Examining attrition rates at one specialty addiction treatment provider in the United States: a case study using a retrospective chart review

Abstract

BackgroundEngaging individuals who have a substance use disorder (SUD) in treatment continues to be a challenge for the specialty addiction treatment field. Research has consistently revealed high rates of missed appointments at each step of the enrollment process: 1. between calling for services and assessment, 2. between assessment and enrollment, and 3. between enrollment and completion of treatment. Extensive research has examined each step of the process; however, there is limited research examining the overall attrition rate across all steps.MethodsA single case study of a specialty addiction treatment agency was used to examine the attrition rates across the first three steps of the enrollment process. Attrition rates were tracked between August 1, 2011 and July 31, 2012. The cohort included 1822 unique individuals who made an initial request for addiction treatment services. Monthly retrospective reviews of medical records, phone logs, and billing data were used to calculate attrition rates. Attrition rates reported in the literature were collected and compared to the rates found at the target agency.ResultsMedian time between request for treatment and assessment was 6 days (mean 7.5) and between assessment and treatment enrollment was 8 days (mean 12.5). An overall attrition rate of 80% was observed, including 45% between call and assessment, 32% between assessment and treatment enrollment (another 17% could not be determined), and 37% left or were removed from treatment before 30 days. Women were less likely to complete 30 days of treatment compared to men. No other demographics were related to attrition rates.DiscussionOne out of every five people who requested treatment completed a minimum of 30 days of a treatment. The attrition rate was high, yet similar to rates noted in the literature. Limitations of the single case study are noted.ConclusionAttrition rates in the U.S. are high with approximately 75% to 80% of treatment seekers disengaging at one of the multiple stages of the enrollment and treatment process. Significant changes in the system are needed to improve engagement rates.

Implementation of Cognitive-Behavioral Substance Abuse Treatment in Sub-Saharan Africa: Treatment Engagement and Abstinence at Treatment Exit

“…Over a period of 72 months, the clinic had attrition rates comparable to that of published research conducted in industrialized nations. For example, the attrition rate at the Matrix Model clinic site between the initial request for service at screening and treatment initiation was 56%, which is consistent with rates between 29%–63% reported in the literature [ 2 ]. Similarly retention after 30 days of treatment was 30%, consistent with rates of 34% reported in the literature for patients with no prior treatment [ 2 , 17 ].…”

“…Historically there has been a gap between research and implementation of substance abuse treatment in developed countries [ 1 , 2 ]. This gap is further heightened in low-and-middle-income countries (LMICs) such as South Africa (SA), where there is limited access to empirically-supported treatments and a shortage of trained health workers to deliver evidence-based interventions [ 3 , 4 ].…”

Behavioral interventions for Cambodian female entertainment and sex workers who use amphetamine-type stimulants

“…Among the total population of FESW eligible for CCT+AC, half attended a sufficient number of CCT urine screening visits to participate in AC and approximately one-third completed three or more cognitive-behavioral AC sessions. This is consistent with previous findings from the United States where only one in ten individuals with a substance use disorder receive addiction treatment (Open Society Foundations, 2010) and three-fourths of those enrolled in substance abuse treatment drop out early (Loveland & Driscoll, 2014). Consistent with the HIV care cascade (Gardner, McLees, Steiner, Del Rio, & Burman, 2011), expanded efforts are needed to support the identification of individuals with substance use disorders followed by interventions to promote linkage to and retention in evidence-based substance abuse interventions.…”

Concurrent Treatment with Prolonged Exposure for Co-Occurring Full or Subthreshold Posttraumatic Stress Disorder and Substance Use Disorders: A Randomized Clinical Trial

“…Although vital for the recognition that exposure-based work does not differentially impact SUD treatment retention, the present study’s overall high attrition rate highlights the reality confronted by PTSD+SUD clinicians and researchers. Client attrition in substance abuse programs remains one of the most intractable barriers to successful treatment outcomes [45]. The heightened challenge of engaging and retaining individuals with co-occurring PTSD and SUD in treatment is well documented and historically reflected in low sample sizes and high attrition rates of PTSD+SUD treatment trials [3, 19, 20, 46, 47].…”