Follow-up difficulty with substance abusers: predictors of time to locate and relationship to outcome.

A sample of 76 alcoholics and 31 drug abusers who had been inpatients at a Veterans Administration Medical Center were followed up 6 months after termination of treatment. Of this population, 100 (93.5%) were located, and additional data were recorded as to both the length of time required for location and the sources which proved useful in the process. Two-thirds of the sample were located within 1 month and most before the fourth month. Multivariate analyses revealed that criminal history, longer time in treatment, and previous treatment each were independent predictors of difficulty in location. Personal addresses provided by the subjects at intake were crucial in the tracking process, as well as female relatives named by addicts. The time to locate a subject was not generally related to outcome. Employed subjects were somewhat harder to find, and those drinking daily-or not at all-were easier to locate.

Three therapeutic communities. A prospective controlled study of narcotic addiction treatment: process and two-year follow-up results.

The efficacy of three different residential therapeutic communities for male veterans addicted to heroin was studied, comparing 181 subjects who were randomly assigned to one of the communities with 166 subjects briefly hospitalized only for the treatment of withdrawal symptoms. At two-year follow-up, subjects from both a professionally staffed community and a peer confrontation community were found significantly more likely than the withdrawal-only group to be working or attending school and less likely to have been convicted of a crime. An eclectic program employing both professionals and paraprofessionals was not found to exceed the withdrawal-only group on any of the major outcome variables. The two relatively successful communities, although different in structure and style, were both perceived by their residents to have greater program clarity, order, staff control, and orientation to personal problems than the unsuccessful program.

The validity of self-reported heroin use.

During a 2-year follow-up interview, 272 male veteran heroin addicts reported their recent heroin use and provided a urine sample. Eighty-four percent of those reporting no heroin use in the 3 months preceding the interview, and 78% of those declaring no use in the previous week had urines found negative for opiates. The subjective impressions of the interviewers were useful in predicting the veracity of the self-reports. Subjects who had been in longer-term treatment, especially therapeutic communities, were more likely to report heroin use truthfully.

Therapeutic communities vs methadone maintenance. A prospective controlled study of narcotic addiction treatment: design and one-year follow-up.

This study compares the efficacy of three residential therapeutic communities and an outpatient methadone maintenance program for 585 male veterans addicted to heroin. Subjects were randomly assigned to the treatment modalities. More than 93% of the subjects completed both six- and 12-month questionnaires. In this report, the treatment settings, characteristics of the sample, assignment protocol, and pattern of treatment entry and first-year follow-up results are outlined. The various clinical demands that affected the research protocol, the degree to which the randomization was compromised, and the implications for the analysis of outcome are discussed. One year after admission to the study, subjects who had been in a therapeutic community for longer than seven weeks or in methadone treatment were more likely to be employed or attending school, and less likely to be in jail, using heroin, or to have been convicted of a serious crime, than subjects who received no treatment at all beyond a short detoxification period. Those who spent less than seven weeks in a therapeutic community were doing no better than subjects in the no treatment group.

Outcome research in therapeutic communities for drug abusers: a critical review 1963-1975.

Twenty-five publications, conference presentations, and unpublished reports on outcome of therapeutic communities for drug abusers are reviewed for the period 1963 to 1975. A wide variety of methodological limitations are noted, including retrospective designs, unclear definition of outcome variables, low follow-up completion rates, lack of descriptive data on either the treatment processes or the patients, inadequate sampling procedures, lack of comparison control groups, and the absence of data to validate self-reports. Some speculations are offered on the reasons for such methodological inadequacies and a model proposed for future studies.

The validity and reliability of self-reported data from heroin addicts: mailed questionnaires compared with face-to-face interviews.

Immediately following receipt of their 1-year follow-up mailed questionnaire, 55 former patients from an addiction treatment program were interviewed personally, and a urine sample was collected. Results indicate a high degree of correspondence of self-reported drug use with the urinalysis reports, and moderately high correspondence between the information on employment, school attendance, legal status,and length of heroin run given in the mailed questionnaire with that provided in the personal interview.

Follow-up evaluation of drug abuse treatment.

Several fundamental issues in the design and planning of a follow-up evaluation are introduced. Many factors, including the design of the questionnaire, relationship to the subject, and confidentiality policies, determine both the rate and validity of the responses. Utilizing the described planning the supervision, staff time can be minimized, and estimates are given for both mailed and personal interviews. A variety of specific tracking techniques is outlined which facilitate the location of subjects who cannot be found at formerly listed addresses.