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Abstract
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Objective: To examine effects of program and patient characteristics on patient retention in residential drug treatment programs, outpatient drug-free programs (ODF), and methadone maintenance (MM) programs.
Data sources/study setting: Patient data were based on admission and discharge records for individuals entering treatment programs in Los Angeles County during 1992 and 1993. Program data were collected from program directors via a mail survey. The study sample included 26,047 patients in 87 programs. The dependent variable was patient completion of a critical threshold of treatment (360 days for MM and 180 days for the other two modalities). We applied logistic regression hierarchical linear modeling analysis for each modality.
Principal findings: Threshold retention rates were generally low in all three modalities (18.1% for residential programs, 22.9% for ODF, and 13.6% for MM). An articulated programmatic focus and low caseload increased patient retention in residential programs. A lower level of group therapy focus increased patient retention in ODF programs. A low programmatic focus and a low percentage of recovering staff were associated with high retention rates among MM patients. For ODF programs, none of the slopes showed random effects, while for residential and MM programs, some program factors contributed to the explanation of the random effects in several slopes (e.g., drug use severity).
Conclusion: Program practice and service provision played important roles in determining patient retention in treatment. Service providers and planners should consider these key factors to improve retention of patients, which is likely to increase overall treatment effectiveness and efficiency. |