Client-reported reasons for non-engagement in drug and alcohol treatment.
OBJECTIVE
To examine client-reported reasons for missed early appointments at a drug and alcohol treatment service and to compare characteristics of those who missed appointments with those who attended.


METHODS
Clients who missed a first or second appointment between 1 May and 31 August 2007 at a public community-based outpatient treatment facility were invited to participate in a semistructured telephone interview. This consisted of an open-ended question asking the reason(s) for nonattendance, followed by a questionnaire of items for therapeutic alliance and service satisfaction, perceived impact of substance use and previous treatment experience, mostly rated on Likert scales. Database information on demographic and clinical variables was gathered for all clients who were accepted for treatment within the study time frame. Characteristics of those who missed a first or second appointment (n = 66) were compared with those who attended at least their first two appointments (n = 97).


RESULTS
Of clients who missed their appointments, 80.6% provided reasons for nonattendance, which included extraneous factors (50.0%), service shortcomings (29.7%), no further need for service (16.2%) and motivational ambivalence (4.1%). They generally had high ratings of therapeutic alliance and service satisfaction and identified their substance use as having a negative impact on their lives. Clients who missed appointments were more likely to be male, unmarried and have a history of polysubstance use.


CONCLUSIONS
Extraneous issues relating to the client may be a dominant obstacle in early treatment engagement. Efforts to overcome these issues may therefore improve early engagement.
Coulson
Carolyn
C
Department of Clinical and Biomedical Sciences, Barwon Health, The University of Melbourne, Geelong, Australia. carolco@barwonhealth.org.au
Ng
Felicity
F
Geertsema
Marjan
M
Dodd
Seetal
S
Berk
Michael
M
D000328:Adult; D000437:Alcoholism / Q000534:rehabilitation*; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology*; D010352:Patient Dropouts / Q000523:psychology; D017060:Patient Satisfaction; D012737:Sex Factors; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000534:rehabilitation*