Who Drops Out of Treatment for Substance Abuse?

September 4, 2014

Psychologists and other therapists often deal with clients who have issues related to substance abuse and various services in Winnipeg and elsewhere specialize in the treatment of addictions. Professionals and clients must consider various factors that influence the success of addiction services.

One strong predictor of successful treatment for alcohol and drug addiction is completion of the treatment program. That is, people who remain in treatment to program completion are more likely to have successful outcomes, as indicated by measures of abstinence, relapse, and personal difficulties following treatment. Unfortunately, many people terminate treatment prematurely, decreasing the likelihood of a successful outcome.

In a recent 2013 article, Brorson and colleagues reviewed studies of risk factors for dropping out of treatment for substance abuse and addiction. A comprehensive review of the research literature discovered 122 articles with sufficiently relevant and valid information to address the question of premature termination.

Many of the articles studied stable demographic characteristics of clients, such as age and gender. But there were only a few consistent findings across these studies, notably that younger clients were more likely to drop out. Research of psychological factors was more promising, although less frequent. The findings suggest that people with compromised cognitive functioning (e.g., attention, memory, reasoning) or certain personality characteristics (e.g., impulsivity, antisocial tendencies) were also more likely to terminate prematurely.

Given these findings, the authors hypothesized that younger age may be associated with drop outs because higher order cognitive functioning and impulse control continue to develop during late adolescence and early adulthood. One useful direction for future research is to examine further this hypothesis.

A few papers examined the therapeutic relationship and reported that dropouts were more common when clients failed to form a strong relationship or bond with their therapist. This relationship is referred to as an alliance between therapist and client, and has been shown to be related to treatment effectiveness for many psychological disorders.

These findings have several implications for therapists and clients. Both parties need to be sensitive to the risk of dropping out of treatment prematurely. Clients can make a solid commitment to continuing treatment and to forming a strong alliance with their therapist, thus increasing the likelihood of a successful outcome.

Therapists, on the other hand, can consider ways to cope with cognitive dysfunctions or personality traits that interfere with treatment. Shorter sessions, for example, may work better with clients with attention difficulties. And clients with anti-social tendencies can benefit from therapeutic approaches that are more consultative and less directive or controlling.

The findings also show that both clients and therapists might need to deal with broader issues than substance abuse, suggesting that an overly narrow focus on addiction might limit the success of outcomes. This is consistent with other research showing that people experiencing substance abuse difficulties often have other psychological issues that contribute to their addictive behaviour and that successful outcome may depend on therapeutic attention to these underlying issues. Licensed clinical psychologists in Winnipeg and elsewhere are specially trained to assist clients with just such a broad array of issues.

For the reference and abstract see here.

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