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A comparison of recidivism rates for alcoholic detox residents referred to treatment facilities
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A COMPARISON OF RECIDIVISM RATES FOR ALCOHOLIC RESIDENTS REFERRED TO TREATMENT FACILITIES REGINALD Addiction
DETOX
G. SMART Research
Foundation,
Toronto
(Canada)
Numerous detoxication facilities have been built in the past five years. In general, such facilities were created to stop the revolving door problem, i.e., the cycle of arrest, trial, jail term, and rearrest. However, if detoxication centres are not to become another revolving door for chronic inebriates, it will be necessary to successfully place their clientele in long-term treatment facilities, such as halfway houses, hospitals, out-patient clinics, etc. Currently, in Ontario there are 12 detoxication centres operating for a population of about 8.2 million persons. Most of these centres were designed to take police arrestees for drunkenness and to detoxify them. However, an important purpose is also to refer as many clients as possible to other health care facilities. Unfortunately, little is known of their relative value for the detoxication centre population. Typically, this population contains mainly older males, who have had previous treatment for alcoholism and may be involved in skid row. It would be of interest to know for various referral facilities what the overall recidivism rate is and whether different facilities have different rates of recidivism and lengths of stay. Smart et al. [l] compared recovery rates for alcoholics sent from a detoxication centre to an out-patient clinic, a long-stay farm, a halfway house, and given no referral at all. They found that recovery rates (in terms of detox readmissions and drunkenness) did not differ from the several types of referral, but that the groups which refused a referral had more detox readmissions than did the treated groups. That study was conducted with only 102 cases and involved only a six-month follow-up. It utilized only one of each type of referral facility. There were some indications that the detox client’s preference for a referral facility may have governed his length of stay and extent of recovery. The current study examines referrals for a similar population but with the following improvements: larger sample (n = 183); longer follow-up (one year); a larger variety of referral facilities (n = 21) including a variety of hospital programs, halfway houses, and residential facilities; and, inclusion of client preference or liking for the referral facility. The aims were to examine: (i) the proportions of clients who arrived at their referral and their length of stay in relation to demographic and drinking characteristics, and preference; (ii) whether the types of clients referred to different referral facilities are similar, i.e., could some facilities appear more successful because they accept clients who have more resources; and (iii) the relative success of different treatment programs in decreasing readmissions to detoxication centres.
219
In general, the aim was to discover which referral agencies are most effective in reducing readmissions of clients for detoxication. The sample of 152 men and 31 women comprised patients at the ARF Detoxication Centre who accepted a referral to a post-detox treatment facility during ten consecutive months. The final sample for this study was 174 as nine were excluded because they went to short-term residential facilities with no treatment program, e.g. old age homes or hostels. In total, referrals were made to some 21 health agencies in this study including out-patient clinics, halfway houses, farms, short-term residential facilities, and public hospitals. Usually, the referral was made on the 3rd to 5th day of the resident’s stay in the detoxication facility. An interview held on his last day at the detoxication facility covered the following areas: social and demographic characteristics (age, sex, employment, marital status, etc.); previous treatment for alcoholism; skid row involvement (employment, living arrangements, use of skid row facilities) measured on a 6-point scale; and the referral agencies most and least attractive to each patient and information on what aspects they liked or disliked. One year following the interview session a follow-up was begun utilizing both detoxication and treatment records. Treatment and detoxication readmission data were gathered for all residents for a period of twelve months prior to and following their discharge from the detoxication centre. A large variety of treatment agencies co-operated in this study. In general, the results provided little indication that post-detoxication facilities were rehabilitating detox clients. Only about 35% were known to actually arrive, despite receiving their preferred referral. A minority improved in terms of recidivism rates. Most had short lengths of stay in treatment and did not complete their treatment programs. However, the improvement rates did not differ between those who arrived and those who did not arrive, or for those who completed their treatment and those who did not. There were no differences in improvement rates for halfway houses, hospital and non-residential programs. Staying in residential care did not improve treatment outcome but there are some signs that frequent out-patient contacts lead to improvement. ‘The results of this study are similar to those of the earlier study [ 11 which showed that the type of referral did not relate to improvement. However, the present study involved a larger sample, a longer period of follow-up and a larger variety of referral facilities. It appears that expectations about the rehabilitative potential of detoxication facilities may have been overestimated. Although they replace the jail as part of the skid-row revolving door they do not appear to be very different in terms of actually changing the population they serve. If improvement rates are not greater for those currently using the facilities than for those ignoring them a mere expansion of existing facilities is unlikely to have a major impact. What is probably needed is the development of totally different concepts of rehabilitation. Perhaps it should be admitted that many de-
220
toxication clients will never be cured and that different approaches will have to be made for those who can be. The development of long-stay programs (years rather than months), compulsory commitment, and more intensive counselling should all be examined.
References 1 R. G. Smart, J. Finley and R. Funston, The effectiveness of post-detoxication referrals: effects on later detoxication admissions, drunkenness and criminality, Drug Ale. Dependence, 2 (1977) 149 - 155.
A COMPARISON OF RECIDIVISM RATES FOR ALCOHOLIC RESIDENTS REFERRED TO TREATMENT FACILITIES REGINALD Addiction
DETOX
G. SMART Research
Foundation,
Toronto
(Canada)
Numerous detoxication facilities have been built in the past five years. In general, such facilities were created to stop the revolving door problem, i.e., the cycle of arrest, trial, jail term, and rearrest. However, if detoxication centres are not to become another revolving door for chronic inebriates, it will be necessary to successfully place their clientele in long-term treatment facilities, such as halfway houses, hospitals, out-patient clinics, etc. Currently, in Ontario there are 12 detoxication centres operating for a population of about 8.2 million persons. Most of these centres were designed to take police arrestees for drunkenness and to detoxify them. However, an important purpose is also to refer as many clients as possible to other health care facilities. Unfortunately, little is known of their relative value for the detoxication centre population. Typically, this population contains mainly older males, who have had previous treatment for alcoholism and may be involved in skid row. It would be of interest to know for various referral facilities what the overall recidivism rate is and whether different facilities have different rates of recidivism and lengths of stay. Smart et al. [l] compared recovery rates for alcoholics sent from a detoxication centre to an out-patient clinic, a long-stay farm, a halfway house, and given no referral at all. They found that recovery rates (in terms of detox readmissions and drunkenness) did not differ from the several types of referral, but that the groups which refused a referral had more detox readmissions than did the treated groups. That study was conducted with only 102 cases and involved only a six-month follow-up. It utilized only one of each type of referral facility. There were some indications that the detox client’s preference for a referral facility may have governed his length of stay and extent of recovery. The current study examines referrals for a similar population but with the following improvements: larger sample (n = 183); longer follow-up (one year); a larger variety of referral facilities (n = 21) including a variety of hospital programs, halfway houses, and residential facilities; and, inclusion of client preference or liking for the referral facility. The aims were to examine: (i) the proportions of clients who arrived at their referral and their length of stay in relation to demographic and drinking characteristics, and preference; (ii) whether the types of clients referred to different referral facilities are similar, i.e., could some facilities appear more successful because they accept clients who have more resources; and (iii) the relative success of different treatment programs in decreasing readmissions to detoxication centres.
219
In general, the aim was to discover which referral agencies are most effective in reducing readmissions of clients for detoxication. The sample of 152 men and 31 women comprised patients at the ARF Detoxication Centre who accepted a referral to a post-detox treatment facility during ten consecutive months. The final sample for this study was 174 as nine were excluded because they went to short-term residential facilities with no treatment program, e.g. old age homes or hostels. In total, referrals were made to some 21 health agencies in this study including out-patient clinics, halfway houses, farms, short-term residential facilities, and public hospitals. Usually, the referral was made on the 3rd to 5th day of the resident’s stay in the detoxication facility. An interview held on his last day at the detoxication facility covered the following areas: social and demographic characteristics (age, sex, employment, marital status, etc.); previous treatment for alcoholism; skid row involvement (employment, living arrangements, use of skid row facilities) measured on a 6-point scale; and the referral agencies most and least attractive to each patient and information on what aspects they liked or disliked. One year following the interview session a follow-up was begun utilizing both detoxication and treatment records. Treatment and detoxication readmission data were gathered for all residents for a period of twelve months prior to and following their discharge from the detoxication centre. A large variety of treatment agencies co-operated in this study. In general, the results provided little indication that post-detoxication facilities were rehabilitating detox clients. Only about 35% were known to actually arrive, despite receiving their preferred referral. A minority improved in terms of recidivism rates. Most had short lengths of stay in treatment and did not complete their treatment programs. However, the improvement rates did not differ between those who arrived and those who did not arrive, or for those who completed their treatment and those who did not. There were no differences in improvement rates for halfway houses, hospital and non-residential programs. Staying in residential care did not improve treatment outcome but there are some signs that frequent out-patient contacts lead to improvement. ‘The results of this study are similar to those of the earlier study [ 11 which showed that the type of referral did not relate to improvement. However, the present study involved a larger sample, a longer period of follow-up and a larger variety of referral facilities. It appears that expectations about the rehabilitative potential of detoxication facilities may have been overestimated. Although they replace the jail as part of the skid-row revolving door they do not appear to be very different in terms of actually changing the population they serve. If improvement rates are not greater for those currently using the facilities than for those ignoring them a mere expansion of existing facilities is unlikely to have a major impact. What is probably needed is the development of totally different concepts of rehabilitation. Perhaps it should be admitted that many de-
220
toxication clients will never be cured and that different approaches will have to be made for those who can be. The development of long-stay programs (years rather than months), compulsory commitment, and more intensive counselling should all be examined.
References 1 R. G. Smart, J. Finley and R. Funston, The effectiveness of post-detoxication referrals: effects on later detoxication admissions, drunkenness and criminality, Drug Ale. Dependence, 2 (1977) 149 - 155.