. "Appendix D: Commissioned Paper: The Treatment of Addiction: What Can Research Offer Practice?." Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment. Washington, DC: The National Academies Press, 1998.
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come domains defined above in any of the major rehabilitation modalities (see Ball and Ross, 1991; Finney and Moos, 1992; McLellan et al., 1994; Rounsaville et al., 1987). For example, a study of 649 patients entering 22 treatment programs (seven inpatient, eight outpatient, seven methadone maintenance) for treatment of primary alcohol, opiate, or cocaine dependence evaluated the contribution of demographic variables including age, ethnicity, gender, marital status, years of education, and years of problematic substance abuse (McLellan et al., 1994). Results showed that none of the demographic measures was a significant predictor of either posttreatment substance use or posttreatment social adjustment. Similarly, studies by Simpson and Savage (1980) showed no significant effect of demographic and social indicators in predicting multiple outcome domains among heroin addicts treated in methadone maintenance and outpatient drug free treatment.
Though less studied at this time, there may be some important exceptions to this conclusion. For example, pregnant and parenting women are an important subgroup of the larger patient population who require different features to permit access to treatment as well as different constellations of treatment to address their often significant treatment problems (see Gomberg and Nirenberg, 1993; Wilsnack and Wilsnack, 1993). There has been indication that these patients have been reluctant to get into "standard" treatments because of stigma and because of the absence of services for their children. There have been experimental programs created to meet the needs of this important subgroup—and some excellent evaluations have followed these groups posttreatment (see Hagan et al., 1994). There have been very few longer term outcome studies of specialized treatments for pregnant and parenting women and only the most obvious conclusions can be drawn regarding the factors that appear to be important for attraction, retention, and improved outcomes for these patients. These factors would include but not be restricted to:
The availability of care for children—and sometimes a residence that will accommodate the patients and their children. Many of the addicted women who could benefit from treatment are responsible for the care of children and facilities that will provide respite care are likely to be necessary for these women to be able to enter outpatient treatment. Other women will not have the resources to be self supporting and may need temporary accommodations for themselves and their children. Still others may require a facility that will offer protection from aggressive and/or drug involved partners. Problems of safety from physical and sexual abuse and separation from drug involved relationships are common in a large proportion of these women (Hagan et al., 1994; Wilsnack and Wilsnack, 1993;