Treatment outcome evaluations are conducted to inform practitioners and decision makers about the efficacy of various treatment modalities and program components. The general findings from such evaluations indicate that substance abuse treatment does work for significant numbers of patients. However, conclusions cannot be made that all treatment approaches work equally well for all individuals; nor can it be stated that every alcohol– or drug–involved person will derive any benefit from treatment. Many of the treatment effectiveness studies to date have focused on narrow
population groups–usually males. It cannot necessarily be generalized that similar programs would be equally effective for women, adolescents, or other special population groups. Many studies also have been limited to one type of substance abuse, such as heroin or alcohol. Again, whether or not a particular modality would produce similar results for persons abusing different substances or those with polysubstance abuse problems cannot be determined without additional research.
Two large studies have focused on populations of narcotic–involved offenders. The Drug Abuse Reporting Program (DARP) measured treatment outcomes on 44,000 patients admitted to 52 treatment programs from 1969 through 1973. The types of programs included in the study were outpatient detoxification, methadone maintenance, therapeutic communities, and drug–free
outpatient. A comparison group consisted of persons interviewed and scheduled for treatment who did not show up at the program. Treatment outcome measures included drug use, productive activity, alcohol use, and criminality. Some general findings from this study include the following (Hubbard, 1992; Institute of Medicine, 1990; Tims, Fletcher & Hubbard, 1991):
Drug use declined dramatically between pre–treatment and post–treatment
measurements and continued to diminish during the three years following treatment. Post–treatment measures, compared with pre–treatment, indicated substantially less use of opiate drugs and nonopioid drugs, including cocaine. However, there was some increase noted in the use of alcohol and marijuana.
The most favorable outcomes for male opiate addicts were associated with methadone maintenance, therapeutic communities, and outpatient drug–free treatment. Detoxification alone was found to be considerably less effective.
Criminal behavior resulting in arrests or incarceration declined following treatment. Employment levels six months after treatment were substantially higher than pre– treatment levels.
Patients remaining in treatment at least three months showed better outcomes. The longer they remained in treatment, the better the outcome on average.
The Treatment Outcome Prospective Study (TOPS) collected data on 10,000 patients in 40
methadone, residential, and outpatient drug–free treatment programs between 1979 and 1981. The sample population for this study was predominately young adult males. However, women made up 30 percent of the sample, youth under age 21 comprised 25 percent of the study group from residential and outpatient drug–free programs, and racial/ethnic minority group members were included. The study measured drug use, alcohol consumption, mental health, criminal behavior, and economic productivity (Hubbard, 1992).
A composite portrait of those included in the study suggests that on average, they began regular drug use at age 16 but did not enter treatment for the first time until age 24. There was an average of five treatment admissions among the sample. Most had been treated in more than one type of treatment program. About 20 percent had also been treated for alcohol problems, and approximately 25 percent had received previous mental health treatment (Hubbard, 1992).
Some findings from this study include the following (Hubbard, 1992; Institute of Medicine, 1990):
Patients remaining in treatment for at least three months exhibited more positive treatment outcomes. However, the major changes in behavior were seen only among those who stayed in treatment for more than a year. Those who remained in
methadone or residential treatment for one year or more showed significant decreases in heroin use following treatment.
Although decline in heroin, cocaine, and psychotherapeutic drug use was noted, especially for those remaining in treatment longer than three months, marijuana and heavy alcohol use tended to continue after treatment.
After treatment, persons in the TOPS sample indicated substantial decreases in indicators of depression.
Individuals from the criminal justice system under legal pressure to participate in treatment did as well or better than those who voluntarily took part.
Involvement in the criminal justice system also helped retain persons in treatment, and more substantial changes in behavior during treatment were noted for
individuals referred from criminal justice agencies.
The criminal justice system tended to refer fewer persons to methadone programs, and it was found that individuals coming from the criminal justice system to drug– free programs received fewer services than other persons in the same programs. Outpatient programs had the poorest retention rates. Forty–one percent of patients dropped out within the first four weeks and only 18 percent eventually completed treatment.
Contrary to the positive findings about employment rates by the DARP study, TOPS researchers found that the level of employment six months after treatment was
slightly lower for all program types. This may, in part, reflect economic conditions during the respective periods in which the studies were conducted.
Reports of illegal activities decreased after treatment in all modalities. The most significant change occurred with those in residential programs.
Another major study of treatment effectiveness is currently in progress. The Drug Abuse Treatment Outcome Study (DATOS) is collecting data between 1991 and 1993. Fifty programs, both publicly and privately funded, including detoxification, methadone maintenance, therapeutic communities, drug– free outpatient, and chemical dependency units are being studied. Approximately 20,000 persons are included in the study sample. Emphasis is being placed on the process of treatment and client change measures during treatment (Tims, Fletcher & Hubbard, 1991).
One national study of alcohol treatment also was conducted in the 1970s. A sample of 593 patients were followed at 18 and 48 months after treatment. At four years after treatment, 21 percent of treatment participants had been abstinent for at least one year before the study was conducted. Both outpatient and inpatient alcohol treatment showed similar results (Hubbard, 1992).
While these studies provide significant information about treatment outcomes, they have some limitations. More information is needed about the comparative effects of different treatment approaches and the benefits of particular treatment components. Both treatment services and the types and needs of patient populations have changed since these earlier studies were conducted. Much additional research is needed on patient differences and how treatment variations respond to diverse needs. The complex process of individual change and the treatment factors that foster this require additional study, as well (Hubbard, 1992).
Despite the need for further evaluation, several points about treatment effectiveness can be made in summary. Overall, treatment is effective, and its benefits outweigh the costs of providing treatment. Generally, the more time spent in treatment, the better the treatment outcome. Individuals who are legally mandated to participate in treatment do as well or better than those who seek treatment on their own. Frequency of drug use and criminal behavior have shown decreases during treatment. Persons whose values and behaviors are more consistent with the majority of society have more favorable treatment outcomes. Persons with severe psychopathology and persons with histories of extensive criminal activity tend to have poorer treatment outcomes. Treatment effectiveness varies within modalities and among programs because of differences in staff, clinical competence, and experience (Hubbard, 1992; Singer, 1992).