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Booking clients for addiction treatment: what works best?

 Vol. 95, Iss. 4,  (Apr 1999): 23-6.

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Considerable effort has been devoted to trying to improve the nature and quality of drug abuse treatment over the past 30 years. While there is evidence that certain treatment modalities are more effective than others,(f.1) there is little evidence that inpatient treatment is more effective than outpatient, that treatment of a long duration is more effective than that of a short duration or that intense treatment is more effective than less intense treatment.(f.2) Attempts to match drug abusers to an optimal treatment type have largely been unsuccessful.(f.3)

On the other hand, it is also clear that people who receive drug abuse treatment do better than people who do not receive treatment.(f.4) Furthermore, treatment attendance is one of the variables that best predicts a positive outcome.(f.5) Despite this evidence, little effort has been devoted to finding ways to increase the number of drug abusers receiving treatment or to increase the length of time abusers stay in treatment.

There is plenty of room for improvement in this area, as only a minority of people with mental health problems seek out help,(f.6) the majority of people who make enquiries about addiction treatment do not follow through with making an appointment,(f.7) general attendance at medical appointments averages only 58 per cent(f.8) and over half the people in drug abuse treatment drop out within the first month.(f.9) Interventions directed at the initial sessions may be particularly important, as this is when most of the dropping out occurs.(f.10)

Research indicates that appointment compliance can be improved through mail or telephone reminders,(f.11) orienting clients to the clinic,(f.12) contracting with clients,(f.13) providing maps or written dates and times of appointments,(f.14) decreasing the time between a client's seeking treatment and the initial appointment,(f.15) providing incentives(f.16) and problem-solving with the client about possible obstacles to attendance.(f.17)

The development of a...