Black poor women were subsequently represented as physically and spiritually depleted, as having regretted prior drug use, and as enthusiastic drug treatment clients, if only to regain custody of their children. Findings are discussed in terms of drugs scares, racial disparity, and the reproductive rights of women.

Methamphetamine Abuse in California: Correlates of Injection Use

Methamphetamine use has recently increased to epidemic proportions in California. In fiscal year 1995, almost 20,000 drug treatment clients reported methamphetamine as primary drug. Of these clients, about one in five reported injection as primary route of administration. This paper identifies correlates of injection among methamphetamine users in order to assist in targeting HIV prevention efforts. Clients reporting methamphetamine as primary drug were selected from the California Alcohol and Drug Data System for analysis. Descriptive statistics were compiled and a logistic regression was conducted to identify correlates of injection use. Latino and African-American methamphetamine users were less likely than White methamphetamine users to report injection as primary route of administration; males were more likely than females. Clients were more likely to report injection use with increasing age. Current heroin use and residence in an urban area were also related to injection status. In conclusion, California is home to a large number of methamphetamine users, a significant portion of whom inject. Data on this population are limited; needle sharing, cleaning of injection equipment, and sexual risk behaviors among this population should be closely studied. Treatment programs targeting methamphetamine users should include comprehensive HIV prevention components.

Child sexual abuse as a predictor of psychiatric co-morbidity and its implications for drug and alcohol treatment

A study of 180 women in and outside drug and alcohol treatment showed that CSA survivors had higher overall levels of psychological distress, compared with drug and alcohol treatment clients who had not experienced CSA. They reported elevated levels of anxiety, somatisation and dissociation but not depression. Higher rates of self-harm, eating disorders and sexual dysfunction were also reported by CSA survivors. Women with a history of both CSA and substance abuse were more likely to have attempted suicide than other women. The results highlight the need for improved liaison between substance abuse treatment programs and other health services.

Profiles of criminal-justice clients in drug treatment: Implications for intervention

Psychosocial differences between criminal-justice-referred and voluntary clients, using a sample of 996 men and women in residential drug treatment in northern New Jersey, were explored. Results suggest differences in demographic characteristics between the two groups as well as differences in attitudes and behaviors likely to impact on treatment outcome. Demographically, criminal-justice clients are younger, more likely to be male, and less likely to be Black than other clients. They also report better health status and better social and psychological adjustment, reporting less homelessness, fewer health problems, lower levels of psychological distress, better family adjustment, and fewer medical, social, and drug problems requiring intervention. Implications for treatment are discussed.

Characteristics and Pretreatment Behaviors of Clients Entering Drug Abuse Treatment: 1969 to 1993

This study summarizes historical changes among clients entering drug treatment in their sociodemographic characteristics and important pretreatment behaviors, such as work activity, criminal behavior, drug use, prior drug treatment, and health insurance. Data are drawn from three major studies of drug abuse treatment clients: the Drug Abuse Reporting Program (DARP), 1969–1972; the Treatment Outcome Prospective Study (TOPS), 1979–1981; and the Drug Abuse Treatment Outcome Study (DATOS), 1991–1993. The mix of drug treatment clients and their interaction with the drug treatment system changed substantially over the past three decades. Because data items are most directly comparable between TOPS and DATOS, the focus of this paper is on changes within the past decade. The most conspicuous change is in types and numbers of drugs used by clients entering treatment. Multiple drug use declined since the late 1970s, while reports of cocaine use since TOPS more than doubled among clients in the long-term residential and outpatient treatment modalities, and increased 1 1/2 times among methadone clients. Other differences in treatment populations include decreases in clients' working full-time and in reports of suicidal ideation and attempts and predatory crime. Data from such studies as DARP, TOPS, and DATOS are valuable in historical, contextual, policy, and evaluative frameworks. The changing nature of the drug treatment client population—from sociodemographics to drug use and multiple treatment problem severities—highlights the complexity of issues and difficulties encountered by those attempting to treat clients or plan treatment strategies.

The trajectory of client progress. A longitudinal pilot study.

Successful nonchemical drug treatment is a transformative experience: client change is the goal of treatment. Two domains in which programs intend to facilitate change are emotional well-being and the therapeutic relationship. Little previous research has addressed the question of what changes clients in drug treatment actually undergo while in treatment. This article presents results from a pilot longitudinal study of clients in two short-term drug treatment programs in Houston, TX. Results showed measurable increases in self-esteem and connection to counselor and decreases in anxiety and depression over the course of treatment for clients who completed treatment. Program graduates and early withdrawals showed distinctly different patterns of progress as measured by emotional and relationship scales.

Modifying the process of treatment to meet the threat of AIDS.

Treatment for drug users is unlikely to receive sufficient resources to expand to the level of treatment need. Moreover, there is indication that a substantial minority of injection drug users have never initiated needed treatment in spite of long histories of injecting drugs. Given the potential for that population to contract and spread AIDS, it is important that we explore street-based treatment alternatives derived from findings regarding the efficacy of outreach/intervention programs. Those programs were found both to reduce drug-taking behaviors of injecting drug users and to prepare those users for clienthood. Additional strategies that need to be explored include: aftercare, behavioral counseling for sex partners of drug treatment clients, and partial (i.e., survival) treatment services for clients who cannot be accommodated within existing treatment capacity.

Barriers to Family Planning Services Among Patients in Drug Treatment Programs

In July 1989, family planning services were integrated into 13 drug treatment programs in Philadelphia. To obtain information on the family planning needs of women in drug treatment programs, baseline interviews were conducted with 599 women. Three-quarters of these women had had a sexually transmitted disease, and although they were in a drug treatment program, 41 percent had injected drugs in the previous month. In addition, 62 percent of the women who were sexually active in the previous month had not used a contraceptive. Twelve months into the program, seven focus groups were conducted with 65 women and men to learn more about their opinions and attitudes related to contraceptives and family planning services in general. The discussions revealed that many of the participants were unsure what family planning services included, saw no need for such services or had had prior negative experiences with health care providers. There was also a great deal of misinformation about contraceptives and the effects they have on health.

Vocational Functioning of Clients in Drug Treatment: Exploring Some Myths and Realities

This paper provides results of secondary analyses of a national study of clients in drug treatment, in which client expressed need and reported receipt of vocational/educational (V/E) services are compared in relation to important SES indicators. It then describes the vocational and educational functioning of clients in four methadone maintenance treatment programs, taking into account various “competing factors” (such as health problems) common to this client population. The paper presents a method for categorizing client V/E status which is then discussed in terms of targeting, as well as integrating VIE services with other treatment planning concerns.

Obstacles to Vocational Rehabilitation: The Clients' Perspectives

The research literature indicates that vocational rehabilitation services are underutilized in many drug treatment programs. This study explored the perceptions of drug treatmentclients concerning use of vocational/educational (V/E) services. Clients from four methadone maintenance treatment clinics were Interviewed regarding: (a) types of VIE services received and desired by clients, (b) perceived obstacles to the use of clinic V/E services, and (c) client/clinic characteristics that may affect service utilization. Although Individuals generally reported receiving vocational counseling, many desired more job placement, vocational training, or educational assistance. Vocational counseling was seldom cited as a desired service; however, results indicated a need for such counseling with certain clients. Client- and clinic-level obstacles to service utilization are reported and ways to enhance service delivery are discussed.

Dissemination of a Job Seekers' Workshop to drug treatment programs

To compare the effectiveness of techniques for disseminating an innovative job skills training program, 172 drug treatment programs in six USA states were randomly assigned to receive either printed materials only, printed materials plus on-site technical assistance, printed materials plus traininjg at a conference, or no intervention. The treatment disseminated was the Job Seekers' Workshop, a skill training program designed to help drug treatment clients obtain employment. Adoption of the workshop was assessed at three-month follow-up. At three months, adoption rates were: site visit, 28%; conference, 19%; printed material, 4%; and control, 0%. Dissemination methods that employed personal contact (site visits and conferences) produced significantly more adoption than did printed materials alone. Residential treatment programs were more likely to adopt the workshop than were outpatient drug-free or methadone maintenance programs.

Obstacles to the utilization of vocational services: an analysis of the literature.

While employment has been linked to positive clinical outcomes with drug abusers, research suggests that many treatment programs do not emphasize vocational services and under-utilize vocational resources. This article summarizes potential client-, program-, and societal-level obstacles to vocational rehabilitation service delivery identified in past studies with both substance abusers and other related client groups. Obstacles identified for related groups are integrated with issues relevant to drug treatment clients. This analysis is based on literature published over the last 20 years.

Patterns of alcohol and drug abuse in drug treatment clients from different ethnic backgrounds.

In this paper we have sought to identify differences in alcohol consumption patterns and problems among young adult males from white, black, and Hispanic ethnic groups entering drug treatment programs. In overall consumption patterns we found results similar to those obtained in general population studies. However, about one-third of the clients in all ethnic groups could be classified as heavier drinkers (drinking at least once a week and 4 or more drinks per drinking occasion) in the period immediately prior to treatment. About one-fourth of the clients in each ethnic group consumed a daily average of 2.5 ounces of absolute alcohol. Compared with the other ethnic groups, blacks were the most likely to be abstainers and reported regular alcohol use and drunkenness at later ages. Regardless of the pattern of development, similar proportions of the clients in all ethnic groups reported heavier drinking levels by age 21-30. Consistent with the current hypotheses in the literature, whites reported much higher levels of alcohol-related problems and prior treatment. Despite having similar levels of drinking, black and Hispanic ethnic groups did not appear to recognize alcohol as a problem or to report alcohol-related problems to the extent that whites did. Examination of drug-use patterns showed great variation in the nature and extent of drug use among the three ethnic groups. Whites were distributed among the seven patterns of use. Heroin use with cocaine, marijuana, and alcohol was the predominant pattern for blacks and Hispanics. Although the patterns of drug use differed greatly, these patterns were not differentially related to alcohol consumption or alcohol-related problems within ethnic groups. On the contrary, the drug-use patterns appeared to be a stronger predictor than ethnicity of use and problems. Multiple-nonnarcotic-users reported the highest levels of alcohol consumption and the greatest numbers of alcohol-related problems. This group typically reported the highest number of alcohol-related problems. Expression of a current need for treatment and a history of prior alcohol treatment were highest for black multiple-nonnarcotic-users. Our examination of the influences of family and friends was based on a limited number of questions available in the data. Heavier drinking was reported by clients who lived with friends, had family or friends who drank regularly, or had extensive involvement in the drug-use network, including drug sales. No ethnic differences were found.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent and adult drug treatment clients: patterns and consequences of use.

†This research was supported in part by grants from the State of Illinois Bureau of Title XX Administration (D-OOD-818-805) and from the Dr. Scholl Foundation.

Drug counselors' perceptions of clients: Demographic, personality and psychopathology correlates

Counselors' interpersonal perceptions of their clients in outpatient drug treatment were studied. Factor analysis produced three general factors, interpreted as perceptions of manageability, treatment readiness, and suitability for group treatment. Counselor perception of client interpersonal attractiveness did not emerge as a separate factor, but appeared equally significantly related to each of the first two factors. Correlates of counselor perceptions were sought among measures of client program performance, demographic and drug use history, psychopathology, and counselor background and personality. With one exception, measures of clients' actual program performance were the best predictors of counselors' perceptions of clients. Clinical implications are discussed.

Attitudinal differences affecting participation in group counseling in outpatient drug treatment centers.

Despite the fact that group counseling is emphasized in most drug treatment programs, client resistance to participation in groups is a common problem. Attitudinal differences between inner-city drug treatment clients and a graduate student sample were investigated as a possible factor contributing to resistance. Drug treatment clients were found to have less experience with counseling and therapy, and less understanding of the nature and purpose of the process.