Predictors of Retention in the ‘Voluntary’ and ‘Quasi-Compulsory’ Treatment of Substance Dependence in Europe

Abstract

Background: Policies and practices related to the quasi-compulsory treatment (QCT) of substance-dependent offenders are currently implemented in many countries, despite the absence of reliable knowledge about significant predictors of treatment retention. This study aimed to identify such predictors in QCT and voluntary treatment. Methods: Participants were treated in one of 65 institutions in 5 European countries. They were interviewed at intake on substance use, crimes committed, perceived pressure for treatment, self-efficacy, stage of change, employment, and health-related variables. Binary logistic regression models were computed to identify predictors of treatment retention at an 18-month follow-up. Moderator analyses were computed to investigate whether these predictors vary by treatment condition (QCT vs. voluntary). Results: A higher number of working days in the previous month was positively associated with treatment retention, while use of heroin, crack, and multiple drugs, psychiatric problems in the previous month, and lifetime depression were negatively associated with treatment retention. Higher perceived medical pressure resulted in higher treatment retention rates only for participants in QCT. Conclusion:Predictors of substance abuse treatment retention are quite similar across both QCT and voluntary treatments. Perceived medical pressure is of higher relevance than the often-believed legal pressure for treatment retention in QCT.

Treatment Attendance Among Veterans With Depression, Substance Use Disorder, and Trauma

“…Session attendance was similar to our prior treatment study with adults with co-occurring depression and substance use disorders who received group-delivered sessions in both phases of treatment (Drapkin et al, 2008). In general, the low rates of attendance found in our study were consistent with previous research that has found attrition to be a significant barrier to mental health treatment (Dutra et al, 2008; Curran et al, 2002; Schaub et al, 2011; Roberts et al, 2015; Spinazzola et al, 2005). …”

“…A number of psychotherapy studies including our prior treatment study have found that predisposing factors of younger age, minority status, and polysubstance use were associated with lower treatment retention (Barrett et al, 2008; Schaub et al, 2011; Tate et al, 2011) and several addictions studies had similar findings with regard to predisposing factors of being female, having less years of education, and having cognitive impairments (Aharonovich et al, 2006; Brady, Dansky, Back, Foa, & Carroll, 2001; Sayre et al, 2002). Our study did not find any other predisposing factors including age, ethnicity, and type of substance use disorder to be associated with treatment attendance.…”

“…Previous therapy studies have found that experiencing more severe depression was negatively associated with depression treatment retention (Bech et al, 2003) and experiencing depression and polysubstance abuse was negatively associated with substance use treatment retention (Schaub et al, 2011). Our previous treatment study found that physical health problems were associated with increased retention (Tate et al, 2011) and Bech et al in their 2003 substance use study found that having a comorbid medical condition was associated with increased retention.…”

“…Attrition rates are high in substance use treatments (Dutra et al, 2008), with greater attrition associated with comorbid depression (Curran, Kirchner, Worley, Rookey, & Booth, 2002; Schaub et al, 2011) and PTSD (Roberts, Roberts, Jones, & Bisson, 2015; Spinazzola, Blaustein, & van der Kolk, 2005). Importantly, treatment attendance is a predictor of positive post-treatment outcomes (Dale et al, 2011; Hansen, Lambert, & Forman, 2002, Reardon, Cukrowicz, Reeves, & Joiner, 2002).…”

Mandatory addiction treatment for people who use drugs: global health and human rights analysis: Table

“…51 However, when people are ready to change and perceive a medical necessity, and effective therapies are accessible, they see a stronger incentive to engage and remain in treatment than through legal pressure. 52 Efficient coordination between treatment providers and police or courts can facilitate better access to treatment and improve outcomes. 53 In recent years, several Asian countries have begun moving to voluntary centres providing comprehensive evidence based treatment and support services.…”