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Drug Abuse and Psychological Disorders


National Trends in Treatment Program Services

Services needed and provided to clients admitted to treatment in DATOS during 1991-1993 were examined and also compared to those of clients admitted to treatment in TOPS during 1979-1981 (Etheridge, Craddock, Dunteman, & Hubbard, 1995). The study focused on seven major categories of services – medical, psychological, family, legal, educational, vocational, and financial.

  • Roughly half of all clients admitted to OMT, LTR, and ODF programs in DATOS and TOPS needed each type of service surveyed after 3 months in treatment, with rates usually varying between 25% to 75% depending on type of service and modality.
     
  • Overall, client needs for services in DATOS were greater than for clients admitted to TOPS 10 years earlier.
     
  • There was a remarkable increase, however, in unmet needs among DATOS clients (compared to TOPS). These are illustrated in two of the major types of services needed by this population – that is, medical and psychological services. In TOPS, unmet needs for medical services in the three modalities were 6-18%, and for psychological services, 7-20%; in contrast, the rate of unmet needs for these services in DATOS rose to 25-40% and 54-57%, respectively. (See Client Needs for Medical Services; Client Needs for Psychological Services)

Chart: Client Needs for Medical Services: 1980s to 1990s        Chart: Client Needs for Psychological Services: 1980s to 1990s

  • Consistent with this trend was the finding that clients receiving services from two or more of these categories in DATOS was only 5% of OMT (down from 20% in TOPS), 50% of LTR (down from 77% in TOPS), and 15% of ODF (down from 60% in TOPS). (See Changes in Treatment Services)

Chart: Changes in Treatment Services: 1980s to 1990s

  • Characteristics of program structure and treatment services in DATOS were examined further and compared with similar data from the TOPS studies (Etheridge, Hubbard, Anderson, Craddock, & Flynn, 1997).
     
  • Primary treatment components for both DATOS and TOPS included treatment planning with client involvement, individual counseling with an emphasis on abstinence from drug misuse, group therapy, relapse prevention, urine monitoring, and supportive 12-Step aftercare.
     
  • These "core" drug counseling services improved, generally to highly positive levels, in all three modalities (OMT, LTR, and ODF) during the past 10 years. (See Changes in Core Services: for OMT, for LTR, for ODF)

Chart: Changes in OMT Core Treatment: 1980s to 1990s      Chart: Changes in LTR Core Treatment: 1980s to 1990s      Chart: Changes in ODF Core Treatment: 1980s to 1990s

  • Simultaneously, there have been major erosions in the comprehensive (sometimes called "wrap-around") services provided in conjunction with basic drug abuse treatment. This especially includes medical, psychological, family, and educational services designed to restore fundamental elements of the recovery process. (See Changes in Comprehensive Services: for OMT, for LTR, for ODF)

Chart: Changes in OMT Comprehensive Services: 1980s to 1990s      Chart: Changes in LTR Comprehensive Services: 1980s to 1990s      Chart: Changes in ODF Comprehensive Services: 1980s to 1990s

  • Declines have been the smallest in OMT settings, in part because this modality has historically been widely lacking in the availability of these supportive services; only 1 in 4 DATOS clients received medical services, and 1 in 10 received psychological, family, or educational services in the first 3 months of treatment.
     
  • Low rates of delivery for these comprehensive services were virtually the same among ODF clients, and they only doubled among residential clients in LTR programs; in both of these modalities, there were major declines from comparable records for treatment services in TOPS approximately 10 years earlier.

References

Etheridge, R. M., Craddock, S. G., Dunteman, G. H., & Hubbard, R. L. (1995). Treatment services in two national studies of community-based drug abuse treatment programs. Journal of Substance Abuse, 7(1), 9-26. [Abstract]

Etheridge, R. M., Hubbard, R. L., Anderson, J., Craddock, S. G., & Flynn, P. M. (1997). Treatment structure and program services in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors, 11(4), 244-260. [Abstract]

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Drug Abuse and Psychological Disorders

Evidence suggests that psychological disorders frequently co-occur with drug abuse problems. Clinical assessment instruments were included in Intake 2 of DATOS (n=8,755) in order to examine the prevalence of these diagnoses in a national sample of drug abuse treatment admissions (Flynn, Craddock, Luckey, Hubbard, & Dunteman, 1996). Special attention was given to antisocial personality disorder, depression, and general anxiety disorder.

  • Overall, approximately 40% of substance dependent clients in DATOS were diagnosed with antisocial personality disorder.
     
  • Men were twice as likely as women to have antisocial personalities.
     
  • Approximately 14% of substance dependent clients in DATOS met DSM diagnostic criteria for an Axis I lifetime depressive or anxiety disorder.
     
  • Women were twice as likely as men to have experienced major depression.
     
  • Clients with co-dependencies on three substances had the highest rates of antisocial personalities and a lifetime diagnosis of generalized anxiety disorder.


Reference

Flynn, P. M., Craddock, S. G., Luckey, J. W., Hubbard, R. L., & Dunteman, G. H. (1996). Comorbidity of antisocial personality and mood disorders among psychoactive substance-dependent treatment clients. Journal of Personality Disorders, 10(1), 56-67. [Abstract]

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