DRUG-ABUSE TREATMENT PROCESS COMPONENTS THAT IMPROVE RETENTION

Background: Longer retention has been the most consistent predictor of favorable drug abuse treatment outcomes, but key therapeutic and pati ent engagement indicators of treatment process need to be more clearly established. Methods: An integrative model representing treatment dyn amics was tested for explaining long-term program retention. It wits b ased on a multisite sample of 527 daily opioid users who remained in m ethadone, maintenance a minimum of 3 months. All had been assigned ran domly to a counseling condition at admission (i.e., cognitively enhanc ed or standard), and information obtained from patient files, as well as periodic assessments completed by patients and their counselors in the first 90 days after admission were the sources of predictors. Resu lts: Counseling enhancements (using node-link mapping, a visual repres entation tool for improving communication and problem solving) contrib uted to stronger therapeutic relationships between counselor and patie nt, which in turn had a positive reciprocal relationship with patient engagement (session attendance). Pretreatment motivation measured at i ntake was also related to higher engagement. More positive therapeutic relationships (in months I and 2) led to lower levels of during-treat ment drug use (defined from urinalysis results in months 2 and 3), and better session attendance and therapeutic relationships both predicte d longer retention. In addition, lower drug use during treatment was r elated to longer retention. Conclusions: Major conceptual domains of d rug abuse treatment process were identified in community-based program s and their interrelationships with retention specified. As intermedia te (during treatment) criteria, they can help guide functional improve ments in program effectiveness as illustrated with our counseling enha ncements. (C) 1997 Elsevier Science Inc.