Retention of Cocaine Abusers in Outpatient Psychotherapy

Abstract

Retention in outpatient psychotherapy of 148 crack and cocaine abusers was examined. The clients were predominantly Black (63%) and Hispanic (21%), predominantly male (87%), and the majority (66%) had completed no more than 12 years of high school. Clients entered treatment in a low-cost treatment center in New York City between June 1987 and November 1988. Forty-two percent (62) of the subjects were seen for one or two research interviews only, and did not return to begin therapy. Of the 86 persons who came to at least one therapy session, 30% (26) dropped out before the third session, 28% (24) dropped out between the third and fifth sessions, and 42% (36) were retained for six or more sessions. Short-term and longer-term retentions were analyzed separately, using a battery including sociodemographic variables, treatment history, psychiatric symptomatology, number of arrests, and drug use variables. None of the variables considered was significantly related to short-term retention. There were large although not significant differences in longer term retention by therapist. Longer-term retention was associated significantly with being White (contrasted with being Black) and being young. Nonsignificant but large associations were found between longer-term retention and having few arrests, being Hispanic (contrasted with being Black), and having low SCL-90 scores. Results are compared with previous findings about retention in drug and alcohol treatment. It is suggested that future research on retention in treatment focus less on client variables and more on therapist and program variables.

Mental health problems: Are they or are they not a risk factor for dropout from drug treatment? A systematic review of the evidence

“…Two studies found that retention was better for depressed clients (Martinez-Raga et al 2002;Gerra et al 2006) and three others found that depression was related to dropout (Kleinman et al 1992;Kokkevi et al 1998;Curran et al 2002). However, Curran et al's study makes a useful distinction between severity of depression: whilst severe depression was related to treatment tenure, mild depression was not.…”

Distress Tolerance as a Predictor of Early Treatment Dropout in a Residential Substance Abuse Treatment Facility.

“…Quinn et al (1996) and Brandon et al (2003) found smoking severity to be significantly related to early lapse among smokers. Additionally, previous work has implicated substance use severity in substance abuse treatment dropout (Kleinman et al, 1992;Stark, 1992). Thus, individuals with more severe levels of substance dependence may have experienced greater difficulty with both the challenge tasks and remaining in treatment due to the long-term effects of more severe substance abuse (e.g., neurological, psychological; Saunders & Brady, 2002).…”

“…However, a number of studies have reported no association between age and the likelihood of completing treatment (Claus, Kindleberger, & Dugan, 2002;Robinson & Little, 1982), making it difficult to draw definitive conclusions regarding age and treatment dropout. Race/ethnicity While some studies have reported that race has little effect on treatment dropout (McFarlain, Cohen, Yoder, & Guidry, 1977;Raynes & Patch, 1973;Sells, Chatham, & Joe, 1972), it has been suggested that Caucasians have higher completion rates than African Americans and Hispanics (Kleinman, Kang, Lipton, & Woody, 1992). In the majority of studies reporting differences in race/ethnicity, the role of race/ethnicity in dropout is not a primary aim, making it unclear from the results that these differences were not confounded by age, employment levels, or education levels.…”

“…Evidence has pointed towards a positive relationship between higher levels of substance use, number of different substances used, and dropping out of treatment (Gainey, Wells, Hawkins, & Catalano, 1993;Kleinman et al, 1992;Stark, 1992;Westreich, Heitner, & Cooper, 1997). Recently, Maglione, Chao, and Anglin (2000) compared characteristics of methamphetamine users in residential treatment who completed at least 90 days of treatment versus those who left before 90 days.…”

Retaining cocaine-abusing women in a therapeutic community: the effect of a child live-in program.

“…7 Clinicians at the authors' therapeutic community observed that cocaine-dependent women drop out of treatment early, often stating that their children need them at home. Unfortunately, these early dropouts too often relapse to cocaine use with disastrous consequences for themselves and their children.…”