Services Research Outcomes Study (SROS)

PURPOSE OF THE STUDY

Public officials and citizens commonly ask a simple question about drug treatment: "Does it work?" Behind this simple question lie a series of more specific questions: Does treatment help people who are addicted to illicit drugs or alcohol to change their behavior — is their drug taking or heavy drinking stopped or greatly reduced? Do they become more productive and healthier? Do they stay out of trouble with the law? Does the public, including the families of users, benefit by sustaining fewer property losses and injuries from dealers and users? Is there a reduced burden on law enforcement and other criminal justice systems, health care, and welfare systems?

Knowledge about effects and costs of the national treatment effort has derived largely from outcome studies such as the National Treatment Improvement Evaluation Study (NTIES, Gerstein et al., 1997), the California Drug and Alcohol Treatment Assessment (CALDATA, Gerstein, et al., 1994), the Drug Abuse Treatment Outcomes Study (DATOS, Fletcher 1997; Hubbard et al., 1997; Simpson et al., 1997, Anglin et al., 1997), the Treatment Outcome Prospective Study (TOPS, Hubbard et al., 1989), the Drug Abuse Reporting Program (DARP, Sells, et al., 1976; Simpson and Friend, 1988), and individual studies of facilities such as Phoenix House (DeLeon, Wexler, and Jainchill, 1982), the California Rehabilitation Center (Anglin, 1988), and a variety of methadone maintenance programs (Hargreaves, 1983; Dole, 1989).

None of the cited studies was designed to represent the treatment system as a whole. Each was a selective sample governed by a standard such as participation in special Government funding efforts. In 1990, the National Institute on Drug Abuse (NIDA), the predecessor agency to the Substance Abuse and Mental Health Services Administration (SAMHSA), was asked by the Office of National Drug Control Policy (ONDCP) to conduct a study that would go further toward the ideal of a national representative sample of the treatment system. The first stage of the response to this request was the Drug Services Research Survey (DSRS, Batten et al., 1993), a representative probability sample survey drawn from a comprehensive list of organized substance abuse treatment programs. The DSRS collected basic facility-level information and successfully abstracted more than 2,200 program client records of individuals discharged during 1989-90 from 120 randomly selected, cooperating treatment facilities, in order to provide a picture of treatment participation and client characteristics.

The Services Research Outcomes Study (SROS), whose results are reported here, was designed as a client outcome study based on the DSRS program sample. SROS staff from the National Opinion Research Center (NORC) at the University of Chicago collected extensive program and client data, completed interviews, and collected urine specimens from a representative sample of individuals discharged from 99 of the 120 DSRS facilities. Out of 3,047 clients selected for follow up, 1,799 interviews were completed five to six years after discharge from the SROS "index" treatment episode, and another 277 clients were found to be deceased, accounting for 68 percent of all those in the SROS sample. Although the SROS sample is not perfect, it is far closer to accurately reflecting the national treatment system as a whole than any other outcome study sample to date, and it provides the first opportunity to examine representative extended outcomes of substance abuse treatment.

SROS interviews, conducted during 1995 and 1996, covered the client’s entire life span, with special attention to their behavior and circumstances during the five years before entry to the index (SROS) treatment in 1989-90 and after leaving that treatment until the time of the interview. The SROS client interview included questions on patterns of drug consumption (including alcohol use), criminal activity, employment, health, social support, and other behavior relevant to treatment goals. The interview and other aspects of the research were designed to answer the following major questions:

·Who entered treatment? Did differences in characteristics at admission, such as stated reasons for entry into treatment, influence client outcomes?

·Which type of treatment (among the four kinds studied) was most effective, for what types of clients?

·How many treatment episodes did clients typically undergo before entering the SROS index treatment episode?

·To what extent did drug use and criminal behavior decline and employment increase during the five years after the SROS treatment episode, compared with the earlier period?

·What were the correlates of treatment outcomes, and what was the relationship between pre-treatment variables and treatment variables?

·How did death rates for those discharged from drug treatment compare with death rates for the U.S. population, and what characteristics were associated with posttreatment mortality?

In short, SROS provides the best nationally representative data, with an extended time perspective, to be used to answer the question: "Does treatment work?"

This page was last updated on June 03, 2008.

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.