Performance Improvement 2000. Substance Abuse Treatment

01/01/2000

A Profile of Clients Entering Treatment for Alcohol Problems

The National Evaluation Data Services (NEDS) of the Center for Substance Abuse Treatment (CSAT) conducted a secondary analysis of data collected in the National Treatment Improvement Evaluation Study (NTIES) to address the problems experienced by those who entered treatment for alcohol use. Results indicated that those using only alcohol tended to be older, more often white, somewhat more educated, and more likely to be employed before entering treatment. Those who used alcohol in addition to other drugs significantly reduced their consumption of drugs after treatment, but clients who had used only alcohol (who were by definition drug-free in the 12 months before treatment) showed minor but statistically significant post-treatment increases in various forms of drug use. With the exception of driving under the influence (DUI) and driving while intoxicated (DWI) offenses, clients who had used only alcohol exhibited fewer instances of criminal behavior and arrests before treatment. On the other hand, they were more likely to have been referred for treatment by the criminal justice system (presumably for these driving offenses) and less frequently sought treatment on their own. Nevertheless, all groups in the study demonstrated substantial reductions in criminal behaviors as well as improvement in general and mental health and employment circumstances during follow-up periods. No significant post-treatment reductions in the self-reported use of alcohol were observed among all concerned, although this finding may be of clinical significance only for those who entered treatment for alcohol use alone. Among the recommendations included a need to define "best practices" in the treatment of alcoholism, bearing in mind that the population of those whose problem is exclusively due to alcohol use may be "aging out".

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994

PERFORMER: Caliber Associates
Fairfax, VA

Drug Use Prevalence Estimates Among Adult Arrestees in California, Texas and the U.S.: Final Report

Society continues to suffer the immense costs and consequences associated with drug use and crime. Drug use prevalence among arrestees has been 50-80 percent in some locations. Policy makers need better information about drug use among criminal populations to more effectively respond to these problems. This research project applied three types of synthetic estimation techniques to estimate the number of drug users in a larger population where the prevalence rates are not known. The report from this project was produced by the Department of Health and Human Services Center for substance Abuse Treatment, through the National Evaluation Data and Technical Assistance Center. To improve prevalence estimation methods, the UCLA Drug Abuse Research Center conducted an initial study of regression modeling to produce their estimates, which resulted in improved conceptualization and preliminary applications of a regression model. This report applies the same regression model to larger scale data and applies it to all jurisdiction levels. The major finding indicates multiple capture rates are significantly higher than those reported in the literature (typically 13%) and their rates dramatically differ by gender, race/ethnicity, and crime type. In conclusion, the report found regression models of synthetic estimation to be sensitive and capable of providing high-confidence estimates of drug use prevalence at local, state, and national levels.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994.6

PERFORMER: Caliber Associates
Fairfax, VA

Methadone Treatment Outcomes in the National Treatment Improvement Evaluation Study (NTIES)

This analytic report examines the outcomes of methadone-treated clients in the National Treatment Improvement Study (NTIES). It addresses two fundamental questions: "How much methadone treatment is required in order to achieve successful outcomes?" and "To what extent will favorable outcomes of methadone treatment persist following the client's termination from treatment?" The results were consistent with findings from other national studies which suggest that better treatment outcomes for outpatient methadone treatment clients are associated with both longer stays in treatment and still being in the program during follow-up. The current study found consistently favorable outcomes including reductions in drug use, HIV/AIDS risk, and reduced criminal behaviors for clients who were maintained on methadone for 12 or more months and discharged clients who were treated for 3 to 12 months. At the policy level, the findings provide support for the expansion of methadone treatment, the expansion of aftercare services for methadone treated clients and the expansion of ancillary services, such as transportation and day care. In terms of implications for practice, information and referral services should be provided to assist discharged clients locate alternative treatment resources.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994.5

PERFORMER: Caliber Associates
Fairfax, VA

Potential Sources of Bias in Substance Abuse Treatment Follow-up Studies

The National Evaluation Data Services (NEDS) of the Center for Substance Abuse Treatment (CSAT) explored two methodological issues of importance to substance abuse treatment researchers and policy analysts alike: a lack of response by a group of those under treatment whose behavior is being studied over time and selection bias in recruiting such study participants. The purpose of the study conducted was to determine the extent and effects of these two issues in a recent series of four large-scale follow-up studies: the California Drug Alcohol Treatment Assessment (CALDATA), the Services Research Outcomes Study (SROS), and the National Treatment Improvement Evaluation Study (NTIES), and the Drug Abuse Treatment Outcome Study (DATOS). Differences in follow-up response rates among these four studies appear to be due partly to differences in research design and partly to a difference between survey organizations in follow-up effectiveness. These and other findings as well as recommendations were issued. (See also PIC ID #s 5994.1-5994.3.)

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994.3

PERFORMER: National Opinion Research Center (NORC)
Chicago, IL

Prospective and Retrospective Studies of Substance Abuse Treatment Outcomes: Methods and Results of Four Large-Scale Follow-Up Studies

An important service of the Center for Substance Abuse Treatment (CSAT) is to create more effective substance abuse treatment and recovery services by developing and analyzing good data on which to base such programs. One of the specific activities of the National Evaluation Data Services (NEDS), created by CSAT, is to pull together databases for broad analytic purposes or to house databases produced under a wide array of activities. This study conducted by NEDS compares research methods, provider and patient characteristics, and outcome results from four large-scale follow-up studies of drug treatment during the 1990s: the California Drug and Alcohol Treatment Assessment (CALDATA), Services Research Outcome Studies (SROS), and the National Treatment Improvement Evaluation Study (NTIES), and Drug Abuse Treatment Outcome Study (DATOS) (See also PIC ID Numbers 5994, 5994.1, 5994.3 and 5994.4). From before to after treatment, each study revealed across-the-board positive changes in drug use, crime, and health status. Clients in both short-term and long-term residential treatment experienced positive changes in drug use, crime, employment and health more often than clients in outpatient treatment. Clients discharged from (rather than maintained on) methadone displayed positive changes less often than any other group in treatment. Clients in the SROS showed consistently fewer changes than others on drug use, crime, employment, and health. This finding may be due to the longer period encompassed by the study and lower precision in measuring long-term patterns of change through the study's measurement of drug use, crime, employment, and health. Further studies are needed on the potential of these data to capture differences in client populations, organization of services, and clinical practices that may explain differential outcomes and costs.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994.2

PERFORMER: National Opinion Research Center (NORC)
Chicago, IL

The National Treatment Improvement Evaluation Study: Retention Analysis

One important mission of the Center for Substance Abuse Treatment (CSAT) is to expand the knowledge about and the availability of effective treatment and recovery services. To aid in accomplishing this mission, CSAT has made a significant commitment to developing and acquiring high-quality data about treatment of clients, the services provided for them, and outcomes. By establishing National Evaluation Data Services (NEDS), CSAT has attempted to provide a wide array of data management and scientific support services to gain evidence on which to base answers to questions about what kinds of treatment are most effective for curbing addiction-related behavior. This study uses data from the National Treatment Improvement Study (NTIES), a national evaluation of the effectiveness of substance abuse treatment services delivered in comprehensive treatment demonstration programs supported by CSAT, to analyze what service-delivery unit factors such as providing vocational training, increase the odds of program completion. The study was based on NTIES intake and treatment episode completion status data for 3,117 clients across 61 service delivery units. Results indicated that: In general, shorter programs have higher treatment episode completion rates but longer programs retain clients for longer periods; long-term residential programs exhibit higher treatment episode completion rates than long-term outpatient (non-methadone) or correctional programs; and the median length of stay for clients in long-term outpatient (non-methadone) or correctional programs with intended lengths of treatment of 120 days or more were lower than in the 90 to 119-day programs, suggesting that setting the intended length of treatment at 120 days or more may be counterproductive to retaining clients. Among the avenues suggested for further analysis was investigating why clients leave programs. (See also PIC ID#s 5994, and 5994.2 through 5994.4.)

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Smith, Ron
301-443-7730

PIC ID: 5994.1

PERFORMER: Battelle Corporation
Arlington, VA