DRUG ABUSE TREATMENT OUTCOME STUDIES (DATOS)

This family of studies is designed to provide comprehensive information on continuing and new questions about the effectiveness of the drug-abuse treatment that is available in a variety of publicly funded and private programs. These data update and augment the information available from earlier national studies, such as the Drug Abuse Reporting Program (DARP) study, which began in the late 1960s, and the Treatment Outcome Prospective Study (TOPS) of clients entering treatment in the 1970s. The work was sponsored by the National Insti-Tute on Drug Abuse (NIDA) and conducted by the National Development and Research Institute, Texas Christian University, and the University of California, Los Angeles.

The major objective of DATOS is to examine the effectiveness of drug-abuse treatment by conducting a multisite, prospective clinical and epidemiological longitudinal study of drug-abuse treatment. Effectiveness was examined by using data from 10,010 client interviews conducted from 1991 to 1993 at entry to treatment each three months, during treatment, and one year after leaving treatment. Interviews of clients at admission were supplemented with comprehensive clinical assessments of psychological, social, and physical impairments in addition to drug and alcohol dependence. Treatment outcomes were compared for clients who entered treatment with varied patterns of drug abuse and levels of psychosocial impairment.

A secondary objective was to investigate the process of drug-abuse treatment. A detailed examination was being conducted of the treatments and services available and provided to each client, how these treatments and services are delivered to the client, and how the client responds to treatment in terms of cognitive and behavioral changes.

The study population includes 1,540 clients from twenty-nine outpatient methadone programs; 2,774 clients from twenty-one long-term residential or Therapeutic Community programs; 2,574 clients from thirty-two outpatient drug-free programs; and 3,122 clients from fourteen short-term, inpatient, or chemical dependency programs. In addition, treatment programs from DATOS were compared with those for TOPS a decade earlier and for DARP two decades earlier in order to determine how drug-abuse treatment programs have changed and what the changes imply for the provision of effective treatment approaches and services.

The DATOS research builds and expands the knowledge generated from previous research on the effectiveness of treatment. Several events, however, have necessitated a continuing nationally based multisite study of drug-abuse treatment and treatment effectiveness. Major changes have occurred in the nation's drug-abusing population and treatment system. The OMNIBUS Recommendation Act of 1981 shifted the administration of treatment programs from the federal government to the states. The Aids epidemic has intensified interest in drug-abuse treatment as a strategy to reduce exposure to the Human Immunodeficiency Virus (HIV), which causes AIDS. Cocaine use rather than Opioid use was the major drug problem of the late 1980s and early 1990s. Efforts to contain health-care costs may dramatically transform both the public and private treatment systems. It has therefore become necessary to update information so as to reexamine what we have learned about treatment effectiveness, and so as to augment the types of data that are available for exploring new issues about the nature, effectiveness, and costs of treatment approaches. The research based on DATOS has been organized into four areas: (1) treatment selection, access, and utilization, (2) treatment engagement and retention, (3) addiction and treatment, and (4) applications and policy development. Details of these studies can be found in the following references as well as at the URL http://www.DATOS.org.

The initial comparison of data from the DATOS and from the TOPS shows the following about the clients in DATOS: They are older, a greater percentage of them are women, they have more years of education, more of them are married, fewer are fully employed, and a lower percentage of them report that they have considered or attempted suicide. A higher proportion of the clients on Metha-Done are entering treatment for the first time, and the proportion of criminal-justice referrals is higher in long-term residential and outpatient drug-free programs than they are in short-term inpatient programs.

In all types of programs, cocaine abuse predominated in the early 1990s, compared to heroin abuse in the past, but the cocaine use was usually combined with extensive use of Alcohol. Multiple abuse of psychotherapeutic agents has decreased, so less than 10 percent of clients report that they regularly use these agents as opposed to treatment services. Outpatient programs have fewer early dropouts, but this may reflect better screening and longer, more extensive intake processes. The influence of cost-containment measures and managed care became evident with shortened durations of treatment for short-term inpatients. Short-term in-patient programs also admit more public sector patients than in the 1980s. Early analyses from the DATOS indicate that rates of drug use toward the start of outpatient treatment are two to three times higher than those that were found in TOPS.

The early results of DATOS also show that clients entering drug treatment are a diverse group who have multiple problems. Two-thirds of the clients are men, and approximately half have previously been in treatment. Those who have health insurance that covers treatment are, by far, in the minority. Although the clients entering short-term inpatient chemical-dependency programs appear to have a higher rate of private insurance coverage (40 percent) than any other classification of clients, their rate is considerably lower than that observed among the same type of clients in the 1980s. Depending on the type of treatment, 25 to 50 percent of clients reported predatory criminal activity in the previous year, and less than 20 percent were fully employed. The clients have a variety of health problems, and many report significant psychiatric impairment. Few have received mental health services, however, and about one in every three clients report that they use emergency rooms as their primary health-care provider. Taken together, these data indicate that most clients have deficits in many areas of their lives and have multiple needs in addition to those directly related to their drug abuse (e.g., medical services and vocational needs).

Patterns of drug use vary markedly by type of treatment in DATOS clients. Although cocaine is the most frequently cited drug of abuse, most clients abuse multiple drugs and exhibit complex patterns of drug use. Frequent alcohol use is also common among many of the clients, as is weekly use of marijuana. Multiple abuse of psychotherapeutic agents is reported by less than 10 percent of clients.

Drug-treatment programs are focusing on providing drug-counseling services to meet the multiple problems of clients, but fewer specialized services, such as medical or psychological services, are being provided to meet clients' other needs. Only a third to a half of clients who report a need for medical services are receiving them, and the situation is much worse in regard to psychological, family, legal, employment, and financial services. Less than 10 percent of clients who report a need actually receive the service while they are in methadone and outpatient drug-free programs. The percentage of clients who receive specialized services other than drug counseling (e.g., medical or psychological attention) has declined dramatically since the mid-1980s. The impact of cost-containment measures and managed care is evident in the shorter stays of clients, particularly those enrolled in short-term inpatient programs.

Limited information on treatment outcomes has provided a mixed indication of the outcomes of treatment. The combination of more severe impairment and less extensive services suggests the potential for poorer outcomes. On the positive side, clients in treatment are being retained in treatment. However, compared to earlier findings, findings from the early 1990s indicated that a higher percentage of clients were actively using drugs during the first months of treatment.

Two other studies have been included under the DATOS program of research. The Drug Abuse Treatment Outcome Study-Adolescent (DATOS-Adolescent) research study is designed to examine the effectiveness of drug-abuse treatment for adolescents through a multisite prospective longitudinal study of youth entering treatment programs that focus on adolescents. Effectiveness will be examined by using interview data from youth under eighteen supplemented by interviews with parents or guardians conducted at entry to treatment, during treatment, and one year after leaving treatment. Treatment outcome will also be assessed by using such measures as changes in the use of the primary problem drug; the use of other drugs; antisocial, delinquent, or criminal behavior; school attendance and achievement; vocational training and employment; family and social functioning; and treatment retention. A secondary objective of DATOS-Adolescent is to investigate the drug-abuse treatment that adolescents receive. A sample of thirty long-term residential, outpatient drug-free, and short-term inpatient programs will be used to accomplish these objectives. The proposed sample design will include three thousand clients.

The Early Retrospective Study of Cocaine Treatment Outcomes is an accelerated retrospective study of clients with a primary diagnosis of cocaine dependence who had been admitted to DATOS-Adult programs prior to or in the early stages of DATOS. The research will provide data about outcomes for cocaine abusers during the first year of treatment, describe the treatment received by these clients through a study of treatment process, and establish a client data base for future follow-up studies. A sample of 2,000 records for cocaine-abusing clients discharged from residential, hospital-based, and outpatient nonmethadone programs will be abstracted to obtain baseline data. A sample of 1,200 face-to-face, follow-up interviews will be completed, after twelve months of treatment, with the discharged clients whose records were reviewed during the record-abstraction phase of the project.

Data analyses of the project will be targeted at describing the posttreatment outcomes for cocaine abusers by detailing their treatment experiences and investigating their posttreatment experiences. This description will include the type, intensity, and duration of services received and an examination of the interrelationships between client and treatment characteristics and posttreatment outcomes. Along with cocaine use, other outcomes that will be considered include the use of drugs other than cocaine, economic functioning, illegal activities, and psychological status. Analytic methods will include univariate and descriptive statistics as well as multivariate methods. The collection of follow-up data for this retrospective study will be conducted simultaneously with the collection of data for the twelve-month follow-up of DATOS clients. A close coordination with the DATOS-Adult is designed to permit comparison across studies.

(See also: Drug Abuse Reporting Program ; Methadone Maintenance Programs ; Opioid Dependence ; Treatment, History of in the United States ; Treatment: Outcome Prospective Study ; Treatment Types )

BIBLIOGRAPHY

Simpson, D. D., & Brown, B. S. (Eds.) (1999). Special issue: Treatment processes and outcome studies from DATOS. Drug and Alcohol Dependence, 57 (2), 81-174.

Simpson, D. D., & Curry, S. J. (Eds.) (1997). Special issue: Drug abuse treatment outcome study (DATOS). Psychology of Addictive Behavior, 11 (4), 211-337.

Simpson, D. D., & Joe, G. W., Fletcher, B. W., et al. (1999). A national evaluation of treatment outcomes for cocaine dependence. Archives of General Psychiatry, 56, 507-514.

Robert Hubbard

Revised by Dwayne Simpson