Evaluation of Treatment for 1971–1972 DARP Admissions: Comments and Conclusions

Abstract

The overall evaluative results indicate that the methadone programs generally have the best marks, at least in relation to retention and outcomes during treatment. The record nevertheless leaves room for much improvement. First, in regard to retention, 45% of MM-A and 38% of MM-CO patients leave treatment under unfavorable conditions within 12 months of admission. As already noted, the retention record of all other treatments is lower than that for MM. Second, with respect to outcome criteria, the noteworthy immediate effects during treatment are on drug use and drug use-related criminal activity. Analysis of the data on employment and productive activities suggests, as found in Cohort 1, that the drug abuse treatment programs are not being effective in these areas. Finally, again in agreement with the Cohort 1 results, it appears that the best results are being obtained with patients above the age of 22. The under-23 segment constitutes about 15% of the MM population, but between 40 to 50% of the patients in TC and DF treatment. As a whole, this group includes a high percentage of whites, polydrug users, and individuals with no previous treatments, and presents a major challenge to the treatment community.

Most of the results from the DARP treatment evaluation research have been summarized by the papers in this journal issue, but several other important studies which could not be included should be noted. First, in relation to outcome measures, additional data have been analyzed on the relations to outcomes of a large profile of patient background measures [3] which supplement the results discussed in the paper by Gorsuch. Second, Demaree has developed some important innovations in criterion measurement involving pattern measures which indicate trends over time during treatment as well as elevation of scores. Using these measures in discriminant analysis, some impressive studies of criminal behavior, opioid use, and employment of patients in MM treatment in the Cohort 2 sample have been completed [6]. Finally, Spiegel has conducted an analysis of group profiles of criterion measures over time for samples of Cohort 2 patients who remained in treatment 12 months or longer [3]. These important studies, using different methodological approaches to treatment evaluation, have yielded results generally consistent with those summarized above.

Further work based on the DARP now in progress is concerned principally with the during-treatment evaluation of Cohort 3 and with the posttreatment follow-up of Cohorts 1 and 2. The during-treatment results are reflected in the design of the follow-up studies, which will make it possible to approach many questions that are presently unsupported by data. In particular, there is much interest in learning whether the positive results obtained during treatment are evidence of control, as some suspect, or of therapeutic change, as many believe.