Drug Abuse Solutions

According to research findings released today by the National Institute on Drug Abuse (NIDA), at least four major types of drug abuse treatment can be extremely effective in reducing drug use. In addition, drug abuse treatment produces decreases in illegal acts and increases in full-time work for most treatment modalities.

The Drug Abuse Treatment Outcome Study (DATOS) tracked 10,010 drug abusers in nearly 100 treatment programs in 11 cities from 1991-1993. Patients were enrolled in one of four types of treatment: outpatient methadone treatment, outpatient drug-free behavioral treatment, long-term residential treatment, and short-term inpatient treatment programs. A random sample was selected for follow-up and nearly 3,000 patients were interviewed 12 months after treatment to compare drug use and behavioral functioning before and after treatment.

Major findings from DATOS include:

- Methadone treatment reduced heroin use by 70%. In the follow-up year, 27.8 percent of patients in outpatient methadone treatment reported weekly or more frequent heroin use, down from 89.4 percent reporting heroin use prior to admission.
- Both long-term residential and outpatient drug free treatment resulted in 50 percent reductions in weekly or more frequent cocaine use at the one-year follow-up point.
- Reductions in drug use were significantly greater for patients in treatment for three months or more.

"DATOS overwhelmingly confirms the effectiveness of drug abuse treatment. In addition to significant reductions in drug use, treatment also led to significant improvements in other aspects of patients' lives, including their abilities to function in their families and communities. The knowledge gained from DATOS will enable us to refine and strengthen treatment further," said Dr. Alan I. Leshner, Director of NIDA, the agency that funded the study.

DATOS also provides information about patients at entry to treatment. The average age of a patient entering treatment was 32.6 years. Ninety seven percent had used alcohol, 95 percent used cocaine, and 46 percent reported having used heroin before entering treatment. The majority of patients were male (66 percent), 47 percent were African American and 13 percent were Hispanic. The average age at first treatment was 29.5 years and patients reported having been addicted for 10-15 years on average before first entering treatment.

DATOS is the third in a series of studies funded by NIDA to assess short- and long-term treatment outcomes. The Drug Abuse Reporting Program (DARP) collected data from 44,000 clients in 52 federally-funded treatment programs from 1969 to 1973. The Treatment Outcome Prospective Study (TOPS) followed 11,000 patients admitted to 41 treatment programs in 10 cities between 1979 and 1981. These studies along with DATOS allow NIDA to make comparisons of drug abuse treatment services over three decades, focusing on the populations and problems that were current at the time of the study.

Dr. Leshner said, "In 1969-1973, heroin was the major problem. In 1979-1981, the problem was heroin along with the illicit use of other psychoactive drugs alone or in combination. In the 1990's cocaine has been by far the most significant drug abuse problem. DATOS shows that cocaine abuse and dependence are being treated effectively and with positive results."

Drug abuse treatment services, in all four types of treatment, typically included supportive group therapy, urine monitoring during treatment, relapse prevention, post-treatment involvement in self-help groups.

Despite the positive findings for the effectiveness of treatment, DATOS found that many drug abuse treatment patients received a decreasing number of health and social services in the past decade even as the need for these services has increased. More than half of patients in all four types of treatment reported that they received no services specifically for medical, psychological, vocational, family, social, or legal problems.

In explaining the importance of DATOS, Dr. Leshner says, "DATOS will be used to examine treatment outcomes and the cost-effectiveness of drug abuse treatment, to describe the evolving treatment system, to research relationships between patient and program factors, and to identify research gaps that will inform future research agendas. DATOS is invaluable in informing treatment providers and policy makers about the effectiveness of treatment. "

NIDA has entered into cooperative agreements with three research sites to provide analysis of DATOS data and wide and rapid dissemination of the study results. DATOS researchers are conducting analyses in four major areas: health services research, retention and engagement in treatment, studies of the life course of treated addicts, and analyses of research issues of significance to drug treatment policy.

Findings from DATOS are published in the December volume of the journal Psychology of Addictive Behaviors. This issue contains nine articles, each focusing on a different aspect of DATOS. Articles are titled: 1) Introduction to Special Issue; 2) Treatment Evaluation Research in the United States; 3) Methodological Overview and Research Design; 4) Treatment Structure and Program Services; 5) Overview of One-Year Follow up Outcomes; 6) Program Diversity and Treatment Retention Rates; 7) Treatment Retention and Follow up Outcomes; 8) Drug Addiction and Treatment Careers Among Clients. The ninth article, The National Treatment Outcome Research Study (UK): 6-Month Follow-up Outcomes, presents an overview of a treatment outcome study in the United Kingdom. Its findings on the effectiveness of treatment in the UK are strikingly similar to findings on outcomes in the United States.

NIDA supports more than 85 percent of the world's research on the health aspects of drug abuse and addiction. The Institute also carries out a large variety of programs to ensure the rapid dissemination of research information and its implementation in policy and practice. Further information on NIDA research and other activities can be found on the NIDA home page at http://www.nida.nih.gov.