Overview of Treatment Engagement Findings from DATOS

Transcription

1 Drug Abuse Outcome Studies (Funded by NIDA) Overview of Engagement 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 13 Drug Abuse Outcome Studies Third National Evaluation of Effectiveness Funded by the National Institute on Drug Abuse 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 2 of 13 Simpson, Hubbard, Anglin, & Fletcher 1

2 Conceptual Model for Evaluating Program Effects Patient Attributes (History) Program Attributes (Resources) Program Services and Retention Outcomes LTR Programs? Slide 3 of 13 Long-Term Residential (LTR) Changes from Before to After Pre Post Cocaine (Weekly)* Heroin (Weekly)* Heavy Alcohol* Illegal Activity* No FT Work* Suicidal Ideation* % of DATOS Sample (N=676) *p<.001 Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997, PAB Slide 4 of 13 Simpson, Hubbard, Anglin, & Fletcher 2

3 Comparison of Year 1 Outcomes by Length of Stay in LTR 100 < 90 Days 90+ Days Cocaine (Any Use)* UA+ (Any Drug)* Alcohol (Daily Use)* Any Jail* *p<.001 % of Sample N=342; Simpson, Joe, & Brown, 1997, PAB Slide 5 of 13 Predictors of Retention in LTR (based on posttreatment interviews) Relationship w/ counselor During Attending education classes Days Aftercare (12-steps) Similar findings in other modalities! Satisfaction w/ program Simpson, Joe, & Brown, 1997, PAB Slide 6 of 13 Simpson, Hubbard, Anglin, & Fletcher 3

4 Motivation & Retention in LTR Client Predictors Motivation Older Never married Alcohol problem Employed Legally involved Fewer arrests Stages Problem Recognition Desire for Help Readiness 90+ Days Intake Joe, Simpson, & Broome, 1998, Addiction Slide 7 of 13 Motivation & Retention in LTR Readiness (at Intake) Similar findings in ODF & OMT Each based on 5-item composites Commitment Confidence Rapport Therapeutic Involvement in Months 1 & 3 Joe, Simpson, & Broome, 1998, Addiction Slide 8 of 13 Simpson, Hubbard, Anglin, & Fletcher 4

5 Process Model for Time in LTR (Structural equation modeling) Previous Trt Depression Cocaine Prob Motivation (Trt Readiness) Hostility - - Frequency & Focus Session Attributes Therapeutic Involvement Client Ratings of Rapport Confidence Commitment Pretreatment Months 1-2 Retention (90+ days) Joe, Simpson, & Broome, 1999, Drug & Alcohol Dependence Slide 9 of 13 Process Model: Client & Program Predictors Hierarchical Linear Modeling (HLM) Session Attendance (Mos 1-3) Client Ratings Rapport w/ Counselor (Mo 1) Readiness Client factors Trt Confidence (Mo 3) Trt Commitment (Mo 3) 2/3 1/3 Program factors Referred services Missed sessions Diversity of needs LTR ODF OMT Broome, Simpson, & Joe, 1999, Drug & Alcohol Dependence Slide 10 of 13 Simpson, Hubbard, Anglin, & Fletcher 5

6 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 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 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 of Cocaine Dependence. Selected Studies 1-Year Outcomes Services & Process Cocaine Selected Web Posters Adolescent Studies Cost Benefits of MM Readiness for Slide 11 of 13 TCU Process Model Induction Enhanced Counseling Family & Friends Personal Health Services Motiv Patient Attributes at Intake Early Engagement Therapeutic Relationship Early Recovery Behavioral Compliance Supportive Networks Counselor Attributes & Skills Program Characteristics Program Participation Psychological Improvement Sufficient Retention Drug Use Crime Social Adj Posttreatment Behavioral Strategies Social Skills Training Social Support Services Slide 12 of 13 Simpson, Hubbard, Anglin, & Fletcher 6

7 IBR HOME PAGE WHAT S NEW ABOUT IBR STAFF PROJECTS NEWSLETTERS PUBLICATIONS WEB POSTERS MANUALS FORMS OTHER LINKS SITE GUIDES: Search Contents Site map DATOS TCU Process Model now available for downloading Counseling Manuals now have sample chapters to download TCU Assessment Forms are re-organized for easier downloading by users Features: Animated slide presentations IBR Research Summaries highlight special topics Research Current Summary issue of Research Roundup Research Roundup Publication lists Data 10 Collection most popular TCU Instruments forms for downloading Slide 13 of 13 Simpson, Hubbard, Anglin, & Fletcher 7