NDARC Technical Report No. 316 (2010)
One of the key predictors of treatment outcome is retention in treatment. Previous research, however, has produced inconsistent results when examining factors that might influence treatment retention and completion in drug and alcohol treatment services. One argument has been that these mixed results have been produced by research that has attempted to combine different services and different types of clients into one group, when there is a great amount of variability. The current research was undertaken to examine client characteristics that might influence retention and completion in residential drug-free services and residential opioid-based treatment services.
A sample of 249 clients were recruited from We Help Ourselves (WHOS) Sydney-based therapeutic community (TC) treatment services. One-hundred and ninety-one were from the drug-free services and fifty eight clients were recruited from the opioid-based services. Clients completed a face-to-face interview that asked about demographics, criminal history, lifetime and current drug use, mental health history and current mental health, and readiness to change. Treatment cessation data was collected on clients once they had left the service.
The mean age of entrants in the WHOS services was early to mid-thirties, and approximately two-thirds were male. Mean years of education was approximately 10 years. Just over half had not completed any tertiary education. The vast majority were receiving their main source of income from a temporary benefit. One-third of clients from the drug-free services and two-thirds of clients from the opioid-based services reported that they had ever been in prison. A lifetime of heavy and poly drug use was evident in clients from both services. Over half of the total sample had ever been diagnosed with a mental health problem and the present study found that there were extremely high rates of psychopathology amongst the clients at the time of their admission.
Treatment completion and early drop-out
High proportions of clients from both the drug-free TC services and the opioid-based services completed treatment. Very early drop-out was confined to a minority, and was almost non-existent in the opioid-based TC services.
Effect of mental health on treatment completion and early drop-out
There were high rates of psychopathology at admission into treatment for both clients in the drug-free and opioid-based services. Despite this, the current study found that there were very limited results with regards to the effect of mental health on treatment completion and early drop-out. Whilst there was no effect of mental health on treatment completion or early drop-out rates amongst the drug-free services, there was some inconsistent results found amongst the opioid-based clients. A lifetime diagnosis of a mental health problem was associated with a higher likelihood of completion; on the other hand, a diagnosis of Borderline Personality Disorder was associated with a lower likelihood of completion. Based on the previous research in this area, it should not be assumed that psychopathology equates to a poorer treatment outcome.
Effect of other client characteristics on treatment completion and early drop-out
The current study found that there was a limited effect of other client characteristics on treatment completion and early drop-out. This is consistent with previous research. In the drug-free services, early drop-out was associated with recently being released from prison and a perception of being less likely to complete treatment. Those that completed treatment in the drug-free client group were more likely to be male and had a lower number of stressful life events. Across the opioid-based clients there were no predictors of treatment completion and only two clients dropped out of treatment within the first week. There was no consistency within the drug-free services between characteristics that predicted early drop-out and treatment completion, suggesting that there are many factors associated with retention and treatment completion and they may come into play throughout different stages of treatment.
The current study found that there was no effect of past, current, frequency or quantity of drug use on treatment retention. WHOS is a non-drug-specific treatment service, and these findings support the effectiveness of the services to provide consistent treatment to clients with a wide range of drug and alcohol and associated issues.
Differences between gender
There were differences between the males and females from the drug-free services, but not from the opioid-based services. Women were more likely to have a university degree, were more likely to have ever engaged in sex work, less likely to have a prison history, and were suffering from more severe mental health problems. Women in the drug-free service also had lower completion rates than the males. There were very few differences amongst the males and females from the opioid-based services, suggesting that they were a more homogenous group.
The major finding was that psychopathology had no relation to either treatment completion or early drop-out in the drug-free services, and only a limited effect in the opioid-based services. Clients with psychopathology should be not be seen as treatment “risks”. A continued non-discriminatory and non-judgmental approach to new admissions, and an equal effort applied to each new admit, is the best practice, which has been the basis of the TC approach for many decades.
Citation: Campbell, G., Darke, S. and Popple, G. (2010) Effects of client characteristics and mental health on treatment completion and retention in a therapeutic community, Sydney: National Drug and Alcohol Research Centre.