A two-rate hypothesis for patterns of retention an psychosocial treatmentsof cocaine dependence: Findings from a study of African-American men and areview of the published data

In this article, we examined patterns of retention in psychosocial treatmen t programs for cocaine dependence. We present new data from a comparision t rial of Drug Counseling and supportive- Expressive Psychotherapy and review published data from all studies utilizing psychosocial interventions alone . We compared Drug Counseling and Psychotherapy on rates of pretreatment an d during-treatment attrition in a sample of 294 African-American men seekin g treatment for cocaine dependence (mean age, 37.6). survival analyses were utilized to identify significant differences in during-treatment attrition between the two treatments and to identify significant changes in the rate of attrition during the course of each treatment. We then compared the pat terns of retention in this study with those from other available published reports of psychosocial treatments for cocaine abuse. The weekly during-tre atment attrition rate was not constant in either treatment condition, and t he change in rate of attrition occurred at week six for both Drug Counselin g and Psychotherapy. Comparison with other studies suggested that the durin g-treatment pattern of attrition among most psychosocial treatments for coc aine abuse is typified by two rates, with the rate of subject attrition ear ly in treatment being greater than the rate of later attrition and also exh ibiting greater variance. Further studies of treatment retention should ide ntify significant shifts in the rate of during-treatment attrition, examine if the pattern of attrition is typified by two rates, and, if so, determin e where the shift occurs. further studies should also assess if changes in the rate of during-treatment attrition signal the timeframes within which s trategies that enhance retention can be implemented in the treatment progra m.