S. B. Sells

Addiction Careers: Etiology, Treatment, and 12-Year Follow-up Outcomes

Follow-up interviews were conducted with 405 black and white male opioid addicts 12 years after admission to drug abuse treatments in the Drug Abuse Reporting Program. Outcomes over time in this longitudinal data system showed that the behavioral improvements observed throughout the first 6-year posttreatment follow-up period (compared with pretreatment baselines) tended to stabilize between Years 6 and 12. About one-fourth of the sample still used opioid drugs daily in Year 12. Demographic and background measures generally failed to predict Year 12 outcomes, although Year 6 outcomes were related to those in Year 12. Reasons for starting, continuing, and terminating opioid addiction were also examined, as well as the importance of treatment during addiction careers.

Treatment process and relapse to opioid use during methadone maintenance

A general framework for studying drug abuse treatment process factors is presented, and components are then used to predict relapse to opioid use during treatment in methadone maintenance. Major domains of the treatment process research framework include client variables at entry, program characteristics, treatment events, and client outcomes. The analyses rely on the use of proportional hazards models to identify significant outcome predictors in a sample of 590 methadone maintenance clients from 21 clinics in the Research Triangle Institute/Treatment Outcome Prospective Study (RTI/TOPS) data system who remained in treatment at least 3 months. The analyses were performed on the total sample and separately on clients from three groups of clinics classified on the basis of the distribution of client relapse rates and tenure in treatment. Relapse rates were related to dosage level, client monitoring with urinalyses, and methadone take-home privileges in some clinics, and hence, these time-varying treatment events were important factors in treatment outcomes. Even at entry to treatment, some measures were found to be related to how the client later performed during treatment. Finally, it was also found that the particular area of professional speciality of the staff making client diagnosis at intake and preparing treatment plans was associated with client outcomes.

Patterns of Multiple Drug Abuse: 1969-1971

Information concerning types and frequencies of pretreatment drug abuse, obtained by interview from 11,380 patients included in the first two years (June 1969-June 1971) of the NIMH-TCU Drug Abuse Reporting Program, were examined with respect to patterns of usage. Twenty-eight patterns were defined, involving various combinations of drugs used and frequencies of use. The results indicated that the most frequent drug-abuse pattern in this patient sample, accounting for 28% of the entire sample, was the daily or weekly use of heroin with no other drugs. The daily or weekly use of heroin with cocaine, with marihuana, and with both cocaine and marihuana were also frequently observed patterns, and combined with the heroin-only pattern, they characterized the majority of all the patients. The most common patterns reported by the remainder of the patients were of poly-drug use, typically involving marihuana, amphetamines, and barbiturates, as well as heroin and cocaine.

A National Follow-up Study to Evaluate the Effectiveness of Drug Abuse Treatment: A Report on Cohort 1 of the DARP Five Years Later

Preliminary findings for the first cohort of a national follow-up study of drug users admitted to treatment in the Drug Abuse Reporting Program (DARP) during 1969-1971 are reported. From a sample of 1,853 selected for follow-up, 87% were located and interviews were completed for 77%. Gross tabulations are shown comparing several outcome measures based on pre-DARP treatment, the posttreatment period, and for the 2 months before interview. Sixty-one percent of all patients returned to treatment at some time after DARP termination. Decreases in drug use, expecially of opioids, were substantial and were generally accompanied by improvements in other outcome measures as well. Plans for more detailed and informative analysis of these and related DARP data are addressed.

Death Rates and Causes of Death Among Opioid Addicts in Community Drug Treatment Programs During 1970–1973

Death rates and causes of death among opioid addicts in 52 community treatment programs in a national reporting network were compared for 3 consecutive years. The greatest proportion of patients in the base samples were male, 21 to 25 years old, black, and in MM programs. The 275 patients in the deceased sample presented essentially the same profile, with the exception that the older patients were more highly represented among the deceased. Death rates were particularly high during each year for patients over 30 years old. Over the 3 years, death rates increased for whites, addicts 21 to 25 years old, and patients in outpatient DF programs. Consistent decreases in rates each year were found for blacks, patients in the 26 to 30 age range, and patients in MM programs.

The DARP Research Program and Data System

The evaluation research on the effectiveness of treatments for drug abuse, which is the subject of several papers in this journal issue, is a multi-faceted program of data base management and substantive research involving the Drug Abuse Reporting Program (DARP). The DARP was established in 1969 by the National Institute of Mental Health (NIMH) at the Institute of Behavioral Research (IBR), Texas Christian University, to provide a data base for research on the evaluation of treatments for drug abuse. One major set of research reports, completed in 1973, has already been published [1] and is related to outcomes during treatment of a cohort of 11,385 patients admitted to treatment at 23 Federally supported treatment agencies during June 1969 to June 1971. This and the following papers focus mainly on the second wave of studies, completed in 1974. They involve a cohort of 15,831 patients admitted to 36 agencies during June 1971 to June 1972. The present report is designed to develop a context for the followi...

Agency Differences in Posttreatment Outcomes: A Follow-Up of Drug Abuse Treatment Clients

The present study examined variations in posttreatment outcomes for clients treated in the same modality but in different treatment agencies located across the United States. Three modalities were studied, represented by seven methadone maintenance (MM) programs, seven therapeutic community (TC) programs, and nine outpatient drug-free (DF) programs. Agency differences within MM and TC programs were not significantly different on posttreatment outcomes for opioid use, nonopioid use, alcohol use, productive activities, and criminality. There were significant outcome differences among the DF agencies, but they were explained by variations in the background characteristics of the particular types of clients served by each agency. In particular, these posttreatment outcome differences appeared to be related to programs treating primarily opioid addicts versus primarily nonopioid users.

A Descriptive Overview of Treatment Modalities in Federally Funded Drug Abuse Treatment Programs

This study presents descriptive information on treatment modality units of drug treatment clinics participating in the Client Oriented Data Acquisition Process (CODAP) and the National Drug Abuse Treatment Utilization Survey (NDATUS) data systems. The units described were (1) drug-free outpatient-nonopiate orientation (DFO-N), (2) drug-free outpatient-opiate orientation (DFO-O), (3) methadone maintenance (MM), (4) drug-free residential (DFR), (5) detoxification-outpatient (DTOP), (6) detoxification-inpatient (DTIP), and (7) day care (DC). The major focus was on the first five units since there were relatively few DTIP and DC units which met the criteria for inclusion in the study. The study was based on 1,077 units. These units represented 73,856 admissions in the first half of 1977. The different types of modality units were compared on client flow information, client aggregate background characteristics, client aggregate drug use at admission, client aggregate outcomes at discharge (drug use, employment...

Retention in outpatient drug free treatment clinics

This study examined time in treatment and the percentage of clients who quit or were expelled from drug treatment clinics as dependent measures in a general model including socioecological aspects of the clinic neighborhood environment, the clinic structure (attributes, e.g., size, and services and staffing), and the client composition of the clinic (sociodemographic and deviance). In this study the clinic was the unit of analysis. The data were analyzed by means of path analysis, for (1) drug free outpatient, nonopiate orientation (DFO-N) and (2) drug free outpatient, opiate orientation (DFO-O). There were 204 DFO-N and 130 DFO-O clinics. The path analytic model proved to be useful for the explanation of clinic retention outcomes. The socioecological variables predicted the types of clients who entered treatment. These in turn along with clinic attributes were significant predictors of clinic retention. Clinic attributes also predicted clinic services and staffing. The results suggested that both clinic variables and client composition variables are important predictors of clinic retention.

Prediction of Retention in Methadone Maintenance in a Contextual Model.

This study investigated predictors of drug treatment retention of individual clients in terms of a contextual model. The model involved eight components: 1) socioecological factors, 2) clinic attributes, 3) clinic staffing and services, 4) clinic sociodemographic (aggregate) characteristics, 5) clinic deviance (aggregate) characteristics, 6) individual level client sociodemographic characteristics, 7) individual level client deviance characteristics, and 8) individual level client retention outcomes (time in treatment and quit or expelled termination status). The components were represented in the study by variables developed from census data, and National Institute of Drug Abuse (NIDA) CODAP and NDATUS data bases. This model was analyzed by path analysis for clients in methadone maintenance programs. There was consistent support for the relationships expected among the components of the model. The socioecological variables predicted the types of clients that entered treatment in terms of clinic level (aggregate) variables, and these were found to predict both the corresponding individual level client variables and client outcomes. Clinic attributes were found to predict clinic staffing and services and both of these components were found to be related to client outcomes in several analyses.