Slide 1 of 19 National Treatment Retention Findings from DATOS Charts Prepared & Released for Public Use by Dwayne Simpson (TCU), Robert Hubbard (NDRI-NC),

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Presentation transcript:

Slide 1 of 19 National Treatment Retention Findings from DATOS Charts Prepared & Released for Public Use by Dwayne Simpson (TCU), Robert Hubbard (NDRI-NC), Douglas Anglin (UCLA), & Bennett Fletcher (NIDA) Drug Abuse Treatment Outcome Studies (Funded by NIDA)

Slide 2 of 19 Drug Abuse Reporting Program First National Evaluation of Treatment Effectiveness Funded by the National Institute on Drug Abuse Sells, Simpson, Demaree, & Joe 6 books & 150 papers published (funded ) Cities 139 Programs ~44,000 Patients All treatment types Follow-ups: 1,3,6,12 Yrs

Slide 3 of 19 Daily Opioid Use: % in Year 1 After Discharge 0 Days (Intake Only) 1-30 Days in Detox Only Mos in Therapeutic Community* Mos in Outpatient Drug-Free* Mos in Methadone Maintenance* *p<.01 Comparison Groups Same for criminality ! N=3,248; Simpson & Sells, 1982 (AASA)

Slide 4 of 19 Treatment Outcome Prospective Study Second National Evaluation of Treatment Effectiveness Funded by the National Institute on Drug Abuse Hubbard, Marsden, Rachal, Harwood, Cavanaugh, & Ginzburg, Drug abuse treatment: A national study of effectiveness (1989) Cities 37 Programs ~11,000 Patients All treatment types Follow-up: 1 year

Slide 5 of 19 “Treatment Process” in TOPS  Comparisons between 21 MM programs  Programs with Longer Retention had - 3Better assessment & program planning 3Higher MM dose & better UA monitoring 3Comprehensive (“wrap-around”) services 3Higher patient ratings for “meeting needs” Similar findings for other modalities Joe, Simpson, & Hubbard, 1991 (J Sub Abuse)

Slide 6 of 19 Drug Abuse Treatment Outcome Studies Third National Evaluation of Treatment Effectiveness Over 40 Studies Published – Over 40 Studies Published – Psychology of Addictive Behaviors (Dec 97) Drug and Alcohol Dependence (Dec 99) Archives of General Psychiatry (June 99) Funded by the National Institute on Drug Abuse Cities 96 Programs ~10,000 Patients All treatment types Follow-up: 1 & 5 Yrs

Slide 7 of 19 Long-Term Residential (LTR)Treatment Changes from Before to After Treatment % of DATOS Sample (N=676) *p<.001 Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)

Slide 8 of 19 Outpatient Drug-Free (ODF) Treatment Changes from Before to After Treatment % of DATOS Sample (N=764) *p<.001 Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)

Slide 9 of 19 % of DATOS Sample (N=727) Outpatient Methadone Treatment (OMT) Changes from Before to After Treatment *p<.001 Hubbard, Craddock, Flynn, Anderson, & Etheridge, 1997 (PAB)

Slide 10 of 19 Average Expected vs Observed Length of Stay by Patients (in months) Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)

Slide 11 of 19 Patient Retention Rates for Programs (beyond minimum “thresholds”) Best Program Poorest Program Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)

Slide 12 of 19 Program Retention Rates in LTR (for 90 days or longer) % of Admissions to 17 LTR Programs (with 40+ patients)

Slide 13 of 19 Program Retention Rates in ODF (for 90 days or longer) % of Admissions to 14 ODF Programs (with 40+ patients)

Slide 14 of 19 Program Retention Rates in OMT (for 360 days or longer) % of Admissions to 10 OMT Programs (with 40+ patients)

Slide 15 of 19 Example from LTR in DATOS Retention Predicts Outcomes  Findings Consistent from National Studies 31970s (44,000 admissions in DARP) 31980s (11,000 admissions in TOPS) 31990s (10,000 admissions in DATOS)  Also in England’s NTORS !  Conclusions from Major Reviews 3Institute of Medicine (Gerstein & Harwood, ‘90)

Slide 16 of 19 Comparison of Year 1 Outcomes by Length of Stay in LTR % of Sample *p<.001 N=342; Simpson, Joe, & Brown, 1997 (PAB)

Slide 17 of 19 DATOS Programs with Lower Retention had more “troubled” caseloads! Admissions to these programs had -  More cocaine & alcohol problems  More previous treatments  More psychological problems But these patient problems did not explain all program differences in retention rates! Simpson, Joe, Broome, Hiller, Knight, Rowan-Szal, 1997 (PAB)

Slide 18 of 19 Patient Problems in LTR Programs Highest % Lowest %

Slide 19 of 19 Selected Studies 1-Year Outcomes Treatment Services & Process Cocaine Treatment Selected Web Posters Adolescent Studies Cost Benefits of MM Treatment Readiness for Treatment News and Features Home Page About DATOS Background Highlights Special Topics Publications Web Posters What’s New CONTENT Cocaine Treatment Outcome Study is Released (in June 1999 issue of Archives of General Psychiatry) Findings emphasize the need for "adequate treatment stays," especially when problem severity is moderate-to-high. At least 90 days in intensive residential (TC) programs was indicated for high-severity cases. More information is provided in a new section of Highlights page, "Outcomes for Treatment of Cocaine Dependence.” Latest DATOS studies have been published in Drug and Alcohol Dependence Treatment process (engagement and participation), retention, and outcomes are the focus of this series of studies, and our first cost-benefit analysis addresses cocaine treatment. The latest DATOS publications and "in press" are listed on the Publications page.

Slide 20 of 19 Slide Navigator 1. Overview of Treatment Retention Findings from DATOS (title slide) Overview of Treatment Retention Findings from DATOS (title slide) 2. DARP: Drug Abuse Reporting Program DARP: Drug Abuse Reporting Program 3. Daily Opioid Use: % in Year 1 after discharge Daily Opioid Use: % in Year 1 after discharge 4. TOPS: Treatment Outcome Prospective Study TOPS: Treatment Outcome Prospective Study 5. “Treatment Process” in TOPS “Treatment Process” in TOPS 6. DATOS: Drug Abuse Treatment Outcome Studies DATOS: Drug Abuse Treatment Outcome Studies 7. Long-Term Residential (LTR) Treatment: Changes from Before to After Treatment Long-Term Residential (LTR) Treatment: Changes from Before to After Treatment 8. Outpatient Drug-Free (ODF) Treatment: Changes from Before to After Treatment Outpatient Drug-Free (ODF) Treatment: Changes from Before to After Treatment 9. Outpatient Methadone Treatment (OMT): Changes from Before to After Treatment Outpatient Methadone Treatment (OMT): Changes from Before to After Treatment 10. Average Expected vs Observed Length of stay by Patients (in months) Average Expected vs Observed Length of stay by Patients (in months) 11. Patient Retention Rates for Programs (beyond minimum “thresholds”) Patient Retention Rates for Programs (beyond minimum “thresholds”) 12. Program Retention Rates in LTR (for 90 days or longer) Program Retention Rates in LTR (for 90 days or longer) 13. Program Retention Rates in ODF (for 90 days or longer) Program Retention Rates in ODF (for 90 days or longer) 14. Program Retention Rates in OMT (for 360 days or longer) Program Retention Rates in OMT (for 360 days or longer) 15. Retention Predicts Outcomes Retention Predicts Outcomes 16. Comparison of Year 1 Outcomes by Length of Stay in LTR Comparison of Year 1 Outcomes by Length of Stay in LTR 17. DATOS Programs with Lower Retention had more “troubled” caseloads! DATOS Programs with Lower Retention had more “troubled” caseloads! 18. Patient Problems in LTR Programs Patient Problems in LTR Programs 19. Slide for DATOS Web site ( Slide for DATOS Web site (