Client Satisfaction with Drug Abuse Day Treatment versus Residential Care

By Chan, Monica; Sorensen, James L et al. | Journal of Drug Issues, Spring 1997 | Go to article overview

Client Satisfaction with Drug Abuse Day Treatment versus Residential Care


Chan, Monica, Sorensen, James L, Guydish, Joseph, Tajima, Barbara, Acampora, Alfonso, Journal of Drug Issues


We compared overall treatment satisfaction and helpfulness of treatment components for 216 clients randomly assigned to day versus residential treatment. Baseline interviews were conducted near admission using the Addiction Severity Index, Beck Depression Inventory, Symptom Checklist-90-R, and a social support measure. Follow-up interviews occurred 6 months later with these instruments plus a client satisfaction measure. Clients in both day and residential treatment were highly satisfied with overall services and most treatment components. Satisfaction scores were high and did not differ between modalities; however, mental health services were less helpful to day treatment clients, and more day treatment clients indicated not receiving certain treatment components. Client satisfaction correlated with treatment retention and several baseline and 6-month severity outcomes. These findings indicate day treatment may be as satisfying to clients as residential treatment, and give credence to the idea that client satisfaction assessment should be routine in outcome evaluations of drug abuse treatment.

Introduction

Drug abuse is a perplexing problem that is difficult to treat effectively. A substantial number of long-term drug users never initiate drug treatment (Brown and Needle 1994), and relapse is common following treatment (De Leon 1990). Several treatment modalities have developed, each with its limitations. Outpatient drug-free treatment can reach large numbers of drug abusers without removing them from the community, but it generally produces less behavioral change than more intensive modalities (Bell et al. 1994). Methadone maintenance therapy produces behavioral change in outpatient opiate abusers when offered in a comprehensive program (Cooper 1992); however, maintenance therapies have not been effective for treatment of other classes of drugs. Residential treatment is effective in producing behavior change, but it is costly in terms of human and financial resources, and it requires that clients be removed from their communities, which limits the appeal of this modality to potential clients.

In the search for effective treatment techniques, day treatment for drug abuse is a promising development. Day treatment involves intervening with clients living in the community by providing intensive, generally day-long, programming. Day treatment has a rich history in the treatment of mental illness (Braun et al. 1981) and the elderly (Fulmer and Edelman 1991). Recently several day treatment programs have been attempted for drug abusers. De Leon and colleagues provided day treatment in the context of a methadone maintenance program. Their observations indicate that compared to non-day treatment clients, those who volunteered for day treatment and stayed at least 6 months exhibited significantly larger reductions in drug use, needle use, criminal activity, and psychological dysfunction (De Leon et al.1995). Other programs have been developed in New York (Galanter et al. 1993), Philadelphia (Alterman et al. 1992, 1994), and Birmingham (Milby et al. 1995).

In assessing program effectiveness, behavioral outcomes are often the focus of evaluative studies. Although behavioral outcomes are important, they do not tap the clients' viewpoint, which can be crucial in assessing the acceptability of a program to potential clients and its perceived effectiveness in giving clients the tools they need to avoid relapse. Assessment of client satisfaction is one way in which clients' opinions of a program can be measured. As the United States enters an age of managed care in health services, client satisfaction is becoming a mandatory evaluation measure that will influence which services will be available (Hiatt and Hargrove 1995). Measurement of client satisfaction can be relatively straightforward, and a number of satisfaction measures have been developed (Ruggeri 1994). This paper compared the satisfaction of clients who received day treatment to those who received residential care to determine if client satisfaction would differ between the two modalities, whether specific treatment components were more helpful than others, and if clients preferred one treatment assignment over the other. …

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