A newly released nationwide study shows impressive reductions in drug use for patients in the four common types of drug abuse treatment. This good news comes from the NIDA-supported Drug Abuse Treatment Outcome Study (DATOS) - a major research effort that tracked more than 10,000 patients in almost 100 programs in 11 cities around the Nation over 3 years. Building on two earlier nationwide studies of treatment outcomes, DATOS investigators have amassed a wealth of information on drug abuse treatment outcomes, psychological disorders, retention rates, and treatment histories of drug abusers. The study also provides new information on changes in availability of drug abuse treatment services - ranging from basic drug abuse counseling to medical, legal, employment, and financial help - over the last two decades.
DATOS overwhelmingly confirms the effectiveness of drug abuse treatment. Although the two earlier studies and many smaller-scale studies have documented this effectiveness, DATOS proves it with nationwide findings for the 1990s. (See "Study Sheds New Light on the State of Drug Abuse Treatment Nationwide.") Among the patients that DATOS studied, drug use dropped significantly from the 12 months before treatment to 12 months after treatment began. This was true for all four types of treatment studied: outpatient methadone, outpatient drug-free, long-term residential, and short-term inpatient. Treatment also led to significant improvements in other aspects of patients' lives such as reduced involvement in illegal acts.
DATOS is one of the few national longitudinal studies to collect data on psychological disorders among drug abusers in treatment. The study also provides invaluable insight into critical differences between men and women entering drug abuse treatment. Knowing the gender-specific problems of addicts entering treatment can help providers tailor treatment to patients' specific needs.
DATOS also provides a wealth of information on the demographic characteristics and treatment histories of addicts in treatment. (See "Treatment Histories: The Long View of Addiction".) As more data are analyzed, researchers will be able to link patients' treatment outcomes to their backgrounds, gender, treatment histories, psychological disorders, and the specific services they have or have not received. This knowledge will enable us to refine and strengthen treatment by helping service providers determine what treatments work best for what kinds of patients.
Although much of the news from DATOS is good, there is also cause for concern. The study identified an alarming drop over time in the provision of services such as medical, legal, employment, and financial help. This decline is of special concern, since drug abusers often need help in one or more of these areas to get into and stay in treatment. Since NIDA's last national study of treatment outcomes, conducted from 1979 to 1981, the provision of these services has declined strikingly while the need for them has increased. From 1991 to 1993, during the time DATOS researchers were collecting data, the typical length of stay in short-term inpatient treatment dropped from 28 days to 14 or fewer days as insurers reduced coverage for addiction treatment. These changes did not go unnoticed by patients. More than half of DATOS participants in the four kinds of treatment programs surveyed did not report receiving support services that they said they needed. And, nearly 75 percent of patients in short-term inpatient programs reported not getting the psychological help they needed. (See "DATOS Documents Dramatic Decline in Drug Abuse Treatment Services".)
The reality is that we now have a treatment system that faces major resource constraints. As drug abuse treatment comes increasingly under managed care and resources are more tightly controlled, we must stay focused on the scientific facts about addiction and how to treat it adequately. Managed care providers must make tough decisions in allocating their resources, and DATOS can provide the hard scientific data they need to guide those decisions.
Given the wealth of findings coming from this study, our challenge is to communicate this information to health care organizations, managed care companies, and public policy-makers. We have a new mechanism in place to do that. Disseminating research findings is a primary goal of NIDA's new Treatment Initiative, as described in the last issue of NIDA NOTES. (See "NIDA Initiative Will Stimulate Improvements in Drug Abuse Treatment," and "NIDA Launches Drug Abuse Treatment Initiative," in NIDA NOTES, July/August 1997.) The DATOS results together with the Treatment Initiative can help us bridge the gap between public perceptions of drug addiction and what science has again shown - that drug abuse and addiction can be treated successfully with science-based methods, adequate treatment, and vigilant followup.