Drug Abuse Treatment Outcome Studies

(Funded by NIDA)

National Cocaine Treatment Outcomes from DATOS

Charts Prepared & Released for Public Use by Dwayne Simpson (TCU), Robert Hubbard (NDRI-NC), Douglas Anglin (UCLA), & Bennett Fletcher (NIDA)

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D rug A buse T reatment O utcome S tudies

Third National Evaluation of Treatment Effectiveness

Funded by the National Institute on Drug Abuse 1991-93

11 Cities 96 Programs ~10,000 Patients All treatment types Follow-up: 1 & 5 Yrs

Over 60 Studies Published

Psychology of Addictive Behaviors

–

(Dec 97)

Drug and Alcohol Dependence Archives of General Psychiatry

(Dec 99) (June 99)

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Cocaine Treatment Study

 About three-fourths of all admissions to non-methadone treatment programs in the U.S. are for cocaine dependence  Managed care pressures are for shorter treatment & outpatient settings  Outcomes of cocaine treatment needs to be studied in “real-world” settings Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry

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Cocaine Treatment Outcomes

(in Year After Discharge in DATOS)

Cumulative Outcome Criteria (N=1605)  Half (52%) had relapses

Wkly Coc 23%

to drug use:  23% to “weekly” cocaine use  19% to “occasional” cocaine  10% to “other drugs”

Any Coc 19%

 4% had alcohol problems  11% reentered treatment (without relapse)

Any Trt 11% Alc Prob 4% Any Drug 10%

Overall, 67% had “problems” during follow-up period

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Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry

Weekly Cocaine Use in Past Year:

Changes from Before to After Treatment

100 80 60 40 20 0 77 24 Before After 58 20 82 26 LTR* ODF* STI* DATOS Treatment Modality *p<.001

Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry

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Any Jail in Past Year:

Changes from Before to After Treatment

100 80 60 40 20 0 79 35 Before 73 After 28 53 20 LTR* ODF* STI* DATOS Treatment Modality *p<.001

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Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry

Drinking 3+ Days/wk in Past Year:

Changes from Before to After Treatment

100 80 60 40 20 0 42 16 Before After 34 16 45 15 LTR* ODF* STI* DATOS Treatment Modality *p<.001

Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry

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Relapse Rates (Drug use & Trt in Yr 1), by Retention in Cocaine Treatments

90 80 70 60 50 40 High-Problem Group 81 69 80 69

“Threshold” of minimum stay for effectiveness!

70 62 % in Outpatient Drug Free (n=466) % in Long-Term Residential (n=549) 65 55 51 49 57 50 1-60 61-90 91-150 151-180 181-270 Number of Days in DATOS Treatment >270

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Types of Problems at Admission

3+ Drugs Alcohol Dep Criminal Act Unemployed-FT Low Social Sup Dep/Anxiety No Insurance 27 47 51 55 60 66 76 0 10 20 30 40 50 60 70 % With Problems in Year Before Admission 80

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Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry

Total Number of Problems

(Problem Severity Index, PSI)

26 % Low (0-3) % Med (4-5) % High (6-7) 54 43 24 11 6 LTR ODF STI Admissions to Each Treatment Modality Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry

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18

Weekly Cocaine Use

(in Year After Treatment)

35 30 27 17

Low Medium High Problem Severity at Intake (p<.001) <90 Days (p<.001)

Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry

90+ Days Length of Treatment Slide 11 of 14

20

Weekly Cocaine Use

(in Year After Treatment)

40 28 20 Short-Term Long-Term

Low Problem Patients

(ns) Short-Term Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry Long-Term

Mid-High Problem Patients (p<.001) Slide 12 of 14

50

Weekly Cocaine Use

(in Year After Treatment)

38 40 29 30 15 20 10 0 LTR (90+ Days) ODF (90+ Days) STI (21+ Days)

HIGH Problem Patients (p<.001)

Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999, Arch Gen Psychiatry

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Home Page About DATOS Background Highlights Special Topics Publications Web Posters What’s New CONTENT

News and Features

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.

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 .”

www.datos.org

Selected Studies 1-Year Outcomes Treatment Services & Process Cocaine Treatment Selected Web Posters Adolescent Studies Cost Benefits of MM Treatment Readiness for Treatment Slide 14 of 14