Factors associated with pretreatment and treatment dropouts: comparisons between Aboriginal and non-Aboriginal clients admitted to medical withdrawal management

Harm Reduction Journal

Aslam H Anis⁴  David C Marsh³  Huiying Sun¹  Xin Li² 

[1] Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard Street, Vancouver, B.C. V6Z 1Y6, Canada;Antai College of Economics & Management, Shanghai Jiao Tong University, 535 Fhuazhen Rd, Shanghai, China;Northern Ontario School of Medicine, Vancouver, B.C. V6Z 1Y6, Canada;School of Population and Public Health, University of British Columbia, Vancouver, B.C. V6Z 1Y6, Canada

关键词: Detoxification;    Substance use disorders;    Withdrawal management;    Treatment dropout rate;    Pretreatment dropout rate;    Housing;    Aboriginal;   

Others  :  809773
DOI  :  10.1186/1477-7517-10-38

 received in 2009-12-09, accepted in 2013-12-03,  发布年份 2013

【 摘 要 】

Background

Addiction treatment faces high pretreatment and treatment dropout rates, especially among Aboriginals. In this study we examined characteristic differences between Aboriginal and non-Aboriginal clients accessing an inpatient medical withdrawal management program, and identified risk factors associated with the probabilities of pretreatment and treatment dropouts, respectively.

Methods

2231 unique clients (Aboriginal = 451; 20%) referred to Vancouver Detox over a two-year period were assessed. For both Aboriginal and non-Aboriginal groups, multivariate logistic regression analyses were conducted with pretreatment dropout and treatment dropout as dependent variables, respectively.

Results

Aboriginal clients had higher pretreatment and treatment dropout rates compared to non-Aboriginal clients (41.0% vs. 32.7% and 25.9% vs. 20.0%, respectively). For Aboriginal people, no fixed address (NFA) was the only predictor of pretreatment dropout. For treatment dropout, significant predictors were: being female, having HCV infection, and being discharged on welfare check issue days or weekends. For non-Aboriginal clients, being male, NFA, alcohol as a preferred substance, and being on methadone maintenance treatment (MMT) at referral were associated with pretreatment dropout. Significant risk factors for treatment dropout were: being younger, having a preferred substance other than alcohol, having opiates as a preferred substance, and being discharged on weekends.

Conclusions

Our results highlight the importance of social factors for the Aboriginal population compared to substance-specific factors for the non-Aboriginal population. These findings should help clinicians and decision-makers to recognize the importance of social supports especially housing and initiate appropriate services to improve treatment intake and subsequent retention, physical and mental health outcomes and the cost-effectiveness of treatment.

【 授权许可】

   
2013 Li et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]MacMillanm H, MacMillan A, Offord D, Dingle J: Aboriginal health. CMAJ 1996, 155:1569-1578.
• [2]Milligan S: Aboriginal population profile for Vancouver, Statistics Canada, 2006. Available at: http://www.statcan.gc.ca/pub/89-638-x/2010004/article/11085-eng.htm webcite
• [3]Public Health Agency of Canada. Summary: Estimates of HIV Prevalence and Incidence in Canada. Ottawa: Surveillance and Risk Assessment Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada; 2009.
• [4]Buxton J: Vancouver Drug Use Epidemiology. [Vancouver site report for the Canadian Epidemiology Network on Drug Use] Available at http://www.ccsa.ca/2007%20CCSA%20Documents/CCENDU-Vancouver-highlights-2007-e.pdf webcite
• [5]Craib KJ, Spittal PM, Wood E, Laliberte N, Hogg RS, Li K, Heath K, Tyndall MW, O’Shaughnessy MV, Schechter MT: Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver. CMAJ 2003, 168(1):19-24.
• [6]McLellan AT, Woody GE, Metzger D, McKay J, Durrell J, Alterman AI, O’Brien CP: Evaluating the effectiveness of addiction treatments: reasonable expectations, appropriate comparisons. Milbank Q 1996, 74(1):51-85.
• [7]Hubbard RL, Craddock SG, Flynn PM, Anderson J, Etheridge PM: Overview of one-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychol Addict Behav 1997, 11(4):261-278.
• [8]Prendergast ML, Podus D, Chang E, Urada D: The effectiveness of drug abuse treatment: a meta-analysis of comparison group studies. Drug Alcohol Depend 2002, 67(1):53-72.
• [9]Donovan DM, Rosengren DB, Downey L, Cox GB, Sloan KL: Attrition prevention with individuals awaiting publicly funded drug treatment. Addiction 2001, 96(8):1149-1160.
• [10]Hser YI, Maglione M, Polinsky ML, Anglin D: Predicting drug treatment entry among treatment-seeking individuals. J Subst Abuse Treat 1998, 15:213-220.
• [11]Stark MJ, Campbell BK, Brinkerhoff CV: “Hello, may we help you?” A study of attrition prevention at the time of the first phone contact with substance-abusing clients. Am J Drug Alcohol Abuse 1990, 16:67-76.
• [12]Endicott P, Watson B: Interventions to improve the AMA-discharge rate for opiate-addicted patients. J Psychosocial Nursing Mental Health Services 1994, 32(8):36-40.
• [13]Gossop M, Johns A, Green L: Opiate withdrawal: inpatient versus outpatient programmes and preferred versus random assignment to treatment. Br Med J (Clin Res Ed) 1986, 293(6539):103-104.
• [14]Luippold R, Zorn M, Lewis BF: Outcomes of a 21-days detoxification program: retention, transfer to further treatment, and HIV risk reduction. Am J Drug Alcohol Abuse 1995, 21:1-16.
• [15]Armenian SH, Chutuape MA, Stitzer ML: Predictors of discharges against medical advice from a short-term hospital detoxification unit. Drug Alcohol Depend 1999, 56:1-8.
• [16]Backmund M, Meyer K, Eichenlaub D, Schutz CG: Predictors for completing an inpatient detoxification program among intravenous heroin users, methadone substituted and codeine substituted patients. Drug Alcohol Depend 2001, 64:173-180.
• [17]Broers B, Giner F, Dumont P, Mino A: Inpatient opiate detoxification in Geneva: follow-up at 1 and 6 months. Drug Alcohol Depend 2000, 58:85-92.
• [18]McCusker J, Bigelow C, Luippold R, Zorn M, Lewis BF: Outcomes of a 21-day drug detoxification program: retention, transfer to further treatment, and HIV risk reduction. Am J Drug Alcohol Abuse 1995, 21(1):2-18.
• [19]Franken IHA, Hendriks VM: Predicting outcome of inpatient detoxification of substance abusers. Psychiatr Serv 1999, 50(6):813-817.
• [20]Callaghan RC: Risk factors associated with dropout and readmission among First Nations individuals admitted to an inpatient alcohol and drug detoxification program. CMAJ 2003, 169(1):23-27.
• [21]Li X, Sun H, Puri A, Marsh DC, Anis AH: Factors associated with pretreatment attrition and dropout among clients admitted to medical detox. J Addictive Diseases 2007, 26(3):77-85.
• [22]Weisner C, Mertens J, Tam T, Moore C: Factors affecting the initiation of substance abuse treatment in managed care. Addiction 2001, 96:705-716.
• [23]Marsh DC, Fair BR: Addiction treatment in Vancouver. Internal J Drug Policy 2006, 17(2):137-141.
• [24]SAS/STAT: User’s Guide, Version 8. Cary, NC, USA: SAS Institute Inc; 1999.
• [25]Turner D, Goulet S, Oelke ND, Thurston W, Woodland A, Bird C, Wilson J, Deschenes C, Boyes M: Aboriginal homelessness – looking for a place to belong. Available at: http://www.ucalgary.ca/wethurston/files/wethurston/Aboriginal_Homelessness_Scan_March2010.pdf webcite
• [26]Perreault S: The incarceration of Aboriginal people in adult correctional services, Statistics Canada. Available at: http://www.statcan.gc.ca/pub/85-002-x/2009003/article/10903-eng.htm webcite
• [27]Trocme N, Knoke D, Blackstock C: Pathways to the overrepresentation of Aboriginal children in Canada’s child welfare system. Soc Serv Rev 2004.
• [28]Mental Health Commission of Canada: At home. Available at: http://www.mentalhealthcommission.ca/English/initiatives-and-projects/home?routetoken=83bead65d23e8380537acdcd14789737&terminitial=38 webcite
• [29]Festinger DS, Lamb RJ, Marlowe DB, Kirby KC: From telephone to office – intake attendance as a function of appointment delay. Addit Behav 2002, 27(1):131-137.
• [30]Stasiewicz PR, Stalker R: Brife report a comparison of three “interventions” on pretreatment dropout rates in an outpatient substance abuse clinic. Addict Behav 1999, 24(4):579-582.
• [31]Tyndall MW, Kerr T, Zhang R, Montaner JS, Wood E: HIV prevalence among injection drug users attending the supervised injection site in Vancouver. Can J Infect Dis Med Microbiol 2005, 16(Suppl A):15.
• [32]Schechter MT, O’Shaughnessy MV: Aids update distribution of injection drug users in the lower mainland. BC Med J 2000, 42(2):80-83.
• [33]Wood E, Kerr T, Spittal PM, Tyndall MW, O’Shaughnessy MV, Schechter MT: The health care and fiscal costs of the illicit drug use epidemic: the impact of conventional drug control strategies, and the potential of a comprehensive approach. BC Med J 2003, 45(3):128-134.
• [34]Brunette D, Kominsky J, Ruiz E: Correlation of emergency health care use, 911 volume and jail activity with welfare check distribution. Ann Emerg Med 1991, 20:739-742.
• [35]Phillips DP, Christenfeld N, Ryan NM: An increase in the number of death in the United States in the first week of the month. NEJM 1999, 341(2):93-98.
• [36]Callaghan RC, Cunninghan JA: Gender differences in detoxification: predictors of completion and re-admission. J Subst Abuse Treat 2002, 23:399-407.
• [37]Zanis D, McLellan A, Randall M: Can you trust patient self-reports of drug use during treatment? Drug Alcohol Depend 1994, 35:127-132.
• [38]Kleyn J, Schwebke J, Holmes KK: The validity of injecting drug users’ self-reports about sexually transmitted diseases: a comparison of survey and serological data. Addiction 1993, 88(5):673-680.
• [39]Gottheil E, Sterling RC, Weinstein SP: Pretreatment dropouts: characteristics and outcomes. J Addict Dis 1997, 16(2):1-14.
• [40]Durran GM, Kirchner JE, Worley M, Rookey C, Booth B: Depressive symptomatology and early attrition from intensive outpatient substance use treatment. J Behav Health Serv Res 2002, 29(2):138-143.