Early attrition from treatment among women with cooccurring substance use disorders and PTSD.

Participant retention is one of the more challenging issues in the treatment of substance use disorders. Using data from the National Institute on Drug Abuse Clinical Trials Network’s Women and Trauma Study (CTN-0015, recruitment in 2004–2005), this analysis examines prominent factors associated with early attrition among women with co-occurring substance use disorders and post-traumatic stress disorder (N=340). Early treatment attrition is associated with a history of youth partner violence, perceived need for psychological treatment, and abuse of alcohol, opioids, and stimulants. Logistical barriers (e.g., transportation, having children) were not significantly associated with early attrition. Additionally, no significant differences in early dropout based on the presence of depression symptoms, PTSD severity, or PTSD diagnoses (full vs. subthreshold) were detected; this is consistent with previous PTSD studies that have found no evidence to suggest that trauma severity is significantly associated with treatment dropout. Perhaps one of the more clinically significant results from this study related to the perceived importance of psychological or emotional treatment. Women who reported that treatment for psychological or emotional problems was highly important to them were significantly more likely to drop out of treatment without attending a single session. Some evidence has suggested that women might perceive their problems to be specific to the trauma and their psychological distress and therefore might prefer to seek treatment in a mental health settings instead of a substance abuse treatment setting. Whether it is the nature of the problem recognition or the desire to seek treatment in another setting, the issue of women’s attrition and co-occurring psychological problems remains a concern for both clinicians and researchers.

Conclusions: This study adds to the growing research on treatment retention and might help identify future clients and study participants at risk for early dropout from treatment.

Related protocols: CTN-0015