What could the program have done differently? A qualitative examination of reasons for leaving outpatient treatment

Abstract

Attrition from treatment for substance abuse disorders (SUD) is a persistent challenge that severely limits the effectiveness of services. Though a large body of research has sought to identify predictors of retention, the perspective of clients of services is rarely examined. This exploratory qualitative study presents clients’ stated reasons for leaving outpatient treatment (N = 135, 54% of the sample of 250) and their views of what could have been done differently to keep them engaged in services. Obstacles to retention fell into program- and individual-level factors; the former includes dissatisfaction with the program, especially counselors, unmet social services needs, and lack of flexibility in scheduling; individual-level barriers to retention were low problem recognition and substance use. Study limitations are noted and the implications of findings for research and practice are discussed, emphasizing the need to understand and address clients’ needs and expectations starting at intake to maximize treatment retention and the likelihood of positive outcomes.

Impulsivity as a vulnerability factor for poor addiction treatment outcomes: A review of neurocognitive findings among individuals with substance use disorders

“…In the past decade, variables associated with treatment retention (e.g., drop-out, completion) have become increasingly important, as one of the most consistent findings in addiction research is the positive association between the length of time spent in treatment and post-treatment outcomes (Laudet, Stanick, & Sands, 2009;Simpson, 2004;Vanderplasschen et al, 2013;Zhang, Friedmann, & Gerstein, 2003). Conversely, premature treatment drop-out has been found to predict relapse and increased legal and employment difficulties (Gossop, Marsden, Stewart, & Rolfe, 1999;Lang & Belenko, 2000;Siegal, Li, & Rapp, 2002).…”

“…During the past decades, a wide range of baseline client characteristics have been examined and identified as potentially relevant to addiction treatment outcomes, including socio-demographic (e.g., ethnicity, gender), drug-related (e.g., drug use severity, poly-drug use) and psychosocial (e.g., personality, stress, coping, self-efficacy) factors (Frawley & Smith, 1992;Hawkins, Baer, & Kivlahan, 2008;King & Canada, 2004;Laudet et al, 2009;McMahon, 2001). Recently however, growing recognition of the centrality of neurocognitive impairments in addiction has led to a new generation of research in which measures of neurocognitive functioning are being applied to the task of predicting treatment outcomes (Passetti, Clark, Mehta, Joyce, & King, 2008).…”

Drugs use by adolescents and their perceptions about specialized treatment adherence and dropout

“…Literature appoints that adherence to psychoactive drugs addiction treatment remains a challenge, which has showed to be even greater among adolescents, as addressed in different studies (8)(9)(10) . What can be observed in institutional practice and is supported by literature is that young people hardly seek any kind of drugs addiction treatment and that, when they do, often drop out early (11) , i.e.…”

O fenômeno da recaída no alcoolismo: uma revisão integrativa das publicações científicas internacionais (2004-2009)

“…Several problems hindered the adhesion, since trivial practicalities as inappropriate hours of care, dissatisfaction with the service and even unfavorable socioeconomic conditions (23) . Thus, the lack of adhesion to treatment may be due to the structure and functioning of services that offer treatment that does not consider the needs of who seek them (24) .…”

“…Treatments with this focus become distant from the reality of the individual, since it does not consider that many patients require other demands, similar or more urgent that abstinence as the requirements to get a job, get a house or to resolve family conflicts (23) . Thus, despite the recognition of the social, economic, family and health (physical and mental) implications of alcoholism, treatments tend to keep the proposal of brief intervention focused on reducing consumption, based on the premise that everything in the life of the patient will improve when the consumption of alcoholic beverages is controlled (24) .…”