AIMS:This study used data from the national Drug Abuse Treatment Outcome Studies (DATOS) to investigate the associations that pre-treatment depression and hostility have with drug use and criminal behavior at 1 year and 5 year follow-up in patients with and without additional treatment involvement in the year prior to each follow-up.DESIGN:Following a naturalistic, non-experimental evaluation design, admissions to methadone treatment were followed up approximately 1 and 5 years later. Data analysis was conducted using multiple logistic regression.SETTING:Eighteen programs from DATOS were included.PARTICIPANTS:An analytic sample consisting of 727 patients at 1 year follow-up and 432 patients at 5 year follow-up was included.FINDINGS:Multiple logistic regression analyses revealed that greater depression predicted less drug use in the year preceding each follow-up, whereas greater hostility predicted increased drug use and more arrests at each follow-up. Furthermore, these predictive relationships appeared only among individuals not involved in additional treatment.CONCLUSIONS:Depression and hostility showed opposite associations with outcomes, underscoring the need to assess these psychological conditions separately and tailor treatment plans appropriately.

Patient attributions for their own long-term recovery were obtained in a 5-year followup of 432 admissions to 18 outpatient methadone treatment programs. Subjects were classified into two groups - recovering and non-recovering-strictly defined and based on both biological and self-report measures of no opioid or cocaine use, less than daily use of alcohol, and no arrests or illegal activity during the year prior to interview. The 28% who were in recovery at Year 5 reported that they had relied primarily upon personal motivation, treatment experiences, religion/spirituality, family, and their job/career. Particular value was placed on the support from family and close friends, indicating the importance of stronger efforts to develop social networks for support of drug-free functioning, especially among patients who lack these resources or need them strengthened. More information is available on the Internet at www.ibr.tcu.edu.

This study examined patient and program factors that influenced the receipt of scheduled supportive services in the Drug Abuse Treatment Outcome Studies (DATOS). Patients (N = 2,932) in 21 long-term residential (LTR) programs, 27 outpatient methadone treatment (OMT), and 25 outpatient drug-free programs were interviewed at admission and at 3 months during treatment. A hierarchical regression analysis was used to examine the relationship between patient-level and program-level factors associated with receiving supportive services in seven categories (medical, psychological, family, legal, educational, vocational, and financial). LTR patients received more services on average than outpatients (especially OMT), but patients overall received few services in the first 3 months of treatment. The patient-level likelihood of receiving services was related to being female and to having higher problem severity at intake. At the program level, outpatient clientele with higher problem severity received more services if they entered a program whose other enrolled patients were less troubled on average.

The intensive, time-limited, short-term inpatient modality treatment for substance abuse appears to have positive outcomes despite its brevity. This study examined patient characteristics and posttreatment experiences to understand who is likely to benefit from this treatment and under what circumstances. Our sample included 748 patients in 12 short-term inpatient programs. Twenty-two percent of patients used cocaine at least weekly in the 1-year follow-up period, and an additional 9% drank frequently (compared with pretreatment rates of 69% and 15% respectively). Overall, patients' social support networks following treatment were more important factors than the pre- or during-treatment variables examined.

Brief but comprehensive instruments measuring patient motivation, psychosocial functioning, treatment process, social network support, and services received are needed for monitoring drug abuse treatment delivery and patient progress. Combining this information across patients within a program also provides useful indicators about institutional composition and functioning. Consequently, the same assessment tools can be used to identify areas where treatment protocols need to be changed, and to monitor improvements following such changes. The Texas Christian University (TCU) Client Evaluation of Self and Treatment (CEST)(1) is a 144-item self-rating instrument that includes 16 scales measuring patient functioning and treatment perceptions. Psychometric properties (including reliability and construct validity) of the scales are examined in this article, based on patient samples drawn from 87 programs that participated in a series of staff training workshops. Acceptable reliabilities (.70 or above) were generally reported, and construct validity was also demonstrated (although the confirmatory factor analyses suggested some item pools could represent more than one factor). Prediction analyses were conducted using selected scales from each measurement domain to illustrate their sensitivity to treatment program contexts.

Based on the importance of during-treatment activities for improving outcomes, relationships between patient background, treatment readiness, and therapeutic engagement were examined in a national sample of adolescents admitted to 20 treatment programs representing three modalities. Patients with higher readiness for treatment at intake subsequently became more therapeutically involved, replicating previous findings on relationships between motivation and engagement in adult samples. One of the most influential background factors associated with higher treatment readiness was patient relationships with family and friends. Interventions that focus on treatment readiness appear to be appropriate strategies for improving treatment engagement.

The availability of a variety of treatment services was examined within a national sample of programs treating adolescent drug abuse patients. Treatment service delivery profiles were created and examined in the context of organizational variables such as program modality program directors' academic credentials, program capacity staff composition, accreditation, and patient problems. Results suggested that distinct profiles of services existed within residential and outpatient modalities and that these service profiles were related both to organizational factors and to patient problem profiles.

Self-efficacy has been shown to be related to outcomes from interventions for alcohol and tobacco abuse but relatively little attention has been focused on it in evaluations of treatment for illicit drug abuse. Almost no research has examined offenders involved with drugs. The current study, therefore, adapted the Alcohol Abstinence Self-efficacy Scale of DiClemente, Carbonari, Montgomery, and Hughes and administered it to 250 probationers mandated to 6 months of residential treatment. With some modifications, confirmatory factory models replicated four previously reported dimensions, e.g., Negative Affect, Social/Positive, Physical and Other Concerns, Cravings and Urges. Findings also indicated high construct validity for the Alcohol Abstinence Self-efficacy Scale as adapted here. Studies are needed to examine the use of self-efficacy as a prospective measure of treatment progress and to explore its association with outcomes from corrections-based treatment.

In the national Drug Abuse Treatment Outcome Studies (DATOS), many clients in outpatient methadone treatment (OMT) and outpatient drug-free (ODF) modalities were admitted with multiple sex and needle-risk behaviors, but they reduced these risks significantly during treatment. Using hierarchical linear model regression analysis, we examined client and treatment program characteristics as predictors of initial risk levels and of reductions over time. Clients who used cocaine frequently before treatment or had antisocial personality disorder entered treatment with elevated risks. In both modalities, cocaine users reduced risky behaviors significantly, but antisocial clients did so only in OMT. Treatment programs located in cities with higher prevalence rates of HIV/AIDS admitted clients with lower baseline levels of risk behavior than found in other cities. OMT programs in lower prevalence cities achieved higher rates of risk reduction than programs in higher prevalence cities. Reduction of sex and needle risks in both the OMT and ODF modalities indicates the importance of outpatient drug abuse treatment to national HIV prevention policy.

Patient ratings of their personal confidence in treatment and commitment to recovery were examined in a national sample of long-term residential, outpatient drug-free, and outpatient methadone programs. It was found that patients expressing greater confidence and commitment after 3 months of treatment generally began with higher motivation at intake, had formed better rapport with counselors, and attended counseling sessions more frequently. In addition, overall levels of patient involvement (as indicated by confidence and commitment) varied across programs; those programs with higher average involvement by patients used more social and public health services, maintained more consistent attendance at counseling sessions, and served patients who collectively had more similar kinds of needs. Thus, patient and program attributes both play a role in determining therapeutic engagement of persons who enter drug treatment.

OBJECTIVE:To examine lifetime and current psychiatric comorbidity measures as predictors of drug abuse treatment retention, and to test the generalizability of results across treatment agencies in diverse settings and with varying practices.DATA SOURCES/STUDY SETTING:The national Drug Abuse Treatment Outcome Studies (DATOS), a longitudinal study of clients from 96 treatment agencies in 11 U.S. cities.STUDY DESIGN:The design is naturalistic and uses longitudinal analysis of treatment retention in long-term residential, outpatient drug-free, and outpatient methadone treatment modalities; client background (including psychiatric comorbidity) and program service provision are predictors. Clinical thresholds for adequate treatment retention were 90 days for long-term residential and outpatient drug-free, and 360 days for outpatient methadone. Psychiatric indicators included lifetime DSM-III-R diagnoses of depression/anxiety and antisocial personality, and dimensional measures of current symptoms for depression and hostility.DATA COLLECTION/EXTRACTION METHODS:Data include structured interviews with clients, a survey of treatment program administrators, and program discharge records.PRINCIPAL FINDINGS:Dimensional measures of current psychiatric symptoms emerged as better predictors than lifetime DSM-III-R diagnoses. In addition, the predictive association of hostility with retention varied significantly across treatment agencies, both in the long-term residential and outpatient drug-free modalities. Other notable findings were that on-site mental health services in long-term residential programs were associated with better retention for clients with symptoms of hostility.CONCLUSIONS:Assessment issues and stability of results across programs are important considerations for treatment research and practice.

This study examined the relationship between perceptions of parent-child relations in the family of origin and antisocial tendency in a sample of drug-addicted adults. Data included retrospective accounts of childhood family factors, adolescent antisocial tendency, and self-reported hostility and risk-taking prior to treatment entry. A developmental model was tested that included adolescent antisocial tendency as a mediator of the relationship between childhood parenting factors and adulthood antisocial tendency. The effects of parental support and conflict were found to operate primarily through adolescent measures. Specifically, lower levels of parental support and higher levels of conflict with parents predicted greater adolescent antisocial tendency, which in turn predicted more hostility and risk-taking in adulthood. Thus, parental support appears to serve as a buffer against deviant behavior and drug use.

AIMS:This study examined client motivation as a predictor of retention and therapeutic engagement across the major types of treatment settings represented in the third national drug abuse treatment outcome study (DATOS) conducted in the United States.DESIGN:Sequential admissions during 1991-93 to 37 programs provided representative samples of community-based treatment populations. Based on this naturalistic non-experimental evaluation design, hierarchical linear model (HLM) analysis for nested data was used to control for systematic variations in retention rates and client attributes among programs within modalities.SETTING:The data were collected from long-term residential (LTR), outpatient methadone (OMT) and outpatient drug-free (ODF) programs located in 11 large cities.PARTICIPANTS:A total of 2265 clients in 18 LTR, 981 clients in 13 OMT and 1791 clients in 16 ODF programs were studied.MEASUREMENTS:Pre-treatment variables included problem recognition and treatment readiness (two stages of motivation), socio-demographic indicators, drug use history and dependence, criminality, co-morbid psychiatric diagnosis and previous treatment. Retention and engagement (based on ratings of client and counselor relationships) served as outcome criteria.FINDINGS:Pre-treatment motivation was related to retention in all three modalities, and the treatment readiness scale was the strongest predictor in LTR and OMT. Higher treatment readiness also was significantly related to early therapeutic engagement in each modality.CONCLUSIONS:Indicators of intrinsic motivation--especially readiness for treatment--were not only significant predictors of engagement and retention, but were more important than socio-demographic, drug use and other background variables. Improved assessments and planning of interventions that focus on stages of readiness for change and recovery should help improve treatment systems.

In the present study, the development of the Career Success Expectations Scale (CSES), and its application to two different significant career transitions, is described. Two independent samples (161 managers in expatriate work assignments and 103 managers obtaining an MBA degree) were employed in conducting, first, an exploratory (orthogonal and oblique rotations) analysis, and second, a confirmatory analysis of the factor structure of the instrument. The three-factor structure that emerged in the exploratory factor analysis was confirmed with structural equation modeling techniques in the second phase of the study.

This study examined the association between legal pressure and treatment retention in a national sample of 2,605 clients admitted to 18 long-term residential facilities that participated in the Drug Abuse Treatment Outcome Study (DATOS). Hierarchical linear models were used to assess the relationship of background factors and legal pressure with treatment participation for 90 days or longer. Two thirds of the sample entered residential treatment with moderate to high pressure from legal authorities, and they were significantly more likely than the low-pressure clients to stay 90 days or more. Moreover, the difference in retention between moderate-to-high-and low-pressure clients was even greater in programs with proportionally larger caseloads under legal surveillance. The criminal justice system (CJS) can influence treatment participation and retention, and it appears essential for the CJS and treatment programs to maintain an open and constructive relationship to maximize their potential combined impact.

Recent studies comparing self-admitted cocaine use with hair and urine test results have raised concerns about underreporting due to variations across situations and settings. Because of the frequent need for self-report data in conducting treatment evaluations, more information is needed on factors that affect the credibility of this information. the present study examines records of cocaine use collected as part of an evaluation of prison-based treatment (N = 396). Specifically, self-reported cocaine use from 6-month postrelease follow-up interviews, completed with treatment graduates and a comparison sample of parolees who were eligible but not sent to treatment, was examined in relation to urine and hair test results. Overall, cocaine use was underreported when compared to hair test results, but underreporting was lower for program graduates than for the untreated comparison group. Furthermore, program graduates originally admitted to prison on a drug-related arrest were the most likely to underre-port cocaine use, seemingly due to a heightened concern about potential consequences, such as returning to prison on another drug-related charge. Given that the validity of self-report for high-risk individuals varies greatly and is difficult to predict across studies, future research with criminal justice samples should continue to assess the validity of these measures under specific research conditions and for diverse types of individuals.

Treatment efforts appear to be effective in reducing crime among drug using individuals, but components of the treatment process associated with client improvement need to be identified. Furthermore, these elements of treatment may play an intermediate role in the connection between client background characteristics and later criminal activity. The current study examines a structural equation model including client perceptions of their drug related problems, peer deviance, and family dysfunction as influences upon the formation of therapeutic relationships during treatment and rearrests following treatment. Results showed therapeutic relationships were positively associated with recognition of drug related problems and negatively related to rearrest. Peer deviance also was positively related to rearrest.

Stays of 3 months or longer in drug abuse treatment generally predict better follow-up outcomes. In a national sample of community-based programs that participated in the Drug Abuse Treatment Outcome Study, median lengths of stay were 3 months for clients in long-term residential and outpatient drug-free treatments and 1 year for clients in outpatient methadone treatment. However, individual programs within each of these modalities differed widely in how long they kept their clients in treatment as well as their service delivery. Programs treating individuals with heavier cocaine and alcohol use and more psychological dysfunction usually had shorter retention rates. Nonetheless, even after statistically controlling for these client differences, some programs were more effective than others in engaging and retaining clients.

Practitioners working in drug treatment programs within the criminal justice system often must choose between the clinical benefits of the counselor-client interview and the time savings of self-administered instruments. The Brief Background Assessment (BBA), an intake instrument, was administered to clients in a probation-based drug treatment program as both a structured interview and as a self-administered assessment. Agreement between the two administrations was high across all areas assessed by the BBA. Likewise, nonagreeing responses were distributed randomly, across administration type. The results suggest that information collected by a self-administered intake assessment such as the BBA provides information similar to that gathered by interview-based intake assessments.