The impact of an outpatient program for women with substance use-related disorders on retention

Meeting the needs of women manifesting substance-use disorders is a goal in developing treatment programs for this population. As retention in treatment is positively related to treatment outcome, the length of stay in outpatient treatment of alcohol- and other drug-dependent women in Brazil was compared between two programs. Data were analyzed from 181 women entering a Mixed-Gender Program from 1986 to 1996 and from 80 women entering a Women-Only Program from 1997 to 1998. A greater 3-month retention rate was observed in the Women-Only as opposed to the Mixed-Gender Program. Moreover, the impact was more significant among the alcohol-dependent women. This finding suggests that the heterogeneity of women with substance-use disorders has to be taken into account when developing appropriate treatment strategies.     

Posttraumatic Stress Disorder,Gender, and Problem Profiles in Substance Dependent Patients

Patients with a chronic and severe substance-use disorder who also have a history of posttraumatic stress disorder (PTSD) are thought to have a unique set of problems. The present study assessed psychiatric disorders, psychosocial problems, and traumatic events with structured interviews in 747 men and 693 women enrolling in urban opioid substitution treatment programs from 1995 to 2001. Participants with versus without a history of PTSD were more likely to have a history of many other psychiatric disorders and demonstrated more current and historical medical, employment, family/social, and psychiatric problems. PTSD was generally unrelated to substance-use disorder severity or diagnoses, with the exception of an increased risk of alcohol dependence. Women were more likely than men to have experienced sexual assault, and less likely to have been physically assaulted, although these events precipitated PTSD at equivalent rates across gender. In contrast, witnessing or hearing about the death or injury of others was more likely to precipitate PTSD in women than men. Female gender, exposure to combat, sexual assault, or physical assault, and a history of major mood or anxiety disorder were the best predictors of PTSD in this group. Study limitations are noted.     

Posttraumatic stress disorder, gender, and problem profiles in substance dependent patients

Patients with a chronic and severe substance-use disorder who also have a history of posttraumatic stress disorder (PTSD) are thought to have a unique set of problems. The present study assessed psychiatric disorders, psychosocial problems, and traumatic events with structured interviews in 747 men and 693 women enrolling in urban opioid substitution treatment programs from 1995 to 2001. Participants with versus without a history of PTSD were more likely to have a history of many other psychiatric disorders and demonstrated more current and historical medical, employment, family/social, and psychiatric problems. PTSD was generally unrelated to substance-use disorder severity or diagnoses, with the exception of an increased risk of alcohol dependence. Women were more likely than men to have experienced sexual assault, and less likely to have been physically assaulted, although these events precipitated PTSD at equivalent rates across gender. In contrast, witnessing or hearing about the death or injury of others was more likely to precipitate PTSD in women than men. Female gender, exposure to combat, sexual assault, or physical assault, and a history of major mood or anxiety disorder were the best predictors of PTSD in this group. Study limitations are noted.     

Women in Drug Abuse Treatment Programs: Factors That Influence Retention at Very Early and Later Stages in Two Treatment Modalities. A Summary

A preliminary study of factors associated with incorporation into the program and retention during the first 4 months of treatment among women entering mixed-sex and all-women demonstration drug abuse treatment programs. Prostitution, parents’ deviance, and entering while under legal jeopardy are among the more important characteristics of women less likely to stay in treatment, although these vary across different programs? One relatively small demonstration therapeutic community proved exceptionally able to retain more difficult clients.     

Interaction Effects of Client and Treatment Program Characteristics on Retention: An Exploratory Analysis Using Hierarchical Linear Models

This paper applied a hierarchical linear modeling approach to explore the interaction effects of treatment program and client characteristics on client retention in treatment for drug users. Program characteristics included services provision, funding sources, and staff-client gender congruence, and client characteristics included gender, age at admission, and drug use level prior to admission. The same model was applied separately to three modalities: residential, methadone maintenance, and outpatient drug-free programs. Data were obtained from 59 treatment programs and 3,764 of their clients who had discharge records. The most noteworthy significant interaction effect detected was program's funding source and client's gender on treatment retention in the outpatient drug-free modality. for example, female clients remained less time in the programs that accepted only public funding than in the programs that accepted both public and private funding. Male clients remained in the treatment an average of 25.3 fewer days than female clients in drug-free programs that only accepted public fund, but stayed about the same time as females if the programs received mixed funding.     

Disaffiliation,Substance Use,and Exiting Homelessness

This study tested whether social affiliation was associated with exits from homelessness for a county-wide probability sample of 397 homeless adults who were followed over a 15-month period culminating in 1992. For the total sample, support from family or friends and service use were related to an increased likelihood of exiting from homelessness. Surprisingly, exits from homelessness were associated with social affiliation (i.e., support from family/friends and services use) only among homeless adults who did not have current substance-use disorders. This relationship did not hold for those with current substance-use disorders. Findings suggest that homeless adults without current substance-use disorders may be better able to engage services and support from family/friends to exit homelessness than homeless adults who have current substance-use disorders. Perhaps service providers who are targeting homeless adults with substance-use disorders and want to help them exit homelessness need to emphasize initiating substance-use treatment before addressing other issues.     

Disaffiliation,substance use,and exiting homelessness

This study tested whether social affiliation was associated with exits from homelessness for a county-wide probability sample of 397 homeless adults who were followed over a 15-month period culminating in 1992. For the total sample, support from family or friends and service use were related to an increased likelihood of exiting from homelessness. Surprisingly, exits from homelessness were associated with social affiliation (i.e., support from family/friends and services use) only among homeless adults who did not have current substance-use disorders. This relationship did not hold for those with current substance-use disorders. Findings suggest that homeless adults without current substance-use disorders may be better able to engage services and support from family/friends to exit homelessness than homeless adults who have current substance-use disorders. Perhaps service providers who are targeting homeless adults with substance-use disorders and want to help them exit homelessness need to emphasize initiating substance-use treatment before addressing other issues.     

The effects of Psychoeducation on the Traumatic Perception of the Birth Phenomenon in women with Substance-use Disorders

Objective: The present study evaluates the traumatic perception of the birth phenomenon in women with substance-use disorders (SUD) and to investigate the effects of psychoeducation on this perception. Material and Methods: The study was conducted between January and July 2017, and involved 60 women with SUD who were divided into two groups: intervention (n?=?30) and control (n?=?30). The study was carried out using the semi-experimental “pre-post test matched group model,” and the Traumatic Perception of Birth Psychoeducation Program (TPBPP) was applied. Results: Traumatic birth perception was found to be decreased after TPBPP was applied in four modules to women with SUD. Conclusion: TPBPP is an effective psychoeducation model in the reduction of the traumatic perception of birth in women with SUD.     

Co-occurring disorders in the adolescent mental health and substance abuse treatment systems

This article explores the rates of co-occurring disorders in two large federally-funded programs that target youth. In the mental health treatment system, the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) supports the Comprehensive Community Mental Health Services for Children and Their Families Program. SAMHSA's Center for Substance Abuse Treatment (CSAT) supports a number of grant programs providing substance abuse treatment for adolescents. The data from these programs underscores the need for the use of systematic, validated, biopsychosocial assessment instruments for all youth entering either the substance abuse or mental health treatment systems. The current evidence base for models of co-occurring treatment for youth is discussed and recommendations made for future activity related to adolescent co-occurring treatment.     

Comparison of Pregnancy-Specific Interventions to a Traditional Treatment Program for Cocaine-Addicted Pregnant Women

Alcohol and drug use in pregnancy is a significant concern. There is a paucity of treatment programs for substance-abusing pregnant women, especially if indigent. Futhermore, treatment retention is compromised when the drug of choice is crack-cocaine. This paper reports the results of a study comparing treatment retention of cocaine-abusing indigent pregnant women before and after incorporating pregnancy-specific interventions. Audits were performed on 603 charts of women enrolled between 1988 and 1994 in either a traditional treatment program (n = 114) or in the Pregnancy Substance Abuse Program (PSAP) (n = 489). Differences in treatment retention were found between the two treatment groups. Drop-out rates from the inpatient component of treatment were significantly lower in the PSAP group than in the control group (11.3% vs. 38.6%, p < .001). There was a higher rate of completion of outpatient treatment in the PSAP compared to the control group (34.4% vs. 13.5%, p < .005). These results were achieved with a 2-day decreased inpatient stay. Treatment retention improved when specialized interventions were provided, at minimal additional cost. These results have implications for other publicly funded treatment programs.     

Substance abuse treatment entry, retention, and outcome in women: a review of the literature

This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.     

Treatment Retention in Women's Residential Chemical Dependency Treatment: The Effect of Admission with Children

In the United States there has been an increased interest in the development of treatment programs that admit chemically dependent women with their children. The Salvation Army Family Treatment Services in Honolulu, Hawaii has had a long history of admitting women both with and without their children to long-term residential treatment. This has provided an opportunity to study the differences in treatment retention between these two groups. Subjects were 130 females who participated in treatment between 1988 and 1993. Analyses were conducted to determine whether there were different outcomes for women with children in treatment and women without children in treatment, with regard to type of discharge and length of time in treatment. Results were significant and clearly indicated better retention rates for women who participated in treatment with their children.     

Sexual abuse, parental bonding, social support, and program retention for women in substance abuse treatment

Residential programs that provide safe environments and child care can attract perinatal women into treatment. Other factors, however, may prevent some women from benefiting from these programs. Attachment theory suggests that one's early history determines the effectiveness with which one can utilize available social supports. Lower levels of program retention were predicted for women who had been sexually abused and for those who had poor early bonding. Eighty-four women in residential substance abuse treatment programs were studied. Clients who reported sexual abuse also reported lower parental care. Parental care and overprotection were inversely related, and related, in predicted directions, to perceptions of social supports. Sexual abuse alone was associated with time in treatment and the likelihood of graduation. Implications for developing effective counseling programs for women in substance abuse treatment are discussed.     

Women-only and mixed-gender drug abuse treatment programs: service needs, utilization and outcomes

OBJECTIVES: This prospective longitudinal study examined service needs, utilization and outcomes for 189 women in women-only (WO) programs and 871 women in mixed-gender (MG) programs. METHODS: The Addiction Severity Index was administered at both intake and the 9-month follow-up interview to assess clients' problem severity and outcomes, and the Treatment Service Review was given at the 3-month interview to measure service utilization. Treatment completion and arrests were based on official records. RESULTS: Compared to women in MG programs, women in WO programs were more likely to be White, less educated, physically abused in the past 30 days and in residential treatment (as opposed to outpatient treatment). Women in WO programs also had greater problem severity in a number of domains including alcohol, drug, family, medical and psychiatric. They utilized more treatment services and had better drug and legal outcomes at follow-up compared to women in MG programs. Program type was not predictive of treatment retention/completion or outcomes in other domains (i.e., alcohol, employment, family, medical and psychiatric). CONCLUSIONS: The greater problem severity of women treated in WO programs and their better drug and legal outcomes suggest that these specialized services are filling an important gap in addiction services.     

Stability in a large drug treatment system: Examining the role of program size and performance on service discontinuation

BackgroundLittle is known about the stability of public drug treatment in the United States to deliver services in an era of expansion of public insurance. Guided by organizational theories, we examined the role of program size, and performance (i.e., rates of treatment initiation and engagement) on discontinuing services in one of the largest treatment systems in the United States.MethodsThis study relied on multi-year (2006–2014) administrative data of 249,029 treatment admission episodes from 482 treatment programs in Los Angeles County, CA. We relied on survival regression analysis to identify associations between program size, treatment initiation (wait time) and engagement (retention and completion rates) and discontinuing services in any given year. We examined program differences between discontinued versus sustained services in pre- and post-expansion periods.ResultsSixty-two percent of programs discontinued services at some point between 2006 and 2014. Program size and rates of treatment retention were negatively associated with risk of discontinuing services. Proportion of female clients was also negatively associated with risk of discontinuing services. Compared to residential programs, methadone programs were associated with reduced likelihood of discontinuing services. Two interactions were significant; program size and retention rates, as well as program size and completion rates were negatively associated with risk of discontinuing services.ConclusionsProgram size (large), type (methadone), performance (retention) and client population (women) were associated with stability in this drug treatment system. Because more than 70% of programs in this system are small, it is critical to support their capacity to sustain services to reduce existing disparities in access to care. We discuss the implications of these findings for system evaluation and for responding to public health crises.     

Incentives for retention of pregnant substance users: A secondary analysis

Retention of pregnant substance users in treatment is challenging. In a multisite clinical trial, 200 pregnant substance users entering outpatient treatment at one of four programs were randomized to either three individual sessions of Motivational Enhancement Therapy for Pregnant Substance users or three individual sessions normally provided. Retail scrip from $25 to $30 was provided for attendance of research visits but not treatment visits. A post hoc analysis of the non-methadone-maintained participants (n = 175) evaluated the hypotheses that monetary reinforcement for attendance would result in more consecutive, and overall, weeks of attendance of research versus nonincentivized treatment visits. Findings indicate participants were nearly three times as likely to attend 4 consecutive weeks of research visits versus treatment sessions. There was no effect for income while fewer dependents were associated with more consecutive weeks of attendance. Incentives in the $25-to-$30 range may serve to significantly increase attendance and retention.     

The relative effectiveness of women-only and mixed-gender treatment for substance-abusing women

Following research indicating that the treatment needs of women are different from those of men, researchers and clinicians have argued that drug treatment programs for women should be designed to take their needs into account. Such programs tend to admit only women and incorporate philosophies and activities that are based on a social, peer-based model that is responsive to women's needs. To assess the relative effectiveness of women-only (WO) outpatient programs compared with mixed-gender (MG) outpatient programs, 291 study volunteers were recruited (152 WO, 139 MG), and a 1-year follow-up was completed with 259 women (135 WO, 124 MG). Using bivariate, logistic regression, and generalized estimating equation analysis, the following four outcomes were examined: drug and alcohol use, criminal activity, arrests, and employment. In both groups, women showed improvement in the four outcome measures. Comparison of the groups on outcomes yielded mixed results; women who participated in the WO treatment reported significantly less substance use and criminal activity than women in the MG treatment, but there were no differences in arrest or employment status at follow-up compared with those in the MG treatment.     

Changes in personal networks of women in residential and outpatient substance abuse treatment

Changes in personal network composition, support and structure over 12 months were examined in 377 women from residential (n = 119) and intensive outpatient substance abuse treatment (n = 258) through face-to-face interviews utilizing computer based data collection. Personal networks of women who entered residential treatment had more substance users, more people with whom they had used alcohol and/or drugs, and fewer people from treatment programs or self- help groups than personal networks of women who entered intensive outpatient treatment. By 12 months post treatment intake, network composition improved for women in residential treatment; however, concrete support was still lower and substance users are still more prevalent in their networks. Network composition of women in outpatient treatment remained largely the same over time. Both groups increased cohesiveness within the network over 12 months. Targeting interventions that support positive changes in personal networks may heighten positive long term outcomes for women entering treatment.     

Ethnic and Cultural Differences in Drug-Using Women Who Are In and Out of Treatment

SUMMARY

In recent years, increasing emphasis has been placed on race, ethnicity and culture as they relate to recruitment into and retention in substance abuse treatment as well as treatment effectiveness. Racial/ethnic and cultural differences were studied among women participating in two programs located within a large southwestern city. One of these programs was residential treatment for drug-using women and the other program provided street outreach for HIV prevention/education to drug-using women. Significant differences were found among racial/ethnic groups within each program and between the two programs. Differences were explored for the following factors: marital status; education; age at entry into the program; drug use history; drug treatment history; current use patterns; injection rates; history of arrests and exchange of sex for drugs. The authors conclude with a discussion of these differences and their potential ramifications for conducting future research and in developing/implementing effective prevention and treatment programs.