title: External influences on drug treatment interventions: East Palo Alto's Free-at-Last.
abstract: External influences on community-based drug treatment program outcomes have not been adequately accounted by either treatment providers or evaluators. In 2001-2003, a cohort of 197 African American and Latino crack cocaine and heroin users was interviewed at intake into the Free-at-Last's treatment program in East Palo Alto, California.
  
  
  OBJECTIVE
  The goal of this research was to identify, and then measure, the impact of a series of theory-based, hypothesized external influences on 3 client treatment outcomes: (1) program completers, (2) dropouts, and (3) referrals to more intensive inpatient treatment.
  
  
  METHODS
  All program clients were interviewed using the Government Performance and Results Act and the California Alcohol and Drug Data System questionnaires. Supplemental questions hypothesized the external influences and were based on prior research and staff focus groups.
  
  
  RESULTS
  There were statistically significant differences in treatment outcomes based on employment status, homelessness, living situation, and jail time. Regression analyses indicated that the strongest outcome predictors were treatment intensity, followed by prior crack use, homelessness, income, and number of illegal drugs used. Path analysis showed that former crack use and time in jail formed a particularly strong cluster of external influences on treatment outcomes. This cluster was the result of court-mandated treatment of arrested crack users who chose treatment over incarceration. If users failed treatment, they went back to jail. In a community such as East Palo Alto, court-mandated referrals had a powerful external influence on treatment and, therefore, need to be considered when evaluating a treatment program.
authors.affiliation: Department of Sociology and Social Services, California State University East Bay, CA, USA. Benjamin.bowser@csueastbay.edu
authors.forename: Benjamin Paul
authors.initials: BP
authors.lastname: Bowser
authors.forename: David
authors.initials: D
authors.lastname: Lewis
authors.forename: Derrick
authors.initials: D
authors.lastname: Dogan
mesh_terms: D001741:Black or African American; D000704:Analysis of Variance; D002140:California; D015331:Cohort Studies; D003153:Community Health Services / Q000379:methods*; D006630:Hispanic or Latino; D006801:Humans; D010352:Patient Dropouts / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods; D015397:Program Evaluation / Q000379:methods* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012424:Rural Population; D012944:Social Support; D012959:Socioeconomic Factors; D016320:Substance Abuse Treatment Centers / Q000379:methods*; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome