Transcript DATOS Master Show

Drug Abuse Treatment
Outcome Studies
(Funded by NIDA)
National Cocaine
Treatment Outcomes
from DATOS
Charts Prepared & Released for Public Use by
Dwayne Simpson (TCU), Robert Hubbard (NDRI-NC),
Douglas Anglin (UCLA), & Bennett Fletcher (NIDA)
Slide 1 of 14
Drug Abuse Treatment Outcome Studies
Third National Evaluation of Treatment Effectiveness
Funded by the
National
Institute on
Drug Abuse
1991-93
11 Cities
96 Programs
~10,000 Patients
All treatment types
Follow-up: 1 & 5 Yrs
Over 60 Studies Published –
Psychology of Addictive Behaviors (Dec 97)
Drug and Alcohol Dependence (Dec 99)
Archives of General Psychiatry (June 99)
Slide 2 of 14
Cocaine Treatment Study
 About three-fourths of all admissions to
non-methadone treatment programs in the
U.S. are for cocaine dependence
 Managed care pressures are for shorter
treatment & outpatient settings
 Outcomes of cocaine treatment needs to be
studied in “real-world” settings
Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry
Slide 3 of 14
Cocaine Treatment Outcomes
(in Year After Discharge in DATOS)
Cumulative Outcome Criteria
(N=1605)
Wkly
Coc
23%
 Half (52%) had relapses
to drug use:
 23% to “weekly” cocaine use
 19% to “occasional” cocaine
 10% to “other drugs”
 4% had alcohol problems
Any
Trt
11%
Any
Coc
19%
Alc
Prob
4%
Any
Drug
10%
 11% reentered treatment
(without relapse)
Overall, 67% had “problems”
during follow-up period
Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry
Slide 4 of 14
Weekly Cocaine Use in Past Year:
Changes from Before to After Treatment
Before
100
After
77
82
80
58
60
40
24
26
20
20
0
LTR*
ODF*
STI*
*p<.001
DATOS Treatment Modality
Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry
Slide 5 of 14
Any Jail in Past Year:
Changes from Before to After Treatment
Before
100
79
After
73
80
53
60
35
28
40
20
20
0
LTR*
ODF*
STI*
*p<.001
DATOS Treatment Modality
Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry
Slide 6 of 14
Drinking 3+ Days/wk in Past Year:
Changes from Before to After Treatment
100
Before
After
80
60
45
42
34
40
16
16
15
20
0
LTR*
ODF*
STI*
*p<.001
DATOS Treatment Modality
Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry
Slide 7 of 14
Relapse Rates (Drug use & Trt in Yr 1),
by Retention in Cocaine Treatments
90
High-Problem Group
80
81
80
69
69
70
70
62
60
50
% in Outpatient Drug Free (n=466)
% in Long-Term Residential (n=549)
“Threshold” of minimum
stay for effectiveness!
65
55
51
49
57
50
40
1-60
61-90
91-150
151-180
181-270
>270
Number of Days in DATOS Treatment
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Types of Problems at Admission
27
3+ Drugs
51
Alcohol Dep
60
Criminal Act
47
Unemployed-FT
55
Low Social Sup
66
Dep/Anxiety
76
No Insurance
0
10
20
30
40
50
60
70
80
% With Problems in Year Before Admission
Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry
Slide 9 of 14
Total Number of Problems
(Problem Severity Index, PSI)
% Low (0-3)
% Med (4-5)
% High (6-7)
54
43
26
24
11
LTR
ODF
6
STI
Admissions to Each Treatment Modality
Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry
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Weekly Cocaine Use
(in Year After Treatment)
35
27
30
18
Low
17
Medium
High
<90 Days
90+ Days
Problem Severity at Intake
Length of Treatment
(p<.001)
(p<.001)
Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry
Slide 11 of 14
Weekly Cocaine Use
(in Year After Treatment)
40
28
20
20
Short-Term
Long-Term
Low Problem
Patients (ns)
Short-Term
Long-Term
Mid-High Problem
Patients (p<.001)
Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry
Slide 12 of 14
Weekly Cocaine Use
(in Year After Treatment)
50
38
40
29
30
20
15
10
0
LTR
(90+ Days)
ODF
(90+ Days)
STI
(21+ Days)
HIGH Problem Patients (p<.001)
Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry
Slide 13 of 14
Home Page
About DATOS
Background
Highlights
Special Topics
Publications
Web Posters
What’s New
CONTENT
News and Features
Latest DATOS studies have
been published in Drug and
Alcohol Dependence
Treatment process (engagement and participation),
retention, and outcomes are the focus of this series of
studies, and our first cost-benefit analysis addresses
cocaine treatment. The latest DATOS publications and "in
press" are listed on the Publications page.
Cocaine Treatment Outcome
Study is Released
(in June 1999 issue of Archives of General Psychiatry)
Findings emphasize the need for "adequate treatment stays,"
especially when problem severity is moderate-to-high. At
least 90 days in intensive residential (TC) programs was
indicated for high-severity cases. More information is
provided in a new section of Highlights page, "Outcomes for
Treatment of Cocaine Dependence.”
Selected
Studies
1-Year
Outcomes
Treatment
Services
& Process
Cocaine
Treatment
Selected
Web Posters
Adolescent
Studies
Cost Benefits of
MM Treatment
www.datos.org
Readiness
for Treatment
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