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Drug Treatment Must Be Flexible, British Study Finds

Increasing numbers of drug users seeking addiction treatment in one region in England have led to a decrease in the proportion of addiction patients who are discharged drug-free and an increase in the proportion who drop out, a new study has found.

The investigators examined outcomes for drug treatment in 26,415 patients in Cheshire and Merseyside in England from 1997 to 2005 to identify those who were in treatment from 1998 through 2002 (BMC Public Health 2006;6:205 [doi:10.1186/1471-2458-6-205]). The period examined coincides with the launch of a national drug strategy that increased the number of treatment personnel and reduced waiting times.

In Cheshire and Merseyside, the number of patients rose from 7,594 in 1998 to 11,530 in 2004/2005, mirroring an increase in the health care system's capacity to treat addiction.

Over the course of the longitudinal study, the researchers found that the proportion of individuals who completed their course of treatment drug-free decreased from 5.8% in 1998 to 3.5% in 2001/2002 (record-keeping changed from a calendar-year basis to a fiscal-year basis in 2000), and the percentage of dropouts increased from 7.2% to 9.6%.

Younger patients were more likely to drop out, as were patients seen in the later years of the study.

The researchers also found an increase in the percentage of patients who had been discharged drug-free and returned for treatment the following year: up from 27.8% in 1998 to 44.5% in 2001/2002. The percentage of patients who dropped out and then returned the following year also increased: 22.9% in 1998 to 48.6% in 2001/2002.

Older patients were more likely to return for further treatment, as were patients who had prior addiction treatment histories. Patients who were referred to treatment through the criminal justice system were much less likely to complete treatment, the researchers found. In 2001/2002, for example, 14% of the patients who came in from the criminal justice system were discharged drug-free, compared with 30.9% of those who came from other sources.

The researchers argued that the drug users referred to treatment in exchange for a lighter sentence in court may not have the same motivation as those who enter treatment voluntarily.

“Once in treatment, practitioners therefore face the challenge of shifting a drug user's motivation from external to internal incentives,” wrote the researchers. “If measures to increase uptake become more coercive, treatment must be flexible to adapt to drug users who may be very different from ones who voluntarily seek assistance.”

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Increasing numbers of drug users seeking addiction treatment in one region in England have led to a decrease in the proportion of addiction patients who are discharged drug-free and an increase in the proportion who drop out, a new study has found.

The investigators examined outcomes for drug treatment in 26,415 patients in Cheshire and Merseyside in England from 1997 to 2005 to identify those who were in treatment from 1998 through 2002 (BMC Public Health 2006;6:205 [doi:10.1186/1471-2458-6-205]). The period examined coincides with the launch of a national drug strategy that increased the number of treatment personnel and reduced waiting times.

In Cheshire and Merseyside, the number of patients rose from 7,594 in 1998 to 11,530 in 2004/2005, mirroring an increase in the health care system's capacity to treat addiction.

Over the course of the longitudinal study, the researchers found that the proportion of individuals who completed their course of treatment drug-free decreased from 5.8% in 1998 to 3.5% in 2001/2002 (record-keeping changed from a calendar-year basis to a fiscal-year basis in 2000), and the percentage of dropouts increased from 7.2% to 9.6%.

Younger patients were more likely to drop out, as were patients seen in the later years of the study.

The researchers also found an increase in the percentage of patients who had been discharged drug-free and returned for treatment the following year: up from 27.8% in 1998 to 44.5% in 2001/2002. The percentage of patients who dropped out and then returned the following year also increased: 22.9% in 1998 to 48.6% in 2001/2002.

Older patients were more likely to return for further treatment, as were patients who had prior addiction treatment histories. Patients who were referred to treatment through the criminal justice system were much less likely to complete treatment, the researchers found. In 2001/2002, for example, 14% of the patients who came in from the criminal justice system were discharged drug-free, compared with 30.9% of those who came from other sources.

The researchers argued that the drug users referred to treatment in exchange for a lighter sentence in court may not have the same motivation as those who enter treatment voluntarily.

“Once in treatment, practitioners therefore face the challenge of shifting a drug user's motivation from external to internal incentives,” wrote the researchers. “If measures to increase uptake become more coercive, treatment must be flexible to adapt to drug users who may be very different from ones who voluntarily seek assistance.”

Increasing numbers of drug users seeking addiction treatment in one region in England have led to a decrease in the proportion of addiction patients who are discharged drug-free and an increase in the proportion who drop out, a new study has found.

The investigators examined outcomes for drug treatment in 26,415 patients in Cheshire and Merseyside in England from 1997 to 2005 to identify those who were in treatment from 1998 through 2002 (BMC Public Health 2006;6:205 [doi:10.1186/1471-2458-6-205]). The period examined coincides with the launch of a national drug strategy that increased the number of treatment personnel and reduced waiting times.

In Cheshire and Merseyside, the number of patients rose from 7,594 in 1998 to 11,530 in 2004/2005, mirroring an increase in the health care system's capacity to treat addiction.

Over the course of the longitudinal study, the researchers found that the proportion of individuals who completed their course of treatment drug-free decreased from 5.8% in 1998 to 3.5% in 2001/2002 (record-keeping changed from a calendar-year basis to a fiscal-year basis in 2000), and the percentage of dropouts increased from 7.2% to 9.6%.

Younger patients were more likely to drop out, as were patients seen in the later years of the study.

The researchers also found an increase in the percentage of patients who had been discharged drug-free and returned for treatment the following year: up from 27.8% in 1998 to 44.5% in 2001/2002. The percentage of patients who dropped out and then returned the following year also increased: 22.9% in 1998 to 48.6% in 2001/2002.

Older patients were more likely to return for further treatment, as were patients who had prior addiction treatment histories. Patients who were referred to treatment through the criminal justice system were much less likely to complete treatment, the researchers found. In 2001/2002, for example, 14% of the patients who came in from the criminal justice system were discharged drug-free, compared with 30.9% of those who came from other sources.

The researchers argued that the drug users referred to treatment in exchange for a lighter sentence in court may not have the same motivation as those who enter treatment voluntarily.

“Once in treatment, practitioners therefore face the challenge of shifting a drug user's motivation from external to internal incentives,” wrote the researchers. “If measures to increase uptake become more coercive, treatment must be flexible to adapt to drug users who may be very different from ones who voluntarily seek assistance.”

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Drug Treatment Must Be Flexible, British Study Finds
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