A Two‐Rate Hypothesis for Patterns of Retention in Psychosocial Treatments of Cocaine Dependence: Findings from a Study of African‐American Men and a Review of the Published Data

Abstract

In this article, we examine patterns of retention in psychosocial treatment programs for cocaine dependence. We present new data from a comparison trial of Drug Counseling and Supportive-Expressive Psychotherapy and review published data from all studies utilizing psychosocial interventions alone. We compared Drug Counseling and Psychotherapy on rates of pretreatment and during-treatment attrition in a sample of 294 African-American men seeking treatment for cocaine dependence (mean age, 37.6). Survival analyses were utilized to identify significant differences in during-treatment attrition between the two treatments and to identify significant changes in the rate of attrition during the course of each treatment. We then compared the patterns of retention in this study with those from other available published reports of psychosocial treatments for cocaine abuse. The weekly during-treatment attrition rate was not constant in either treatment condition, and the change in rate of attrition occurred at week six for both Drug Counseling and Psychotherapy. Comparison with other studies suggested that the during-treatment pattern of attrition among most psychosocial treatments for cocaine abuse is typified by two rates, with the rate of subject attrition early in treatment being greater than the rate of later attrition and also exhibiting greater variance. Future studies of treatment retention should identify significant shifts in the rate of during-treatment attrition, examine if the pattern of attrition is typified by two rates, and, if so, determine where the shift occurs. Future studies should also assess if changes in the rate of during-treatment attrition signal the timeframes within which strategies that enhance retention can be implemented in the treatment program.

Examining attrition rates at one specialty addiction treatment provider in the United States: a case study using a retrospective chart review

“…[ 32 ] Multiple Assessment 372 56% 44% Pinto et al, 2011* [ 33 ] 7 Assessment 286 70% 30% Resko & Mendoza, 2012* [ 34 ] 7 Assessment 340 82% 18% Molfenter, 2013+ [ 35 ] 67 Assessment ? 63% 37% Pena et al, 1999 (lit review) [ 26 ] 22 studies Assessment ? 73% 27% Assessment weighted mean 56% 44% Assessment un-weighted mean 67% 33% *= randomized clinical trial – secondary analysis; !…”

“…Publications are listed in ascending order based on publication year within the two categories of IRS and assessment. Pena et al’s [ 26 ] literature review of show rates after assessment is listed at the bottom of the Table, but excluded from the calculation of show/no-show rates. Molfenter [ 35 ] did not provide a sample size, so the study was included only in the un-weighted mean estimation.…”