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BACKGROUND
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ADULTS
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Introduction
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Drug Abuse Reporting Program (DARP)
Treatment Outcome Prospective Study (TOPS)
Comparisons with DATOS
Summaries of DARP and TOPS Findings
The research plan for DATOS was based on studies and findings about drug abuse treatment outcomes over the past 30 years. Much of this knowledge came from previous national, multi-site longitudinal evaluation studies funded by NIDA. Two major studies – the Drug Abuse Reporting Program (DARP) and the Treatment Outcomes Prospective Study (TOPS) – helped shape the direction and research questions for the DATOS studies of treatment outcomes and drug abuse patterns.
Drug Abuse Reporting Program (DARP)
The DARP study collected data from 44,000 clients admitted to 52 federally-funded treatment agencies (representing 139 separate programs) between 1969 and 1972. (See TCU DARP Publications List including a featured overview article provided in PDF.) During this time, a growing heroin epidemic was shaping national policy. Treatment modalities studied were methadone maintenance (MM), therapeutic communities (TC), outpatient drug-free (ODF), and detoxification (DT). Data were collected at intake, during treatment, and at a series of follow-ups that focused on outcomes up to 12 years after treatment.
DARP was a highly productive longitudinal drug treatment evaluation project that helped establish standards for naturalistic field-based studies in the U.S. and abroad. Over 150 DARP publications developed methodology for subsequent studies, demonstrated the value of field-based research, and produced many significant findings that have played a role in national drug abuse policy. Major findings include:
- At 12-month follow-up, 64% of clients
in MM, 61% in TC, and 56% in ODF no longer used opiates on a daily basis.
(See DARP 1-Year Outcomes below.)
- Time spent in treatment was a major predictor
of outcome. Treatment stays of 90 days or longer were significantly
associated with favorable outcomes.
- Community-based treatment for opiate addiction
was found to be effective in reducing both drug use and criminal behavior.
- At 6-year follow-up, 61% of the sample
had quit daily opiate use for at least a full year or longer. Participating
in on-going treatment or returning for subsequent treatment episodes
was associated with better outcomes. (See DARP
6-Year Outcomes below.)
- At 12-year follow-up, 75% of the sample
had not used opiates daily in the past year or longer, and 67% had not
used them in the past 3 years. (See DARP 12-Year
Outcomes below.)
- Clients averaged over 6 lifetime treatment
admissions, an average of one admission every 18 months across an average
duration of 10 years of addiction.
- This research served as the basis for developing a comprehensive set of TCU Data Collection Manuals for assessing intake, during-treatment performance, treatment process, and follow-up outcomes. (These are available free-of-charge in the Forms Section of the TCU/IBR web site.)
Treatment Outcome Prospective Study (TOPS)
The TOPS study collected data from 11,750 clients admitted to 41 treatment programs in 10 cities between 1979 and 1981. During this time, the heroin epidemic in the U.S. was subsiding and new patterns of drug use were emerging. Treatment modalities studied in TOPS included methadone maintenance (MM), outpatient drug-free (ODF), and long-term residential (LTR), which included therapeutic communities.
TOPS was designed to expand on DARP and provide a framework for more specialized studies, such as those dealing with changing drug use patterns, comorbidity, the impact of legal involvement, and the cost-effectiveness of drug abuse treatment. Major findings include:
- Treatment was found to be effective in
reducing daily opiate use and other illicit drug use during and after
treatment, a finding that supported DARP studies. (See TOPS
1-Year Outcomes below.)
- Drug use patterns in the U.S. changed
in the decade following DARP, with less daily use of opiates and more
polysubstance abuse (primarily stimulants and cocaine). However, 77%
of the sample reported opiates as their primary drug problem.
- Clients with legal involvement or legal
pressure to enter treatment were just as likely as those without such
pressure to benefit from treatment. Those with legal involvement stayed
in treatment slightly longer.
- When costs associated with crime were
calculated, drug abuse treatment was found to be cost effective.
- Among methadone maintenance programs, those with flexible dosing policies, specialized personnel, frequent urine monitoring, and comprehensive services were more likely to have higher client retention rates. (See TOPS Treatment Process below.)
Together with the DARP findings of the 1970s and the TOPS findings of the 1980s, the current DATOS studies captures a longitudinal snapshot of drug abuse patterns and treatment responses in the U. S. The large number of programs from comparable metropolitan areas represented in this naturalistic field research design sheds light on changes in treatment populations and service delivery over time. Some important changes in treatment admissions services over the last 30 years include:
- Reductions in opiate use and dramatic
increases in cocaine use
- Older client populations
- Reductions in the availability of ancillary health and social services
National drug treatment evaluation studies
have made significant contributions to knowledge about treatment effectiveness,
as well as to treatment policy, delivery, and research. These studies
illuminate changing drug abuse trends and treatment populations, and provide
direction for programming and service delivery. DATOS will continue this
work by studying a wide range of scientific and policy-relevant issues.
The emerging changes in client profiles, drugs of choice, and accessibility
of needed client services highlight the challenges facing both researchers
and drug abuse treatment providers in the years ahead.
Summaries of DARP and TOPS Findings
DARP 1-Year Outcomes: National Multi-modality Treatment Outcome Evaluation
Simpson, D. D. & Sells, S. B. (1982). Effectiveness of treatment for drug abuse: An overview of the DARP research program. Advances in Alcohol and Substance Abuse, 2(1), 7-29. (Full article now available in PDF format, (PDF; 2.5mg / 23 pages and see also TCU DARP Publications List both in the TCU/IBR web.)
- N=4,627 from 34 programs (83% of target
sample located)
- Focused on major treatment modalities–MM,
TC, and DF–along with short-term detoxification (DT) and intake
only (IO) comparison groups
- Among daily opioid users (N=3,248), posttreatment
prevalence for daily use declined to 36-44% in MM, TC, and DF and to
53-64% in IO and DT groups; nonopioid use (excluding marijuana and alcohol),
criminal involvement, and employment levels also improved following
treatment
- Time spent in treatment was a major predictor of posttreatment outcomes; however, clients staying less than 3 months in MM, TC, or DF did not differ at follow-up from DT and IO comparison groups
DARP 6-Year Outcomes: National Multimodality Treatment Outcome Evaluation
Simpson, D. D., Joe, G. W., & Bracy, S. A. (1982). Six-year follow-up of opioid addicts after admission to treatment. Archives of General Psychiatry, 39(11), 1318-1323. (See TCU DARP Publications List in the TCU/IBR web.)
- N=990; black and white male daily opioid
users from 26 DARP agencies (77% of target sample located)
- "Outcome patterns" were classified
longitudinally over follow-up interval
- Outcome differences between modalities
observed throughout the first 3 years after DARP became insignificant
by Year 6, due to cumulative effects of subsequent admissions to
other treatments (40%) as well as incarcerations and other life
events
- Outcome differences between modalities
observed throughout the first 3 years after DARP became insignificant
by Year 6, due to cumulative effects of subsequent admissions to
other treatments (40%) as well as incarcerations and other life
events
- 61% of the sample had quit daily opioid
use for a full year or longer by Year 6; this was accompanied by related
improvements in other outcome indicators, including crime, employment,
nonopioid use, and alcohol use
- The remaining 39% still had problems;
21% continued long-term daily opioid use, and 18% had other special
problems (chronic pattern of relapsing, prison, heavy alcohol/nonopioid
use)
- The remaining 39% still had problems;
21% continued long-term daily opioid use, and 18% had other special
problems (chronic pattern of relapsing, prison, heavy alcohol/nonopioid
use)
- 48% of the sample quit opioid drug
use while in a treatment program (thus, over three-fourths
of persons who quit did so while in treatment)
- 18% quit drugs while in DARP treatment, 17% quit during subsequent treatment, and 13% stayed abstinent while remaining in long-term MM treatment
DARP 12-Year Outcomes: National Addiction Careers Study
Simpson, D. D. & Sells, S. B. (Eds.). (1990). Opioid addiction and treatment: A 12-year follow-up. Malabar, FL: Krieger]. (See TCU DARP Publications List in the TCU/IBR web.)
- N=405; black and white male daily opioid
users from 18 DARP treatment agencies (80% of target sample located)
- Relapse rates:
Almost three-fourths of the sample reported one or more relapses
to daily opioid use (during addiction careers averaging 10 years); only
41% ever had a continuous episode of daily use lasting over 2 years
- Relapse was most likely in the first 3 months after quitting, but of those who were able to abstain for 3 months or more, 80% were still abstinent 12 months later
- Reasons for relapse: Primary
risk factors include youth with high risk-taking orientation and
poor socialization into supportive networks; social influences on
relapse diminished over time (compared to "first use"),
while psychological pressures–anxiety reduction, euphoria,
and craving–were cited in over 80% of relapses
- Criminal involvement:
Among males, 95% had been arrested or jailed during their lifetime;
21% reported arrests or jail before, 88% during, and 32% after active
periods of drug addiction (these overall rates for males were 10-14%
higher than for females, but trends were the same)
- 91% of the male sample had been incarcerated in their lifetime, with 60% having spent a year or longer behind bars
- Self-reported occurrences of violent
and property-related crimes rose during periods of daily
drug use; prevalence rates before, during, and after active addiction
phases were 14-49-9% for violent crimes, and 27-73-13% for crimes
against property
- Quitting: By Year
12, 75% had not used any opioids daily in the past year or longer
(61% had not used them at all), and for 67% it had been 3 or more
years since their last daily usage
- Reasons for quitting: Becoming
"tired of the street hustle" and "hitting bottom
and needing to change" were cited by 82-83%; other prominent
reasons included personal events or crises (66%), fear of being
jailed (57%), and family responsibilities (56%)
- Reasons for quitting: Becoming
"tired of the street hustle" and "hitting bottom
and needing to change" were cited by 82-83%; other prominent
reasons included personal events or crises (66%), fear of being
jailed (57%), and family responsibilities (56%)
- Treatment history:
Persons in this sample averaged over 6 treatment admissions in their
lifetime (thus averaging about once every 18 months across 10 years
of addiction), with most of these occurring after DARP when community-based
treatments became more widely available (and most often there was a
gravitation towards MM in subsequent admissions)
- Reasons for treatment admission: "Family pressures" were prominent incentives for treatment, cited by 75% of the sample, followed by "legal problems or pressures" by almost half (but least frequently for MM program admissions)
- Over half of those in recovery at
Year 12 had quit in treatment
TOPS 1-Year Outcomes: National Multimodality Treatment Outcome Evaluation
Hubbard, R. L., Marsden, M. E., Rachal. J. V., Harwood, H. J., Cavenaugh, E. R., & Ginzburg, H. M. (Eds.). (1989). Drug Abuse Treatment: A National Study of Effectiveness. Chapel Hill, NC: University of North Carolina Press.
TOPS Treatment Process: Client Retention in Treatment
Joe, G. W., Simpson, D. D., & Hubbard, R. L. (1991). Treatment predictors of tenure in methadone maintenance. Journal of Substance Abuse, 3(1), 73-84]. (See TCU DARP Publications List in the TCU/IBR web.)
- N=606; daily opioid users from 21 TOPS
MM treatment programs
- Programs with higher client retention rates were found to have (1) specialized personnel to diagnose client problems and guide treatment plans, (2) more flexible MM dosing policies and frequent urine monitoring, (3) more comprehensive and frequent delivery of services, and (4) more favorable client satisfaction and attitudes about services.
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Last Revised:
September 21, 2007
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