Post on 05-Jan-2016
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Slide 1 of 19
National National Treatment Treatment
Retention Findings Retention Findings from DATOSfrom DATOS
Charts Prepared & Released for Public Use by Charts Prepared & Released for Public Use by Dwayne Simpson (TCU), Robert Hubbard (NDRI-NC), Dwayne Simpson (TCU), Robert Hubbard (NDRI-NC),
Douglas Anglin (UCLA), & Bennett Fletcher (NIDA)Douglas Anglin (UCLA), & Bennett Fletcher (NIDA)
Drug Abuse Treatment Drug Abuse Treatment Outcome StudiesOutcome Studies(Funded by NIDA)(Funded by NIDA)
Slide 2 of 19
DDrug rug AAbuse buse RReporting eporting PProgramrogramFirst National Evaluation of Treatment Effectiveness
Funded by the Funded by the National National
Institute on Institute on Drug AbuseDrug Abuse
Sells, Simpson, Demaree, & Joe Sells, Simpson, Demaree, & Joe 6 books & 150 papers published (funded 1970-19906 books & 150 papers published (funded 1970-1990))
1969-73
35 Cities
139 Programs
~44,000 Patients
All treatment types
Follow-ups: 1,3,6,12 Yrs
Slide 3 of 19
53
64
52
29
53
33
43 42
30
0
20
40
60
80
100
Daily Opioid Use: Daily Opioid Use: % in Year 1 After Discharge% in Year 1 After Discharge
0Days
(IntakeOnly)
1-30Days inDetoxOnly
1-3 3+Mos in
TherapeuticCommunity*
1-3 3+Mos in
OutpatientDrug-Free*
1-3 3-12 12+Mos in
MethadoneMaintenance*
*p<.01
ComparisonGroups Same for criminality !
N=3,248; Simpson & Sells, 1982 (AASA)
Slide 4 of 19
TTreatment reatment OOutcome utcome PProspective rospective SStudytudySecond National Evaluation of Treatment Effectiveness
Funded by the Funded by the National National
Institute on Institute on Drug AbuseDrug Abuse
Hubbard, Marsden, Rachal, Harwood, Cavanaugh, & Ginzburg, Hubbard, Marsden, Rachal, Harwood, Cavanaugh, & Ginzburg, Drug abuse treatment: A national study of effectivenessDrug abuse treatment: A national study of effectiveness (1989) (1989)
1979-81
10 Cities
37 Programs
~11,000 Patients
All treatment types
Follow-up: 1 year
Slide 5 of 19
““Treatment Process” in Treatment Process” in TOPSTOPS
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 modalitiesSimilar findings for other modalities
Joe, Simpson, & Hubbard, 1991 (J Sub Abuse)
Slide 6 of 19
DDrug rug AAbuse buse TTreatment reatment OOutcome utcome SStudiestudiesThird National Evaluation of Treatment Effectiveness
Over Over 40 Studies Published40 Studies Published – – Psychology of Addictive BehaviorsPsychology of Addictive Behaviors (Dec 97) (Dec 97)Drug and Alcohol DependenceDrug and Alcohol Dependence (Dec 99) (Dec 99) Archives of General PsychiatryArchives of General Psychiatry (June 99) (June 99)
Funded by the Funded by the National National
Institute on Institute on Drug AbuseDrug Abuse
1991-93
11 Cities
96 Programs
~10,000 Patients
All treatment types
Follow-up: 1 & 5 Yrs
Slide 7 of 19
Long-Term ResidentialLong-Term Residential (LTR)Treatment(LTR)Treatment
Changes from Before to After TreatmentChanges from Before to After Treatment
66
2217
6
40
19
41
16
88
77
24
13
0
20
40
60
80
100
Cocaine (Weekly)*
Heroin (Weekly)*
Heavy Alcohol*
Illegal Activity*
No FTWork*
SuicidalIdeation*
Pre Post
% of DATOS Sample (N=676)*p<.001
Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)
Slide 8 of 19
Outpatient Drug-FreeOutpatient Drug-Free (ODF) (ODF) TreatmentTreatment
Changes from Before to After TreatmentChanges from Before to After Treatment
42
1825
9
31
1522
14
8276
19
11
0
20
40
60
80
100
Cocaine (Weekly)*
Marijuana (Weekly)*
Heavy Alcohol*
Illegal Activity*
No FTWork*
SuicidalIdeation*
Pre Post
% of DATOS Sample (N=764)*p<.001
Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)
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42
22
89
28
15 16
29
14
85 82
1713
0
20
40
60
80
100
Cocaine (Weekly)*
Heroin (Weekly)*
Heavy Alcohol
Illegal Activity*
No FTWork
SuicidalIdeation
Pre Post
% of DATOS Sample (N=727)
Outpatient Methadone TreatmentOutpatient Methadone Treatment (OMT)(OMT)
Changes from Before to After TreatmentChanges from Before to After Treatment
*p<.001
Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)
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Average Average ExpectedExpected vs vs ObservedObserved Length of Stay by Patients Length of Stay by Patients (in (in
months)months)
96
24
3 3
12
Long-TermResidential
(n=17)
Outpatient Drug-Free
(n=14)
OutpatientMethadone
(n=10)
Observed (Median)Expected (Median)
Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)
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Patient Retention Rates for Patient Retention Rates for ProgramsPrograms
(beyond minimum “thresholds”)(beyond minimum “thresholds”)
65%75% 76%
21% 16% 15%
3+ Mos inLong-TermResidential
(n=17)
3+ Mos in Outpatient Drug-Free
(n=14)
12+ Mos inOutpatient
Methadone (n=10)
BestProgram
PoorestProgram
Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)
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Program Retention Rates in Program Retention Rates in LTRLTR(for 90 days or longer)(for 90 days or longer)
21
3133
4043 43 43 44
50 50 50
56 56 5759
6165
% of Admissions to 17 LTR Programs (with 40+ patients)
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Program Retention Rates in Program Retention Rates in ODFODF(for 90 days or longer)(for 90 days or longer)
1619
31
40 4144
51
56 57 5861
6769
75
% of Admissions to 14 ODF Programs (with 40+ patients)
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Program Retention Rates in Program Retention Rates in OMTOMT(for 360 days or longer)(for 360 days or longer)
1520
4246 47 49
5255
63
76
% of Admissions to 10 OMT Programs (with 40+ patients)
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Example from LTR in DATOSExample from LTR in DATOSExample from LTR in DATOSExample from LTR in DATOS
Retention Predicts Retention Predicts OutcomesOutcomes
Findings Consistent from National Studies1970s (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 ReviewsInstitute of Medicine (Gerstein & Harwood, ‘90)
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Comparison of Year 1 Comparison of Year 1 Outcomes Outcomes
by Length of Stay in by Length of Stay in LTRLTR
55
28
53
1915
9
54
24
0
20
40
60
80
100
Cocaine (Any Use)*
UA+ (Any Drug)*
Alcohol (Daily Use)*
Any Jail*
< 90 Days 90+ Days
% of Sample
*p<.001
N=342; Simpson, Joe, & Brown, 1997 (PAB)
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DATOS Programs with DATOS Programs with Lower Lower RetentionRetention had more “troubled” had more “troubled”
caseloads!caseloads!
Admissions to these programs had -
More cocaine & alcohol problems More previous treatments More psychological problems
But these patient problems did not explainall program differences in retention rates!
Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)
Slide 18 of 19
Patient Problems in Patient Problems in LTRLTR Programs Programs
6782
9686 86
75
41
6
42 33 4429
Highest %
Lowest %
Slide 19 of 19
Selected Studies
1-Year Outcomes
Treatment Services
& Process
CocaineTreatment
SelectedWeb Posters
AdolescentStudies
Cost Benefits ofMM Treatment
Readinessfor Treatment
News and FeaturesHome Page
About DATOS
Background
Highlights
Special Topics
Publications
Web Posters
What’s New
CONTENT
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.”
Latest DATOS studies have been published in Drug and Alcohol DependenceTreatment 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.
www.datos.orgwww.datos.org