Treatment retention and follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS).

Clients in the national Drug Abuse Treatment Outcome Study reported significant overall improvements in drug use and related measures during a 12-month follow-up period. A quasi-experimental design was used to examine the relationship of treatment duration with outcomes in each of the 3 major modalities represented. Client subsamples with longer retention in long-term residential programs and in outpatient methadone treatment had significantly better outcomes than those with shorter lengths of stay (results were inconclusive for outpatient drug-free programs because of sample limitations). This study used several methodological enhancements and showed general continuity of findings on retention effects from previous national evaluations of treatment effectiveness. It supports the need for more careful study of treatment process in relation to outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment structure and program services in the Drug Abuse Treatment Outcome Study (DATOS).

Program and client data from the Drug Abuse Treatment Outcome Study (DATOS) were used to examine program structural and treatment characteristics in 1991–1993. Similar data from the Treatment Outcome Prospective Study were used to compare the characteristics of DATOS programs with those in 1979–1981. Drug abuse treatment typically consisted of supportive therapy delivered primarily in groups, emphasizing abstinence from all illicit substances, including alcohol, buttressed by relapse prevention and urine monitoring during treatment. Secondary treatment emphases reflected each modality's unique orientations. Over the 2 eras, comprehensive services declined while many core elements of treatment strengthened, including client awareness of treatment plans and posttreatment involvement in 12-step groups. Some programs began to experience structural changes resulting from cost containment and managed care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methodological overview and Research Design for the Drug Abuse Treatment Outcome Study (DATOS).

The Drug Abuse Treatment Outcome Study (DATOS) is the 3rd in a series of national multisite studies of community-based treatment sponsored by the National Institute on Drug Abuse. The major goal of this prospective cohort study of adult clients entering treatment from 1991 to 1993 is to evaluate treatment effectiveness. The study included 10,010 admissions from 96 programs in 11 cities. Interviews were conducted at admission and during treatment, and 2,966 selected participants completed a 12-month follow-up interview. This article describes the methodological aspects of the study and provides an overview of program and client samples. Data collection procedures and instrumentation are described, and the analytical approach used to attain the research objectives is presented. Future plans for a longer term follow-up are also described, along with the potential contributions of DATOS findings to treatment policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug addiction and treatment careers among clients in the Drug Abuse Treatment Outcome Study (DATOS).

Considerable heterogeneity in patterns of addiction and treatment career histories was observed among the 10,010 clients participating in the Drug Abuse Treatment Outcome Study (DATOS). For half of the clients, DATOS was their first treatment episode; for the other half, their mean number of prior treatment episodes was 3.5. Type of treatment and cumulative length of treatment exposure reflected the interaction of clients' drug use patterns and the historical availability of different treatment approaches. Regression analyses showed that a higher level of prior treatment use was associated with more severe addiction career characteristics, injection drug use, and criminal activities. Effective and cost-effective approaches to treatment need to include more strategic interventions that consider clients' diverse treatment histories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Program diversity and treatment retention rates in the Drug Abuse Treatment Outcome Study (DATOS).

Stays of 3 months or longer in drug abuse treatment generally predict better follow-up outcomes. In a national sample of community-based programs that participated in the Drug Abuse Treatment Outcome Study, median lengths of stay were 3 months for clients in long-term residential and outpatient drug-free treatments and 1 year for clients in outpatient methadone treatment. However, individual programs within each of these modalities differed widely in how long they kept their clients in treatment as well as their service delivery. Programs treating individuals with heavier cocaine and alcohol use and more psychological dysfunction usually had shorter retention rates. Nonetheless, even after statistically controlling for these client differences, some programs were more effective than others in engaging and retaining clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug Abuse Treatment Outcome Study (DATOS): Treatment Evaluation Research in the United States.

Much of what is known about typical drug abuse treatment outcomes comes from a series of large-scale national prospective longitudinal treatment evaluation studies supported by the National Institute on Drug Abuse over the past 3 decades. An overview of the historical context, research design, and findings from the Drug Abuse Reporting Program (DARP) and the Treatment Outcome Prospective Study (TOPS) is presented. The Drug Abuse Treatment Outcome Study (DATOS), a multisite cooperative agreement, is the latest and most advanced in this research designed to understand drug abuse treatment. DATOS investigators are conducting analyses in 4 thematic areas: health services research, retention and engagement in treatment, the life course of treated addicts, and policy-relevant treatment outcome studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special issue: The National Institute on Drug Abuse's (NIDA's) Drug Abuse Treatment Outcome Study (DATOS).

Seven of the articles in this special issue of Psychology & Addictive Behaviors compose the 1st comprehensive look at an important collaborative research endeavor of the National Inst on Drug Abuse (NIDA), the Drug Abuse Treatment Outcome Study (DATOS). This introduction highlights some of the key findings of DATOS that are reported in this special issue. Also highlighted are areas that future DATOS studies should help illuminate about the effectiveness of drug abuse treatment as it is typically practiced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The National Treatment Outcome Research Study in the United Kingdom: Six-month follow-up outcomes.

The National Treatment Outcome Research Study is the first prospective, multisite treatment outcome investigation of drug users in the United Kingdom. The findings of this influential national study are being used by the Department of Health to formulate purchasing guidance. This article presents data on substance use problems for clients (N?=?1,075) in specialist inpatient, rehabilitation, methadone maintenance, and methadone reduction modalities. The most frequent problem was heroin addiction with associated polydrug use problems. There were differences between modalities in substance use at intake. Clients in residential modalities were older, were more likely to use cocaine and alcohol in addition to opiates, had longer drug careers, and had more previous treatment contact. Substantial improvements in a range of substance use problems were observed at 6-month follow-up among clients in all treatment modalities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome of the depressed elderly living in the community in Liverpool: a 5-year follow-up

BACKGROUND: Comparatively little is known about the long-term natural history of depressive disorders in the elderly living in the community. This is a follow-up of a subsample of the Continuing Health in the Community study random sample of the elderly population living in Liverpool. METHODS: The investigators followed up 120 cases of depression identified by a semi-structured interview schedule (GMS) for a period of 5 years. A similar number of other subjects defined as subcases of depression, other cases of mental illness and a random selection of non-cases were also included. RESULTS: The 5-year outcome for the cases of depression was worse than the outcome of the non-cases (relative mortality risk of 2.1, 95% confidence interval 1.1 to 3.9). Thirty-four per cent of the cases of depression died and 28% had dropped out during the follow-up. Of the 46 cases of depression who had a complete follow-up, 22% recovered from their symptoms, 30% were found to be AGECAT cases at one of the three follow-up waves, 24% were AGECAT cases at two of the three follow-up waves and the remaining 24% were AGECAT cases at each follow-up wave. Fifteen per cent of the surviving cases of depression were organic cases at the follow-up. Their anxiety comorbid state and depression score were identified as predictors of poor outcome. CONCLUSION: The findings of this study indicate that depressive disorders (most of which were untreated) found in the elderly community have a poor prognosis.     

Linking Session Focus to Treatment Outcome in Evidence-Based Treatments for Adolescent Substance Abuse.

The relation between specific therapy techniques and treatment outcome was examined for 2 empirically supported treatments for adolescent substance abuse: individual cognitive-behavioral therapy and multidimensional family therapy. Participants were 51 inner-city, substance-abusing adolescents receiving outpatient psychotherapy within a larger randomized trial. One session per case was evaluated using a 17-item observational measure of model-specific techniques and therapeutic foci. Exploratory factor analysis identified 2 subscales, Adolescent Focus and Family Focus, with strong interrater reliability and internal consistency. Process-outcome analyses revealed that family focus, but not adolescent focus, predicted posttreatment improvement in drug use, externalizing symptoms, and internalizing symptoms within both study conditions. Implications for the implementation and dissemination of individual-based and family-based approaches for adolescent drug use are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug abuse treatment readmissions and outcomes. Three-year follow-up of DARP patients

Temporal patterns of drug abuse treatment reentry and other outcome measures were examined over a three-year period based on a national follow-up sample of persons admitted to treatment in the Drug Abuse Reporting Program (DARP) during 1969 to 1972. Follow-up treatment modes included methadone maintenance, residence in a therapeutic community, outpatient drug-free treatment, outpatient detoxification treatment, and a comparison group whose members completed intake only and did not return for treatment in the DARP. Treatment readmission patterns were examined in relation to outcome measures for illicit drug use, alcohol use, employment, and criminality over time. The findings showed there were reliable associations between readmission patterns and posttreatment outcomes, which suggested there were beneficial effects of drug abuse treatment.     

Coronary Artery Smoking Intervention Study (CASIS): 5-year follow-up

A case of an endometrial polyp which developed in a 74-year-old woman treated with tamoxifen for 15 years after breast cancer surgery was the stimulus for this brief and concise review of the endometrial changes caused by anti-estrogen treatment in post-menopausal women with breast cancer. Tamoxifen therapy has been associated with the development of endometrial polyps, hyperplasia and adenocarcinoma possibly mediated through its agonistic estrogenic properties. Hysteroscopy follow-up should be performed in this group of patients and hysteroscopy should be done before the beginning of therapy and repeated once a year during the treatment.     

Therapeutic alliance as a predictor of outcome and retention in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study.

The authors examined the relation between therapeutic alliance, retention, and outcome for 308 cocaine-dependent outpatients participating in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. High levels of alliance were observed in supportive–expressive therapy (SE), cognitive therapy (CT), and individual drug counseling (IDC), and alliance levels increased slightly but significantly from Session 2 to Session 5 in all groups. In contrast to other studies, alliance was not a significant predictor of drug outcome. However, alliance did predict patient retention differentially across the 3 treatments. In SE and IDC, either higher levels of alliance were associated with increased retention or no relationship between alliance and retention was found, depending on the time alliance was measured. In CT, higher levels of alliance were associated with decreased retention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Top 1 in 10,000: A 10-year follow-up of the profoundly gifted.

Adolescents identified before the age of 13 (N?=?320) as having exceptional mathematical or verbal reasoning abilities (top 1 in 10,000) were tracked over 10 years. They pursued doctoral degrees at rates over 50 times base-rate expectations, with several participants having created noteworthy literary, scientific, or technical products by their early 20s. Early observed distinctions in intellectual strength (viz., quantitative reasoning ability over verbal reasoning ability, and vice versa) predicted sharp differences in their developmental trajectories and occupational pursuits. This special population strongly preferred educational opportunities tailored to their precocious rate of learning (i.e., appropriate developmental placement), with 95% using some form of acceleration to individualize their education. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug eruptions in Bangkok: a 1-year study at Ramathibodi Hospital

Concentration of camphorquinone initiator, exposure time of the light source and particle size of a radiopaque glass filler have been varied for an indigenously developed light-curing dental composite and the changes in the microhardness, compressive strength and diametral tensile strength studied. Higher initiator concentration and exposure times are found to improve the microhardness values while a concentration above 0.25% does not signify any drastic improvement in compressive and diametral strength. Changes in properties are found to be statistically significant at low initiator concentrations. A filler particle size around 1 microm is found to give better properties compared with larger sizes.     

Reliability and validity of the Functional Outcome Questionnaire for Aphasia (FOQ-A).

Objective: To perform a psychometric evaluation of the Functional Outcome Questionnaire for Aphasia (FOQ-A), a 32-item instrument designed to assess the extent to which a person who has had a stroke performs several important functional communication behaviors. Research Design: The FOQ-A was administered to family caregivers of persons with a history of left hemisphere stroke (N = 91) undergoing a comprehensive screening assessment to determine their eligibility for participation in research trials for novel stroke rehabilitation interventions. Results: Statistical analyses provided strong support for the internal consistency reliability and the convergent and discriminant validity of the FOQ-A. An exploratory factor analysis revealed a two-factor solution, Basic Verbal Expression and Conversational Response Skills. Conclusions: The present findings build on earlier evidence indicating that the FOQ-A has good psychometric properties and considerable promise as a measure of functional communication in aphasia rehabilitation. Future research will focus on the test-retest reliability, criterion-oriented validity, and predictive validity of the instrument. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric properties of the Drug Abuse Screening Test in psychiatric outpatients.

Individuals with a severe mental illness frequently have substance abuse and dependence problems, placing them at increased risk for poor treatment outcome. However, the reliability and validity of self-report measures assessing substance abuse and dependence remains understudied in this population. This investigation evaluates 2 versions of the Drug Abuse Screening Test (DAST; H. Skinner, 1982) as screening tools for an outpatient psychiatric sample. Participants were 73 men and 24 women who had been receiving treatment at a public psychiatric facility. All participants completed the DAST along with other measures of substance use and psychiatric status. The DAST demonstrated adequate internal consistency and temporal stability in this sample. Factor analysis supports a multidimensional scale. We evaluated criterion-related, concurrent and discriminant evidence for validity, and we have concluded that both tested versions of the DAST have sound psychometric properties when used with psychiatric outpatients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Millon Clinical Multiaxial Inventory Alcohol Abuse and Drug Abuse scales and the identification of substance-abuse patients.

This study investigated the effectiveness of the Millon Clinical Multiaxial Inventory Alcohol- and Drug-Abuse scales in identifying known alcohol and drug abusers in a sample of 561 adult psychiatric inpatients (408 women and 153 men). Only 43% of the alcoholics and 49% of the drug abusers were identified with the recommended base rate cutoff score of 75. False-positive rates were greater than 50% for each scale, and the scales had a significant positive intercorrelation. Although this study may have some limitations regarding how substance-abuse diagnoses were determined, these findings raise questions about the validity and clinical utility of these scales. Further studies of the item composition and effectiveness of these scales, as well as comparisons with other approaches to substance abuse assessment, are indicated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)