Treatment Outcome Prospective Study Research Articles

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

Overview of 5-year followup outcomes in the drug abuse treatment outcome studies (DATOS)

Followup results from the Drug Abuse Treatment Outcome Studies (DATOS) 1-year and 5-year followups were used to describe the long-term outcomes of drug treatment and to further clarify the relationship between treatment duration and post-treatment outcomes in four treatment modalities: outpatient methadone, long-term residential (LTR), outpatient drug free (ODF), and short-term inpatient. Methods replicating those used in earlier analyses of the DATOS 1-year followup of 2,966 patients admitted to treatment in 1991–1993 and those of the Treatment Outcome Prospective Study patients admitted in 1979–1981 were employed. DATOS is a non-experimental longitudinal study conducted within the natural settings of 96 treatment programs in the U.S.A. The study followed patients during and after treatment at specified periods of time. Prevalence of drug use and behaviors were evaluated for the year prior to treatment; and the post-treatment time frames defined by the 1- and 5-year followups. In addition, the multivariate analytic technique of generalized estimating equations was used to examine the relationship of treatment duration and outcomes across both followups while also controlling for patient characteristics and pretreatment levels of behaviors. The 5-year stratified followup sample included 1,393 of the same individuals in the 1-year followup sample. Analyses were restricted to patients participating in both followups. Reductions in prevalence of cocaine use in the year after treatment (compared to the preadmission year) by patients were associated with longer treatment durations (particularly 6 months or more in LTR and ODF). In addition, reductions in illegal activity and increases in full-time employment were related to treatment stays of 6 months or longer for patients in LTR. The DATOS results from the 1-year and 5-year post-treatment followup combined suggest the stability of outcomes of substance abuse treatment. While results are generally consistent with the full 1-year followup, reduced sample size and bias of the sample toward patients with longer treatment retention may have attenuated the findings.

Drug Abuse Treatment and Comprehensive Services for Adolescents

Data from two national studies of treatment spanning two decades—Treatment Outcome Prospective Study (TOPS), 1979 to 1981, and Drug Abuse Treatment Outcome Studies for Adolescents (DATOS-A), 1993 to 1995—provided a comparison of treatment and services provided to 261 TOPS and 1,519 DATOS-A intreatment adolescent patients in a cross-modality sample of 24 TOPS and 31 DATOS-A programs. The authors used patient self-reports of treatment needs and services received to compare unmet needs for six services. Findings showed a general decline over treatment eras in services received that was only partially offset by significant decreases in some self-reported service needs in DATOS-A. Unmet needs increased significantly over treatment eras for specific services, including psychological, family, employment, and financial services. Potential explanations include changes in treatment access and decreases in program resources for services.

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.

Measuring program performance in methadone treatment using in-treatment outcomes: an illustration.

Quality measurement and quality assurance in substance abuse treatment have, over the past few years, become a major policy issue. In addition, there is interest in the degree to which client outcomes can play a role in measuring treatment program performance. This article discusses the movement toward outcome-based performance measurement in substance abuse treatment. Examples of the products that such a performance measurement system might produce are provided. Why outcomes must be case-mix adjusted is discussed. In addition, using data from 18 methadone programs and more than 2,000 methadone clients from the Treatment Outcome Prospective Study, an illustration of case-mix-adjusted performance measurement is provided.

Treatment services in two national studies of community-based drug abuse treatment programs

Findings from a number of sources over the past decade have documented a decline in the resources available for drug abuse treatment and the services being provided to clients in community-based drug abuse treatment programs. We compared client reports of services received and unmet service needs in a national crossmodality sample of clients in two studies of drug abuse treatment: the Treatment Outcome Prospective Study (TOPS), 1979-1981, and the Drug Abuse Treatment Outcome Study (DATOS), 1991-1993. Findings showed a marked decrease over the past decade in the number and variety of services clients reported receiving. Most striking was the large increase in self-reported unmet service needs in the DATOS investigation. Although most clients reported having received at least some sessions of drug abuse counseling during treatment and the level of satisfaction with treatment and services was generally high across modalities, client reports indicated that drug abuse counseling alone did not address their wider ranging service needs. Programs in the methadone modality generally reflected the lowest level of drug abuse counseling and services.

Relationship between time spent in treatment and client outcomes from therapeutic communities

Research found that therapeutic communities and other types of residential programs are effective in reducing drug use, unemployment, and criminal behavior and that length of time spent in treatment is an important predictor of client outcomes from programs. Studies vary considerably, however, in terms of the amount of time they found clients need to stay in treatment to produce those outcomes. Data collected for the Treatment Outcome Prospective Study (TOPS) were analyzed to explore the relationship between time spent in treatment and client outcomes from therapeutic communities and other types of residential drug treatment programs. The analysis took into account client characteristics and whether clients received drug treatment during the follow-up year. The results indicate there is a stronger relationship between time spent in treatment and client outcomes from therapeutic communities than was suggested in earlier analysis of TOPS data.

Issues to consider when predicting retention in therapeutic communities.

Many studies have focused on retention in therapeutic communities (TCs) because research shows that retention is an important predictor of client outcomes from these programs. A comparison of the three largest studies found there was little overlap between predictors of retention in TCs. Treatment Outcome Prospective Study data were analyzed to assess whether these findings may have been due to differences in times when the data were collected, measures of length of stay, and domains of variables used to predict retention. While the results suggest that each of these factors contributed to some differences between predictors of retention, the predictors still were unable to explain more than a small amount of the variance in retention. Research indicates that other variables need to be taken into account if future studies are to be more successful in predicting retention in TCs.

Strategies for increasing retention in methadone programs.

Data from the nationwide Treatment Outcome Prospective Study were analyzed to develop strategies for increasing patient retention in methadone programs. The sample comprised 351 daily or weekly heroin users who were admitted to 17 publicly funded methadone programs and completed intake, one month in treatment, and one-year follow-up questionnaires. The analysis suggests three strategies for increasing patient retention: providing more high-quality social services, making programs more easily accessible, and individualizing treatment. The analysis also identifies characteristics of patients and programs to which these strategies should be targeted to increase patient retention in methadone programs.

Exposure to Methadone Programs and Heroin Use

The aims of this study were to: (a) assess the effects of various patterns of exposure to methadone programs on heroin use; (b) assess the effects of other patient, program, and treatment variables; and (c) identify variables that promote the type of exposure to methadone programs that is most effective for reducing heroin use. The sample was 526 patients who were admitted from 1979 to 1981 into 17 methadone programs that participated in the Treatment Outcome Prospective Study. The study differs from previous research in that it addresses the time that patients spent in methadone programs during the follow-up period in defining exposure patterns. Heroin use was lowest among patients who were continuously exposed to methadone programs. Retention was highest among patients who attended programs that informed them of their methadone dose levels, were easy to access, and provided them with high quality social services.

Do Methadone Patients Substitute Other Drugs for Heroin? Predicting Substance Use at 1-Year Follow-up

Data were analyzed from the nationwide Treatment Outcome Prospective Study (TOPS) to assess whether current and former methadone patients substitute other drugs for heroin. The sample comprised 513 heroin users who were admitted to methadone programs in 10 cities across the United States and followed for at least 1 year. Structured face-to-face interviews were administered at admission and at follow-up to assess use of six substances: cocaine, amphetamines, illegal methadone, tranquilizers, marijuana, and alcohol. The study found a decline in the use of all substances except alcohol. Patients who substantially reduced or eliminated their use of heroin during the follow-up year were more likely to decrease their use of other drugs than were patients who continued to use heroin on a weekly or more frequent basis. These findings suggest that methadone programs indirectly reduce patients' use of cocaine, amphetamines, illegal methadone, tranquilizers, and marijuana, insofar as they are successful in eliminating or decreasing heroin use. Similar reductions in drug use were found among patients who were not enrolled in methadone programs during the follow-up year. These findings do not support the commonly held belief that heroin addicts substitute other drugs for heroin.

The Effects of Time in Drug Abuse Treatment and Employment on Posttreatment Drug Use and Criminal Activity

The impact of length of stay in drug abuse treatment on follow-up drug use and criminal behavior has important clinical and policy implications. In this paper we use longitudinal data from the Treatment Outcome Prospective Study to estimate the simultaneous effects of time in treatment and employment outcomes--weeks worked and total earnings--on posttreatment drug use and criminal activity. The drug use/criminal activity variables include four indexes measuring the severity of use, drug-related problems, predatory illegal acts, and overall criminal behavior. The results show that time in treatment had a negative and statistically significant impact on these outcome variables for every modality with residential clients experiencing the largest relative impact. The time-in-treatment effect was robust even when employment outcomes were modeled jointly with drug use and criminal activity outcomes. These findings highlight the importance of length of stay in treatment in the recovery and rehabilitation of drug abusers.

Assessing outpatient drug abuse treatment programs

Drug abuse is a major domestic health problem in the United States, and evaluators, policy makers, interest groups, and the general public are critically interested in knowing which treatments work best. Costs of drug abuse in America are conservatively estimated at 47 billion dollars per year (Harwood, 1984). It is estimated that over 27 million persons in households in the United States, or about one in every ten Americans, used illicit drugs in 1990 (National Institute on Drug Abuse, 1991). The Drug Abuse Reporting Program (DARP) and the Treatment Outcome Prospective Study (TOPS) represent two major drug abuse treatment outcome studies. The DARP study tracked over 44,000 drug users admitted to 52 drug abuse treatment programs during 1969-1973. DARP found that demographic and socioeconomic characteristics explained only a small amount of outcome variance (Sells and Simpson, 1980). Better predictors of treatment outcome were the length of time in treatment and the behavior during treatment (Simpson et al., 1982). TOPS included 11,750 drug users admitted to 41 drug abuse programs during 1979-l 98 1. A finding from this study was that drug abuse treatment reduced illicit drug use and criminal behavior (Hubbard et al., 1989). As in DARP, time in treatment was positively related to drug abuse treatment outcome. While the DARP and TOPS studies established the effectiveness of drug abuse treatment, many issues remain to be clarified. For example, more work is needed in efforts to match clients to treatment. The study of treatment process has remained tantalizingly difficult and little is known about the role that treatment structure and organization play in treatment outcome (Tims and Ludford, 1984). The purpose of this paper is to report data about outpatient treatment unit followup evaluations drawn from selected evaluation items in the recent National Drug Abuse Treatment Survey. A section of questions related to treatment evaluation activities was included in this national survey of drug abuse treatment programs. These

Indicators of depression and suicidal ideation among drug abusers.

The purpose of this study was to provide data relating to the validity of the Dysthymia and Psychotic Depression scales of the Millon Clinical Mulriaxial Inventory as indicators of serious depression measured by self-report data from che Treatment Outcome Prospective Study (TOPS) survey form. Scores on both Millon scales had low bur staristically significant correlations with TOPS survey items dealing with depression-related physical immobilization and suicidal ideation. Results indicate that these scale had limited value in identifying these significant depression-related symptoms among the 88 drug abusers (M age of 29 yr.)