Substance use disorder patients who are mandated to treatment: Characteristics, treatment process, and 1- and 5-year outcomes

Kelly, John F.; Finney, John W.; Moos, Rudolf H.

doi:10.1016/j.jsat.2004.10.014

Cited by 106 publications

(103 citation statements)

References 33 publications

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“…Prior research has found legally coerced clients to have better post-treatment outcomes (Anglin et al, 1989;Brecht et al, 1993;Burke and Gregoire, 2007;Easton et al, 2007;Fagan, 1999;Kelly et al, 2005;Polcin, 2001). The current study showed that legally coerced clients were more likely to stay in treatment longer, although the NTIES final report found coerced clients to have worse outcomes.…”

Section: Discussioncontrasting

confidence: 40%

“…This finding is at odds with prior research which shows that legally coerced clients enter treatment with more problems than voluntary clients (Marshall and Hser, 2002), but tend to have better post-treatment outcomes (Anglin et al, 1989;Brecht et al, 1993;Burke and Gregoire, 2007;Easton et al, 2007;Fagan, 1999;Kelly et al, 2005;Polcin, 2001). This discrepancy of findings underscores the importance of understanding the extent to which legal coercion actually keeps people in treatment, given that time in treatment is associated with more positive outcomes (National Institute of Drug Abuse, 1999).…”

Section: Introductionmentioning

confidence: 69%

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The influence of legal coercion on dropout from substance abuse treatment: Results from a national survey

Perron

Bright

2008

Drug and Alcohol Dependence

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Legal coercion is frequently used to leverage substance abuse treatment upon persons who would otherwise not seek it voluntarily. Various methodological and conceptual problems of the existing research have prevented a clear understanding of its effectiveness. The influence of legal coercion on retention in substance abuse treatment was examined using a national survey of programs in the public sector of care and three different treatment modalities including short-term residential (N = 756), long-term residential (N = 757), and outpatient treatment (N = 1181). Legal coercion was found to reduce the risk of dropout across all three treatment modalities. The greatest effect was among persons in short-term residential treatment. The smallest effect was observed in outpatient treatment. This study shows that legal coercion significantly reduces the risk of dropout in substance abuse treatment. However, the differential effects across treatment conditions must be carefully considered when using coercion to involve individuals in treatment.

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Section: Discussioncontrasting

confidence: 40%

Section: Introductionmentioning

confidence: 69%

The influence of legal coercion on dropout from substance abuse treatment: Results from a national survey

Perron

Bright

2008

Drug and Alcohol Dependence

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“…This is understandable given that individuals in the throes of substance abuse and dependence are unlikely to voluntarily enter treatment (54). In addition, in mandated care, outcomes related to substance abuse and legal outcomes are as good as or better than those in voluntary care (55,56), and treatment programs in prisons have been shown to be successful and are likely to provide treatment to many persons who would not otherwise receive it (57–60). …”

Section: Discussionmentioning

confidence: 99%

Racial-Ethnic Disparities in Substance Abuse Treatment: The Role of Criminal History and Socioeconomic Status

Cook¹,

Alegrı́a²

2011

Psychiatric Services

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Objective Among persons with substance use disorders, those from racial-ethnic minority groups have been found to receive substance abuse treatment at rates equal to or higher than those of non-Latino whites. Little is known about factors underlying this apparent lack of disparities. This study examines racial-ethnic disparities in treatment receipt and mechanisms that reduce or contribute to disparities. Methods Black-white and Latino-white disparities in any and in specialty substance abuse treatment were measured among adult respondents with substance use disorders from the 2005–2009 National Survey on Drug Use and Health (N=25,159). Three staged models were used to measure disparities concordant with the Institute of Medicine definition, assess the extent to which criminal history and socioeconomic indicators contributed to disparities, and identify correlates of treatment receipt. Results Treatment was rare (about 10%) for all racial-ethnic groups. Odds ratios for black-white and Latino-white differences decreased and became significantly less than 1 after adjustment for criminal history and socioeconomic status factors. Higher rates of criminal history and enrollment in Medicaid among blacks and Latinos and lower income were specific mechanisms that influenced changes in estimates of disparities across models. Conclusions The greater likelihood of treatment receipt among persons with a criminal history and lower socioeconomic status is a pattern unlike those seen in most other areas of medical treatment and important to the understanding of substance abuse treatment disparities. Treatment programs that are mandated by the criminal justice system may provide access to individuals resistant to care, which raises concerns about perceived coercion.

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“…Although this study did not address mandates, prior studies suggest that mandates are effective. For example, patients who were mandated to treatment by the justice system experienced similar therapeutic gains and satisfaction during treatment and as good or better 1-year and 5-year substance use and functioning outcomes, as did patients who were involved in the justice system but were not mandated to treatment (Kelly et al, 2005).…”

Section: Limitations and Conclusionmentioning

confidence: 99%

Driving While Intoxicated Among Individuals Initially Untreated for Alcohol Use Disorders: One- and Sixteen-Year Follow-Ups

Timko¹,

Desai²,

Blonigen³

et al. 2011

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: This study examined associations between frequency of driving while intoxicated (DWI) at baseline and obtaining alcohol-related help at follow-up, and between obtaining help and subsequent reductions in DWI. It also examined improvements on personal functioning and life context indices as mediators between obtaining help and reduced occurrences of DWI. Method: A total of 628 individuals who were initially untreated for alcohol use problems completed a baseline inventory; follow-ups were 1, 3, and 16 years later. Results: More extended participation in outpatient treatment and Alcoholics Anonymous (AA) during Year 1 was associated with a lower likelihood of DWI at the 1-year follow-up. More extended participation in AA through Year 3 was associated with a lower likelihood of DWI at the 16-year follow-up. Improvement on personal functioning and life context indices was associated with reduced risk of subsequent occurrences of DWI. Decreases in drinking-related problems, impulsivity, and drinking to reduce tension mediated associations between more AA participation and reductions in DWI at 1 year. Conclusions: Among initially untreated individuals, sustained mutual help may be associated with a reduced number of occurrences of DWI via fewer drinking consequences and improved psychological functioning and coping. Treatment providers should attend to these concomitants of DWI and consider actively referring individuals to AA to ensure ongoing AA affi liation. The majority of studies of DWI have focused on community samples or samples of people arrested and convicted for DWI who were mandated to treatment. In contrast, we examined DWI in a sample of individuals who, at entry into the study, had initiated help seeking but were untreated for alcohol use problems; these individuals were followed for 16 years. Compared with non-help-seeking community samples, these help seekers likely have more severe alcohol-related dysfunction (George and Tucker, 1996;Tucker, 1995) but also more recognition of their alcohol misuse, motivation to change, and commitment to abstinence (Timko et al., 1994). However, compared with individuals reporting previous treatment for alcohol use disorders, these individuals likely have less severe alcohol-related dysfunction but also less motivation to change and commitment to abstinence (LoCastro et al., 2008). Thus, in the context of previous studies of DWI, we examined a sample that, by virtue of seeking help for the fi rst time, was unique in terms of severity of alcoholrelated disorder and motivation to change.To examine the behavior of DWI, this study used the conceptual framework developed by Moos and colleagues (Moos and Finney, 1983;Moos et al., 1990b) and adopted by other investigators (e.g., Buri et al., 2007) to examine the context of alcohol-related outcomes (Figure 1). The framework suggests that there is an association between (a) the individual's functioning and life context (e.g., severity of alcohol misuse, psychological symptoms, negative life events, social su...

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Substance use disorder patients who are mandated to treatment: Characteristics, treatment process, and 1- and 5-year outcomes

Cited by 106 publications

References 33 publications

The influence of legal coercion on dropout from substance abuse treatment: Results from a national survey

The influence of legal coercion on dropout from substance abuse treatment: Results from a national survey

Racial-Ethnic Disparities in Substance Abuse Treatment: The Role of Criminal History and Socioeconomic Status

Driving While Intoxicated Among Individuals Initially Untreated for Alcohol Use Disorders: One- and Sixteen-Year Follow-Ups

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