Attrition from treatment for substance abuse disorders (SUD) is a persistent challenge that severely limits the effectiveness of services. Though a large body of research has sought to identify predictors of retention, the perspective of clients of services is rarely examined. This exploratory qualitative study presents clients’ stated reasons for leaving outpatient treatment (N = 135, 54% of the sample of 250) and their views of what could have been done differently to keep them engaged in services. Obstacles to retention fell into program- and individual-level factors; the former includes dissatisfaction with the program, especially counselors, unmet social services needs, and lack of flexibility in scheduling; individual-level barriers to retention were low problem recognition and substance use. Study limitations are noted and the implications of findings for research and practice are discussed, emphasizing the need to understand and address clients’ needs and expectations starting at intake to maximize treatment retention and the likelihood of positive outcomes.

Rates of return to active substance use after addiction treatment tend to be high; participation in 12-step fellowships (e.g., Alcoholics Anonymous) reduces relapse rates but many clients do not attend or attend for a short period only. This quasi-experimental study uses repeated measurement to explore the role of presence/absence of onsite 12-step meetings during treatment on post-treatment outcomes. Polysubstance-dependent clients (N = 219) recruited at a program with and one without 12-step onsite, were followed for one year post-treatment. Onsite 12-step enhanced 12-step attendance, especially during treatment, and predicted continuous abstinence for the post treatment year. Holding 12-step meetings onsite is a low-cost strategy that programs should consider to foster post-treatment remission maintenance. Keywords 12-step; treatment; recovery; self-helpSubstance use disorders (SUD) are conceptualized as chronic (e.g., McLellan, Lewis, O'Brien, C., and Kleber, 2000); the chronicity of SUD is empirically supported by findings on addiction and treatment 'career' indicating that most SUD-affected individuals, especially those with severe dependence, make multiple attempts at remission often involving several treatment episodes prior to resolving their alcohol or drug dependence (e.g., Dennis, Scott, Funk, and Foss, 2005;Hser, Anglin, Grella, Longshore and Prendergast, 1997; Laudet, Stanick, Carway, and Sands, 2004). Because of the multiple costs of long chronic addiction 'careers' that include the acquisition/transmission of infectious diseases (e.g., HIV, HepC), deterioration in mental and physical health and other functioning impairments (e.g., Smith and Larson, 2003), it is critical to identify strategies that contribute to sustaining remission, thus shortening addition careers and resulting nefarious effects to the individual and to society. A number of therapeutic modalities have proven effective at addressing drug and alcohol dependence and improving related functioning but treatment gains are often short lived (Hser, Grella, Hsieh and Anglin, 1999). Participation in post-treatment 'stepped down' continuing (or after) care is associated with sustained treatment gains (McKay, Alterman, Cacciola, Rutherford and O'Brien, 1997;Mckay 2001). In the currently austere fiscal context of health services provision, few drug and alcohol treatment programs offer continuing care, NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript especially following outpatient treatment, the most prevalent treatment modality in the US. Twelve-step fellowships such as Alcoholics and Narcotics Anonymous are the most frequently used form of aftercare in the United States (Tonigan, Toscova, and Miller, 1996). Twelve-step fellowships are particularly well-suited to provide ongoing recovery support from chronic substance abuse and dependence because, unlike formal services that are limited in time, these groups are widely and consistently available throughout the US and free of charge. As with treatment, 12-st...

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It has been postulated that many alcoholics use alcohol to "self-mediate" symptoms of anxiety or panic. Early diagnosis and treatment in this population are both complicated by symptoms of alcohol withdrawal and controversial because of the belief that alcoholics will abuse anxiolytics. The authors present three patients with alcoholism in whom diagnosis of panic was facilitated by intravenous lactate infusion, and whose symptoms were alleviated by clonazepam. All three patients were able to maintain sobriety during treatment. The authors conclude that in a subpopulation of alcoholics, pharmacotherapy for panic may be indicated and not lead to anxiolytic abuse.