While abstinence on a continuing basis is one “gold standard” representing a successful addiction treatment outcome, substance use treatment completion, compared to dropping out of treatment, does show a vital therapeutic goal has been met, which is a major indicator of positive outcomes and treatment compliance. People who complete their treatment for substance abuse, as opposed to non-completers, are more apt to stay abstinent, have less relapses, a higher rate of employment at better pay, less criminal activity in the future, fewer readmissions for treatment, and better overall health.

More Americans are diagnosed with some form of addiction than have cancer, heart disease or diabetes. They number about 22.7 million and only 2.5 million, or about 11% of those needing addiction treatment, actually get it at a specialized addiction facility for addiction treatment. Research done on treating addictions has generally shown that it’s effective, with similar outcomes as other chronic medical conditions, such as hypertension, asthma, and diabetes.

There has been a substantial amount of research done on the factors involved in substance use treatment completion vs. early dropout (aka premature termination), which has generally shown that treatment in different settings (residential vs. outpatient) have differing rates of completion. Research has also shown that there is a lot of uncertainty about which personal characteristics among clients best predict drop out or substance use treatment completion.

The point of the study discussed in this article was to examine the impact of residential settings vs. outpatient settings on substance use treatment completion, and to further look at how this might vary depending on demographics and drug choice. The researchers reasoned that the effectiveness of residential treatment would be greater for those with more severe addictions since treatment in a residential facility, as opposed to an outpatient setting, could better control for exposure to social and environmental triggers that could cause relapse and therefore dropout. This might be more important for those with more severe addictions who are possibly less functional than people who primarily abuse alcohol and/or marijuana.

This study analyzed data taken from the Substance Abuse & Mental Health Services Administration (SAMHSA) 2011 Treatment Episode Data Set (TEDS-D). There were 318,924 cases in total analyzed. Residential treatment programs reported that they had a 65% completion rate as opposed to a 52% completion rate for outpatient settings. Higher rates of substance use treatment completion were associated with higher education, older age, full-time employment, stable home life, being Caucasian, less recently using substances, drug of choice being alcohol and/or opioids, and having been referred for treatment by the criminal justice system and employers. Premature termination or drop out from treatment was associated with lower education, younger age, unemployment, etc.

It should not be surprising that the rates of completion for residential treatment programs are higher when compared to treatment in outpatient programs because entry to residential substance abuse treatment facilities requires more severe addictions, provides environmental controls and often occurs as a result of legal or employer related problems. Dropping out of treatment is therefore more prevalent in outpatient programs, where there is greater freedom and choice.

Since residential programs offer far more structure and intensity in their services than do outpatient treatment programs, it stands to reason that the completion rate for residential treatment facilities would be higher. Furthermore, it takes far less effort to drop out of treatment in an outpatient setting than it would in a residential program. Hence, in considering residential or intensive outpatient treatment, for example, commitment to and motivation to complete treatment is certainly one factor to consider.  Drop out rates are likely to be higher is there is a poor fit between the individual and the level of care prescribed.

A recent Substance Abuse & Mental Health Services Administration (SAMHSA) sponsored research study showed that IOPs can be just as effective as residential and/or inpatient treatment programs when recovering from substance abuse. Research done on these programs consistently shows equivalent reductions in number of days abstinent and in levels of problem severity between those who received treatment in IOPs, day treatment, residential or inpatient care.  If you are considering an intensive outpatient program for substance use, please call us to schedule an assessment now.

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