Complaints that predict drop-out from a detoxification and counselling unit
Introduction
Drug addiction can be classified as a disease (McCrady & Miller 1993), a social dysfunction (Beck, Wright, Newman, & Liese 1993; Bergmark et al. 1989), or rational behaviour in an economic sense (Becker & Murphy 1988). This multifaceted etiology may influence the outcome of the rehabilitation process (Byqvist 1993). Client complaints during the course of detoxification may guide or mislead therapists.
Psychological functioning, symptoms like pain and fatigue, and vocational abilities may be considered before suggesting a treatment. Tests that predict successful outcome may be interesting from a public finance point of view. Several tests have been proposed to match clients to the best suitable facilities (Beck, Wright, Newman, & Liese 1993; Gossop 1990; Grissom & Bragg 1991; Lindström 1992). However, the low success rate of treatment suggests the need for better matching of clients and treatment programs. A high level of stress or pain over a time period may be a risk factor for developing drug abuse. Fishbain et al. found that in patients with chronic pain, rates of drug-abuse, drug dependence, and drug addiction according to established DSM-III-R criteria were in the range of 3.2% to 18.9%. This is much higher than in the general population (Fishbain, Rosomoff, & Rosomoff 1992). A literature search did not show any studies of recorded pain in the course of detoxification and initial treatment of drug addiction, except more general studies on withdrawal symptoms (Gossop 1990; Gossop et al. 1995). Clinical observations do, however, suggest that drug addicts in a detoxification program report pain in muscles, joints and headache. Most addicts have been used to take pain-reducing substances in supratherapeutic doses.
Treatment success is often measured indirectly by counting the number of participants completing a residential stay (Edwards & Taylor 1994; Eklund, Melin, Hiltunen, & Borg 1994; Ellwood 1988; Gossop 1992; Simpson 1979; Waisberg & Porter 1994; Worner, Zeller, Schwarz, Zwas, & Lyon 1992). It is suggested that the duration of the residential period contributes positively to the overall rehabilitation process (Bergmark et al. 1989). Drop-out, which indicates an unsuccessful outcome of treatment or rehabilitation, has been associated with depression, use of methadone, and use of acupuncture. Ravndal and Vaglum also found that male clients and clients with depressive symptoms as measured by the HSCL-90 scale had an increased probability of drop-out (Ravndal & Vaglum 1991Ravndal & Vaglum 1994).
Section snippets
Materials and methods
The addicts of the present study were mainly admitted after signing a contract of treatment after detoxification with one of the detoxification units of the city of Oslo, Norway. After many years of observing that the majority of addicts continued their abuse after leaving the detoxification units, a counselling period after detoxification was proposed. A smaller proportion of clients were, however, admitted as emergencies. The main variable was outcome of the counselling program immediately
Results
There were 39 men and 22 women in the client group (Table 1). Eighteen of 61 clients (29.5%) terminated the scheduled stay less than 3 weeks after detoxification. Ten women and eight men were noncompleters, i.e., 45.5% of women and 20.5% of men. Female addicts had significantly shorter length of drug abuse career than did men, 13.9 versus 17.8 years. Mean age was also significantly different: 28.1 years in females and 33.0 years in males. The number of detoxification admissions in the same unit
Discussion
Sensations of bodily pain and fatigue may be a latent indicator of willingness to change abusing activities, i.e., an indication of the motivational aspect of rehabilitation (Miller & Rollnick 1991). Although pain may be a reason for taking up the use of illegal drugs, the use of illegal drugs over some period may distort normal sensations of pain. A study by Margaret Compton shows that current drug users tolerate pain less than do former users, and that pain tolerance was lower in opiate than
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