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Essential Elements of TCS

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					                       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

                                                    1969-73
Funded by the                                      35 Cities
  National
                                                139 Programs
 Institute on
                                               ~44,000 Patients
 Drug Abuse
                                             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
      Comparison
 80     Groups                   Same for criminality !
              64

 60   53                   52           53
                                                      43 42
 40                                          33               30
                                29


 20


  0
     0       1-30        1-3 3+         1-3 3+       1-3 3-12 12+
   Days     Days in       Mos in         Mos in          Mos in
  (Intake    Detox      Therapeutic    Outpatient      Methadone
   Only)     Only       Community*     Drug-Free*     Maintenance*
                                                        *p<.01
                                                                     Slide 3 of 19
             N=3,248; Simpson & Sells, 1982 (AASA)
  Treatment Outcome Prospective Study
  Second National Evaluation of Treatment Effectiveness

                                                         1979-81
Funded by the                                           10 Cities
  National
                                                      37 Programs
 Institute on
                                                   ~11,000 Patients
 Drug Abuse
                                                  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

                                                     1991-93
Funded by the                                       11 Cities
  National
                                                  96 Programs
 Institute on
                                               ~10,000 Patients
 Drug Abuse
                                              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

                                  40          41
 40
               22                                                    24
                       17              19          16
 20                                                                       13
                            6

  0
       Cocaine       Heroin      Heavy      Illegal     No FT       Suicidal
       (Weekly)*    (Weekly)*   Alcohol*    Activity*   Work*      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                                                    19
                                       15           14
 20                                                                       11
                            9

  0
       Cocaine      Marijuana    Heavy      Illegal      No FT      Suicidal
       (Weekly)*    (Weekly)*   Alcohol*    Activity*    Work*     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        Post
                         89
                                                            85   82
  80


  60
            42

  40                                              29
                              28
                 22
                                     15   16                            17
  20                                                   14                    13


   0
         Cocaine       Heroin      Heavy        Illegal     No FT     Suicidal
         (Weekly)*    (Weekly)*    Alcohol      Activity*   Work      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)                    24




               9                                      12
                                     6

           3                     3
    Long-Term             Outpatient           Outpatient
    Residential           Drug-Free            Methadone
      (n=17)               (n=14)                (n=10)

                                                                 Slide 10 of 19
  Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)
Patient Retention Rates for Programs
     (beyond minimum “thresholds”)


  Best                              75%                 76%
Program          65%


Poorest
               21%                 16%                 15%
Program
           3+ Mos in           3+ Mos in          12+ Mos in
           Long-Term           Outpatient          Outpatient
           Residential         Drug-Free          Methadone
             (n=17)              (n=14)             (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
                                                                            61
                                                                       59
                                                        56   56   57
                                         50   50   50
                     43   43   43   44
                40
           33
      31

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
                                                             69
                                                        67
                                                   61
                                         57   58
                                    56
                               51
                          44
                40   41

           31


      19
 16




  % 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

                                         55
                                   52
                             49
                  46   47
            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

         55             53                                 54
 60


 40           28
                                                                   24
                              19
                                        15
 20                                           9

  0
       Cocaine         UA+           Alcohol         Any Jail*
      (Any Use)*   (Any Drug)*     (Daily Use)*          *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                                     86               86
Highest %              67                                                                                     75


Lowest %
                   41                                 42                  33                   44
                                                                                                          29
                                       6
                   l               g                 l                 l                   s              t
            oh
               o
                            Dr
                               u
                                            l Inv                 g ica               iend           m en
       Alc             oly
                          -
                                         ina            h   olo               y/F
                                                                                  r
                                                                                              plo
                                                                                                    y
                   P               i   m             yc               i   l
                              Cr                   s               am                      em
                                               P              F                       Un
                                                                                                                   Slide 18 of 19
Home Page        News and Features
About DATOS      Latest DATOS studies have
Background       been published in Drug and
                                                                                 Selected
Highlights       Alcohol Dependence                                              Studies
                 Treatment process (engagement and participation),
                                                                                   1-Year
Special Topics   retention, and outcomes are the focus of this series of
                 studies, and our first cost-benefit analysis addresses           Outcomes
                 cocaine treatment. The latest DATOS publications and "in
Publications     press" are listed on the Publications page.                      Treatment
                                                                                   Services
Web Posters                                                                       & Process
                 Cocaine Treatment Outcome
What’s New       Study is Released                                                 Cocaine
                                                                                  Treatment
                 (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       Selected
CONTENT          least 90 days in intensive residential (TC) programs was      Web Posters
                 indicated for high-severity cases. More information is
                 provided in a new section of Highlights page, "Outcomes for      Adolescent
                 Treatment of Cocaine Dependence.”                                 Studies

                                                                                Cost Benefits of
                                                                                 MM Treatment

                 www.datos.org                                                     Readiness
                                                                                 for Treatment
                                                                                                   Slide 19 of 19

				
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