A look at the dark side of addiction treatment: a profile of those who drop out
Background: As a spectrum of disorders that see their prevalence rise and affect more people globally than other leading diseases such as heart conditions and diabetes, addiction is thankfully attracting more research from various scientific disciplines. The focus is usually on the etiology, development and treatment of the disease. Research into this last object of study, the treatment, finds itself almost exclusively interested in finding out what works for the patients who stick to the various treatment programs available, but rarely ventures into the well-known dark side of treatment: those who drop out. Dropping out of an addiction treatment is said to be more likely than its completion. The objective of this study was to explore the differences at the moment of admission, between those who complete and those who drop out of treatment.
Method: Considering only one moment of evaluation, this study has a cross-sectional design. The sample was composed of all the 65 patients who were admitted into and ended treatment at VillaRamadas International Treatment Centre throughout 2018. The data used for this study was collected in the first week of treatment, with the use of an intake psychiatric evaluation, a sociodemographic questionnaire and an evaluation protocol that included the following measures: Alcohol Use Disorders Identification Test (AUDIT), Beck Depression Inventory – II (BDI-II), Suicide Ideation Questionnaire (SIQ), and State-Trait Anxiety Inventory (STAI).
Results: From the 65 patients, 18 were women; 15 did not complete treatment with success. Age varied from 16 to 64 years (M= 35.91; SD= 11.46), and did not differ significantly between drop-outs and those who completed treatment. Similarly, there were no significant differences on the mean results of any of the psychological measures and on the reported level of motivation for treatment. Regarding diagnosis, drop-outs reported higher percentages of a behavioral addiction diagnosis, and of an history of past psychosis. Cannabis appeared as the most common drug of choice in drop-outs, representing 41.7 percent of all main diagnoses, and contrasting with the 19.4 percent found In those who completed treatment. Sedative medication dependence or abuse accounted for 16.7 percent in drop-outs but did not appear in those who completed treatment. Concerning psychotropic medication, drop-outs presented an higher prevalence of medication at admission (100 percent), specifically anxiolytics and antipsychotics. Interestingly, drop-outs had a lower prevalence of dual pathology, of polydrug use throughout life, of reported previous overdose and history of non-suicidal self-injury.
Discussion: Although a small study with limitations, it was possible to start to understand the profile of those who drop-out of treatment at the VillaRamadas Treatment Centre. More research needs to be made to understand if these results reflect only the reality of this single centre, as well as what can we do in order to reduce this drop-out number.