Facilitating outpatient treatment entry following detoxification for injection drug use: A multisite test of three interventions.

Abstract

A multisite, randomized trial within the National Drug Abuse Treatment Clinical Trials Network (CTN) was conducted to test three interventions to enhance treatment initiation following detoxification: 1) a single session, therapeutic alliance intervention (TA) added to usual treatment, 2) a 2-session, counseling and education, HIV/HCV risk reduction intervention (C&E), added to usual treatment and 3) treatment as usual (TAU) only. Injection drug users (n = 632) enrolled in residential detoxification at 8 community treatment programs were randomized to 1 of the 3 study conditions. There was a significant difference between TA participants and those receiving TAU in reported outpatient treatment entry. TA participants reported entering outpatient treatment sooner and in greater numbers than TAU participants. Reported treatment entry for C&E fell between TA and TAU with no significant differences between C&E and the other conditions. There were no differences among the interventions in retention, as measured by weeks of outpatient treatment for all participants who reported treatment entry. Alliance building interventions appear to be effective in facilitating transfer from detoxification to outpatient treatment, but additional treatment engagement interventions may be necessary to improve retention.Correspondence concerning this article should be addressed to Barbara K. Campbell, Oregon/Hawaii Node - CTN, 1942 (Gerstein et al., 1994;Hubbard, Craddock, Flynn, Anderson & Etheridge, 1997;Hubbard et al., 1989;Sells & Simpson, 1976;Simpson, Joe & Brown, 1997;Sorenson & Copeland, 2000). Most patients leaving detoxification report plans to enter some form of treatment (Tuten, Jones, Lertch & Stitzer, 2007). Research consistently shows, however, that many do not follow through. Lundgren, Sullivan and Amodeo (2006), for example, analyzed data for injection drug users with multiple treatment admissions in Massachusetts from 1997 through 2001; the most common treatment pattern (30%) was repeated admissions to detoxification only. reported that 43% of heroin and cocaine addicted patients received no treatment in the 30 days following detoxification. Similarly, Chutuape, Jasinski, Fingerhood and Stitzer (2001) followed patients for six months following a 3-day, inpatient detoxification for opiates; most (59%) had no formal treatment during the follow-up period. Only 26% of patients in a 21-day inpatient publicly-funded detoxification center transferred to residential or outpatient treatment following discharge (McCusker, Bigelow, Luippold, Zorn & Lewis, 1995). Finally, national hospital data suggest that the percentage of patients receiving inpatient or residential treatment following detoxification dropped from 38.9% to 21.1% between 1992(Mark, Dilonardo, Chalk &Coffey, 2002.Patients who enter treatment following detoxification have consistently better outcomes. Heroin users engaged in formal treatment for a minimum of seven days during the six months following detoxification reported significantly reduced drug us...

Alcohol detoxification completion, acceptance of referral to substance abuse treatment, and entry into substance abuse treatment among Alaska Native people

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