Deborah Podus

The effectiveness of drug abuse treatment: a meta-analysis of comparison group studies

A meta-analysis was conducted on 78 studies of drug treatment conducted between 1965 and 1996. Each study compared outcomes among clients who received drug treatment with outcomes among clients who received either minimal treatment or no treatment. Five methodological variables were significant predictors of effect size. Larger effect sizes were associated with studies with the following characteristics: smaller numbers of dependent variables, significant differences between groups at admission, low levels of attrition in the treatment group, a passive comparison group (no treatment, minimal treatment) as opposed to an active comparison group (standard treatment), and drug use determined by a drug test. Controlling for these methodological variables, further analyses indicated that drug abuse treatment has both a statistically significant and a clinically meaningful effect in reducing drug use and crime, and that these effects are unlikely to be due to publication bias. For substance abuse outcomes, larger effect sizes tended to be found in studies in which treatment implementation was rated high, the degree of theoretical development of the treatment was rated low, or researcher allegiance to the treatment was rated as favorable. For crime outcomes, only the average age of study participants was a significant predictor of effect size, with treatment reducing crime to a greater degree among studies with samples consisting of younger adults as opposed to older adults. Treatment modality and other variables were not related to effect sizes for either drug use or crime outcomes

Meta-analysis of HIV risk-reduction interventions within drug abuse treatment programs.

A meta-analysis was conducted on studies using a treatment-comparison group design to evaluate HIV/AIDS risk-reduction interventions for clients enrolled in drug abuse treatment programs. Overall, the interventions studied were found to have a reliable positive (weighted) effect size (d = 0.31), and this was unlikely to be due to publication bias. Effect sizes for specific categories of outcome variables were 0.31 for knowledge, attitudes, and beliefs; 0.26 for sexual behavior; 0.62 for risk-reduction skills; and 0.04 for injection practices. A number of potential moderators were examined. Effect sizes were negatively correlated with the presence of predominantly ethnic minority samples and positively correlated with the number of intervention techniques used, the intensity of the intervention, intervention delivery at a later stage of drug treatment or within methadone treatment, and the presence of a number of specific intervention techniques.

Program Factors and Treatment Outcomes in Drug Dependence Treatment: An Examination Using Meta-Analysis

In comparison with studies of client characteristics and treatment processes, limited research has been conducted on how program features of drug dependence treatment programs may affect client outcomes. Of particular interest are those characteristics of programs that may have a clinically significant impact on outcomes and that are amenable to change within programs. This study examines the impact of various program factors on client outcomes using data from a meta-analysis of drug dependence effectiveness studies (n = 143). Because of heterogeneity among studies, the data are analyzed in terms of type of outcome variable (drug use and crime), type of design (single-group and treatment-comparison group), and type of treatment (methadone maintenance, therapeutic communities, outpatient drug free, and detoxification). For the more valid treatment-comparison group studies, the weighted mean effect size was 0.29 for drug use outcomes and 0.17 for crime outcomes. Program factors found to be significantly correlated with effect size in one or more modalities were decade of treatment, researcher involvement in treatment delivery, maturity of the program, counselor/client ratio, treatment implementation, treatment exposure, and methadone dosage.

THE EFFECT OF PROVIDER CHARACTERISTICS ON CASE MANAGEMENT ACTIVITIES

The authors investigated the impact of provider characteristics on the performance of clinical case managers. Case managers in a large California county were interviewed using a structured instrument that assessed service linkage, assertive outreach, and family management. Findings indicate that assertive outreach was done more often by more experienced case managers, and less often by those with larger caseloads. Belief in the efficacy of an activity was associated with doing it much more frequently.

Drug Treatment Effectiveness: An Examination of Conceptual and Policy Issues

This paper discusses different concepts or views of what constitutes effective treatment for drug dependence and how these views are involved in policy decisions regarding treatment. The paper reviews the rise of evidence-based medicine, discusses the emergence of efficacy research, effectiveness research, and other types of outcome-based evaluations of drug user treatment, but notes that despite a growing consensus among researchers on the effectiveness of drug user treatment, substantial public skepticism about the value of treatment still exists in the United States. The paper argues that one of the primary reasons for the lack of public consensus in the United States is that there is wide disagreement over which type of problem drug dependence is and for whom it may be a problem. The paper reviews some of the most common models and their implications for evaluating effectiveness, and argues that it is the differences in perspective among these models that are at the heart of policy debate over drug treatment policy in the United States. The paper concludes that because evaluation research as currently practiced does not address these issues, its utility for policy purposes is limited in the American context.

Lessons Learned From the Deadly Sisters: Drug and Alcohol Treatment Disruption, and Consequences from Hurricanes Katrina and Rita

This paper reports on the effects of Hurricanes Katrina and Rita on drug and alcohol treatment in Texas in 2005–2006. Findings are based on a secondary analysis of administrative data on 567 hurricane-related admissions and on interview data from a sample of 20 staff in 11 treatment programs. Katrina evacuees differed from Rita clients in terms of demographics and primary problem substances and treatment needs, while the experiences of program staff and needed changes to improve disaster readiness were more similar. Additional systematic research is needed to document the intermediate and long-term impacts of the storms in these and other affected areas.

The health and mental health of disabled substance abusers.

In 1996 Congress terminated Supplemental Security Income (SSI) benefits to individuals disabled by substance abuse. Although most were expected to continue benefits under another disability category, 64% were not reclassified. This article examines data from a longitudinal study of individuals in Los Angeles County affected by the legislation. While poor physical health predicted both continued SSI benefits and receipt of public income assistance, many individuals reporting significant mental and physical health problems were not reclassified and did not receive public income assistance, raising concern for their welfare. Local safety nets may become increasingly important for this population.

Drug use Prevalence among Former SSI DA&A Recipients

This paper examines illegal drug use prevalence among former recipients of Supplemental Security Income (SSI) disability benefits for drug addiction and alcoholism (DA&A) in Chicago, Los Angeles, and Seattle, based on urinalysis and self-report data. It presents estimates of current prevalence (past three days) for four categories of illegal drugs–-opiates, cocaine, marijuana, or any use–-at 12 and 24 months after termination of the DA&A program. Data were obtained as part of a longitudinal study of 1,764 former SSI DA&A recipients in nine sites. Analyses indicate that a substantial number of former DA&A recipients, probably 45%–55%, were engaged in active drug use after termination of the program. Among users, cocaine and opiate use were extensive. Although there were high rates of underreporting by self-reported non-users, underreporting was not systematically associated with age, gender, ethnicity, criminal justice involvement, recent substance abuse treatment, or SSI benefit status.

Medical and Mental Health Services Utilization among Requalified and Former Drug Addiction and Alcoholism Recipients of SSI

This article examines the impact of the elimination of the Supplemental Security Income (SSI) drug addiction and alcoholism (DA&A) disability category–-and the consequent loss of Medicaid benefits by most of those terminated from SSI–-on the medical and mental health services utilization of affected individuals. Data are from a two-year, five-wave panel study of a random sample of 1,764 former DA&A recipients in nine sites. Respondents were grouped into three categories: those who requalified for SSI on other grounds: those who lost SSI but obtained alternative health coverage: and those who lost SSI and were uninsured. We found, after controlling for covariates, that the uninsured were significantly less likely than those who requalified for SSI to receive any medical or mental health care. Disparities in care were less pronounced between those who requalified for SSI and those who lost SSI but obtained other coverage. Lack of insurance was associated with greater difficulty in accessing care in four sites, but it was not associated with higher emergency room use.

Team leadership: Network differences in women's and men's instrumental and expressive relations

Recent studies have emphasised differences in leadership styles between women and men. Women have an “interactive” leadership style while men are more “directive” and “authoritative.” Social network analysis is used to examine differences in eight mental health case management teams, half formally supervised by women and half by men. The techniques used are graphical displays and measures of centrality. Results show male leaders as the most central team member for both instrumental and expressive relations. Female leaders, however, do not adhere to a single leadership style. Team centralisation also differs with gender composition of teams influencing leadership differences.