BackgroundDrop-out is an important problem in the treatment of substance use disorder. The focus of this study was to investigate the effectiveness of within treatment assessment with feedback directly to patients with multiple substance use disorder on outpatient individual treatment adherence. Feedback consisted of personal resources' and readiness to change status and progress that facilitate or hinder change, thereby using graphical representation.MethodsInformed consent was obtained from both the control and experimental groups to be involved in research and follow-up. Following Zelen's single consent design, baseline participants (n = 280) were randomised (sample-size-estimation: 80%power, p=.05, 2-sided) and treatment consent was obtained from those allocated to the experiment (n = 142). In both groups, equal numbers of patients did not attend sessions after allocation. So, 227 persons were analyzed according to intention-to-treat analysis (ITT: experiment n = 116;control n = 111). Excluding refusals 211 participants remained for per-protocol analysis (PP: experiment n = 100; control n = 111), The study was conducted in five outpatient treatment-centres of a large network (De Sleutel) in Belgium. Participants were people with multiple substance use disorder -abuse and dependence- who had asked for treatment and who had been advised to start individual treatment after a standardised admission assessment with the European Addiction Severity Index.The experimental condition consisted of informing the patient about the intervention and of subsequent assessments plus feedback following a protocol within the first seven sessions. Assessments were made with the Readiness to Change Questionnaire and the Personal Resources Diagnostic System. The control group received the usual treatment without within treatment assessment with feedback. The most important outcome measure in this analysis of the study was the level of adherence to treatment at and beyond eight sessions.ResultsIndividual treatment that included assessment with feedback increased adherence to treatment at and beyond eight sessions (RR = 1.6,95%CI:1.2-2.2). Benefit was also found at and beyond twelve sessions, which was the number of sessions required to complete 90% of the assessments with feedback in practice (RR = 1.6,95%CI:1.2-2.5).ConclusionsAssessment with feedback in routine practice improved adherence to treatment. More research is needed to evaluate progress in social functioning and motivation to change in outpatient treatment of substance use disorder, thereby using objective measuresTrial registrationCurrent Controlled Trials ISRCTN65456186

An overview of the state of the art of research on the treatment services of the therapeutic community for drug addicts in Europe is presented. This research tradition has largely been fragmented and local in its implementation. There has been a scientific gap concerning evaluation research and the treatment services offered by the therapeutic community. The American research antecedents to the European tradition are reviewed. The essential European groups, research designs and results are presented for each country with something greater than an ad hoc study experience. The strengths and weaknesses of the research designs, results and organizations are critically assessed. Recommendations for future research are presented and referenced to specific recommendations for therapeutic community research coming out of an American National Institute on Drug Abuse Technical Review. Among the conclusions of the overview is the need for more qualitative phenomenological research to complement the existing quantitative approach.

Aim: The transtheoretical model is often used in substance abuse treatment planning. For polydrug abusing patients, operationalizing the stages of change is more difficult, as their readiness to change may differ depending on the substances. It was the aim of this study to investigate if the same structure of the Dutch Readiness to Change Questionnaire (RCQ-D) in a group of alcohol abusers could be found in an inpatient group of polydrug abusers for all substances. Design: For each substance, the structure of RCQ-D was tested using factor-analysis. Internal consistency was evaluated with Cronbach's alpha. Mean scores were calculated to evaluate conformity with stage assignment. Around 305 polydrug abusers completed 1248 RCQ-D during their first week of stay. Findings: The RCQ-D had a different, but interpretable structure from the expected one. A two-factor structure was found for alcohol, nicotine and opiates, a three-factor structure for benzodiazepines, cannabis, methadone and cocaine. The underlying construct, based on the transtheoretical model, seemed to fit for alcohol and nicotine. There were some problems of stage allocation for benzodiazepines, cannabis and methadone. But, people in action could be distinguished from those not in action. More serious problems of allocation were found for opiates and cocaine. Conclusions: RCQ-D can be used to measure polydrug abusers' thinking and use-behaviour separately by substance. The validity of RCQ-D to assign stages in case of opiates and cocaine is unclear

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