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National Treatment Retention Findings from DATOS

Drug Abuse Treatment Outcome Studies (Funded by NIDA). DATOS. 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).

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National Treatment Retention Findings from DATOS

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  1. Drug Abuse Treatment Outcome Studies (Funded by NIDA) DATOS 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)

  2. Drug Abuse Reporting Program DARP First National Evaluation of Treatment Effectiveness 1969-73 35 Cities 139 Programs ~44,000 Patients All treatment types Follow-ups: 1,3,6,12 Yrs Funded by the National Institute on Drug Abuse Sells, Simpson, Demaree, & Joe 6 books & 150 papers published (funded 1970-1990)

  3. Daily Opioid Use: % in Year 1 After Discharge Comparison Groups Same for criminality ! 0 Days (Intake Only) 1-30 Days in Detox Only 1-3 3+ Mos in Outpatient Drug-Free* 1-3 3-12 12+ Mos in Methadone Maintenance* 1-3 3+ Mos in Therapeutic Community* *p<.01 N=3,248; Simpson & Sells, 1982 (AASA)

  4. Treatment Outcome Prospective Study TOPS Second National Evaluation of Treatment Effectiveness 1979-81 10 Cities 37 Programs ~11,000 Patients All treatment types Follow-up: 1 year Funded by the National Institute on Drug Abuse Hubbard, Marsden, Rachal, Harwood, Cavanaugh, & Ginzburg, Drug abuse treatment: A national study of effectiveness(1989)

  5. “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 Joe, Simpson, & Hubbard, 1991 (J Sub Abuse)

  6. Drug Abuse Treatment Outcome Studies DATOS Third National Evaluation of Treatment Effectiveness 1991-93 11 Cities 96 Programs ~10,000 Patients All treatment types Follow-up: 1 & 5 Yrs Funded by the National Institute on Drug Abuse Over 40 Studies Published – Psychology of Addictive Behaviors (Dec 97) Drug and Alcohol Dependence (Dec 99) Archives of General Psychiatry (June 99)

  7. Long-Term Residential (LTR)TreatmentChanges from Before to After Treatment *p<.001 % of DATOS Sample (N=676) Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)

  8. Outpatient Drug-Free (ODF) TreatmentChanges from Before to After Treatment *p<.001 % of DATOS Sample (N=764) Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)

  9. Outpatient Methadone Treatment (OMT)Changes from Before to After Treatment Program Variations in Retention? *p<.001 % of DATOS Sample (N=727) Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)

  10. Average Expected vs ObservedLength of Stay by Patients (in months) Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)

  11. Patient Retention Rates for Programs(beyond minimum “thresholds”) BestProgram PoorestProgram Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)

  12. Program Retention Rates in LTR(for 90 days or longer) % of Admissions to 17 LTR Programs (with 40+ patients)

  13. Program Retention Rates in ODF(for 90 days or longer) % of Admissions to 14 ODF Programs (with 40+ patients)

  14. Program Retention Rates in OMT(for 360 days or longer) % of Admissions to 10 OMT Programs (with 40+ patients)

  15. 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

  16. Comparison of Year 1 Outcomes by Length of Stay in LTR *p<.001 % of Sample N=342; Simpson, Joe, & Brown, 1997 (PAB)

  17. 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! Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)

  18. Patient Problems in LTR Programs Highest % Lowest %

  19. Selected Studies 1-Year Outcomes Treatment Services& Process Cocaine Treatment Selected Web Posters Adolescent Studies Cost Benefits of MM Treatment Readiness for Treatment News and Features Home Page About DATOS Background Highlights Special Topics Publications Web Posters What’s New CONTENT 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. More Information at 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

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