Do Drug Treatment Facilities Increase Clients’ Exposure to Potential Neighborhood-Level Triggers for Relapse? A Small-Area Assessment of a Large, Public Treatment System

Abstract

Research on drug treatment facility locations has focused narrowly on the issue of geographic proximity to clients. We argue that neighborhood conditions should also enter into the facility location decision and illustrate a formal assessment of neighborhood conditions at facilities in a large, metropolitan area, taking into account conditions clients already face at home. We discuss choice and construction of smallarea measures relevant to the drug treatment context, including drug activity, disadvantage, and violence as well as statistical comparisons of clients`home and treatment locations with respect to these measures. Analysis of 22,707 clients discharged from 494 community-based outpatient and residential treatment facilities that received public funds during 1998-2000 in Los Angeles County revealed no significant mean differences between home and treatment neighborhoods. However, up to 20% of clients are exposed to markedly higher levels of disadvantage, violence, or drug activity where they attend treatment than where they live, suggesting that it is not uncommon for treatment locations to increase clients`exposure to potential environmental triggers for relapse. Whereas on average both home and treatment locations exhibit higher levels of these measures than the household locations of the general population, substantial variability in public treatment clients`home neighborhoods calls into question the notion that they hail exclusively from poor, high drug activity areas. Shortcomings of measures available for neighborhood assessment of treatment locations and implications of the findings for other areas of treatment research are also discussed.

A Multilevel Analysis of Regional and Individual Effects on Methadone Maintenance Treatment in Taiwan

“…In addition, Saxe et al [14] indicated that visible drug sales in poor neighborhoods presented a more serious problem than drug use. Few studies have identified neighborhood environment as a factor associated with treatment outcomes [15,16,27]. The findings in this study are consistent with a study by Jacobson [27], who determined that the location of drug treatment facilities might increase client exposure to potential environmental relapse triggers, including neighborhood disadvantage, violence, and drug activity.…”

“…Few studies have identified neighborhood environment as a factor associated with treatment outcomes [15,16,27]. The findings in this study are consistent with a study by Jacobson [27], who determined that the location of drug treatment facilities might increase client exposure to potential environmental relapse triggers, including neighborhood disadvantage, violence, and drug activity. In addition, this study is partly consistent with that of Stahler et al [16] that determined that participants living in areas of higher education had a reduced likelihood of readmission.…”

“…Jacobson [27] and Stahler et al [16] both used bivariate analysis or traditional regression to handle confusion-induced bias of neighborhood-level effect caused by neglecting the individual-level characteristics. Furthermore, the mechanisms underlying the decreased OTI improvement score of disadvantaged regions remain unclear.…”

New Directions in Community Supervision: Should We Target High Risk Offenders, High Risk Times, and High Risk Locations?

“…A number of recent research studies have focused on the impact of community resource availability, quality, and location on the behavior of offenders under community supervision (Morenoff and Harding, 2011;Mears and Bhati, 2006;Jacobson, 2006;Byrne and Taxman, 2006;and Clear, 2007). Such strategies appear to be consistent with the view that you cannot change offenders unless you change the communities (e.g.…”

Where is the ‘Where?’ in Considerations of Treatment for Drug Abuse?

“…1 In this issue of the Journal of Urban Health, Jacobson extends conceptual thinking about contextual factors that may influence drug treatment retention 2 and undertakes the first quantitative exploration assessing Bappropriateness[ of treatment locations. 3 In the study, Jacobson identifies neighborhood-level disadvantage, violence and victimization, and drug activity as elements with likely influence on treatment attrition. To do this, he compared measures of these factors for public treatment facility locales in the city of Los Angeles with those for the residential neighborhoods of the patients enrolled in treatment.…”