Associations with substance abuse treatment completion among drug court participants

Disparities in substance use treatment retention: An exploration of reasons for discharge from publicly funded treatment

Although Delaware is the seventh smallest state in the country (including Washington, D.C.) in terms of population size, it has the second highest drug overdose death rate. The Delaware Division of Substance Abuse and Mental Health has increased attention in identifying disparities in treatment outcomes. We explored reasons for discharge from publicly-funded treatment in Delaware with special attention to populations at risk for health inequities, with a focus on covariates of treatment non-completion. Using secondary data collected from publicly-funded treatment providers, we analyzed data from individuals that were admitted to substance use treatment between 2015 and 2019 and had been discharged in 2019. We did this by using logistic and multinomial regression, focusing on non-completion treatment outcomes such as failure to meet requirements, loss of contact, and treatment refusal. Clients who were Black or African American, compared to white clients, were more likely to be lost contact with, administratively discharged, or marked as failing to meet treatment requirements than having a completed treatment discharge. Women were 30% less likely than men to have "failed to meet treatment requirements" compared to completing treatment. Further investigation is needed into these patterns. While treatment quality cannot be assessed using this data, the results point to a need for closer study of disparities in treatment related to race, ethnicity, gender, employment, criminal justice involvement, and type of drug used. Treatment providers should be made aware of culturally informed care, as well as client-created goals, in order to reduce disparities in exit from treatment.

Impulsivity, trauma history, and interoceptive awareness contribute to completion of a criminal diversion substance use treatment program for women

Introduction

In the US, women are one of the fastest-growing segments of the prison population and more than a quarter of women in state prison are incarcerated for drug offenses. Substance use criminal diversion programs can be effective. It may be beneficial to identify individuals who are most likely to complete the program versus terminate early as this can provide information regarding who may need additional or unique programming to improve the likelihood of successful program completion. Prior research investigating prediction of success in these programs has primarily focused on demographic factors in male samples.

Methods

The current study used machine learning (ML) to examine other non-demographic factors related to the likelihood of completing a substance use criminal diversion program for women. A total of 179 women who were enrolled in a criminal diversion program consented and completed neuropsychological, self-report symptom measures, criminal history and demographic surveys at baseline. Model one entered 145 variables into a machine learning (ML) ensemble model, using repeated, nested cross-validation, predicting subsequent graduation versus termination from the program. An identical ML analysis was conducted for model two, in which 34 variables were entered, including the Women's Risk/Needs Assessment (WRNA).

Results

ML models were unable to predict graduation at an individual level better than chance (AUC = 0.59 [SE = 0.08] and 0.54 [SE = 0.13]). Post-hoc analyses indicated measures of impulsivity, trauma history, interoceptive awareness, employment/financial risk, housing safety, antisocial friends, anger/hostility, and WRNA total score and risk scores exhibited medium to large effect sizes in predicting treatment completion (p < 0.05; ds = 0.29 to 0.81).

Discussion

Results point towards the complexity involved in attempting to predict treatment completion at the individual level but also provide potential targets to inform future research aiming to reduce recidivism.

Racial and gender differences in relapse potential and treatment acceptance among rural residents in a substance use disorder treatment program

PURPOSE

To examine racial and gender differences in treatment acceptance and relapse potential among rural residents admitted to a substance use disorder (SUD) treatment program.

METHODS

A cross-sectional study using data collected from a sample of 1850 rural residents admitted to a South Carolina state-run SUD treatment center between the years of 2018 and 2020. Chi-square and t-tests were used to compare treatment acceptance and relapse potential by race and gender. Multivariate logistic regression analyses was conducted to further examine the relationship of race and gender with treatment acceptance and relapse potential after adjusting for potential confounding variables.

FINDINGS

Approximately 50% of participants were classified as being accepting of their treatment and committed to changing their substance use, and there were no racial or gender differences in the bivariate and multivariate analyses. Approximately 25% of participants were classified as having low/no potential risk for relapsing, and there were no racial or gender differences in the bivariate analysis. However, the adjusted odds ratio of relapsing risk were lower among White compared to Black adults [AOR = 0.49 with 95% CI (0.31-0.77)].

CONCLUSION

This study suggests there are no gender or racial differences in treatment acceptance for SUD but that Black adults are at greater risk of relapsing relative to White adults. Additional research is needed to identify factors that increase Black adults' risk for relapse to inform interventions that can improve SUD treatment outcomes in this population.

Typologies of Family Dependency Treatment Court Participants: Parental Characteristics and Differential Child Placement Outcomes

Background: Family Dependency Treatment Court (FDTC) is a problem-solving court for parents who have child welfare involvement and designed to address parental substance misuse by providing treatment and wrap-around services, with the goal of reunifying parents with their children. Objectives: This study aimed to identify different classes of FDTC parents and compare how child placement outcomes differ by class. Parental characteristics and permanent placement outcomes for 354 parents participating in a Central Florida FDTC were assessed using administrative data. An exploratory latent class analysis was conducted to classify parents. Results: Results revealed three distinct classes of FDTC participants: 1) co-occurring issues, 2) racial/ethnic minority participants, and 3) prescription opioid, meth, and heroin users. Regression analyses showed that parents with co-occurring issues were over two times more likely to achieve permanency (OR = 2.05, p < .05), and were two times less likely to terminate their parental rights (TPR) compared to the other two classes. Conclusions: Implications for tailoring FDTC procedures to parents' individual needs, combating racial/ethnic disparities in access to services and placement outcomes, and improved child welfare and placement outcomes are discussed.

Predicting drug court graduation: Examining the role of individual and programmatic characteristics

INTRODUCTION

Although existing research suggests drug courts reduce recidivism and substance use, a large portion of drug court participants do not graduate. According to a conceptual framework, severity of need and program intensity may help to explain variation in drug court effectiveness. Understanding variation in drug court graduation can help to identify high risk participants and effective programmatic elements.

METHODS

Our sample included 247 drug court participants from an adult felony-level drug court located in a large metropolitan area of the southeastern United States that either graduated (n = 113) or were terminated (n = 134) from the program. We used participant and program characteristics from drug court program records to predict drug court graduation.

RESULTS

In bivariate analyses, several participant and program characteristics were significantly associated with drug court graduation. In the final multivariate model, only one participant-level characteristic was significantly related to graduation: emotional/personal risk and needs (aOR: 0.56, 95% CI: 0.33, 0.93). Alternatively, three program characteristics remained statistically significant predictors of drug court graduation in the final multivariate model. Receiving more individual counseling sessions was positively associated with drug court graduation (aOR: 1.27, 95% CI: 1.14, 1.41), while jail and monetary fine sanctions were negatively associated with drug court graduation (aOR jail: 0.45, 95% CI: 0.30, 0.68; aOR fine: 0.28, 95% CI: 0.10, 0.78).

CONCLUSIONS

Our findings suggest that drug court programs may benefit by tailoring services for individuals with high emotional/personal risk and participants who receive certain types of sanctions. More rigorous research should explore the causal relationship between individual counseling and drug court graduation to determine if wide-scale programmatic changes are warranted.

Factors associated with substance use disorder treatment completion: a cross-sectional analysis of justice-involved adolescents

Background

Substance use disorders (SUD) are prevalent among those in the juvenile justice system. SUD treatment programs implemented in correctional settings can prevent overdose and other health-related problems among an underserved health disparity population. However, only a fraction of justice-involved adolescents with SUDs complete a treatment program and the factors associated with treatment completion among adolescents in the criminal justice system have not been thoroughly investigated.

Methods

Using cross-sectional data on 25,587 adolescents from the Florida Department of Juvenile Justice (FLDJJ) who met the criteria for SUD treatment, the study investigated the factors associated with the completion of SUD treatment. Sociodemographic, mental health, and other variables were examined.

Results

Several factors were associated with an increased likelihood of SUD treatment completion: previous participation in treatment programs, prior drug and alcohol education class attendance, and involvement in court-directed programs. Additional factors included multiple incarcerations, and strong financial and support networks.

Conclusions

The strongest factors associated with a higher likelihood of SUD treatment completion among adolescents in the justice system are ones that can be translated into programs and practices. Repeated referrals to treatment, court-directed programs, and strong support networks may yield higher rates of completion.

Examining Predisposing Factors and Program Performance Indicators Associated With Program Completion: A Comparison of Opioid and Non-Opioid-Preferring Participants in Drug Court

Opioid use and abuse, as well as criminal justice involvement, have increased dramatically in the past two decades. Drug court is a community-based rehabilitation program for individuals with substance abuse issues involved in the criminal justice system. Given unique treatment needs associated with opioids, the current study examined predisposing factors and program performance indicators associated with drug court completion based on individuals' opioid preference. Secondary data (i.e., participant assessment and drug court Management Information System) as well as conviction information from a statewide database were examined for a sample of drug court participants (N = 534). Data analyses compared opioid-preferring (n = 267) and non-opioid-preferring (n = 267) program participants. For non-opioid-preferring participants, a combination of predisposing characteristics, including both social/demographic characteristics and substance use (i.e., education, drug court site, lifetime benzodiazepine use), as well as program performance indicators (i.e., number of days in drug court, number of positive drug tests, and sanctions/therapeutic responses) influenced drug court completion. For opioid-preferring participants, only program performance indicators emerged as important for program completion, specifically number of days in drug court, number of positive drug tests, and sanctions/therapeutic responses. Findings for non-opioid-preferring participants are consistent with past research, suggesting that individual predisposing characteristics and program performance indicators are influential on program completion. However, findings suggesting that only program performance indicators are influential for opioid-preferring participants adds a unique contribution to the literature. This information may help provide more individualized program planning and ultimately more programmatic success.

Substance use profile, treatment compliance, treatment outcomes and related factors in probation: a retrospective file review

OBJECTIVE

In this study, we aimed to investigate the sociodemographic characteristics of the individuals who mandated to the probation unit as the substances they use, their compliance with the programs, treatment outcomes and the relationships between these parameters. Secondly we aimed to determine the predictive factors that guide in taking protective measures.

METHODS

The files of the individuals who applied to probation clinic of Gaziantep 25 Aralik State Hospital between 01.01.2019-31.12.2019 were examined retrospectively. SPSS 22.0 program was used to statistical analysis.

RESULTS

Totally 1024 cases were included in the study. Most of the cases were between the ages of 16-35 (84.1%) and 68.3% of individuals were primary school graduates. Most (n: 607, 59.3%) were single in terms of marital status. Substance was detected in the urine of 30.3% of the applicants (n: 311). Among the substances detected in urine, amphetamine-methamphetamine was in the first place with 13.6%. In terms of treatment compliance levels of probation, it was seen that 593 (57.9%) reports were prepared as "no treatment required", 117 (11.4%) were "compliant to treatment" and 303 (29.6%) were "noncompliant to treatment". A statistically significant difference was found between working status and treatment outcomes (p = 0.001). When the first urine result of the patients were grouped as negative and positive; A statistically significant difference was found between the first urine test and the treatment outcomes and criminal score (for both p = 0.001).There was a statistically significant difference between the status of being a probation measure previously and the outcome of treatment (p = 0.019).

CONCLUSION

In our study, the most used substance type was found to be amphetamine-methamphetamine (13.6%). Prevalence in substance use appears to be changing. This is an important finding about the prevalence of use of amphetamine-methamphetamine in Turkey. We suggest that those who have irregular jobs in the probation process, those with substance metabolites detected in the first urine, and those who have previously had probation precautions may have a poor prognosis and that it may be more effective to apply to those profiles in a general program that includes social and occupational fields.

Examining Contextual Differences in Participant Characteristics and During-Program Occurrences With Drug Court Program Completion

The study purpose was to compare individuals participating in rural and urban drug courts to examine factors associated with program completion. Secondary data (participant assessment; drug court Management Information System) as well as conviction information from a statewide database were examined for a sample of drug court participants ( N = 534). Based on multivariate analysis, for rural participants, two variables were significantly associated with increased program completion: age and outpatient treatment. Conversely, for rural participants, the number of felony/misdemeanor convictions before drug court and receiving an incarceration sanction during drug court were associated with program non-completion. For urban participants, gender and age were associated with increased odds of completion, whereas marital status, education, and past 30-day cocaine use were associated with program non-completion. Findings suggest contextual differences in participant characteristics and during-program occurrences, which ultimately influenced program completion. Understanding contextual factors has important implications for program planning and implementation.

Seven Core Principles of Substance Use Treatment System Design to Aid in Identifying Strengths, Gaps, and Required Enhancements

OBJECTIVE

System planners and funders encounter many challenges in taking action toward evidence-informed enhancement of substance use treatment systems. Researchers are increasingly asked to contribute expertise to these processes through comprehensive system reviews. In this role, all parties can benefit from guiding frameworks to help organize key questions and data collection activities, and thereby set the stage for both high-level and on-the-ground strategic directions and recommendations. This article summarizes seven core principles of substance use treatment system design that are supported by a large international evidence base and that together have proven applicable as a framework for several systems review projects conducted predominantly in Canada.

METHOD

The methodology was based on a narrative review approach.

RESULTS

The principles address a wide range of issues. Specifically, a broad systems approach is needed to address the full spectrum of issues; accessibility and effectiveness are improved through collaboration across stakeholders; a range of system supports are needed; need for services should be grounded in self-determination, holistic cultural practices, choice, and partnership; attention to diversity and social-structural disadvantages are crucial to equitable system design; systematic screening and assessment is needed to match people to appropriate treatment services in a stepped service framework; and, last, individualized treatment planning must include the right mix of evidence-informed interventions.

CONCLUSIONS

By bringing researchers and stakeholders back to the high-level goals of substance use treatment systems, these principles provide a comprehensive, evidence-based, organizing framework that has the potential to improve the quality of system design and review internationally.

The Effect of Treatment Completion on Recidivism Among TASC Program Clients

Despite the enormous resources spent by states in the United States on bridging the gap between criminal justice and behavioral health services, there have been relatively few statewide evaluations of drug treatment client recidivism. We present the results of an evaluation of recidivism outcomes for a sample of individuals ( n = 1,274) referred to the Treatment Accountability for Safer Communities (TASC) program in North Carolina from 2007 to 2008. The methodology accounted for both client and offense characteristics drawn from TASC, court, and corrections records. Multivariate analyses indicated that program completion is the most important predictor of re-arrest in the 3-year follow-up period, followed by a number of protective and risk factors. More specifically, being female, older at the time of program entry, as well as higher levels of educational attainment decreased the odds of re-arrest, whereas using crack/cocaine increased the odds of re-arrest. Suggestions for future research and policy implications are provided.

IDENTIFYING PREDICTORS OF SUBSTANCE USE AND RECIDIVISM OUTCOME TRAJECTORIES AMONG DRUG TREATMENT COURT CLIENTS

Drug treatment court (DTC) is a diversion program for individuals with drug-related crimes. However, the DTC literature is conflicting with regard to substance use and recidivism outcomes. This study examines factors associated with improved client outcome trajectories among a multisite, national DTC sample. We conducted a secondary analysis of 2,295 participants using the Global Appraisal of Individual Needs assessment tool. Participants in community-based treatment comprised a nonequivalent comparison group. Zero-inflated Poisson (ZIP) regression examined client sociodemographics in relation to substance use and rearrest at 6-month follow-up. Employed DTC clients were more likely to abstain from substances, but among all study participants, higher baseline use, male gender, and employment predicted substance use. Similarly, among DTC clients, older age and employment predicted no rearrests, but among all study participants, older and employed individuals had worse arrest outcome trajectories. Future work is needed to better understand how client characteristics may inform individualized treatment approaches.

Abstinence at Successful Discharge in Publicly Funded Addiction Health Services

Abstinence at successful discharge in substance use disorder treatment is important to reducing relapse rates and increasing long-term recovery from substance use disorders. However, few studies have examined abstinence as an essential component of successful discharge. This study examined rates and correlates of reported abstinence (nonuse of drugs 30 days prior to successful discharge) among clients attending publicly funded treatment in Los Angeles County, California. Finding show that only 36% of clients who were successfully discharged reported abstinence. Black clients were less likely than non-Hispanic Whites to report abstinence at successful discharge. Clients in methadone treatment programs were less likely than outpatient clients to report abstinence, whereas clients referred to treatment through the legal system (Proposition 36) were more likely to report abstinence compared to self-referred clients. Findings underscore the importance of systematic assessment of abstinence in determining successful discharge and provide a basis for further examination of strategies to improve abstinence and reduce relapse.

Determination of Clinical and Socio-demographical Differences of Adolescents Applying to a Treatment Center with Family Encouragement or the Decision of the Probation Office and Determination of Predictive Factors in Maintaining Soberness among Probation Cases

INTRODUCTION

This study has two objectives. The first objective of this study was the determination of some basic clinical and socio-demographical differences among the adolescents with substance abuse who apply to a treatment center with support from their family or by order of the probation office. The other objective of this study was the determination of the predictive factors in maintaining soberness among adolescents who successfully complete the probation treatment process.

METHODS

The target population of this study is young adults under 19 years of age who apply to a substance addiction center for adolescents as a result of encouragement from their family or ordered by the Probation Office between 2005 and 2013. These two groups were analyzed in terms of socio-demographical characteristics such as age, the age at which they tried the substance, the age at which they applied to the treatment center, sex, substances they used, education period, employment history, and street life experience. The Statistical Package for the Social Sciences (SPSS) 18.0 software was used for the statistical analysis.

RESULTS

It was detected that among the cases who applied to the treatment center with family support, their education period was longer than probation (PR) cases (p<0.0001), and the rates of previous treatment, their mother being alive, and having street life experiences were more frequent (p values: <0.0001; =0.010; =0.027; <0.0001, respectively) and employment history was higher among PR cases (p<0.0001). In terms of the substances used, ecstasy, alcohol, inhalants, and volatile substances are more common among those applying with family support (p=0.018; 0.001; <0.0001, respectively). However, use of cannabis was found to be more common among PR cases (p<0.0001). It was found that PR cases who successfully completed their treatment process had married parents (p=0.008) and had more years of education (p=0.004). It can be predicted that if the subject is well educated and does not use multiple substances or have an alcohol history, the treatment process for PR cases can be successfully completed. (R2=0.176; p<0.0001).

CONCLUSION

The rates of completing the treatment among cases analyzed in this study were higher than those among cases from adults. In the studies conducted, the results of the treatment efficiency among PR cases were inconsistent. This inconsistency may result from, except for legal obligations, having different circumstances such as socio-economic factors during the treatment period.

The effects of participation level on recidivism: a study of drug treatment courts using propensity score matching

Background

Empirical evidence has suggested that drug treatment courts (DTCs) reduce re-arrest rates. However, DTC program completion rates are low and little is known about the effectiveness of lower levels of program participation.

Objectives

We examined how DTC program referral, enrollment without completion, and completion, affected re-arrest rates during a two-year follow-up.

Research design

We used statewide North Carolina data from criminal courts merged with DTC data. Propensity score matching was used to select comparison groups based on demographic characteristics, criminal histories, and drug of choice (when available). Average treatment effects on the treated were computed.

Measures

DTC participation levels included referral without enrollment, (n = 2,174), enrollment without completion (n = 954), and completion (n = 747). Recidivism measured as re-arrest on a substance-related charge, on a violent offense charge not involving an allegation of substance abuse, and on any charge (excluding infractions) was examined by felony and misdemeanor status during a two-year follow-up period.

Results

Re-arrest rates were high, 53–76 percent. In general, re-arrest rates were similar for individuals who were referred but who did not enroll and a matched comparison group consisting of individuals who were not referred. In contrast, enrollees who did not complete had lower re-arrest rates than a matched group of individuals who were referred but did not enroll, for arrests on any charge, on any felony charge, and on substance-related charges (felonies and misdemeanors). Finally, relative to persons who enrolled but did not complete, those who completed had lower re-arrest rates on any charge, any felony charge, any misdemeanor charge, any substance-related charge, any substance-related misdemeanor or felony charge, and any violent felony charge.

Conclusions

Enrolling in a DTC, even without completing, reduced re-arrest rates. Given the generally low DTC completion rate, this finding implies that only examining effects of completion underestimates the benefits of DTC programs.

Anxiety and suicidal ideation predict successful completion of substance abuse treatment in a criminal justice sample

The goal of this study was to identify predictors of successful substance abuse treatment in an out-patient clinic for individuals being monitored under community corrections supervision. Of the 615 participants, 117 (19%) successfully completed treatment. The results of a multivariate logistic regression analysis indicated that successful treatment was associated with several baseline characteristics including: older age, White race, having greater than a high school education, lower level of care, meeting criteria for an anxiety disorder, reporting suicidal ideation, and not having a history of opioid use. The value of self-report of problems and its influence on treatment in the culture of the criminal justice population is discussed in this article.

Does mandating offenders to treatment improve completion rates?

While it is known that community-based outpatient treatment for substance abusing offenders is effective, treatment completion rates are low and much of the prior research has been conducted with offenders in residential treatment or therapeutic communities. The aim of the present study was to assess whether offenders who are mandated to community-based outpatient treatment have better completion rates compared to those who enter treatment voluntarily. The 160 research participants were a heterogeneous group of substance abusers who were under various levels of criminal justice supervision (CJS) in the community. The participants were enrolled in an intensive outpatient program and were recruited into the study between July 2007 and October 2010. All offenders received weekly therapy sessions using a cognitive problem solving framework and 45% completed the 6 month treatment program. Interestingly, those who were mandated demonstrated less motivation at treatment entry, yet were more likely to complete treatment compared to those who were not court-ordered to treatment. While controlling for covariates known to be related to treatment completion, the logistic regression analyses demonstrated that court-ordered offenders were over 10 times more likely to complete treatment compared to those who entered treatment voluntarily (OR=10.9, CI=2.0-59.1, p=.006). These findings demonstrate that stipulated treatment for offenders may be an effective way to increase treatment compliance.

The relationship between substance abuse treatment completion, sociodemographics, substance use characteristics, and criminal history

The purpose of this study is to determine if a significant relationship exists between the sociodemographics, substance use characteristics, criminal history, and completion of substance abuse treatment. In this study, 115 individuals being monitored for substance abuse treatment on probation at the Probation and Help Center under the Republic of Turkey's Ministry of Justice's Chief Public Prosecutor's Office of Istanbul were included successively between the dates of April 2008 and April 2009. During a 24-week follow-up, individuals whose urine analyses were clean 6 times consecutively were considered to have completed the treatment successfully. To determine the effect of sociodemographic factors and substance use characteristics on treatment completion, a semistructured sociodemographic data survey was used. Also, the participants' criminal records were examined. A total of 115 people participated in the study. One hundred ten (95.7%) of them were male. Sixty-eight (59.1%) of the participants had completed treatment. Age group, education level, age of onset for substance use, number of substances used, employment status, and criminal records showed a significant difference between treatment completers and noncompleters. When a logistic regression analysis was done, only number of substances used and criminal record (other than drug possession) were significantly different for the 2 groups. The current treatment program for polysubstance users and individuals with a criminal record is insufficient. It is necessary that treatment systems be developed so they can be beneficial for these types of patients.

Successful completion: an examination of factors influencing drug court completion for white and non-white male participants

This research examines the influence of demographic and legal factors on the successful completion of the Seahawk Drug Treatment Court Program for White and Non-White male participants. Located in a medium-size city, the program targets male felony offenders and has been in operation for more than 10 years. The research sample is comprised of 526 participants with a program disposition between January 1, 2005 and September 30, 2010. Using race-specific logistic regression models, results reveal both similarities and differences among these groups. The implications and limitations of this research are discussed, as well as avenues for future research.