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February 26, 2009 |
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Among adults who seek treatment for an alcohol or drug abuse problem, many do not complete an entire course of treatment. This finding is a concern given the research showing that length of stay in treatment is one of the strongest predictors of positive treatment outcomes.1,2 Identifying factors that predict treatment completion is an important step towards understanding what leads to successful treatment.
The Treatment Episode Data Set (TEDS) is an annual compilation of data on the demographic characteristics and substance abuse problems of those admitted to and discharged from substance abuse treatment. TEDS also collects information on reasons for leaving substance abuse treatment. These include treatment completion, transfer to another substance abuse program or facility within a single episode of treatment, left against professional advice (i.e., dropped out), terminated by the facility (i.e., discharge was not because the client dropped out, was incarcerated, or any other client reason), and other reasons, such as death.3 Clients’ treatment may be terminated by a facility for a variety of reasons, such as not following facility rules or exhibiting violent behavior.
This report focuses on the 973,000 clients who were discharged from outpatient, intensive outpatient, long-term residential (more than 30 days), and short-term residential (30 days or fewer) treatment in 2005.4 Specifically, this report examines the proportion of clients discharged who completed treatment or transferred to further treatment and the demographic and substance use characteristics that predict treatment completion and transfer. Because treatment completion and transfer to further treatment represent positive conclusions to a treatment episode, understanding the characteristics of clients who are completing treatment or transferring to further treatment may assist providers to tailor programs that will yield more successful outcomes for their clients.
In 2005, clients discharged from short-term residential treatment were more likely to complete treatment than clients discharged from long-term residential, outpatient, or intensive outpatient treatment settings (57 vs. 38 percent or less) (Figure 1). Clients discharged from intensive outpatient and short-term residential treatment were more likely to transfer to another program or facility than clients discharged from long-term residential and outpatient treatment settings (19 and 17 vs. 13 and 12 percent).
Source: 2005 SAMHSA Treatment Episode Data Set (TEDS). |
Reason for Discharge | Outpatient | Intensive Outpatient | Short-term Residential | Long-term Residential |
---|---|---|---|---|
Completed | 36% | 36% | 57% | 38% |
Transferred | 12% | 19% | 17% | 13% |
Dropped Out | 29% | 24% | 15% | 31% |
Terminated | 11% | 13% | 7% | 9% |
Other | 12% | 8% | 4% | 9% |
Source: 2005 SAMHSA Treatment Episode Data Set (TEDS). |
To examine the client characteristics associated with treatment completion or transfer to further treatment, a statistical analysis was conducted.5 This analysis identifies the likelihood of one group completing treatment or transferring to further treatment compared with another group. The remainder of this report presents the client characteristics that significantly predicted treatment completion or transfer to further treatment for each of the four major service types.
As shown in Tables 1 through 4, across the four treatment types (outpatient, intensive outpatient, short-term residential, and long-term residential), the strongest predictors of treatment completion or transfer to further treatment were use of alcohol as the primary substance, being referred to treatment from the criminal justice system, and being employed. However, the strength of each predictor varied across service types. For example, clients referred from the criminal justice system (versus any other referral source) were 58 percent more likely to complete outpatient treatment or be transferred to further treatment, 37 percent more likely to complete short-term residential treatment or be transferred to further treatment, 34 percent more likely to complete intensive outpatient treatment or be transferred to further treatment, and 28 percent more likely to complete long-term residential treatment or be transferred to further treatment.
Source: 2005 SAMHSA Treatment Episode Data Set (TEDS). |
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Source: 2005 SAMHSA Treatment Episode Data Set (TEDS). |
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Source: 2005 SAMHSA Treatment Episode Data Set (TEDS). |
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Source: 2005 SAMHSA Treatment Episode Data Set (TEDS). |
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Identifying factors that predict treatment completion is a critical part of understanding what leads to successful treatment. The TEDS analyses presented here look at the relationship between treatment completion or transfer to further treatment and gender, age at admission, race/ethnicity, primary substance of abuse, frequency of use, referral source, employment status, and education. The results show that the client characteristics that most strongly predicted treatment completion varied depending on the type of treatment (outpatient, intensive outpatient, short-term residential, or long-term residential). The findings underscore the strong positive influence of being employed on the likelihood of completing treatment or transferring to further treatment. These findings provide important insights to treatment providers and policymakers as they work to ensure that treatment is successful for all clients in all service settings.
1 McKay, J. R., & Weiss, R. V. (2001). A review of temporal effects and outcome predictors in substance abuse treatment studies with long-term follow-ups: Preliminary results and methodological issues. Evaluation Review, 25, 113-161.
2 Gossop, M., Marsden, J., Stewart, D., & Rolfe, A. (1999). Treatment retention and 1 year outcomes for residential programmes in England. Drug and Alcohol Dependence, 57(2), 89-98.
3 Other reasons for discharge include incarceration, death, or other factors external to the treatment regimen (i.e., client moved, was hospitalized, or some other reason out of the client’s control). Clients may be terminated from a treatment program by a facility for a variety of reasons, such as refusing to follow the prescribed treatment program, failing to follow facility rules and procedures, and exhibiting violent behavior.
4 In 2005, 34 States submitted discharge data, including AR, AZ, CA, CO, CT, FL, GA, HI, IA, ID, IL, KS, MA, MD, ME, MI, MN, MO, MS, MT, NE, NH, NJ, NY, OH, OK, OR, RI, SC, SD, TN, TX, UT, and VA.
5 Statistical analysis of odds ratios was conducted using multiple conditional logistic regression. This method involves simultaneous entry of a set of predictors into a logistic odds model. The results from the model give the statistical significance of each predictor variable relative to a reference value (e.g., the estimate for males provides a comparison to females).
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (February 26, 2009). The TEDS Report - - Predictors of Substance Abuse Treatment Completion or Transfer to Further Treatment, by Service Type. Rockville, MD
The Treatment Episode Data Set (TEDS) is one component of the Drug and Alcohol Services Information System (DASIS), an integrated data system maintained by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). TEDS is a compilation of data on the demographic characteristics and substance abuse problems of those admitted for substance abuse treatment. The information comes primarily from facilities that receive some public funding. Information on treatment admissions is routinely collected by State administrative systems and then submitted to SAMHSA in a standard format. TEDS records represent admissions rather than individuals, as a person may be admitted to treatment more than once. State admission data are reported to TEDS by the Single State Agencies (SSAs) for substance abuse treatment. There are significant differences among State data collection systems. Sources of State variation include completeness of reporting, facilities reporting TEDS data, clients included, and treatment resources available. In 2005, TEDS received approximately 1.85 million treatment admission records from all 50 States, the District of Columbia, and Puerto Rico, and approximately 1.52 million discharge records submitted by 34 States. See the annual TEDS reports for details. Definitions for demographic, substance use, and other measures mentioned in this report are available in the following publication: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (December 11, 2008). The TEDS Report - - TEDS Report Definitions. Rockville, MD. The TEDS Report is prepared by the Office of Applied Studies, SAMHSA; Synectics for Management Decisions, Inc., Arlington, Virginia; and by RTI International in Research Triangle Park, North Carolina (RTI International is the trade name of Research Triangle Institute). Information and data for this issue are based on data reported to TEDS through October 3, 2006. Access the latest TEDS reports
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The TEDS Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available online: http://oas.samhsa.gov. Citation of the source is appreciated. For questions about this report please e-mail: shortreports@samhsa.hhs.gov |
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SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States. ![]()
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