Treatment Programs Reduce Drug Use

A five-year study conducted by the National Opinion Research Center at the University of Chicago.

A study of drug treatment programs funded by the federal government shows an overall 50 percent decline in drug use and significant declines in alcohol use among participants one year after treatment.

The study, the largest of its kind, also highlights large changes in criminal behavior, a 19 percent increase in employment, and a 42 percent drop in the percentage of respondents who were homeless. The study included interviews with participants before and after treatment.

The National Treatment Improvement Evaluation Study (NTIES), released in September 1996, looked at the impact of drug and alcohol treatment on a sample of 5,388 clients treated in programs supported by the U.S. Center for Substance Abuse Treatment (CSAT). The center is part of the Substance Abuse and Mental Health Services Administration (SAMHSA) of the Department of Health and Human Services (HHS).

SAMHSA Administrator Nelba Chavez has observed that treatment is far less expensive than likely alternatives. For example, one year of methadone maintenance treatment for heroin addiction costs $3,500, while one year of incarceration (jail time) can cost as much as $40,000.

Following is a summary of the findings of the study entitled The Persistent Effects of Substance Abuse Treatment -- One Year Later.

Overall Findings:

• Clients served by CSAT-funded treatment programs significantly reduced their alcohol and drug use.

• Treatment resulted in lasting benefits, with significant decreases in drug and alcohol use one year after treatment.

• Clients also reported increases in employment, income, and physical and mental health, and decreases in criminal activity, homelessness, and risk behaviors for HIV/AIDS infection, one year after treatment.

Typically, significant reductions in substance abuse are found immediately following treatment. More importantly, however, NTIES shows that clients served by federally funded substance abuse treatment programs were able to reduce their drug use by approximately 50 percent as long as one year after leaving treatment. This analysis includes clients who completed an intake interview and may have only returned for one single visit (i.e., they did not really become involved in treatment). Therefore, these results should be viewed as conservative estimates of effectiveness of substance abuse treatment.

NTIES compared respondents' drug use one year before treatment and one year following discharge from that treatment and found that:

• (The number of clients using) their primary drugs (those drugs that led clients to seek treatment) decreased from 72.8 percent before treatment to 37.7 percent one year after treatment.

• Cocaine use significantly decreased from 39.5 percent before treatment to 17.8 percent 12 months after discharge from treatment, a 55 percent drop.

• Heroin use, which most experts believe to be more treatment resistant than use of other drugs, decreased by nearly half, from 23.6 percent of respondents reporting use in the 12 months prior to treatment to only 12.6 percent one year after discharge.

• The use of crack, a drug used by approximately half the NTIES respondents, showed a large and statistically significant post-treatment decline, decreasing from 50.4 percent before treatment to 24.8 percent in the 12 months after treatment.

• As a group, NTIES respondents also demonstrated significant improvement in their assessments of being troubled by alcohol use
• 23 percent reported being troubled before treatment and only 7 percent reported being troubled after treatment.

The data suggest that, in this study, clients were generally candid in reporting drug use. There was some under reporting of recent use (last 30 days) of heroin and cocaine. Among the clients interviewed, 20.4 percent reported cocaine/crack use and 11.3 percent heroin use, while urine tests (sensitive for very recent and recent use) found 28.7 percent positive for cocaine/crack use and 16.2 percent positive for opiate use (e.g. heroin). However, when asked about any use over a longer term (last 12 months), self-reports of marijuana use (27.8 percent) and cocaine/crack use (33.5 percent) were higher than use detected by urine tests (as above). Self-report and urine tests for heroin were about the same (16.5 percent and 16.2 percent, respectively).

Reduced Involvement in Criminal Activity:

The linkage between active substance abuse and criminal involvement has been well established. The results from NTIES add to the literature which suggests that substance abuse treatment can play a major role in crime reduction. NTIES respondents reported statistically significant decreases in multiple indicators of criminal involvement.

• Approximately half (49.3 percent) of the NTIES respondents reported "beating someone up" in the year before treatment and only 11 percent reported being involved in this type of behavior one year after treatment.

• Similar substantial decreases (occurred with)...reports of arrest (from 48.2 percent to 17.2 percent) and...of the majority of financial support derived from illegal activities (from 17.4 percent to 9 percent).

In addition to the reduced criminal activity noted above, gains in employment and housing appear to be an ancillary benefit of substance abuse treatment.

• Slightly more than 60 percent of all respondents reported receiving income from a job after treatment, up from 50 percent before treatment. In addition, there was a small but statistically significant decrease in the number of respondents reporting the receipt of general assistance payments.

• Client reports of homelessness dropped from 19 percent before treatment to 11 percent after treatment.

Substance abuse is known to be a major contributor to poor health.

• The number of health visits related to alcohol/drugs...decreased by more than half in the year following treatment, in comparison to the year before.

• NTIES respondents also reported significantly fewer suicide attempts (both those directly related to alcohol and drugs and those not directly related to alcohol and drugs) after treatment, in comparison to before treatment.

• NTIES also found a smaller but still sizable decline in the proportion of NTIES respondents who received inpatient care for a mental health problem....

The sexual behavior of persons who abuse substances is considered to be a major risk pathway for the transmission of HIV, the virus that causes AIDS.

• Compared to their reports before treatment, NTIES respondents successfully reduced behaviors that put them at risk of contracting HIV including relatively large decreases in unprotected heterosexual intercourse, having more than one sexual partner, and having sex for money or drugs.

• Although small in absolute number, male respondents' reports of high-risk homosexual...behaviors, including unprotected sex and having more than one sexual partner, (significantly decreased)...in the one year after treatment....

• A total of 6,593 NTIES clients were interviewed at treatment intake. Of these, 5,274 clients were also interviewed at discharge from treatment and 5,388 at follow-up, which for the majority of the sample was one year after discharge from treatment.

• An excellent follow-up rate of 83 percent was achieved, yielding a large data base on the treatment outcomes of persons who received publicly supported substance abuse treatment.

• Data were collected across several important outcome areas, including drug and alcohol use, physical and mental health, criminal activity, social functioning, and employment.

• For a random sample of approximately 50 percent of those interviewed, urine specimens were collected at follow-up to corroborate clients' self-report of substance abuse.

• NTIES was originally funded to meet specific Congressional requirements to evaluate the activities of the demonstration programs supported by CSAT (formerly the Office of Treatment Improvement) now part of SAMHSA and HHS.

• The demonstration programs focused on underserved and vulnerable populations whose drug problems tend to be more severe and who have few social supports to help in their recovery (e.g. minority populations, pregnant and parenting women, those living in inner cities or public housing, recipients of public welfare, and those involved with the criminal justice system.)

Global Issues
USIA Electronic Journal, Vol. 2, No. 3, June 1997