Dropout rates of in‐person psychosocial substance use disorder treatments: a systematic review and meta‐analysis

Abstract

Background and Aims Relapse rates for psychosocial substance use disorder (SUD) treatments are high, and dropout is a robust predictor of relapse. This study aimed to estimate average dropout rates of in-person psychosocial SUD treatments and to assess predictors of dropout. Design A comprehensive meta-analysis of dropout rates of studies of in-person psychosocial SUD treatment. Studies included randomized controlled trials (RCTs) and cohort studies. Setting Studies conducted anywhere in the world that examined SUD treatment and were published from 1965 to 2016, inclusive. Participants/casesOne hundred and fifty-one studies, 338 study arms and 299 dropout rates including 26 243 participants. Measurements Databases were searched for studies of SUD treatment that included an in-person psychosocial component. Meta-analyses and meta-regressions were conducted to estimate dropout rates and identify predictors of dropout, including participant characteristics, facilitator characteristics and treatment characteristics. Pooled estimates were calculated with random-effects analyses accounting for the hierarchical structure of study arms nested within studies. Findings The average dropout rate across all studies and study arms was 30.4% [95% confidence interval (CI) = 27.2-33.8 and 95% prediction interval (PI) = 6.25-74.15], with substantial heterogeneity (I 2 = 93.7%, P < 0.0001). Studies including a higher percentage of African Americans and lower-income individuals were associated with higher dropout rates. At intake, more cigarettes/day and a greater percentage of heroin use days were associated with lower dropout rates, whereas heavier cocaine use was associated with higher dropout rates. Dropout rates were highest for studies targeting cocaine, methamphetamines and major stimulants (broadly defined) and lowest for studies targeting alcohol, tobacco and heroin, although there were few studies on methamphetamines, major stimulants and heroin. Programs characterized by more treatment sessions and greater average session length were associated with higher dropout rates. Facilitator characteristics were not significantly associated with dropout. Conclusions On average, approximately 30% of participants drop out of in-person psychosocial SUD treatment studies, but there is wide variability. Dropout rates vary with the treated population, the substance being targeted, and the characteristics of the treatment.

Targeting the Barriers in the Substance Use Disorder Continuum of Care With Peer Recovery Support

“…54 It is extremely important to improve the rates of treatment retention and completion as it represents the achievement of personal recovery goals and is associated with reducing substance use, mortality and relapse while increasing quality of life and social functioning. 12,20,52,55 There are a number of factors that act as barriers to treatment retention. Having psychiatric co-morbidity is associated with not only higher odds of treatment dropout but also shorter stays in treatment.…”

“…[9][10][11] Unsuccessful outcomes of this model identified at different stages-such as difficulty engaging in treatment, lack of referral to the next step in the continuum of care, high rates of treatment dropout and relapse, and disconnection from post-treatment services-demonstrate the need to shift from the acute care model to a chronic care model of SUD treatment and to better integrate services across treatment modalities. 7,8,12 Recognizing this long-standing treatment gap, recent calls have been made to develop a comprehensive SUD prevention and care continuum as a tool to monitor and evaluate the effectiveness and quality of healthcare delivery by estimating the proportion of people progressing over time through sequential steps along a continuum. 13,14 A similar cascade of care for HIV was successfully developed and applied to track people from the moment they are diagnosed with HIV to achieving sustained viral suppression, highlighting the main gaps in healthcare along the way.…”

Effects of Acute Exercise on Drug Craving, Self-Esteem, Mood, and Affect in Adults with Polysubstance Use Disorder: Protocol for a Multicenter Randomized Controlled Trial

“…Dropout rates from treatment studies of SUDs are often high [ 6 , 28 ]. To minimize the risk of dropout, a member of the research group visited the treatment center 1 week before the study to answer questions.…”

“…Although documented as effective, these methods do not help all patients. Relapse rates range between 40% and 60% [ 5 ], and dropout rates from in-patient treatment is around 30% [ 6 ].…”

Validation of a three-item Fatigue Severity Scale for patients with substance use disorder: a cohort study from Norway for the period 2016-2020

“…Patients with SUDs often live in a chaotic situation with extensive medical and psychosocial health challenges, including polysubstance use, substance intoxications and withdrawals, psychiatric comorbidities (e.g., attention de cit hyperactivity disorder, psychosis disorders, or personality disorders), chronic viral hepatitis, nancial risk, and temporary living situations [7,8]. This might make surveying fatigue with questionnaires particularly challenging and might in uence the patients' fatigue experiences and how they respond to questionnaires [9][10][11]. Using simple wording and phrases, avoiding the use of questions which differ in subtle ways which make them appear repetitive, and administering measures that produce reliable and valid scores based on very few questions, might be essential to ensuring reliable results in clinical trials on fatigue in this population.…”