What Could the Program Have Done Differently? A Qualitative Examination of Reasons for Leaving Outpatient Treatment

Overview

Journal J Subst Abuse Treat

Specialty Psychiatry

Date 2009 Apr 3

PMID 19339133

Citations 40

Authors

Alexandre B Laudet

Virginia Stanick

Brian Sands

Affiliations

Soon will be listed here.

Abstract

Attrition from treatment for substance abuse disorders is a persistent challenge that severely limits the effectiveness of services. Although 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. Program-level barriers include 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.

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References

. What is recovery? A working definition from the Betty Ford Institute. J Subst Abuse Treat. 2007; 33(3):221-8. DOI: 10.1016/j.jsat.2007.06.001. View

Zhang Z, Friedmann P, Gerstein D . Does retention matter? Treatment duration and improvement in drug use. Addiction. 2003; 98(5):673-84. DOI: 10.1046/j.1360-0443.2003.00354.x. View

SIMPSON D, Joe G, Greener J . Client engagement and change during drug abuse treatment. J Subst Abuse. 1995; 7(1):117-34. DOI: 10.1016/0899-3289(95)90309-7. View

Najavits L . Clinicians' views on treating posttraumatic stress disorder and substance use disorder. J Subst Abuse Treat. 2002; 22(2):79-85. DOI: 10.1016/s0740-5472(02)00219-2. View

Hellemann G, Conner B, Anglin M, Longshore D . Seeing the trees despite the forest: applying recursive partitioning to the evaluation of drug treatment retention. J Subst Abuse Treat. 2008; 36(1):59-64. DOI: 10.1016/j.jsat.2008.03.005. View

Redko C, Rapp R, Carlson R . Pathways of Substance Users Linking (Or Not) With Treatment. J Drug Issues. 2008; 37(3):597-618. PMC: 2168035. DOI: 10.1177/002204260703700306. View

Laudet A, Becker J, White W . Don't wanna go through that madness no more: quality of life satisfaction as predictor of sustained remission from illicit drug misuse. Subst Use Misuse. 2009; 44(2):227-52. PMC: 2629650. DOI: 10.1080/10826080802714462. View

McLellan A, McKay J, Forman R, Cacciola J, Kemp J . Reconsidering the evaluation of addiction treatment: from retrospective follow-up to concurrent recovery monitoring. Addiction. 2005; 100(4):447-58. DOI: 10.1111/j.1360-0443.2005.01012.x. View

Hawkins E, Baer J, Kivlahan D . Concurrent monitoring of psychological distress and satisfaction measures as predictors of addiction treatment retention. J Subst Abuse Treat. 2007; 35(2):207-16. DOI: 10.1016/j.jsat.2007.10.001. View

10.

McLellan A, Woody G, Luborsky L, Goehl L . Is the counselor an "active ingredient" in substance abuse rehabilitation? An examination of treatment success among four counselors. J Nerv Ment Dis. 1988; 176(7):423-30. DOI: 10.1097/00005053-198807000-00004. View

11.

McLellan A, Lewis D, OBrien C, KLEBER H . Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000; 284(13):1689-95. DOI: 10.1001/jama.284.13.1689. View

12.

Lee C, Longabaugh R, Baird J, Abrantes A, Borrelli B, Stein L . Do patient intervention ratings predict alcohol-related consequences?. Addict Behav. 2007; 32(12):3136-41. PMC: 2847830. DOI: 10.1016/j.addbeh.2007.07.011. View

13.

Hatcher R, Barends A . Patients' view of the alliance of psychotherapy: exploratory factor analysis of three alliance measures. J Consult Clin Psychol. 1996; 64(6):1326-36. DOI: 10.1037//0022-006x.64.6.1326. View

14.

Sobell L, Ellingstad T, Sobell M . Natural recovery from alcohol and drug problems: methodological review of the research with suggestions for future directions. Addiction. 2000; 95(5):749-64. DOI: 10.1046/j.1360-0443.2000.95574911.x. View

15.

Laudet A . What does recovery mean to you? Lessons from the recovery experience for research and practice. J Subst Abuse Treat. 2007; 33(3):243-56. PMC: 2083562. DOI: 10.1016/j.jsat.2007.04.014. View

16.

Carlson M, Gabriel R . Patient satisfaction, use of services, and one-year outcomes in publicly funded substance abuse treatment. Psychiatr Serv. 2001; 52(9):1230-6. DOI: 10.1176/appi.ps.52.9.1230. View

17.

Evans E, Li L, Hser Y . Treatment entry barriers among California's Proposition 36 offenders. J Subst Abuse Treat. 2008; 35(4):410-8. PMC: 2576498. DOI: 10.1016/j.jsat.2008.03.003. View

18.

Dennis M, Scott C, Funk R, Foss M . The duration and correlates of addiction and treatment careers. J Subst Abuse Treat. 2005; 28 Suppl 1:S51-62. DOI: 10.1016/j.jsat.2004.10.013. View

19.

Hser Y, Evans E, Huang D, Anglin D . Relationship between drug treatment services, retention, and outcomes. Psychiatr Serv. 2004; 55(7):767-74. DOI: 10.1176/appi.ps.55.7.767. View

20.

Najavits L, Crits-Christoph P, Dierberger A . Clinicians' impact on the quality of substance use disorder treatment. Subst Use Misuse. 2001; 35(12-14):2161-90. DOI: 10.3109/10826080009148253. View