The congressionally mandated 5-year study National Treatment Improvement Evaluation Study (NTIES) examined the impact of three federally-sponsored drug and alcohol treatment demonstration programs. The study found that the demonstration programs significantly reduced drug and alcohol use, and that treatment had lasting benefits. Clients reported increases in employment and income, improvements in mental and physical health, decreases in criminal activities and homelessness, and modification of sexually-risky behavior.
In addition to profiling the services, programs, and clients involved in three demonstration programs funded by the Center for Substance Abuse Treatment (CSAT), the study was designed to address the effects of comprehensive treatment on client access to services and on patient outcomes. Lessons learned about the implementation and cost of delivering comprehensive drug treatment services were to be documented.
A comprehensive treatment model assumes that positive and well-sustained outcomes occur when substance abuse treatment systems draw from a full array of medical and rehabilitative services. These services can include primary medical care, psychiatric services, health education, HIV/AIDS counseling, psychological counseling, legal assistance, social and welfare services, spiritual counseling, job training, educational counseling, social activities, and continuing care services. To demonstrate the value of such a comprehensive substance abuse treatment model, CSAT initiated three major demonstration projects to enhance treatment services by building on an existing infrastructure for substance abuse treatment. The three demonstration programs were Cooperative Agreement for Drug Abuse Treatment in Large Cities, Model Comprehensive Treatment Programs for Critical Populations (with special components for adolescent/juvenile justice and public housing), and Model Drug Abuse Treatment Programs for Criminal Justice Populations (for nonincarcerated offenders and those in correctional settings). Recipients of demonstration funding were required to initiate some form of local self-study and to participate in a multisite evaluation (the NTIES) to capture and disseminate lessons learned from these programs.
NTIES employed a two-level study design to assess the effectiveness of the demonstration programs and a comprehensive treatment approach. The first level was a multiphase survey that addressed treatment unit administration, including treatment orientation, size, budget, and staffing distribution for each of the demonstration programs. The second level involved collecting data on clinical outcomes from clients enrolled in drug treatment at a subsample of the funded sites. This level included three waves of longitudinal data collection. Clients were interviewed at admission to treatment, when they left treatment, and at a followup 1 year after treatment. A total of 6,593 clients at 78 service delivery units were enrolled in the clinical outcomes study. More than 82 percent of the recruited sample completed the followup interview. The outcomes analyses focused on the 4,411 clients for whom followup data were available, along with either an interview at treatment exit or a patient records abstract form.
NTIES, like many other major research surveys, relied primarily on self-reported data. To validate self-reports regarding illicit drug use and arrests, the study also collected data on urine sample drug testing and arrest records. A pre- and post-panel design was used. This method compares behaviors or other individual characteristics in the same research subjects, measured in similar ways before and after intervention. The findings are expressed as percentage of the occurrence of a behavior or circumstances in the NTIES population during clearly defined intervals.
The study generally found significant reductions in substance abuse during and immediately following treatment. Clients served by the demonstration programs were able to reduce their drug use by about 50 percent for as long as 1 year after leaving treatment. The NTIES data indicate that substance abuse treatment can play a major role in crime reduction. Respondents reported significant decreases in multiple indicators of criminal involvement. The study found that self-reported outcome data on arrests were similar to what might be seen if official records were used, especially for clients interviewed in the community rather than in jails or prisons.
NTIES also explored whether specific patient or treatment unit characteristics could explain variations in pre- and post-treatment outcomes. It found that drug and alcohol use, criminal activity, and employment outcomes were measurably better among individuals who completed their treatment, received more intensive treatment, and were treated longer. The results showed that the length of stay varied across gender, race and ethnicity, and age groups within each type of treatment.
Nearly all clients were involved in the development of their own treatment plans. About 38 percent of the clients said that they received HIV tests, 57 percent received TB tests, and 72 percent received AIDS prevention classes or counseling. Although almost half of the clients needed legal or housing services, only 10 percent were receiving these services. The multivariate analysis showed a significant relationship between the duration of services provided and client satisfaction with the treatment program.
Treatment was determined to be less costly than incarceration. Treatment costs ranged from $1,800 to almost $6,800 per client, while the American Correctional Association estimates the annual cost of incarceration at $18,330.
Use of Results
The study documents that comprehensive and focused substance abuse treatment can make a difference in patient outcomes. The evidence is compelling that the nature and duration of treatment has a positive impact on clinical and employment outcomes and on rates of crime and incarceration. The lower cost of substance abuse treatment (compared to that of incarceration) could have significant implications for the allocation of resources among competing public program priorities.
AGENCY SPONSOR: Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment
FEDERAL CONTACT: Ron Smith
PHONE NUMBER: (301) 443-7730
PIC ID: 5346.1
PERFORMER ORGANIZATION: National Opinion Research Center (NORC), Chicago, IL; and Research Triangle Park, Chapel Hill, NC