Drug Abuse Treatment Outcome Study Research Articles

Improving the effectiveness of SUD treatment through a national registry.

Recent research into the effectiveness of abstinence-based substance use disorder (SUD) treatment indicates that there has not been a substantial improvement since the Drug Abuse Treatment Outcome Study research in 1993. Research into medication-supported treatments for SUD are hindered by a dearth of real-world longitudinal outcome studies. Patient registries have dramatically improved survival rates in many diseases by providing researchers with longitudinal data on a broad spectrum of patients undergoing a variety of treatments. Policy prescription: We recommend the creation of a national registry for patients receiving treatment for SUD akin to the Surveillance, Epidemiology, and End Results Program established in 1971 to track cancer patient outcomes. One option would be to expand the data currently being collected in the Treatment Episode Data Set (TEDS) to include all nonpublicly funded treatment and to allow for longitudinal tracking of deidentified individuals. Information on medication use and deaths could be kept up to date through integrations with state-wide death registries and Prescription Drug Monitoring Programs. The TEDS dataset already undergoes extensive data deidentification to make sure individuals cannot be identified prior to releasing the admissions and discharge datasets to researchers. Once longitudinal tracking is available, even more stringent deidentification will be necessary, and access to the dataset would be restricted to public health researchers. The development of a registry of individuals undergoing treatment for SUD can be expected to enhance our understanding of the progression of the disease and the relative effectiveness of different treatment modalities for patients with different drug use histories and characteristics.

Social support as protective factor for suicidal ideation during treatment for substance abuse: Differential effects across treatment modalities

Substance abuse treatment constitutes a period of increased risk for suicide. It is unclear if social support during treatment influences suicide risk during treatment, or how this is characterized across different treatment modalities. The present study involved secondary analyses of the Drug Abuse Treatment Outcome Study, a large, longitudinal multi-site study conducted from 1991 to 1994 that involved interviews with patients at various treatment programs reporting on experiences while receiving substance abuse treatment. Data from people in inpatient (n = 2530) and outpatient treatment (n = 2568) programs were analyzed to determine the extent that various indicators of social support influenced odds of having suicidal ideation during treatment. Across both treatment modalities, ongoing interpersonal problems and patient perception of their performance in relationships significantly predicted odds of suicidal ideation one month into treatment. Contact with one's social support system during treatment only significantly decreased odds of suicidal ideation for inpatients. Relationship status did not significantly influence odds of suicidal ideation in either group. Overall, social support appears to be associated with decreased risk for suicidal ideation during substance abuse treatment, and certain indicators of social support may be especially important for specific treatment modalities.

Life-time history of insomnia and hypersomnia symptoms as correlates of alcohol, cocaine and heroin use and relapse among adults seeking substance use treatment in the United States from 1991 to 1994.

To examine the association between a life-time history of insomnia and hypersomnia compared with no sleep disturbance and substance use patterns and amounts before and after a substance use treatment episode. Secondary analysis of data from the Drug Abuse Treatment Outcome Studies conducted from 1991 to 1994. Data were collected at 96 substance use treatment programs in 11 United States cities, including short-term in-patient, long-term residential, methadone maintenance and out-patient drug-free treatment modalities. Study samples included 7168 adults at treatment entry and 2965 at 12months post-treatment entry whose primary substance use at entry was alcohol (14.7%), cocaine (62.7%) or heroin (22.6%). Life-time history of insomnia and hypersomnia was assessed via self-report. Type and frequency of substance use were assessed at treatment entry. Substance use was also assessed 12months following treatment completion. Associations were examined using linear and logistic regression with age, sex, race, education level, depression history, treatment modality and in-treatment substance use as covariates. Life-time history of insomnia, hypersomnia, both or neither was reported by 26.3, 9.5, 28.0 and 36.2% of participants, respectively. Compared with no sleep disturbance, life-time insomnia and hypersomnia were associated at treatment entry with unique substance use patterns and a higher frequency of any substance use (P<0.001). All types of sleep disturbance were associated with higher rates of cocaine use at 12-month post-entry (odds ratios: 1.30-1.57). There is evidence of an adverse association between substance use and sleep disturbance including higher frequency of all substance use before substance abuse treatment and higher rates of cocaine use after a treatment episode.

Anger and Its Association with Substance Use Treatment Outcomes in a Sample of Adolescents

ABSTRACTAnger is a common affective experience, yet it is relatively understudied in the substance use treatment literature. This study explored anger as a predictor of treatment outcomes in a large sample of adolescents. Data were extracted from the Drug Abuse Treatment Outcome Study for Adolescents (DATOS-A). An anger profile was created based on adolescents’ pre-treatment responses to four items assessing history of temper outbursts and aggression. Individuals were classified as High Anger (N = 506) and Normal/Low Anger (N = 2,326) based on their pattern of responses to these items. High Anger at baseline was associated with several poor outcomes at the 12-month follow-up point, including a greater likelihood of experiencing delirium tremens, relapsing on drugs due to alcohol use, having difficulty controlling temper and behavior, and being arrested for attacks on persons.

Therapeutic Engagement and Posttreatment Substance Use in Adolescent TC Clients

The problem of adolescent drug use places a huge toll on society and a heavy burden on the criminal justice system. Despite the ability of therapeutic communities (TCs) to lower drug relapse, a great deal remains unknown in terms of how the process of treatment actually works for adolescents. Using data collected as part of the Drug Abuse Treatment Outcomes Studies–Adolescents, this study examines the direct and indirect relationship between therapeutic engagement and posttreatment substance use. Though there are few direct effects of therapeutic engagement on substance use, findings suggest that those more engaged in treatment are more likely to complete treatment and, therefore, less likely to use substances. This suggests that instruments that evaluate therapeutic engagement are important in assessing involvement in treatment, and that programming designed to engage the adolescents in TC treatment should be utilized to reduce the risk of posttreatment relapse.

Examining the relationship between self-control and adolescent TC treatment completion

A type of treatment intervention that is widely regarded in terms of treating adolescents with issues of substance use is the therapeutic community (TC). Despite their effectiveness, empirical studies of drug treatment are mostly atheoretical, even though treatment programming is based on theory. In this study, an attempt was made to apply concepts related to a Gottfredson and Hirschi’s General Theory of Crime to predict treatment completion. Using data collected as part of the Drug Abuse Treatment Outcomes Studies Adolescents (DATOS-A), a multisite prospective study of adolescent drug abuse treatment effectiveness, this study examined whether characteristics associated with low self-control predicted treatment completion. The primary finding was that motivation for treatment was significantly related to treatment completion. Although the characteristics associated with low self-control did not predict treatment completion in the hierarchical linear modeling (HLM) models that included the demographics and risk and protective factors, there were several significant bivariate relationships between pretreatment behaviors and the characteristics associated with low self-control. Because of these relationships, it is important that TC practitioners are aware of how these characteristics might interplay with treatment completion and how TC strategies may help the adolescent to overcome them.

Self-Control as a Predictor of Relapse and Recidivism in Adolescent Therapeutic Community Treatment

Despite the effectiveness of Therapeutic Communities (TCs), empirical studies of TCs are mostly atheoretical. In this study, concepts related to Gottfredson and Hirschi's General Theory of Crime were used to predict posttreatment delinquency among adolescents. Using data collected as part of Drug Abuse Treatment Outcomes Studies–-Adolescents (1993–1996), this study examined whether characteristics associated with low self-control predicted posttreatment substance use and posttreatment crime (N = 727). Contrary to the hypotheses, characteristics associated with low self-control had no relationship with posttreatment delinquency. Although these findings do not support the hypothesis, this study begins the process of linking criminological theory to adolescent TC treatment research. The study's limitations are noted.

The Impact of Substance User Treatment Participation on Legal Employment and Income Among Probationers and Parolees

Employment is essential for recovery. But treatment could conflict with work schedules, and employment gains could be short lived. This study examined how employment and income varied during and after treatment, what aspects of treatment impacted on employment, and whether treatment improved income. Baseline and follow-up data were analyzed for 760 probationers and parolees in 11 US cities that participated in the 1992–1995 Drug Abuse Treatment Outcomes Study. Results showed that only residential/inpatient treatment was associated, temporarily, with employment. Retention, compliance, and self-efficacy were correlated to posttreatment employment. However, treatment had no impact on income, which was determined by education and work history.

Simulated evidence on the prospects of treating more drug-involved offenders

Despite a growing consensus among scholars that substance abuse treatment is effective at reducing offending, strict eligibility rules and budgetary considerations greatly limit the impact that current models of therapeutic jurisprudence can have on public safety in the United States. A question of pressing importance for U.S. drug policy is whether it is beneficial to expand application of this model to treat every offender in need and, if so, whether a set of evidence-based, going-to-scale strategies can be developed to prioritize participation. We use evidence from several sources to construct a synthetic dataset for answering the question: What are the benefits we can reasonably expect by expanding treatment to drug-involved offenders? We combine information from the National Survey on Drug Use and Health (NSDUH) and the Arrestee Drug Abuse Monitoring (ADAM) program to estimate the likelihood of various arrestee profiles having drug addiction or dependence problems. We use the same sources to also develop prevalence estimates of these profiles among arrestees nationally. We use information in the Drug Abuse Treatment Outcome Study (DATOS) to compute expected crime-reducing benefits of treating various types of drug-involved offenders under different treatment modalities. We find that annually nearly 1.5 million (probably guilty) arrestees in the U.S. are at risk of abuse or dependence and that treatment alone could avert several million crimes that these individuals would otherwise commit. Results vary by treatment modality and arrestee traits and those results are described herein.

Progression through early drinking milestones in an adolescent treatment sample

Research using nationally representative and community samples demonstrates a robust association between early onset of drinking and increased likelihood of numerous adverse outcomes. However, little is known about the subsequent drinking that occurs early in the drinking career. The present study dissects the transition from any alcohol use to treatment entry by taking a fine-grained approach to examining the attainment and progression of drinking events in a sample of adolescents in substance use treatment. Data were taken from the Drug Abuse Treatment Outcome Study for Adolescents (DATOS-A), a multi-site, community-based study of adolescents entering treatment. Respondents included 3331 youth aged 12-18 years (mean = 15.75) admitted to treatment in 1993-95 (74% male, 52% white, 24% African American, 20% Hispanic). Age of attainment was obtained for five drinking-related milestones, including first drink of alcohol, first time drunk, first monthly drinking, first drank five or more drinks/day on a weekly basis and first drank five or more drinks/day on a daily basis. Most milestones were attained at a very early age, and average progression through adjacent drinking events was relatively swift, Movement through early drinking milestones was accelerated in girls and white youth. Youth who reported their first drink at an early age (age 10 or younger) showed slower progression, suggesting the existence of distinct processes underlying early use and drinking transitions within an individual. This study provides data relevant to understanding drinking progression/natural history in a large clinical sample, especially for differences by gender and ethnicity. The findings have implications for the identification of intermediate stages that might benefit from selected intervention programs.

Suicide Attempts within 12 Months of Treatment for Substance Use Disorders

There are limited prospective data on suicide attempts (SA) during the months following treatment for substance use disorders (SUD), a period of high risk. In an analysis of the Drug Abuse Treatment Outcomes Study, a longitudinal naturalistic multisite study of treated SUDs, variables associated with SA in the 12 months following SUD treatment were examined. Participants included 2,966 patients with one or more SUDs. By 12 months, 77 (2.6%) subjects had attempted suicide. Multivariate logistic regression analyses were used to identify variables associated with SA. Variables collected at baseline that were associated with SA included lifetime histories of SA, suicidal ideation (SI), depression, cocaine as primary substance of use, outpatient methadone treatment, and short-term inpatient treatment. Male sex, older age, and minority race or ethnicity were associated with lower likelihood of SA. After controlling for baseline predictors, variables assessed at 12 months associated with SA included SI during follow-up and daily or more use of cocaine. The data contribute to a small but growing literature of prospective studies of SA among treated SUDs, and suggest that SUDs with cocaine use disorders in particular should be a focus of prevention efforts.

Non-fatal overdose in the 12 months following treatment for substance use disorders

Background Overdose (OD) is a leading cause of mortality and morbidity for individuals with substance use disorders (SUDs), and there are limited prospective data on OD during the months following treatment for SUDs. Methods Variables associated with an OD in the 12 months after leaving an initial treatment episode were examined in an analysis of the Drug Abuse Treatment Outcomes Study (DATOS), a longitudinal naturalistic multisite study. Participants included 2966 patients with one or more SUDs. Non-fatal OD was ascertained by a positive response to “In the past 12 months, have you overdosed on drugs?” Multivariate logistic regression analyses were used to identify variables associated with OD. Results By 12 months, 93 (3.1%) participants reported one or more ODs. Variables associated with OD were lifetime history of OD, injection drug use (IDU), male sex, greater pain, and history of sexual abuse. Conclusions OD-risk appears to be increased by IDU, lifetime OD, sexual abuse history, and pain. The latter finding is novel for a prospective report and requires further study.

Theories of Motivation in Addiction Treatment: Testing the Relationship of the Transtheoretical Model of Change and Self-Determination Theory

This study explored the relationship between 2 theories of motivation: self-determination theory (SDT) and the transtheoretical model of change (TTM), and sought to determine whether the source of motivation described by SDT would predict TTM's stage of change. SDT was operationalized as the level of internal or external motivation for treatment, and TTM was operationalized as 3 stages of change: precontemplation, contemplation, and action. Our data came from the Drug Abuse Treatment Outcome Study published in 2004. A multinomial logistic regression analysis indicated that there was a significant relationship between source of motivation and stage of change at intake. Controlling for severity, treatment history, legal status, and primary substance use, persons entering treatment with higher levels of internal motivation were more likely to be in the action stage than the precontemplation stage. Higher levels of internal motivation also predicted a greater likelihood of being in the contemplation rather than the precontemplation stage.

Adolescent tobacco use and substance abuse treatment outcomes

This study investigated the relationship between cigarette-smoking status and 12-month alcohol and marijuana treatment outcomes in a sample of 1,779 adolescents from the Drug Abuse Treatment Outcomes Study for Adolescents. Participants were classified into four groups based on change in cigarette-smoking status from intake to the 12-month follow-up: persistent smokers, nonsmokers, quitters, and smoking initiators. Logistic regression was used to predict likelihood of relapse to alcohol, marijuana, and other drugs after controlling for intake levels and demographic/treatment characteristics. Results found persistent smokers and smoking initiators to have significantly greater odds of alcohol and marijuana relapse compared with quitters. Furthermore, persistent smokers and smoking initiators were also found to have distinctively shorter periods to marijuana relapse at follow-up. Implications for the implementation of tobacco cessation treatment in the context of substance abuse treatment for adolescents are discussed.

Racial Differences in Desistance From Substance Abuse

This study examines variations by race in the relationship between religiosity and desistance from substance abuse. Although most studies have included race as a control variable, only a few studies compared the equivalence of associations among religiosity, delinquency, recovery from substance abuse, and other variables between Black and White samples. Using data from the intake and 12-month follow-up survey of the Drug Abuse Treatment Outcome Study, this study examines levels of religious involvement of Black and White drug treatment clients. In addition, it empirically tests whether religious involvement exerts differential effects on Black and White clients' recovery from substance abuse. It was found that Black clients reported higher levels of religious involvement (measured by church attendance) than did White clients. Data indicated that religious behavior at 1-year follow-up was positively associated with Black clients' recovery from substance abuse. In contrast, religious behavior was not a significant predictor of White clients' desistance from substance abuse. Directions for future research and policy implications are discussed.

Client Matching: A Severity-Treatment Intensity Paradigm

ABSTRACT Despite considerable effort to develop matching strategies and client placement protocols, research studies fail to yield compelling results regarding the benefits of matching to treatment. The most consistent findings suggest a matching paradigm, which defines a successful placement as the least treatment intensity required addressing the severity of the disorder. The purpose of the present study is to provide further empirical support for the validity of a severity-intensity paradigm utilizing data from the Drug Abuse Treatment Outcome Studies. A “passive match” approach employed the Client Matching Protocol decision algorithm, which recommended clients to long-term residential or outpatient drug-free treatment. One-year outcomes for clients matched to long-term residential treatment were better on all outcome variables compared to those undertreated in outpatient drug-free treatment. Findings supported the validity of the severity-intensity paradigm in that undertreated clients showed less improvement compared to matched and overtreated clients.

Physical Pain and Associated Clinical Characteristics in Treatment‐Seeking Patients in Four Substance Use Disorder Treatment Modalities

Physical pain among persons seeking treatment for substance use disorders (SUD) and characteristics associated with pain were examined in a secondary analysis of data from the Drug Abuse Treatment Outcome Study (DATOS), a multi-site treatment outcome study. Patients (N = 7,876) in four treatment modalities - long-term residential (LTR), short-term inpatient (STI), outpatient methadone treatment (OMT), and outpatient drug-free (ODF) - reported severity of physical pain experienced during the preceding 12 months. Moderate to severe physical pain was reported by 21.2% of LTR patients, 26.8% of STI patients, 33.6% of OMT patients, and 17.6% of ODF patients. Individuals with and without physical pain were compared across treatment modalities. Patients with pain were more likely to report weekly heroin use [aOR = 1.73 (1.44-2.08)], weekly narcotics use [aOR = 1.43 (1.18-1.74)] and greater depressive symptoms [aOR = 1.30 (1.21-1.38)]. These findings support the presence of a sizable proportion of SUD patients with pain who may benefit from pain assessment as part of their SUD treatment.

Longitudinal Research That Can Inform Dynamic Models for the Treatment of Addiction as a Disease

Longitudinal Research That Can Inform Dynamic Models for the Treatment of Addiction as a Disease

Longitudinal HIV risk behavior among the Drug Abuse Treatment Outcome Studies (DATOS) adult sample.

Longitudinal trajectories for HIV risk were examined over 5 years following treatment among 1,393 patients who participated in the nationwide Drug Abuse Treatment Outcome Studies. Both injection drug use and sexual risk behavior declined over time, with most of the decline occurring between intake and the first-year follow-up. However, results of the application of growth mixture models for both sets of trajectories indicated that a subgroup of individuals reverted to a high-risk behavior over time, with a higher level of risk at the 5-year follow-up than their original risk level at intake. Of clients who were engaged in regular injection drug use at intake, 76% continued to inject drug at a moderate-stable or increased rate during the 5-year follow-up.

Client consensus on beliefs about abstinence: Effects on substance abuse treatment outcomes

Organizational culture, as evinced by consensus regarding staff and client beliefs and values, has been shown to affect client engagement in residential substance abuse treatment. The present paper extends this work to treatment outcomes. Secondary analysis of data from a “Beliefs About Abstinence Scale,” used in the Drug Abuse Treatment Outcomes Study (DATOS), was conducted for 76 programs, including outpatient methadone treatment, outpatient drug-free, short-term inpatient, and long-term residential programs. Findings show that higher levels of client consensus after 1 month of treatment were associated with less use of drugs and alcohol at 1-year follow-up, after controlling for the mean of the scale score, gender, age, client substance use at baseline and treatment modality. The implications of the results for substance abuse treatment are discussed.