Dropout Of Treatment Research Articles

The impact of borderline personality disorder on residential substance abuse treatment dropout among men

BackgroundResearch is increasingly focusing on identifying factors distinguishing patients who complete vs. dropout of residential substance abuse treatment. One potentially relevant factor that has received relatively little attention is borderline personality disorder (BPD). MethodsThis study sought to examine the effect of BPD on residential substance abuse treatment dropout within a sample of 159 male patients with substance use disorders—a population often understudied with regard to BPD and at high-risk for treatment dropout. Patients were administered a structured diagnostic interview to establish BPD diagnoses. Patients were then followed throughout the course of residential substance abuse treatment to identify those who completed treatment and those who prematurely dropped out of treatment. ResultsPatients with BPD were significantly more likely to prematurely dropout of treatment, and this finding remained even when taking into account relevant covariates (i.e., court-ordered treatment status, contract duration, and major depressive disorder). Further, patients with BPD were more likely to experience center-initiated dropout as opposed to voluntary withdrawal from treatment. ConclusionsThese findings add to the literature on BPD–SUD co-occurrence, suggesting that the presence of co-occurring BPD among male SUD patients may increase the risk for dropout from residential substance abuse treatment, necessitating targeted interventions focused on decreasing dropout within this patient subgroup.

Unrecognised dual diagnosis – a risk factor for dropout of addiction treatment

Background: While many studies have examined the prevalence of concurrent substance misuse and mental health problems across different treatment populations, we know little as to what extent such co-morbidity is identified in routine clinical practice. However, literature in the field has emphasised the importance of recognising co-morbidity early to avoid adverse treatment outcomes. Aims: To determine: (1) the degree to which co-morbidity is recognised and addressed in outpatient addiction services; and (2) whether unaddressed co-morbidity increases the risk of dropout. Method: Clients (n = 176) starting treatment at six UK-based drug and/or alcohol services and their 46 practitioners were followed for 3 months. Multiple assessments were carried out in order to obtain information about clients' mental health, 90-day retention rates, treatment perceptions and practitioners' expertise and training levels in the co-morbidity field. Services' assessment protocols and in-treatment case notes for each client w...

Les ruptures de prise en charge chez des patients d’un centre de soin de réadaptation psychiatrique et leurs liens avec les capacités relationnelles, les relations d’objets intériorisées et l’intensité des troubles

Between 30 and 60% of patients drop-out of institutional psychiatric treatment. There are few studies on this issue and these have not provided a clear understanding of this fact. Although it is a different therapeutic setting, there are many studies on patients' dropout in psychotherapy: the influence of many patient sociodemographic variables such as gender, age, diagnostic, were studied without providing strong and regular links with early dropout. Other, more relational variables (such as object relation and interpersonal functioning), gave stronger results although insufficiently confirmed by different studies. A third kind of variable involves the concrete relationship between patient and therapist (therapeutic alliance, patient's expectations) and provided interesting results (but not easy to use in institutional treatment). The aim of this study is to provide data to understand patients' institutional dropout in a French psychiatric centre. The latter's aim is psychosocial rehabilitation for schizophrenic and borderline patients. Thirty percent of these dropout during psychosocial treatment. According to the specificities and aims of this psychiatric centre, we hypothesize that there are strong links between relational dimensions (objet relation, interpersonal functioning), subjective evaluation of pathology intensity, and early dropout. Thirty-one subjects; 65% schizophrenic, 23% borderline, 13% other (according to the ICD10 criteria); 71% females; mean age 34 years (min=23; max=55); mean education level=3.4 (2 years of high school university). to have dropped out before 6 months' of the treatment, or continuing the treatment after 6 months (mean of treatment for all patients=15 months). patients present in the service for less than 6 months). At the beginning of the treatment, each patient (informed consent provided) underwent a psychological assessment with: Échelle d'aptitude psychosociale (EAPS) for assessing interactional functioning; SCL90-R for assessing the intensity of psychopathology; TAT (with Social Cognition and Object Relation Scale [SCORS] scales) and Rorschach (with Mutuality Of Autonomy [MOA] scale) for assessing object relations. After 6 months of treatment, each patient was evaluated with a five-point scale (dropout and continuity scale), which assessed the investment in the treatment (criteria: dropout at 3 or 6 months or continuity; according or not to the centre's professionals; level of assiduity). We have correlated this variable with EAPS, SCORS and MOA. In addition, we have calculated statistical relationships between age, gender, diagnostic, education level and early dropout. Correlation was found neither between interactional functioning (EAPS) and dropout nor between object relations (SCORS and MOA) and dropout. Correlations were found between the dropout and intensity of the psychopathology (SCL90-R): the more the patient sees himself suffering, the more he invests the centre and the less he drops out (Spearman R=0.37, P<0.05). No differences were found between the dropout (N=10) and continuity group (N=21) regarding age, gender and diagnostic. However, a correlation was found regarding the education level: the more patients are educated, the more they continue the treatment (R=0.45; P<0.05). The dropout (and the continuity of treatment) seems more likely related to concrete variables such as psychological and relational suffering, educational level in this study, than structural psychological variables such as object relation, relational skills, and diagnostic. Other studies are necessary for a better understanding of these drops out. An interesting way should be the study in institution of the therapeutic alliance.

Comparative Study of Oral Azathioprine and Intravenous Cyclophosphamide Pulses in the Treatment of Idiopathic Pulmonary Fibrosis

Introduction The purpose of the study was to establish the efficacy of treatment with intravenous cyclophosphamide pulses and oral corticoids in idiopathic pulmonary fibrosis, compared with the standard treatment with corticoids and azathioprine. Patients and methods A prospective, non-controlled study with 2 parallel groups. One group received prednisone plus oral azathioprine for 24 months (AZA group). The second one (CIC group) received prednisone plus intravenous cyclophosphamide pulses (6 monthly and 6 three-monthly). The primary outcome was survival or period without need for a transplant at 36 months. The secondary outcomes were the forced vital capacity, the carbon monoxide diffusing capacity, and baseline arterial oxygen pressure at 3, 6, 12, 18, 24, 30, and 36 months. Results A total of 46 patients were included in the study, of whom 25 were assigned to the AZA group and 21 to the CIC group. The survival or absence of lung transplant at 36 months was 44% in the AZA group and 76% in the CIC group (p = 0.028). The forced vital capacity was worse in 8.8% of the AZA group, compared to 6.7% in the CIC group (p = 0.16). The carbon monoxide diffusing capacity worsened in 11.81% of patients of the AZA group and in 4.4% of those in the CIC group (p =0.0569). No significant differences were observed in the arterial oxygen pressure. There was one dropout of treatment with prednisone. Conclusions Treatment with intravenous cyclophosphamide pulses produced a significant improvement in survival. There were no significant differences in the lung function parameters or gas exchange. Neither of the cytostatics had serious side effects.

Diagnoses and Dropout Among Patients of Danish Psychiatrists in Private Practice

This study examined diagnoses of patients treated by psychiatrists in private practice in Denmark and identified predictors of dropout. Between 1996 and 2006, a total of 37 psychiatrists contributed data about treatment episodes to a quality assurance database. The diagnostic distribution was determined, and univariate and backward stepwise regression analysis was used to identify dropout predictors. Among 41,462 episodes (35,205 patients), 39%-41% were for an ICD-10 diagnosis of affective disorders, 30%-35% for nervous and stress-related disorders, and 10% for personality disorders. For episodes involving these diagnoses, 26,443 were terminated; 26.2% ended in dropout, which was predicted by the patient's being male, younger age (< or =44 years), presence of personality disorder, shorter treatment duration (< or =111 days), use of psychotropic medication, and a larger population per psychiatrist in the catchment area. Attention should be given to younger male patients treated for personality disorders, because they are at higher risk of treatment dropout.

Diagnoses and Dropout Among Patients of Danish Psychiatrists in Private Practice

Diagnoses and Dropout Among Patients of Danish Psychiatrists in Private Practice

Estudio comparativo entre azatioprina oral y pulsos intravenosos de ciclofosfamida en el tratamiento de la fibrosis pulmonar idiopática

Introduction The purpose of the study was to establish the efficacy of treatment with intravenous cyclophosphamide pulses and oral corticoids in idiopathic pulmonary fibrosis, compared with the standard treatment with corticoids and azathioprine. Patients and method A prospective, non-controlled study with 2 parallel groups. One group received prednisone plus oral azathioprine for 24 months (AZA group). The second one (CIC group) received prednisone plus intravenous cyclophosphamide pulses (6 monthly and 6 three-monthly). The primary outcome was survival or period without need for a transplant at 36 months. The secondary outcomes were the forced vital capacity, the carbon monoxide diffusing capacity, and baseline arterial oxygen pressure at 3, 6, 12, 18, 24, 30, and 36 months. Results A total of 46 patients were included in the study, of whom 25 were assigned to the AZA group and 21 to the CIC group. The survival or absence of lung transplant at 36 months was 44% in the AZA group and 76% in the CIC group ( P=0.028). The forced vital capacity was worse in 8.8% of the AZA group compared to 6.7% in the CIC group ( P=0.16). The carbon monoxide diffusing capacity worsened in 11.81% of patients of the AZA group and in 4.6% of those in the CIC group ( P=0.0569). No significant differences were observed in the arterial oxygen pressure. There was one dropout of treatment with prednisone. Conclusions Treatment with intravenous cyclophosphamide pulses produced a significant improvement in survival. There were no significant differences in the lung function parameters or gas exchange. Neither of the cytostatics had serious side effects.

The impact of client treatment preferences on outcome: a meta‐analysis

An important part of evidence-based practice is to include client preferences in the treatment decision-making process. However, based on previous reviews of the literature there is some question as to whether including client preferences actually has an effect on treatment outcome. This meta-analytic review summarized data from over 2,300 clients across 26 studies comparing the treatment outcome differences between clients matched to a preferred treatment and clients not matched to a preferred treatment. The findings indicate a small significant effect (r=.15, CI(.95): .09 to .21) in favor of clients who received a preferred treatment. The binomial effect size indicated that matched clients have a 58% chance of showing greater improvement, and further analysis indicate that they are about half as likely to drop-out of treatment when compared with clients not receiving a preferred treatment. Study design was seen to be a moderating variable in that partially randomized preference trials may underestimate the treatment preference effect. Implications for best practice standards are discussed.

Client and program factors associated with dropout from court mandated drug treatment

To examine why court mandated offenders dropout of drug treatment and to compare their characteristics, treatment experiences, perceptions, and outcomes with treatment completers, we analyzed self-reported and administrative data on 542 dropouts (59%) and 384 completers (41%) assessed for Proposition 36 treatment by thirty sites in five California counties during 2004. At intake, dropouts had lengthier criminal histories, lower treatment motivation, more severe employment and psychiatric problems, and more were using drugs, especially heroin. Relatively fewer dropouts received residential treatment and their retention was much shorter. A similar proportion of dropouts received services as completers and the mean number of services received per day by dropouts was generally more, especially to address psychiatric problems, during the first three months of treatment. The most commonly offender-reported reasons for dropout included low treatment motivation (46.2%) and the difficulty of the Proposition 36 program (20.0%). Consequences for dropout included incarceration (25.3%) and permission to try treatment again (24.0%). Several factors predicting drug treatment dropout were identified. Both groups demonstrated improved functioning at one-year follow-up, but fewer dropouts had a successful outcome (34.5% vs. 59.1%) and their recidivism rate was significantly higher (62.9% vs. 28.9%) even after controlling for baseline differences. Understanding factors associated with drug treatment dropout can aid efforts to improve completion rates, outcomes, and overall effectiveness of California's Proposition 36 program. Findings may also aid a broader audience of researchers and policy analysts who are charged with designing and evaluating criminal-justice diversion programs for treating drug-addicted offenders.

Adapted Couple Therapy (ACT) for Pathological Gamblers: A Promising Avenue

The study of the effectiveness of treatment for pathological gambling constitutes a field that is still largely unexplored. To date, the models assessed primarily target the individual and include little or no involvement of the family circle. Yet, the deleterious effects of gambling on loved ones and especially spouses are well recognized. Further, the addition of a couple modality to individual treatment has been shown to be effective on many levels in the treatment of substances use disorders. This article therefore proposes a critical review of (1) the literature providing a better understanding of the complex interactions between the couple relationship and pathological gambling, (2) studies on the effects of couple therapies on gamblers and their partners. We then present the therapeutic model developed by our team of clinician-researchers in collaboration with actors from Québec clinical settings: Adapted Couple Therapy (ACT) for pathological gamblers. In the Québec context, this model will serve as a complement to an individual cognitive-behavioral treatment model that has been proven effective and is employed throughout the Canadian province. The assessment of couple therapies could reveal avenues of solutions to better assist pathological gamblers who tend to drop-out of treatment and relapse.

Predicting dropout of court-mandated treatment in a British sample of domestic violence offenders

Prior to starting a pro-feminist domestic violence rehabilitation programme, 120 British male domestic violence offenders completed psychometric and attitudinal measures that assessed pro-domestic violence attitudes, anger, locus of control, self-reported emotional and psychological abuse of a partner, interpersonal dependency and social desirability. Offenders who completed the programme were compared to those who dropped out on these measures and demographic variables. Just under one-third (32.5%) of offenders failed to complete the programme. Of those variables that discriminated between completers and dropouts (age, previous custodial sentences, age at first conviction, marital status, self-reported abuse, and diagnosis of depression), only age (being young), having previously received a custodial sentence and self-reported low levels of physical abuse of a partner predicted attrition. These results are discussed with reference to probation supervision.

The Effectiveness of Therapy with Couples Reporting a History of Childhood Sexual Abuse: An Exploratory Study

The purpose of this pilot study was to explore the impact of childhood sexual abuse (CSA) on couples therapy. Participants were couples seeking therapy who were screened for CSA prior to therapy. Groups were compared using self-report and therapist-rated measures of individual and relational distress. Results indicate that although therapists report significant differences between CSA couples and couples not reporting abuse at the onset of therapy, those differences do not translate into significant differences in the perceived effectiveness of therapy as measured by change scores on therapist rated levels of distress, questions regarding the effectiveness of therapy, dropout, and length of treatment.

Factors associated with psychiatric treatment dropout in a mental health reference center, Belo Horizonte

To characterize an outpatient public referral center for mental health and to assess factors associated with treatment dropout. A non-concurrent prospective study was undertaken to review 295 patient files. Patients, whose first consultation took place between January and December 1997, were followed-up for at least four months until April 1998. Patients were considered as having abandoned their treatment when, following a recommendation for at least a second visit, they did not return within four months after the first consultation. Social, demographic and clinical variables were compared to verify possible factors associated with dropout of treatment. Statistical analysis was performed using relative hazard (RR) with 95% confidence interval (CI) estimated by the Cox Regression Model. Cumulative incidence of treatment dropout was 39.2% while multivariate analysis indicated that the following characteristics were statistically associated with treatment interruption: to live outside the referral area (RR = 1.95), no history of previous psychiatric hospitalizations (RR = 1.88), alcohol or drug use at admission (RR = 1.72), spontaneous demand to the service (RR = 2.12), lack of bus-passes (RR = 3.68) and to have less than four clinical appointments (RR = 7.31). Our findings suggest that services should be aware of the high incidence of treatment interruption, especially among those with no history of previous psychiatric hospitalizations and with less institutional bonds. This may indicate that mental health services should develop and implement public policies targeted at this population.

Stage of Change as a Predictor of Attrition Among Men in a Batterer Treatment Program

This study assessed the contribution of the men's stage of change to the prediction of attrition among men attending a batterer treatment program. As outlined by the transtheoretical model of change, men were classified into the precontemplation, contemplation, or action stage based on their level of change motivation and behavior. It was hypothesized that men in the precontemplation stage would dropout of treatment at higher rates than men in later stages of change. Participants were 308 men who enrolled in a batterer treatment program over the course of 1 year, 61.4% of whom dropped out of treatment. Counselor rated, but not self-rated stage of change significantly predicted treatment completion once traditionally used demographic, contextual, and personality variables were taken into account. Specifically, men identified by counselors as being in the precontemplation stage were 2.3 times as likely as men rated in the contemplation stage and 8.8 times as likely as men rated in the action stage to dropout of treatment. Referral source, age, and history of arrest also made significant contributions to the prediction of attrition. The best combination of predictors led to the successful classification of 72% of the cases, 98% of the dropouts but only 19% of the completers. Discussion focuses on the limitations of current findings and their implications for the use of the transtheoretical model to predict attrition from batterer treatment.

Dropout and Completion of Treatment Among Spouse Abusers

This study examines a population of spouse abusers undertaking a treatment program. Its purpose was to identify the variables associated with dropout and completion of treatment and to build a predictive model. Data were collected on 286 men who began group treatment in one of eight community programs in the province of Quebec, Canada. Results show that men who complete treatment are older, better educated and have better economic conditions than men who drop out. They also have a more stable family life, have been in a relationship for a longer period of time and have more children with their actual spouse. Men who completed treatment showed more commitment, better working capacities and a higher level of agreement with their therapists, thus developing a stronger therapeutic alliance. Support provided by people in the environment was significantly related to treatment completion. Social and judicial pressures were not related to completion.

Factors associated with immediate dropout of outpatient treatment for drug abuse in Rio de Janeiro.

The advantage of treatment of drug addiction over no intervention has long been recognized. The high dropout rates that are often reported in outpatient clinics may limit treatment effectiveness. This study aimed to analyze adherence to an outpatient program for drug addicts, mainly cocaine addicts, in Rio de Janeiro, Brazil, and its correlates. Of particular interest was immediate dropping out, defined as coming just once to the facility. The data were collected from medical charts and registers of a randomly selected sample of 480 patients. A total of 468 medical records were available for review, and 57% of the patients came just once to the facility. A negative association was found between immediately dropping out and female gender, being white, prescription of medication and use of multiple management resources by the therapist (referral to mutual support groups, social workers, family therapy and medical assessment, even with no prescription). A positive association was found with parental death in childhood, history of mental illness in the family and addiction to alcohol combined with abuse of other illicit substance(s). The high dropout rates associated with certain treatment approaches strongly indicate opportunities for improving care of drug addicts at that outpatient center.

Personality pattern in first-time-admitted alcoholics

First-time-admitted (n = 90) alcoholics in an outpatient clinic completed the Millon Clinical Multiaxial Inventory (MCMI) as part of the initial evaluation. Many patients had one of two personality disorders: the passive-aggressive (59.5%) or dependent personality disorder (56.8%). Alcohol abuse for more than 5 years was related to high-scores on the following scales: Anxiety, somatoform, hypomanic, dysthymia, drug abuse, and alcohol abuse. The alcohol abuse scale was the only scale to show discriminate validity when compared with norms of the American Standardization. High scores on the passive-aggressive scale was shown to be predictive of an early dropout of treatment. A high proportion of respondents showed invalid MCMI scores (17.7%), a finding correlated to comorbid intellectual impairment, concurrent treatment with the benzodiazepines, the length of time the patients spent in completing the test, and the length of time since abstinence. The MCMI seemed to be a valid and useful instrument in evaluat...