Objective: To examine effects of program and patient characteristics on pat
ient retention in residential drug treatment programs, outpatient drug-free
programs (ODF), and methadone maintenance (NIM) programs.
Data sources/study setting: Patient data were based on admission and discha
rge records for individuals entering treatment programs in Los Angeles Coun
ty during 1992 and 1993. Program data were collected from program directors
via a mail survey. The study sample included 26,047 patients in 87 program
s. The dependent variable was patient completion of a critical threshold of
treatment (360 days for MM and 180 days for the other two modalities). We
applied logistic regression hierarchical linear modeling analysis for each
modality.
Principal findings: Threshold retention rates were generally low in all thr
ee modalities (18.1% for residential programs, 22.9% for ODF, and 13.6% for
MM). An articulated programmatic focus and low caseload increased patient
retention in residential programs. A lower level of group therapy focus inc
reased patient retention in ODF programs. A low programmatic focus and a lo
w percentage of recovering staff were associated with high retention rates
among MM patients. For ODF programs, none of the slopes showed random effec
ts, while for residential and MM programs, some program factors contributed
to the explanation of the random effects in several slopes (e.g., drug use
severity).
Conclusion: Program practice and service provision played important roles i
n determining patient retention in treatment. Service providers and planner
s should consider these key factors to improve retention of patients, which
is likely to increase overall treatment effectiveness and efficiency. (C)
2001 Elsevier Science Ltd. All fights reserved.