Transcript Erianna Daliani - European Federation of Therapeutic Communities

Factors that Influence Retention in
Greek Therapeutic Communities
Erianna Daliani MSc
(Gerasimos Papanastasatos)
KETHEA Research Dept.
11th European Conference on Rehabilitation & Drug Policy
Why retention?

Retention in treatment has been the most consistent
and important predictor of post-treatment outcome

It is an index that captures the effect of the various
client characteristics, as well as that of different
treatment characteristics
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Previous research
Drug – and
alcohol related
problems
Psychiatric
problems (?)
Law
problems
Family/social
problems
Higher rates of
retention
Gender (?)
Employment
problems
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Aims of the present study



Investigation of the effect of type of treatment programme
on retention
Investigation of the effect of client characteristics on
retention
Investigation of their combined effect
Population & Sample

Population: Drug addicts that were admitted for
treatment in one of 9 Therapeutic Communities for adults (4
residential and 5 open care)

Sample: Clients that had completed EuropASI
questionnaire during intake
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Sample (a)
18.3%
.8%
16.2%
.5%
57.4%
6.8%
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Sample (b)
86.8%
men
Mean age:
26.6 years
Ν = 1496
70.8% in
residential
treatment
setting
29.2% in
intensive
outpatient
facility
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Data Collection
Personal interviews
Questionnaire: EuropASI, European modification of
the Addiction Severity Index
Duration: 01.01.2002 – 31.12.2005
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EuropASI summary indices –
Methodological issues
7 problem areas
2 summary indices for each area
Both indices combine quantitative information and
client’s subjective ratings of the current importance
of the problems and the need for treatment
Composite scores are calculated automatically based
on questions about the present that are subject to
change
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EuropASI summary indices –
Methodological issues
Severity ratings are established by the interviewers
after following a standard procedure. Existence and
severity of lifetime problems is taken into account
together with client’s present condition and need for
treatment
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Clients’ Profile – Lifetime and recent
problems in 7 areas
0,80
0,70
severity
com posite
0,67
0,60
0,50
0,47
0,43
0,40
0,36
0,30
0,32
0,20
0,22
0,21
0,10
0,34
0,28
0,26
0,26
0,33
0,21
0,12
*intercorrelations ≤ 0.3
0,00
medical
employment*
alcohol
drugs*
legal
family/social*
psychiatric
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Annual Retention
Outcomes of several follow up studies show that length of stay in
treatment is directly related to positive outcomes
Greek Therapeutic Communities, residential and open care,
expect clients to stay in treatment for 12 months in order to
complete it
After TC clients enter a less intensive, rehabilitation phase that
last for another 12 months
"Completers" are the clients who stay in treatment for at least 12
months, while "Dropouts" are the clients that leave the
therapeutic programme before they complete the one-year period
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Annual retention
100
90
81,50
80
74,30
69,10
64,80
70
60,60
56,80
60
53,70
51,40
48,60
50
45,60
44,20
42,00
40
30
20
10
0
0
30
60
90
120
150
180
210
240
270
300
330
360
retention (in days)
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Annual retention - type of treatment
100
87,9
90
83,5
79,4
80
76,2
72,8
78,8
71,2
70
68,9
67,3
64,1
70,4
61,3
60,4
64,9
60
58,8
60,2
residence
55,5
50
outpatient
50,8
47,5
40
44,9
42,2
39,1
37,5
30
35,1
20
10
0
0
30
60
90
120
150
180
210
240
270
300
330
360
retention (in days)
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Annual retention –
gender and type of treatment
100
90,9
90
85,5
87,4
77,8
80
85,3
70
83,6
83,6
81,8
80,0
80,0
80,0
76,4
83,2
70,3
71,3
60
74,5
74,5
74,5
78,8
65,1
75,1
71,5
60,0
63,6
60,8
men/ open care
69,9
67,3
55,5
62,3
47,7
45,0
49,7
46,2
40
women/ residence
65,4
51,0
55,9
50
men/ residence
42,7
59,4
39,7
44,1
58,4
38,2
women/ open care
56,5
35,8
39,2
35,0
30
32,9
30,8
20
10
0
0
30
60
90
120
150
180
210
240
270
300
330
360
retention (in days)
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Data analysis
Logistic regression was performed for annual retention as the
dependent variable and type of treatment, gender, age, number
of previous treatment episodes, EuropASI composite and severity
indices as independent variables (predictors)
Both composite (recent) and severity (lifetime) indices were used
since intercorrelations between them were not high in absolute
magnitude
Interactions between type of treatment and other predictors were
entered simultaneously to include the affect shown in annual
retention diagram
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Significant Predictors of Treatment
Completion
Beta
1,67
-1,31
-1,22
SE
0,43
0,39
0,30
df
1
1
1
Odds Ratio
5,33
0,27
0,29
Family/Social (composite) X treatment
type (open care) *
-1,14
0,62
1
0,32
Drugs(severity) by X treatment type (open
care) **
-1,99
0,82
1
0,14
Legal (severity) by X treatment type (open
care) **
-1,23
0,48
1
0,29
Family/Social (severity) X treatment type
(open care) **
1,30
0,61
1
3,66
Psychological (severity) by treatment type
(open care) **
1,75
0,70
1
5,75
Treatment type (open care) ***
Drug problems (composite)***
Psychological problems (severity)***
Interactions
•p<0.1
**p<0.05
***p<0.01
Main Effects
Type of treatment – clients in open care (outpatient intensive) are
more likely to complete treatment
Clients with heavier drug use during the period before admission
are more likely to dropout from treatment
Clients with more severe lifetime psychological problems are less
likely to stay for a year in treatment
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Investigating the interactions –
family/ social support and type of treatment
Family/ social relations and
support is an important
predictor for completion of
outpatient treatment
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Investigating the interactions –
drug problems and type of treatment
Severity of lifetime drug
use related problems is
always a predictor – more
so in outpatient
programmes
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Investigating the interactions –
legal problems and type of treatment
Severe legal problems are
related with dropout from
outpatient treatment
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Investigating the interactions –
psychological problems and type of treatment
Clients with medium – severe
psychological problems are
usually referred to outpatient
treatment – no statistical
difference between "dropouts“
and "completers“ (open care)
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Discussion (a)
More drug problems before admission are related with higher rates
of dropout, regardless of treatment setting. Further analysis will
determine the actual time of dropout
Outpatient settings are associated with higher treatment
completion rates. Residential clients tend to have more problems
than outpatient clients in most of the examined areas
Clients with more severe lifetime psychological problems are less
likely to stay for a year in treatment. This effect is stronger in
residential treatment.
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Discussion (b)
Gender factor was initially found to be important when combined with
type of treatment. This difference did not remain after we controlled
for problems’ severity
Previous studies have shown that family/ social problems are related
to lower rates of retention. In this study this effect was found to be
present only in outpatient treatment
Unlike other studies severity of legal problems was found to be
negatively related to treatment completion – this effect is more clear in
outpatient treatment
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Limitations & Issues for further research
Adequacy and consistency of EuropASI indices
Relation between former therapeutic experience and retention in
treatment
Investigate early – late dropout criteria
Retention is predictive of treatment related outcomes but there is need
for actually measuring these outcomes – FOLLOW UP study
Significance of interactions between clients characteristics and
treatment settings, stresses the importance of matching therapeutic
interventions to clients needs
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