Facilities can take steps to reduce risk of early departure

A more comprehensive assessment of patients at intake could hold the key to limiting the prevalent problem of some patients leaving an addiction treatment program early “against clinical advice,” a director at Foundations Recovery Network told an Addiction Professional webinar audience this week.

Based on data collected from several studies of trends among patients at its residential dual-diagnosis treatment programs, Foundations now incorporates into its intake procedures a checklist approach to assessing risk of early departure. In one action taken as a result, a finding that individuals with opioid use problems were less likely to stay in treatment fueled creation of a special weekly group for opioid patients only, to give longer-staying patients an opportunity to mentor newer arrivals, said Siobhan A. Morse, Foundations' director of research and fidelity.

The Jan. 27 webinar was titled “Lower ACA Rates Equal Better Outcomes: Improving Treatment Retention at Your Facility.” Morse said that understanding the factors in a patient's life that can contribute to early departure from treatment will lead to an appreciation of the need for more comprehensive assessment.

“It's important to really get to know what's going on with patients when they come to you,” including in their work and family lives, Morse said. “This is not outside of your scope of practice.”

She added, “Just by using basic intake data, ... you can begin to identify patients who are at greater risk.”

Study results

Morse said that most of the existing research on who is primarily at risk of leaving against clinical advice has focused on public-sector treatment populations, often in outpatient settings. Given that it serves a different patient profile in a for-profit care environment, Foundations arrived at some divergent conclusions from the literature in its examination of who tends to leave its programs prematurely.

Focusing on the danger zone of the initial four weeks of treatment, it found (contrary to what much of the other research says) that older patients were less likely than younger patients to remain in treatment for that period. Women were more likely to remain in treatment than men.

Foundations then decided to look more closely at gender differences, and found that women had more complicating issues related to family matters and psychiatric concerns, while men had more legal and drug use issues. Also, Morse said, while men who were in more of a precontemplative or contemplative stage of change still showed the capacity for growth in treatment, being at the early end of the stages-of-change continuum predicted early departure for women.

Foundation's third analysis looked at age differences, finding more employment and legal challenges for adults ages 18 to 25 and more medical and alcohol issues for adults 26 and older. For both younger and older patients, greater severity on the employment subscale of the Addiction Severity Index (ASI) made it less likely that a patient would stay in treatment, with concerns about job security beginning to preoccupy many individuals in the early stages of treatment.

Morse continually pointed to identifying some of the potential risk factors for early departure at a program's first contact with patients. “If we can do at intake a thorough assessment of their education, employment, and family life, we can have a better idea of how stressed they're going to be,” she said.