Factors that Influence Retention in Greek Therapeutic Communities Erianna Daliani MSc (Gerasimos Papanastasatos) KETHEA Research Dept. 11th European Conference on Rehabilitation & Drug Policy

Why retention? Retention in treatment has been the most consistent and important predictor of post-treatment outcome It is an index that captures the effect of the various client characteristics, as well as that of different treatment characteristics 11th European Conference on Rehabilitation & Drug Policy

Previous research 11th European Conference on Rehabilitation & Drug Policy Drug – and alcohol related problems Family/social problems Psychiatric problems (?) Gender (?) Higher rates of retention Employment problems Law problems

Aims of the present study Investigation of the effect of type of treatment programme on retention Investigation of the effect of client characteristics on retention Investigation of their combined effect

Population & Sample Population: Drug addicts that were admitted for treatment in one of 9 Therapeutic Communities for adults (4 residential and 5 open care) Sample: Clients that had completed EuropASI questionnaire during intake 11th European Conference on Rehabilitation & Drug Policy

Sample (a) 6.8% 57.4%.8%.5% 16.2% 18.3% 11th European Conference on Rehabilitation & Drug Policy

Sample (b) 86.8% men Mean age: 26.6 years Ν = % in residential treatment setting 29.2% in intensive outpatient facility 11th European Conference on Rehabilitation & Drug Policy

Data Collection Personal interviews Questionnaire: EuropASI, European modification of the Addiction Severity Index Duration: – th European Conference on Rehabilitation & Drug Policy

7 problem areas 2 summary indices for each area Both indices combine quantitative information and client’s subjective ratings of the current importance of the problems and the need for treatment Composite scores are calculated automatically based on questions about the present that are subject to change EuropASI summary indices – Methodological issues 11th European Conference on Rehabilitation & Drug Policy

Severity ratings are established by the interviewers after following a standard procedure. Existence and severity of lifetime problems is taken into account together with client’s present condition and need for treatment 11th European Conference on Rehabilitation & Drug Policy EuropASI summary indices – Methodological issues

Clients’ Profile – Lifetime and recent problems in 7 areas 11th European Conference on Rehabilitation & Drug Policy *intercorrelations ≤ 0.3

Outcomes of several follow up studies show that length of stay in treatment is directly related to positive outcomes Greek Therapeutic Communities, residential and open care, expect clients to stay in treatment for 12 months in order to complete it After TC clients enter a less intensive, rehabilitation phase that last for another 12 months " Completers " are the clients who stay in treatment for at least 12 months, while " Dropouts " are the clients that leave the therapeutic programme before they complete the one-year period Annual Retention 11th European Conference on Rehabilitation & Drug Policy

Annual retention retention (in days) 11th European Conference on Rehabilitation & Drug Policy

Annual retention - type of treatment retention (in days) 11th European Conference on Rehabilitation & Drug Policy

Annual retention – gender and type of treatment retention (in days) 11th European Conference on Rehabilitation & Drug Policy

Logistic regression was performed for annual retention as the dependent variable and type of treatment, gender, age, number of previous treatment episodes, EuropASI composite and severity indices as independent variables (predictors) Both composite (recent) and severity (lifetime) indices were used since intercorrelations between them were not high in absolute magnitude Interactions between type of treatment and other predictors were entered simultaneously to include the affect shown in annual retention diagram Data analysis 11th European Conference on Rehabilitation & Drug Policy

Significant Predictors of Treatment Completion p<0.1**p<0.05***p<0.01

Main Effects 11th European Conference on Rehabilitation & Drug Policy Type of treatment – clients in open care (outpatient intensive) are more likely to complete treatment Clients with heavier drug use during the period before admission are more likely to dropout from treatment Clients with more severe lifetime psychological problems are less likely to stay for a year in treatment

Investigating the interactions – family/ social support and type of treatment 11th European Conference on Rehabilitation & Drug Policy Family/ social relations and support is an important predictor for completion of outpatient treatment

11th European Conference on Rehabilitation & Drug Policy Severity of lifetime drug use related problems is always a predictor – more so in outpatient programmes Investigating the interactions – drug problems and type of treatment

11th European Conference on Rehabilitation & Drug Policy Investigating the interactions – legal problems and type of treatment Severe legal problems are related with dropout from outpatient treatment

11th European Conference on Rehabilitation & Drug Policy Investigating the interactions – psychological problems and type of treatment Clients with medium – severe psychological problems are usually referred to outpatient treatment – no statistical difference between " dropouts “ and " completers“ (open care)

Discussion (a) 11th European Conference on Rehabilitation & Drug Policy More drug problems before admission are related with higher rates of dropout, regardless of treatment setting. Further analysis will determine the actual time of dropout Outpatient settings are associated with higher treatment completion rates. Residential clients tend to have more problems than outpatient clients in most of the examined areas Clients with more severe lifetime psychological problems are less likely to stay for a year in treatment. This effect is stronger in residential treatment.

Discussion (b) 11th European Conference on Rehabilitation & Drug Policy Gender factor was initially found to be important when combined with type of treatment. This difference did not remain after we controlled for problems’ severity Previous studies have shown that family/ social problems are related to lower rates of retention. In this study this effect was found to be present only in outpatient treatment Unlike other studies severity of legal problems was found to be negatively related to treatment completion – this effect is more clear in outpatient treatment

Limitations & Issues for further research 11th European Conference on Rehabilitation & Drug Policy Adequacy and consistency of EuropASI indices Relation between former therapeutic experience and retention in treatment Investigate early – late dropout criteria Retention is predictive of treatment related outcomes but there is need for actually measuring these outcomes – FOLLOW UP study Significance of interactions between clients characteristics and treatment settings, stresses the importance of matching therapeutic interventions to clients needs