Effectiveness of an outreach treatment program for inner city crack abusers: compliance, outcome, and client satisfaction.

In a randomized controlled trial the effectiveness of an outreach treatment program (OTP) was compared with standard addiction care services for hard-drug addicts in Rotterdam (The Netherlands). The study aimed at chronic, high-risk crack abusers who were insufficiently engaged in standard addiction treatment services. Data were collected from February 2000 to December 2001. A total of 124 subjects participated in the study at baseline. Follow-up data were available for 94 subjects. Outcome measures included treatment compliance, outcome, and satisfaction. Data were collected by means of monthly registrations, EuropAsi interviews and an evaluation form. There was a high compliance with OTP in the treatment group; the average length-of-stay was 6 months, with visits three times a week. Although both groups were well represented in standard care, participation was mainly based on methadone maintenance. Subjects treated in OTP showed significant improvements in physical health, general living conditions, and psychiatric status, but no change in employment, substance abuse, and legal status. The control group remained almost unchanged. Clients of OTP reported feeling very satisfied with their treatment. On-the-spot incentives and a positive relationship with the care provider were directly associated with treatment retention. An outreach treatment program, as conducted in this study, is associated with high compliance, general improvement, and treatment satisfaction. Characteristics of this treatment modality are (1) assertive outreach, (2) a mixed program with incentives, and (3) a strong focus on individual-bound therapy. Further research is needed with larger groups and similar conditions at baseline assessment.

Fidelity of an outreach treatment program for chronic crack abusers in the Netherlands to the ACT model.

This study evaluated an effective outreach treatment program in the Netherlands for chronic, high-risk crack abusers on its adherence to the assertive community treatment model. Fidelity was tested on 25 criteria of the Dartmouth Assertive Community Treatment Scale. Adherence was high on several factors: a small caseload, staff capacity, a nurse and a substance abuse specialist on staff, explicit admission criteria, low intake rate, and intensity of service. Future programs that focus on treating crack addiction should implement these components. The outreach treatment program showed low adherence to the assertive community treatment model for including a psychiatrist and a vocational specialist, both of which are important factors that should be implemented in future programs. Other factors were observed to be important for treating this population: a strong focus on the client-therapist relationship, stagewise substance abuse treatment, and on-the-spot incentives to keep this population involved in treatment.