Stark M J, Campbell B K
Graduate Program in Counseling Psychology, Lewis and Clark College, Portland, Oregon 97219.
Am J Drug Alcohol Abuse. 1988;14(4):475-85. doi: 10.3109/00952998809001565.
This study examined the relationships among demographics, personality variables, drug use, and early attrition from substance abuse treatment. Attrition was considered at two time intervals; immediately (after one visit) and after 2 months. One hundred consecutive admissions to a community drug-abuse treatment center were given the MCMI and the SCL-90R following a standard intake interview. Subjects were classified according to their primary drug of abuse, yielding 16 opiate, 16 amphetamine, 34 cocaine, and 29 marijuana abusers. ANOVA's, ANCOVA's, and chi-squares were performed to compare characteristics of the different groups. Immediate Dropouts were less likely to be court mandated than Remainers, but were not different on any other demographic or drug use variable. Remainers had higher scores than Immediate Dropouts on 7 MCMI scales. A significant interaction between drug type, symptom severity, and early attrition was found for amphetamine abusers with high levels of subjective distress as measured by the SCL-90R. These clients dropped out earlier than amphetamine abusers without elevated SCL-90R scores. Analysis also indicated that Long-Term Remainers were less likely to be employed than Dropouts. All other comparisons between these groups failed to produce significant differences. This study confirms earlier research which found a high rate of early attrition from treatment with substance-abusing clients. Results also indicate that severity of psychopathology is not key in predicting attrition; it is more the nature of the disorder that influences client dropout. It is argued that continuation in community treatment is problematic for most substances abusers, and treatment facilities should routinely employ attrition prevention procedures.
本研究考察了人口统计学特征、人格变量、药物使用与药物滥用治疗早期脱落之间的关系。在两个时间间隔对脱落情况进行考量，即立即（一次就诊后）和2个月后。在社区药物滥用治疗中心连续收治的100名患者在标准入院访谈后接受了米隆临床多轴量表（MCMI）和症状自评量表（SCL - 90R）测试。根据主要滥用药物对受试者进行分类，产生了16名阿片类药物滥用者、16名苯丙胺滥用者、34名可卡因滥用者和29名大麻滥用者。进行方差分析（ANOVA）、协方差分析（ANCOVA）和卡方检验以比较不同组的特征。与继续治疗者相比，立即退出者受法庭强制要求的可能性较小，但在任何其他人口统计学或药物使用变量上并无差异。在7个MCMI量表上，继续治疗者的得分高于立即退出者。对于苯丙胺滥用者，通过SCL - 90R测量发现，药物类型、症状严重程度与早期脱落之间存在显著交互作用，主观痛苦程度高的这些患者比SCL - 90R得分未升高的苯丙胺滥用者更早退出。分析还表明，长期继续治疗者就业的可能性低于退出者。这些组之间的所有其他比较均未产生显著差异。本研究证实了早期研究结果，即药物滥用患者治疗早期脱落率很高。结果还表明，精神病理学的严重程度并非预测脱落的关键因素；更重要的是疾病的性质影响患者退出。有人认为，对于大多数药物滥用者来说，在社区治疗中持续治疗存在问题，治疗机构应常规采用预防脱落的程序。
