Factors that Influence Retention Factors that Influence Retention in Greek Therapeutic in Greek Therapeutic CommunitiesCommunities

Erianna DalianiErianna Daliani MSc MSc (Gerasimos (Gerasimos Papanastasatos) Papanastasatos) KETHEA Research Dept.KETHEA Research Dept.

11th European Conference on Rehabilitation & Drug Policy

Why retention?

Retention in treatment has been the most consistent and important predictor of post-treatment outcome

It is an index that captures the effect of the various client characteristics, as well as that of different treatment characteristics

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Previous research

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Drug – and alcohol related

problems

Family/social problems

Psychiatric problems

(?)

Gender (?)Higher rates of retention

Employment problems

Law problems

Aims of the present study

Investigation of the effect of type of treatment programme on retention

Investigation of the effect of client characteristics on retention

Investigation of their combined effect

Population & Sample

Population: Drug addicts that were admitted for treatment in one of 9 Therapeutic Communities for adults (4 residential and 5 open care)

Sample: Clients that had completed EuropASI questionnaire during intake

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Sample (a)

6.8%

57.4%

.8%

.5%

16.2%

18.3%

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Sample (b)

86.8% men

Mean age:26.6 years

Ν = 1496

70.8% in residential treatment setting

29.2% in intensive outpatient facility

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Data Collection

Personal interviews

Questionnaire: EuropASI, European

modification of the Addiction Severity Index

Duration: 01.01.2002 – 31.12.2005

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7 problem areas

2 summary indices for each area

Both indices combine quantitative

information and client’s subjective ratings

of the current importance of the problems

and the need for treatment

Composite scores are calculated

automatically based on questions about the

present that are subject to change

EuropASI summary indices – EuropASI summary indices – Methodological issuesMethodological issues

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Severity ratings are established by the Severity ratings are established by the interviewers after following a standard interviewers after following a standard procedure. Existence and severity of procedure. Existence and severity of lifetime problemslifetime problems is taken into account is taken into account together with client’s present condition together with client’s present condition and need for treatmentand need for treatment

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EuropASI summary indices – EuropASI summary indices – Methodological issuesMethodological issues

Clients’ Profile – Clients’ Profile – Lifetime and Lifetime and recent problems in 7 areasrecent problems in 7 areas

0,26

0,36

0,26

0,67

0,28

0,47

0,34

0,21

0,43

0,12

0,22

0,32 0,33

0,21

0,00

0,10

0,20

0,30

0,40

0,50

0,60

0,70

0,80

medical employment* alcohol drugs* legal family/ social* psychiatric

severity

composite

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*intercorrelations ≤ 0.3

Outcomes of several follow up studies show that

length of stay in treatment is directly related to

positive outcomes

Greek Therapeutic Communities, residential and

open care, expect clients to stay in treatment for

12 months in order to complete it

After TC clients enter a less intensive,

rehabilitation phase that last for another 12

months

"Completers" are the clients who stay in

treatment for at least 12 months, while

"Dropouts" are the clients that leave the

therapeutic programme before they complete the

one-year period

Annual Retention Annual Retention

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Annual retention

81,50

74,30

69,1064,80

60,6056,80

53,7051,40

48,6045,60 44,20

42,00

0

10

20

30

40

50

60

70

80

90

100

0 30 60 90 120 150 180 210 240 270 300 330 360

retention (in days)

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Annual retention - type of treatment

retention (in days)

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78,8

70,4

64,9

60,2

55,5

50,847,5

44,942,2

39,137,5

35,1

87,9

83,5

79,476,2

72,871,2

68,967,3

64,161,3 60,4

58,8

0

10

20

30

40

50

60

70

80

90

100

0 30 60 90 120 150 180 210 240 270 300 330 360

residence

outpatient

Annual retention – gender and type of treatment

retention (in days)

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77,8

70,3

60,0

51,047,7

45,0

83,2

78,875,1

71,5 69,967,3

65,462,3

59,4 58,456,5

71,3

60,8

55,9

49,746,2

90,9

85,583,6 83,6

81,880,0 80,0 80,0

76,474,5 74,5 74,5

55,5

65,1

35,8

42,7

38,239,7

87,4

63,6

85,3

30,8

39,2

32,935,0

44,1

0

10

20

30

40

50

60

70

80

90

100

0 30 60 90 120 150 180 210 240 270 300 330 360

men/ residence

men/ open care

women/ residence

women/ open care

Logistic regression was performed for annual

retention as the dependent variable and type of

treatment, gender, age, number of previous

treatment episodes, EuropASI composite and

severity indices as independent variables

(predictors)

Both composite (recent) and severity (lifetime)

indices were used since intercorrelations

between them were not high in absolute

magnitude

Interactions between type of treatment and

other predictors were entered simultaneously to

include the affect shown in annual retention

diagram

Data analysisData analysis

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Significant Predictors of Treatment Completion

•p<0.1 **p<0.05 ***p<0.01

Beta SE df Odds RatioTreatment type (open care) *** 1,67 0,43 1 5,33Drug problems (composite)*** -1,31 0,39 1 0,27Psychological problems (severity)*** -1,22 0,30 1 0,29

InteractionsFamily/Social (composite) X treatment type (open care) * -1,14 0,62 1 0,32

Drugs(severity) by X treatment type (open care) ** -1,99 0,82 1 0,14

Legal (severity) by X treatment type (open care) ** -1,23 0,48 1 0,29

Family/Social (severity) X treatment type (open care) ** 1,30 0,61 1 3,66

Psychological (severity) by treatment type (open care) ** 1,75 0,70 1 5,75

Main EffectsMain Effects

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Type of treatment – clients in open care

(outpatient intensive) are more likely to

complete treatment

Clients with heavier drug use during the period

before admission are more likely to dropout from

treatment

Clients with more severe lifetime psychological

problems are less likely to stay for a year in

treatment

Investigating the interactions – family/ social support and type of treatment

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Family/ social relations and support is an important predictor for completion of outpatient treatment

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Severity of lifetime drug use related problems is always a predictor – more so in outpatient programmes

Investigating the interactions – drug problems and type of treatment

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Investigating the interactions – legal problems and type of treatment

Severe legal problems are related with dropout from outpatient treatment

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Investigating the interactions – psychological problems and type of treatment

Clients with medium – severe psychological problems are usually referred to outpatient treatment – no statistical difference between "dropouts“ and "completers“ (open care)

Discussion (a)Discussion (a)

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More drug problems before admission are related

with higher rates of dropout, regardless of

treatment setting. Further analysis will determine

the actual time of dropout

Outpatient settings are associated with higher

treatment completion rates. Residential clients

tend to have more problems than outpatient

clients in most of the examined areas

Clients with more severe lifetime psychological

problems are less likely to stay for a year in

treatment. This effect is stronger in residential

treatment.

Discussion (b)Discussion (b)

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Gender factor was initially found to be important

when combined with type of treatment. This

difference did not remain after we controlled for

problems’ severity

Previous studies have shown that family/ social

problems are related to lower rates of retention. In

this study this effect was found to be present only in

outpatient treatment

Unlike other studies severity of legal problems was

found to be negatively related to treatment

completion – this effect is more clear in outpatient

treatment

Limitations & Issues for further Limitations & Issues for further researchresearch

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Adequacy and consistency of EuropASI indices

Relation between former therapeutic experience and

retention in treatment

Investigate early – late dropout criteria

Retention is predictive of treatment related

outcomes but there is need for actually measuring

these outcomes – FOLLOW UP study

Significance of interactions between clients

characteristics and treatment settings, stresses the

importance of matching therapeutic interventions to

clients needs