Attrition prevention with individuals awaiting publicly funded drug treatment

Aims. To evaluate the effectiveness of a motivational intervention to reduc e attrition from a waiting list for substance abusers seeking publicly fund ed treatment. Design. Randomized clinical trial comparing an "attrition pre vention" condition to standard care while awaiting treatment admission. Set ting. A centralized substance abuse assessment and referral center in Seatt le, Washington. Participants. Substance abusers (n=654) eligible for public ly funded drug abuse treatment. Measurements. Alcohol and drug use, substan ce-related negative consequences, areas in need of help, perceived need for help, emotional status, readiness to change, reasons for seeking and perce ived barriers to entering treatment. Findings. Overall, approximately 70% o f clients entered treatment, and of these approximatey 70% completed their assigned treatment. Those who entered treatment showed significant reductio ns in substance use and improved psychosocial function at a short-term 3-mo nth follow-up. However, the attrition prevention intervention had no differ ential effect on treatment entry, completion or outcome compared to the sta ndard waiting list. Further, there were no differences across therapists on these outcome measures. Conclusions. A motivational attrition prevention i ntervention did not enhance treatment entry, completion or outcome among tr eatment-seeking substance abusers. It is suggested that alternative strateg ies, such as contingency management and case management, may help facilitat e treatment entry for individuals seeking publicly funded treatment.