Contemporaneous relationship between substance abuse treatment and poly-substance use: Evidence from the Persistent Effect of Treatment Studies

The solution space: developing research and policy agendas to eliminate employment-related health inequalities

As in many other areas of social determinants of health, policy recommendations on employment conditions and health inequalities need to be implemented and evaluated. Case studies at the country level can provide a flavor of "what works," but they remain essentially subjective. Employment conditions research should provide policies that actually reduce health inequalities among workers. Workplace trials showing some desired effect on the intervention group are insufficient for such a broad policy research area. To provide a positive heuristic, the authors propose a set of new policy research priorities, including placing more focus on "solving" and less on"problematizing" the health effects of employment conditions; developing policy-oriented theoretical frameworks to reduce employment-related inequalities in health; developing research on methods to test the effects of labor market policies; generalizing labor market interventions; engaging, reaching out to, and holding onto workers exposed to multiple forms of unhealthy employment conditions; measuring labor market inequalities in health; planning, early on, for sustainability in labor market interventions; studying intersectoral effects across multiple interventions to reduce health inequalities; and looking for evidence in a global context.

Profiles associated with treatment retention in Japanese patients with methamphetamine use disorder: preliminary survey

AIMS

To identify profiles associated with treatment retention in Japanese patients with methamphetamine use disorder.

METHODS

The study used a retrospective design based on clinical records. The subjects were 101 patients at the Kanagawa Psychiatric Center, Serigaya Hospital, who were diagnosed as having methamphetamine use disorder. They were divided in two groups, namely those who remained in treatment 3 months after the initial assessment, and those who did not. The primary analysis compared patient profiles between the two groups to detect discriminating variables, which were then submitted for secondary analysis using logistic regression to determine the most relevant predictor of retention.

RESULTS

Primary analysis indicated that older age, having psychotic symptoms, receiving public assistance, and history of incarceration were associated with treatment retention after 3 months. Secondary analysis showed that positive history of incarceration was the most significant predictor of the outcome.

CONCLUSIONS

History of incarceration had the most significant treatment-retention effect on Japanese patients with methamphetamine use disorder. The development and introduction of integrated programs that link methamphetamine-dependent offenders to drug treatment is recommended in outpatient treatment for Japanese patients with methamphetamine user disorder.

Trends in drop out, drug free discharge and rates of re-presentation: a retrospective cohort study of drug treatment clients in the North West of England

Background

Governments aim to increase treatment participation by problematic drug users. In the UK this has been achieved by fiscal investment, an expanded workforce, reduced waiting times and coercive measures (usually criminal justice (CJ) led). No assessment of these measures on treatment outcomes has been made. Using established monitoring systems we assessed trends in 'dropped out' and 'discharged drug free' (DDF), since the launch of the national drug strategy, and rates of treatment re-presentation for these cohorts.

Methods

A longitudinal dataset of drug users (1997 to 2004/05, n = 26,415) was used to identify people who dropped out of, and were DDF from, services for years 1998 to 2001/02, and re-presentations of these people in years to 2004/05. Trends in drop out and DDF, baseline comparisons of those DDF and those who dropped out and outcome comparisons for those referred from the CJ system versus other routes of referral were examined using chi square. Logistic regression analyses identified variables predicting drop out versus DDF and subsequent re-presentation versus no re-presentation.

Results

The proportion of individuals dropping out has increased from 7.2% in 1998 to 9.6% in 2001/02 (P < 0.001). The proportion DDF has fallen from 5.8% to 3.5% (P < 0.001). Drop out was more likely in later years, by those of younger age and by CJ referrals. The proportion re-presenting to treatment in the following year increased from 27.8% in 1998 to 44.5% in 2001/02 (P < 0.001) for those DDF, and from 22.9% to 48.6% (P < 0.001) for those who dropped out. Older age and prior treatment experience predicted re-presentation. Outcome (drop out or DDF) did not predict re-presentation.

Conclusion

Increasing numbers in treatment is associated with an increased proportion dropping out and an ever-smaller proportion DDF. Rates of drop out are significantly higher for those coerced into treatment via the CJ system. Rates of re-presentation are similar for those dropping out and those DDF. Encouragingly, those who need to re-engage with treatment, particularly those who drop out, are doing so more quickly. The impact of coercion on treatment outcomes and the appropriateness of aftercare provision require further consideration.