title: Predictors of outcome for patients with substance-use disorders five years after treatment dropout.
abstract: OBJECTIVE
  Few studies focus on the outcome of patients after they drop out of substance-use disorder (SUD) treatment, and there appear to be no prior studies of the long-term outcomes of these patients. The aim of this study is to determine how well such patients do after dropping out of treatment and to identify predictors of differential outcomes.
  
  
  METHODS
  Patients in 15 residential SUD treatment programs were assessed at treatment entry and at 5-year follow-up on their frequency and severity of substance use, expectancies and beliefs about substance use, and social resources and stressors. Patients who dropped out and stayed out of treatment (n = 193) were compared with those who completed treatment (n = 3,204). Predictors of 5-year SUD problems among dropouts were identified.
  
  
  RESULTS
  In general, dropouts and treatment completers did not differ significantly on their levels of SUD problems at 5 years. At baseline, patients who dropped out reported more involvement in 12-step organizations and greater cognitive impairment and more closely identified with the label "drug addict" than "alcoholic." Lower severity of SUD, lower self-efficacy, fewer positive substance- use expectancies, and less stress from social networks predicted fewer SUD problems at 5 years among dropouts.
  
  
  CONCLUSIONS
  In addition to focusing on substance use, providers should address the adequacy of patients' social support and counter positive substance-use expectancies at the earliest stages of treatment before patients drop out.
authors.affiliation: Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California 94025, USA. John.McKellar@med.va.gov
authors.forename: John D
authors.initials: JD
authors.lastname: McKellar
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Harris
authors.forename: Rudolf H
authors.initials: RH
authors.lastname: Moos
mesh_terms: D000328:Adult; D003469:Culture; D003710:Demography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012112:Residential Facilities / Q000706:statistics & numerical data*; D020377:Self Efficacy; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome