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5-Year Outcomes and Recovery Patterns
Journal of Substance Abuse Treatment (2003)   

Simpson, D. D. (Guest Ed.) (2003).  Special Section:  5-year follow-up treatment outcome studies from DATOS.  Journal of Substance Abuse Treatment, 25(3), 123-186.

1)  Simpson, D. D. (2003).  Introduction to 5-year follow-up treatment outcome studies [Editorial].  Journal of Substance Abuse Treatment, 25(3), 123-124.

Abstract:  There are clinical and political urgencies to questions about treatment effectiveness – for example, does treatment work, for whom, for how long, and what are the critical elements.  It is expected that evidence from large-scale national samples of treatment programs must be “refreshed” and expanded periodically.  Findings by DATOS reported here again made it clear that treatment effectiveness is related to patient motivation and problem severity, therapeutic engagement and intensity of services, as well as linkages to community-based social supports.  The studies reported in this issue contribute to our on-going efforts to identify and assess both patient and program-level factors that contribute to recovery in real-world settings.

2)  Hubbard, R. L., Craddock, S. G., & Anderson, J. (2003).  Overview of 5-year follow-up outcomes in the Drug Abuse Treatment Outcome Studies (DATOS). Journal of Substance Abuse Treatment, 25(3), 125-134.

Abstract:   Followup results from the Drug Abuse Treatment Outcome Studies (DATOS) 1-year and 5-year followups were used to describe the long-term outcomes of drug treatment and to further clarify the relationship between treatment duration and post-treatment outcomes in four treatment modalities: outpatient methadone, long-term residential (LTR), outpatient drug free (ODF), and short-term inpatient.  Methods replicating those used in earlier analyses of the DATOS 1-year followup of 2,966 patients admitted to treatment in 1991-1993 and those of the Treatment Outcome Prospective Study patients admitted in 1979-1981 were employed.  DATOS is a non-experimental longitudinal study conducted within the natural settings of 96 treatment programs in the U.S.A. The study followed patients during and after treatment at specified periods of time.  Prevalence of drug use and behaviors were evaluated for the year prior to treatment; and the post-treatment time frames defined by the 1- and 5-year followups.  In addition, the multivariate analytic technique of generalized estimating equations was used to examine the relationship of treatment duration and outcomes across both followups while also controlling for patient characteristics and pretreatment levels of behaviors.  The 5-year stratified followup sample included 1,393 of the same individuals in the 1-year followup sample.  Analyses were restricted to patients participating in both followups.  Reductions in prevalence of cocaine use in the year after treatment (compared to the preadmission year) by patients were associated with longer treatment durations (particularly 6 months or more in LTR and ODF).  In addition, reductions in illegal activity and increases in full-time employment were related to treatment stays of 6 months or longer for patients in LTR.  The DATOS results from the 1-year and 5-year post-treatment followup combined suggest the stability of outcomes of substance abuse treatment. While results are generally consistent with the full 1-year followup, reduced sample size and bias of the sample toward patients with longer treatment retention may have attenuated the findings. [Keywords: Long-term outcomes; DATOS; retention; multiple logistic regression analyses; treatment modality differences].

3)  Gossop, M., Browne, N., Stewart, D., & Marsden, J. (2003).  Alcohol use outcomes and heavy drinking at 4-5 years among a treatment sample of drug misusers.  Journal of Substance Abuse Treatment, 25(3), 135-143.

Abstract:  This paper investigates alcohol outcomes and heavy drinking among 418 drug misusers from the National Treatment Outcome Research Study who completed followup interviews at 1, 2, and 4-5 years.  About a quarter of the sample were drinking heavily at intake.  Alcohol consumption at followup was predicted by drinking prior to intake, and about a quarter of those who were classified as alcohol abstainers, medium-level drinkers, or heavy drinkers at intake, remained in the same drinking category at all assessment points.  Drinking outcomes were not related to opioid use. Heavy drinkers at followup were more likely to be using non-opioid drugs.  The poor drinking outcomes are a matter for concern.  Drug misusers with concurrent alcohol problems may require special treatment provision.  The extent of heavy drinking among drug misusers both before and after treatment indicates a need to develop and strengthen programs and interventions to tackle alcohol-related problems in this patient group. [Keywords: Drug misuse; alcohol outcomes; heavy drinking; treatment].

4)  Grella, C. E., Hser, Y. I., & Hsieh, S. (2003).  Predictors of drug treatment re-entry following relapse to cocaine use in DATOS.  Journal of Substance Abuse Treatment, 25(3), 145-154.

Abstract:  Many drug abusers have repeated exposure to treatment, yet little is known about the reasons some individuals re-enter treatment following relapse to drug use.  This paper examines the predictors of treatment re-entry among cocaine abusers who relapsed to cocaine use (N = 347) within 5 years following their index treatment episode.  In-depth assessments were conducted at treatment intake in 1991-93 and at 1 and 5 years following treatment discharge.  About 44% of the sample returned to treatment, at an average of 2.6 years following discharge.  A logistic regression analysis demonstrated that individuals who were African American, were previously married, used cocaine at least weekly after treatment discharge, and had more service needs at the time of index treatment were more likely to re-enter treatment.  The findings suggest that a longer-term perspective on treatment utilization is needed to more fully address chronic substance abuse and the problems typically associated with it.  [Keywords: Cocaine dependence; relapse; treatment re-entry; treatment career; service needs].

5)  Grella, C. E., Joshi, V., & Hser, Y. I. (2003).  Follow-up of cocaine-dependent men and women with antisocial personality disorder in DATOS.  Journal of Substance Abuse Treatment, 25(3), 155-164.

Abstract:  Long-term outcomes following drug treatment were examined for cocaine-dependent men (N = 453) and women (N = 254) with and without antisocial personality disorder (ASP).  In-depth assessments were conducted at treatment intake in 1991-93 and at 1 and 5 years following treatment discharge.  Overall, 47.2% of the males and 34.3% of females were diagnosed with ASP using DSM-III-R criteria derived from the Diagnostic Interview Schedule.  All groups reduced their cocaine, marijuana, and alcohol use; reduced their levels of psychological distress; and improved in functioning (e.g., employment, arrests, residential status).  At Year 5 ASP was associated with an increased likelihood of heavy alcohol use and additional substance abuse treatment among men, whereas women with ASP were more likely to report psychological problems and to receive mental health treatment and other services than either women without ASP or men with ASP.  The findings suggest the need to address the specific treatment needs of male and female cocaine abusers with ASP.  [Keywords: Antisocial personality disorder; cocaine dependence; gender; drug treatment outcomes; service utilization].

6)  Fletcher, B. W., Broome, K. M., Delany, P. J., Shields, J., & Flynn, P. M. (2003).  Patient and program factors in obtaining supportive services in DATOS.  Journal of Substance Abuse Treatment, 25(3), 165-175.

Abstract:  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.  [ Keywords: Treatment service utilization; supportive services; patient and program factors].

7)  Flynn, P. M., Joe, G. W., Broome, K. M., Simpson, D. D., & Brown, B. S. (2003).  Recovery from opioid addiction in DATOS.  Journal of Substance Abuse Treatment, 25(3), 177-186.

Abstract:  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.  [Keywords: Recovery; opioids; addiction; methadone treatment; treatment outcomes].

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Publications listed
by topics:
A. Outcome Overviews
B. Methods & Design
C. Services & Utilization
  1. Client descriptions
  2. Treatment services
  3. Support systems
D. Engagement & Retention
  1. Engagement
  2. Retention
E. Addiction & Treatment History
  1. Outcome patterns
  2. Career patterns
F. Special Populations & Issues
  1. Gender & ethnicity
  2. HIV risks
  3. Criminal behavior
  4. Co-morbidity
G. 5-Year Outcomes
H. Adolescents
I. Policy Issues
 
Special collections of
DATOS publications:
  Methods and 1-Year Outcomes
   (1997 in PAB)
 
•  Treatment Process, Engagement,
   and Retention
   (1999 in DAD)
 
•  Adolescent Treatment Outcomes
   (2001 in JAR)
  
•  5-year Outcomes and
   Recovery Patterns
   (2003 in JSAT)


   

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