Transcript Essential Elements of TCS

Drug Abuse Treatment
Outcome Studies
(Funded by NIDA)
National
Treatment Retention
Findings 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 19
Drug Abuse Reporting Program
First National Evaluation of Treatment Effectiveness
Funded by the
National
Institute on
Drug Abuse
1969-73
35 Cities
139 Programs
~44,000 Patients
All treatment types
Follow-ups: 1,3,6,12 Yrs
Sells, Simpson, Demaree, & Joe
6 books & 150 papers published (funded 1970-1990)
Slide 2 of 19
Daily Opioid Use:
% in Year 1 After Discharge
100
80
Comparison
Groups
Same for criminality !
64
60
52
53
53
43 42
40
29
33
30
20
0
0
Days
(Intake
Only)
1-30
Days in
Detox
Only
1-3 3+
Mos in
Therapeutic
Community*
1-3 3+
Mos in
Outpatient
Drug-Free*
1-3 3-12 12+
Mos in
Methadone
Maintenance*
*p<.01
Slide 3 of 19
N=3,248; Simpson & Sells, 1982 (AASA)
Treatment Outcome Prospective Study
Second National Evaluation of Treatment Effectiveness
Funded by the
National
Institute on
Drug Abuse
1979-81
10 Cities
37 Programs
~11,000 Patients
All treatment types
Follow-up: 1 year
Hubbard, Marsden, Rachal, Harwood, Cavanaugh, & Ginzburg,
Drug abuse treatment: A national study of effectiveness (1989)
Slide 4 of 19
“Treatment Process” in TOPS
 Comparisons between 21 MM programs
 Programs with Longer Retention had Better assessment & program planning
Higher MM dose & better UA monitoring
Comprehensive (“wrap-around”) services
Higher patient ratings for “meeting needs”
Similar findings for other modalities
Slide 5 of 19
Joe, Simpson, & Hubbard, 1991 (J Sub Abuse)
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 40 Studies Published –
Psychology of Addictive Behaviors (Dec 97)
Drug and Alcohol Dependence (Dec 99)
Archives of General Psychiatry (June 99)
Slide 6 of 19
Long-Term Residential (LTR)Treatment
Changes from Before to After Treatment
100
Pre
Post
88
77
80
66
60
41
40
40
22
20
24
19
17
16
13
6
0
Cocaine
(Weekly)*
Heroin
(Weekly)*
Heavy
Alcohol*
Illegal
Activity*
No FT
Work*
Suicidal
Ideation*
*p<.001
% of DATOS Sample (N=676)
Slide 7 of 19
Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)
Outpatient Drug-Free (ODF) Treatment
Changes from Before to After Treatment
100
Pre
Post
82
76
80
60
42
40
31
25
22
18
20
15
19
14
11
9
0
Cocaine
(Weekly)*
Marijuana
(Weekly)*
Heavy
Alcohol*
Illegal
Activity*
No FT
Work*
Suicidal
Ideation*
*p<.001
% of DATOS Sample (N=764)
Slide 8 of 19
Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)
Outpatient Methadone Treatment (OMT)
Changes from Before to After Treatment
100
Pre
89
Post
85
82
80
60
42
40
29
28
22
15
20
16
17
14
13
0
Cocaine
(Weekly)*
Heroin
(Weekly)*
Heavy
Alcohol
Illegal
Activity*
No FT
Work
Suicidal
Ideation
*p<.001
% of DATOS Sample (N=727)
Slide 9 of 19
Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)
Average Expected vs Observed
Length of Stay by Patients (in months)
Observed (Median)
Expected (Median)
9
6
3
Long-Term
Residential
(n=17)
24
12
3
Outpatient
Drug-Free
(n=14)
Outpatient
Methadone
(n=10)
Slide 10 of 19
Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)
Patient Retention Rates for Programs
(beyond minimum “thresholds”)
Best
Program
Poorest
Program
65%
75%
76%
21%
16%
15%
3+ Mos in
Long-Term
Residential
(n=17)
3+ Mos in
Outpatient
Drug-Free
(n=14)
12+ Mos in
Outpatient
Methadone
(n=10)
Slide 11 of 19
Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)
Program Retention Rates in LTR
(for 90 days or longer)
65
56
50
40
31
43
43
43
50
56
57
59
61
50
44
33
21
% of Admissions to 17 LTR Programs (with 40+ patients)
Slide 12 of 19
Program Retention Rates in ODF
(for 90 days or longer)
75
67
56
57
58
69
61
51
40
41
44
31
16
19
% of Admissions to 14 ODF Programs (with 40+ patients)
Slide 13 of 19
Program Retention Rates in OMT
(for 360 days or longer)
76
63
46
47
49
52
55
42
20
15
% of Admissions to 10 OMT Programs (with 40+ patients)
Slide 14 of 19
Retention Predicts Outcomes
 Findings Consistent from National Studies
1970s (44,000 admissions in DARP)
1980s (11,000 admissions in TOPS)
1990s (10,000 admissions in DATOS)
 Also in England’s NTORS !
 Conclusions from Major Reviews
Institute of Medicine (Gerstein & Harwood, ‘90)
Example from LTR in DATOS
Slide 15 of 19
Comparison of Year 1 Outcomes
by Length of Stay in LTR
100
< 90 Days
90+ Days
80
60
40
55
54
53
28
19
20
24
15
9
0
Cocaine
(Any Use)*
UA+
(Any Drug)*
Alcohol
(Daily Use)*
Any Jail*
*p<.001
% of Sample
Slide 16 of 19
N=342; Simpson, Joe, & Brown, 1997 (PAB)
DATOS Programs with Lower Retention
had more “troubled” caseloads!
Admissions to these programs had  More cocaine & alcohol problems
 More previous treatments
 More psychological problems
But these patient problems did not explain
all program differences in retention rates!
Slide 17 of 19
Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)
Patient Problems in LTR Programs
96
82
Highest %
86
86
75
67
Lowest %
42
41
33
44
29
6
Alc
o
oh
l
al
vl
nt
ds
ug
c
n
e
r
i
I
n
g
l
-D
a
o
ym
rie
l
y
n
l
o
F
i
o
/
l
p
Po
ch
im
ily
r
m
y
m
e
s
C
P
Fa
Un
Slide 18 of 19
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.”
www.datos.org
Selected
Studies
1-Year
Outcomes
Treatment
Services
& Process
Cocaine
Treatment
Selected
Web Posters
Adolescent
Studies
Cost Benefits of
MM Treatment
Readiness
for Treatment
Slide 19 of 19