Individual and Social Factors Associated With Participation in Treatment Programs for Drug Users

Abstract

Since only about one third of people who are dependent on drugs are in treatment, there is a need to promote both treatment entry and retention. Previous research has described the role of individual and social characteristics in drug user treatment participation, but little is known about the interaction of individual and social factors. Injecting and noninjecting drug users (2002–2004; N = 581) were recruited, as part of Self-Help in Eliminating Life-Threatening Diseases (SHIELD) study, in Baltimore, MD, and were administered a structured questionnaire. The mean age of participants was 43.6 years, out of which 41% were female, 50% had high school education, and 16% self-reported being HIV infected. Logistic regression analyses of interaction terms revealed that compared to those with no plans to stop and no friends encouraging them to enter treatment those who planned to cease drug use or whose friends encouraged treatment were more likely to attend a 12-step program. Furthermore, compared to those with no problems with drug use and no friends encouraging them to enter treatment those with greater perceived drug problem severity or with friends encouraging treatment were more likely to attend methadone maintenance, as were those who did not receive free drugs from others. The influence of friends may have a crucial modifying effect by getting into treatment less addicted individuals who have higher chances of successful recovery.

Keywords:

• drug user treatment
• injecting and noninjecting drug users
• interaction
• relapse
• treatment entry
• treatment retention
• sustained treatment

Acknowledgments

The SHIELD study was funded by a National Institute on Drug Abuse grant. The first author was funded by the Ruth L. Kirschstein award and a Drug Dependence Epidemiology Training Program, National Institute on Drug Abuse, grant. We would like to thank the entire study staff and participants. Valerie Harder gave us valuable advice on the statistical analysis of interactions. Special thanks to Dr. Alexandre Laudet for her insightful comments.

Notes

¹ Treatment can be briefly and usefully defined as a planned, goal directed change process, of necessary quality, appropriateness and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA,NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users- of whatever types- which aren't also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Editor's note.

* p < .05; PE = Multivariate parameter estimate of main effects and interaction term.

* p < .05; PE = multivariate parameter estimate of main effects and interaction term.