Predictors of Retention in Treatment in a Tertiary Care De-Addiction Center

By Majumder, Pradipta; Sarkar, Siddharth et al. | Indian Journal of Psychiatry, January-March 2016 | Go to article overview

Predictors of Retention in Treatment in a Tertiary Care De-Addiction Center


Majumder, Pradipta, Sarkar, Siddharth, Gupta, Rishab, Patra, Bichitra, Balhara, Yatan, Indian Journal of Psychiatry


Byline: Pradipta. Majumder, Siddharth. Sarkar, Rishab. Gupta, Bichitra. Patra, Yatan. Balhara

Context: Retention in treatment can improve the outcomes of patients with substance use disorders. Aims: This study aimed to assess the predictors of treatment retention in a set of patients admitted with substance use disorders. Setting and Design: This record-based study was conducted among consecutive patients discharged from the inpatient unit of a tertiary care de-addiction facility in Northern India. Materials and Methods: Patients were classified as being retained in treatment or drop-outs based on follow-up records. Statistical Analysis: Those who were retained and those who dropped out were compared using appropriate parametric and nonparametric tests. Logistic regression was used to find out the predictors of retention in treatment. Results: A total of 88 case records were evaluated. All subjects were males and majority of the sample was married, educated up to 10 [sup]th grade, employed, belonged to the nuclear family and urban background. Opioid dependence syndrome (96.6%) was the most common substance use disorder identified. Guilt feelings, general weakness of body, and loss of social respect were the most common substance-related complications experienced. Of the total sample, 40 (45.4%) were classified as retained into treatment. Higher socioeconomic status and having a family member with substance use was associated with higher chances of treatment retention. Conclusion: Identification of patient characteristics predicting drop-outs can help in targeting those individuals at higher risk. This can help in more favorable patient outcomes.

INTRODUCTION

Retention in treatment is very important for successful outcomes in the management of substance use disorders. [sup][1],[2] Patients with substance use disorders have been found to have significant drop-out rates. [sup][3],[4] Drop-out from treatment in-turn leads to poor prognosis and recurrent relapses. [sup][2]

Many factors have been associated with drop-out among patients seeking treatment for substance use disorders. Some of the demographic factors associated with drop-out status include age, [sup][5],[6] employment status, [sup][6] and educational status. [sup][7],[8] Other factors that have been implicated in retention in treatment include presence of a psychiatric disorder, [sup][8],[9] motivation for treatment, [sup][10],[11] and cognitive characteristics of the client. [sup][3] Mitchell and Selmes [sup][12] have reviewed these factors, and a comprehensive list of the same has been proposed by them. Those relevant to Indian context have been summarized in [Box 1] (modified based upon Mitchell and Selmes, 2007). [sup][12] [INLINE:1]

There is a relative paucity of published literature about factors predicting retention of treatment among substance users in India. Selected studies are available about treatment retention among substance abusers. [sup][13],[14] With the relative lack of published literature, this study attempted to find out the predictors of retention in a substance use treatment setting.

MATERIALS AND METHODS

The present chart-based study was conducted at a tertiary level de-addiction center. The center provides treatment services to patients with a variety of substance use disorders. Apart from that, the center is also involved in teaching of health care personnel and trainers about substance use disorder and their management. The center is also actively involved in research activities, ranging from biological, epidemiological, and therapeutic to service-based research.

The therapeutic services provided by the center include both inpatient and outpatient services. The clientele of the centre primarily comprises of patients with opioid and alcohol use disorders, though the center also encounters patients with disorders of other substances of use. Patients either seek treatment directly or are referred from elsewhere. …

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