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PubMed1990

Meaningful involvement in instrumental activity and well-being: studies of older adolescents and at risk urban teen-agers.

Meaningful involvement in instrumental activity, social support, and well-being were assessed in two studies. The first study focused on older adolescents enrolled in college (mean age, 18.8; N = 152), and the second on urban black male, and pregnant female, teen-agers (mean age, 17.1; N = 92), half of whom (N = 46) were school dropouts. In both studies, regression analyses indicated that meaningful instrumental activity was positively related to life satisfaction, independent of social support from friends and from parents. In addition, meaningful instrumental activity was positively related to self-esteem to a greater extent (a) for male than for female college students (Study 1); and (b) for school-attending than for school-dropout urban black males (Study 2). In Study 2, higher mean levels of meaningful instrumental activity were reported (a) by school-attending than by school-dropout urban adolescents; and (b) by black male teens than by pregnant female teens. The implications for future research and intervention are discussed.

Adolescent↗
PubMed2002

What happens to eating disorder outpatients who withdrew from therapy?

OBJECTIVE: Dropouts are frequent among eating disorder (ED) patients, but less is known about their natural history. This paper assesses the outcome of outpatients who dropped out from a therapy programme and its possible causes. MATERIAL AND METHODS: From 1992 to 1994, we assessed 222 ED subjects. Psychiatrists expert in EDs evaluated these subjects by defining baseline parameters and diagnosis was made according to the 3rd revisioned edition of the Diagnostic and Statistical Manual of Mental Disorders. One hundred and twenty-eight subjects (57%) dropped out during the treatment. In 1997, we contacted them, reassessed the same baseline parameters and asked for a self-judgment about their social and clinical condition during the previous 2-5 years. Patients were classified as "improved" and "not improved" (stationary or worse) according to their social, physical and psychological condition. The relation between baseline condition and outcome was determined statistically. RESULTS: Seventy-one percent of subjects were "improved" and no deaths were recorded. A significant correlation was found between "duration of illness" and no treatment following a dropout. DISCUSSION: The high percentage of improvement among dropouts was unexpected. Shorter duration of illness and lack of specific therapy in the improved patients suggest the existence of a subset of ED patients with acute onset and a spontaneous tendency to improve. This point obviously requires further investigation.

Adaptation, Psychological↗
PubMed2003

Long-term interferon-beta treatment for multiple sclerosis.

The aim of our study was to analyze the dropout rate in patients with relapsing-remitting multiple sclerosis (RRMS) under long-term treatment with the three commercially available interferon beta (IFNbeta) preparations. According to the drug taken, we divided 122 RRMS patients into 4 groups: Betaferon group, 56 patients taking INFbeta-1b (24 MIU weekly, subcutaneous injections); Avonex group, 38 patients taking IFNbeta-1a (6 MIU weekly, intramuscularly); Rebif group, 18 patients taking INFbeta-1b (18 MIU subcutaneously). Ten patients who shifted from Betaferon to Avonex were included in a fourth group. Dropouts were registered every trimester with the related cause. Data were evaluated using Kaplan-Meier survival analysis and log-rank test. During the observation period of five years, 48 patients (39.9%) dropped out: 48% of the patients in Betaferon group withdrew at a median of 758 days, 26% of the Avonex group at 356 days; 38% of the Rebif group at 421 days, and 40% of those who shifted from Betaferon to Avonex at 259 days. The differences between groups were not significant on survival analysis. Patients receiving higher dose treatment (Betaferon and Rebif groups) dropped out mainly for clinical adverse events; conversely, patients receiving lower dose therapy (Avonex group) dropped out most often for inefficacy. Patients who shifted to a lower dose treatment (fourth group) had a dropout rate similar to that of the initial treatment. Our data showed that one-third of the patients stopped the therapy, mostly for adverse events and then for inefficacy, while the remaining two-thirds were still on treatment without problems up to 5 years of follow-up. Compliance seems related to the dose of the drug, but further analysis is needed to confirm our data.

Adult↗
PubMed2005

Where perception and reality differ: dropping out is not the same as failure.

The present study examined whether exercise adherers and dropouts differ in their perceptions of success and, in turn, whether their social cognitions and behavior correspondingly differ. Using a prospective, observational design, exercise class participants were followed over 12 weeks of attendance. Social-cognitive measures were assessed at both early and late program while attendance was tracked for each half of the program. Multivariate analyses of variance (MANOVAs) using a 2 (Success/Failure) x 2 (Adherer/Dropout) factorial design revealed significant interactions for self-efficacy, affect, causal attributions, as well as rate of perceived exertion. Multiple main effects for perceived success and adherence were also found. The results suggest that "successful" dropouts possess social-cognitive characteristics that may enable them to resume their exercise participation at some later date. These findings provide evidence that the examination of perceived success allows for valuable insight into the differences among and between exercise adherers and dropouts, which may have implications regarding long-term exercise participation.

Adult↗
PubMed1992

The abstinence violation effect and very low calorie diet success.

This study evaluated the relationship between Marlatt and Gordon's (1985) Abstinence Violation Effect (AVE) and fasting outcomes of patients enrolled in a Very Low Calorie Diet (VLCD) and behavior education program. Within the first 11 weeks of the VLCD, 41 of 76 patients reported a fasting lapse and rated this lapse on an attribution scale. Patients reporting greater characterological attributions for their first lapse (i.e., a higher AVE) lost a smaller percentage of their excess weight during active fasting than patients reporting more situational attributions r(39) = -.36, p less than .025. First lapse AVE ratings did not distinguish between program dropout versus completer status, but high AVE dropouts did spend fewer weeks in the VLCD program than low AVE dropouts, r(12) = -.54, p less than .05. Although a faster's initial level of obesity accounted for the largest portion of weight loss outcome variance, the AVE accounted for a significant additional portion of outcome.

Adult↗
PubMedDate not supplied

Examination of pretreatment predictors of attrition in a VLCD and behavior therapy weight-loss program.

Seventeen pretreatment predictors of attrition in a very low-calorie diet (VLCD) and behavior therapy combined weight-loss program (Optifast) were examined. A multiple discriminant function analysis was conducted on historical data in an attempt to distinguish early dropouts (weeks 2-14) from late dropouts (weeks 15-26) from completers. The following seven predictor variables contributed to the significant discriminant function equation: the number of past diets, past emotional difficulties, past physical or emotional difficulties while dieting, expected stress over the next 6 months, the number of close friends, the number of people who annoy the dieter about his or her weight, and the expectation of insurance coverage. In addition, it was found that completers reported a significantly greater number of previous diets than early dropouts.

Adolescent↗
PubMed2005

Assessing missing data assumptions in longitudinal studies: an example using a smoking cessation trial.

Due to the chaotic nature of the clinical disorder, longitudinal data analysis in substance abuse research is plagued by missing values. To obtain an unbiased estimation on intervention effects, different longitudinal modeling strategies require various assumptions on the patterns and mechanisms of missing data. By defining missingness as intermittent missingness (occasional omission) and dropout (premature withdrawal), this article demonstrates statistical ways for assessing missing data assumptions using evidence from a clinical trial. Within the framework of multiple imputation, intermittent missing data are imputed first so that dropouts can be isolated and treated specifically. A computational tool called "pattern reduction resampling" is proposed to simplify missing data methods when the number of intra-subject repeated measures is large. To test whether missingness patterns are nondifferential across treatment conditions, a formal testing approach treats indicators of missingness as a special type of repeated measures (e.g., 0: intermittent missing, 1: observed, and 2: dropout missing). After reviewing the idea of ignorability for missing data and of classifying missingness mechanisms into subcategories, the article provides an example for assessing common assumptions on missingness mechanisms and how these assumptions affect model selection for significance testing. A carbon monoxide longitudinal data set in a smoking cessation study is used for illustration.

Bias↗
PubMed2005

Cognitive deficits predict low treatment retention in cocaine dependent patients.

Previously, we found that impaired cognition predicted treatment dropout from cognitive behavioral therapy (CBT) in a small sample of cocaine dependent patients. To further address the role of impaired cognition in retention and treatment outcome of cocaine-dependent patients in CBT, we expanded a previous investigation to a larger sample, added depressed cocaine patients, and added an additional cognitive assessment. Fifty-six cocaine dependent patients receiving CBT in outpatient clinical trials were assessed for cognitive performance at treatment entry with the computerized MicroCog (MC) and the Wisconsin Card Sort Test (WCST). Treatment completion was defined as 12 or more weeks. Treatment dropouts had significantly lower MC scores (poorer cognitive functioning) than completers on attention, memory, spatial ability, speed, accuracy, global functioning, and cognitive proficiency, with effect sizes in the moderate to large range. These findings were not affected by depression, demographics (age, gender, race, sex, marital status) or drug use (years of cocaine use or average weekly cocaine expenditure in the prior 30 days). In contrast, patients' performance on the WCST was in the average or near-average range, and WCST scores did not differentiate between completers and dropouts. Consistent with previous research, results suggest that mild cognitive impairments (< or =1 S.D. below the mean) negatively affect retention in outpatient CBT treatment for cocaine dependence. Future studies should examine whether there are specific effects of different executive functioning abilities on treatment outcome. Modified behavioral and pharmacologic interventions should be considered to target mild cognitive impairments to improve substance treatment outcome.

Adult↗
PubMed2004

Substance abuse intensive outpatient treatment: does program graduation matter?

Program graduation, even after controlling for length of stay, may predict for improved outcomes in some substance abuse treatment settings. We investigated the role of program graduation by comparing social outcomes and inpatient utilization the years before and after treatment among graduates and dropouts of a Veterans Administration substance abuse intensive outpatient program. At enrollment, graduates and dropouts were similar in all spheres measured. Patients who completed the treatment program used significantly fewer psychiatric inpatient bed days of care the year after they completed the program, both in comparison to their own prior use and in comparison to program dropouts. Graduates were more likely to be abstinent and less likely to fully relapse or be incarcerated at 6-month followup. Further research is needed to discern optimal treatment length-that which maximizes both length of stay and completion rates, while optimizing use of limited treatment resources.

Female↗
PubMed2004

Feasibility of diabetes peer education for Turkish type 2 diabetes patients in Dutch general practice.

The feasibility of a 9-month educational diabetes programme (tailored to Turkish patients, provided by Turkish bicultural female educators) was assessed in terms of dropout rate, patient and GP satisfaction, and GP's perceived workload. Of the 54 Turkish patients (39% males) that signed informed consent, 45 actually started the education. Dropout rate during the programme was 41% (main reason: going abroad for a long period (18%)). The individual education sessions and the consultations with the GP were highly appreciated by 87% of the patients and the group sessions by 66%. Although all nine interviewed GPs experienced a higher workload, overall appreciation of the programme was high in six GPs. Although implementation of an ethic-specific diabetes programme in general practice is well appreciated by both patients and GPs, the high dropout rate indicates that the programme needs to be more finely tuned to the individual patient.

Attitude of Health Personnel↗
PubMedDate not supplied

Substance abuse treatment outcomes for cognitively impaired and intact outpatients.

The purpose of this research was to examine the effects of cognitive impairment on the efficacy of substance abuse treatment outcome. Alcohol, drug, medical, legal, psychological, employment, and family functioning related treatment outcomes were examined for 26 cognitively impaired and 68 cognitively intact abusing outpatients. Subjects were enrolled in an intensive, 3-week, outpatient program for the treatment of their substance abuse. Subjects were administered a battery of neuropsychological tests prior to treatment onset, and outcome data were obtained at 1, 3, 6, and 12 months posttreatment entry. No significant between-group differences were found on any of the outcome measures, and significant treatment gains were observed across all problem domains in both groups. Subjects' largest improvements were made in the first month of treatment for alcohol, drug, legal, family, and psychological problems. Improvements for employment and medical problems were not observed until 6 months posttreatment. Success across domains was maintained through 12 months follow-up, with the exception of psychological problems; 12-month data indicated a return to thelevel observed at 30 days posttreatment for psychological problems, a level that reflected significant improvement from baseline functioning. A greater proportion of treatment dropouts (i.e., no follow-up data obtained after 30 days) were cognitively impaired as compared to treatment completers. These results suggest that this method of intensive substance abuse outpatient treatment is effective for cognitively impaired patients, an important finding given that research evaluating the efficacy of interventions for such patients is limited. Additionally, neuropsychological evaluation may be important in reducing treatment dropouts, as the present findings indicated that greater cognitive impairment was related to an increased likelihood of treatment dropout.

Adult↗
PubMed1999

Cocaine abstinence symptomatology and treatment attrition.

Premature termination from outpatient cocaine treatment predicts a number of poor outcomes, including higher rates of relapse and unemployment. This study attempted to predict dropouts from outpatient cocaine treatment, as well as those unable to achieve initial abstinence from cocaine, using two baseline variables that had previously been shown to predict treatment dropout: a measure of the severity of cocaine abstinence symptomatology using the Cocaine Selective Severity Assessment (CSSA) and the initial urine toxicology. Results of logistic regression analyses indicated that those with more intense abstinence symptoms, as measured by the CSSA, were five times more likely to terminate treatment prematurely. When combined with the CSSA, the initial urine did not significantly predict dropouts. The CSSA and the baseline urine were equal in their ability to predict those who would fail in their initial attempts to achieve abstinence. Implications for treatment are discussed.

Ambulatory Care↗
PubMed2002

Ranking the correlates of psychotherapy duration.

This study examined the relative strength (importance) of associations between the number of treatment sessions in mental health clinics and some pretherapy (e.g., payer source), treatment (e.g., use of medication), and outcome (e.g., improvement) variables. Data on clients who withdrew prematurely (dropouts) and data on those discharged by counselors (completers) were compared. A combined sample that included both groups of clients was also examined. The strongest correlates of the number of sessions were treatment outcome (for the combined sample) and the identity of the counselor (for clients who completed treatment). No leading predictor for the dropout group was found. Results of the study suggest that different factors may emerge as the most important correlates of the number of treatment sessions, depending on whether dropouts, completers, or both are included in the sample.

Adolescent↗
PubMed1997

Outcome, attrition, and family-couples treatment for drug abuse: a meta-analysis and review of the controlled, comparative studies.

This review synthesizes drug abuse outcome studies that included a family-couples therapy treatment condition. The meta-analytic evidence, across 1,571 cases involving an estimated 3,500 patients and family members, favors family therapy over (a) individual counseling or therapy, (b) peer group therapy, and (c) family psychoeducation. Family therapy is as effective for adults as for adolescents and appears to be a cost-effective adjunct to methadone maintenance. Because family therapy frequently had higher treatment retention rates than did nonfamily therapy modalities, it was modestly penalized in studies that excluded treatment dropouts from their analyses, as family therapy apparently had retained a higher proportion of poorer prognosis cases. Re-analysis, with dropouts regarded as failures, generally offset this artifact. Two statistical effect size measures to contend with attrition (dropout d and total attrition d) are offered for future researchers and policy makers.

Adult↗
PubMed1994

Clinical, sociodemographic, and systems risk factors for attrition in a children's mental health clinic.

Clinical, sociodemographic, and systems risk factors for attrition at a child guidance clinic were identified. All patients who completed the intake process were followed through various clinic phases. Lower socioeconomic status and low family cohesion predicted dropout. Dropouts and continuers were equally psychiatrically impaired. The Family Environment Scale was the only standardized measure that distinguished between dropouts and continuers.

Adolescent↗
PubMed2006

Randomized, multi-center trial of two hypo-energetic diets in obese subjects: high- versus low-fat content.

OBJECTIVE: To investigate whether a hypo-energetic low-fat diet is superior to a hypo-energetic high-fat diet for the treatment of obesity. DESIGN: Open-label, 10-week dietary intervention comparing two hypo-energetic (-600 kcal/day) diets with a fat energy percent of 20-25 or 40-45. SUBJECTS: Obese (BMI >or=30 kg/m(2)) adult subjects (n = 771), from eight European centers. MEASUREMENTS: Body weight loss, dropout rates, proportion of subjects who lost more than 10% of initial body weight, blood lipid profile, insulin and glucose. RESULTS: The dietary fat energy percent was 25% in the low-fat group and 40% in the high-fat group (mean difference: 16 (95% confidence interval (CI) 15-17)%). Average weight loss was 6.9 kg in the low-fat group and 6.6 kg in the high-fat group (mean difference: 0.3 (95% CI -0.2 to 0.8) kg). Dropout was 13.6% (n = 53) in the low-fat group and 18.3% (n = 70) in the high-fat group (P=0.001). Among completers, more subjects lost >10% in the low-fat group than in the high-fat group ((20.8%, n = 70) versus (14.7%, n = 46), P = 0.02). Fasting plasma total, low-density lipoprotein- and high-density lipoprotein-cholesterol decreased in both groups, but more so in the low-fat group than in the high-fat group. Fasting plasma insulin and glucose were lowered equally by both diets. CONCLUSIONS: The low-fat diet produced similar mean weight loss as the high-fat diet, but resulted in more subjects losing >10% of initial body weight and fewer dropouts. Both diets produced favorable changes in fasting blood lipids, insulin and glucose.

Adult↗
PubMed1998

Therapist/patient race and sex matching: treatment retention and 9-month follow-up outcome.

AIMS: The current study was conducted to (a) replicate previous findings regarding the effect of patient/therapist race and sex-matching as this relates to the early dropout rate of substance abusers, and (b) to extend previous work by examining the impact of such matching on treatment retention and 9-month outcome. DESIGN: Patient and therapist characteristics were crossed in a 2 x 2 factorial design. Matching effects were then tested using retrospective data. PARTICIPANTS: Participants were 967 African-American cocaine-dependent people. SETTING: The study site was a university sponsored outpatient treatment facility located in an economically depressed section of a large Northeastern US city. MEASUREMENTS: Follow-up data were drawn from the Addiction Severity Index, the Risk for AIDS Behavior Inventory, and a questionnaire measuring post-discharge need for treatment, employment and education. Retention was defined as the number of days inclusive between the last date of service and the date of admission. FINDINGS: No significant differences in early dropout rates were found after initial contact with 10 different therapists. Matching therapist and patients with respect to gender and race did not decrease the premature dropout rate, but partial support for gender matching was noted. CONCLUSION: Matching therapist and substance abusing patients on gender and race may not be essential to improving retention and outcome.

Adult↗
PubMed2002

Pharmacological treatment of cocaine dependence: a systematic review.

AIMS: Cocaine dependence is a common and serious condition, associated with severe medical, psychological and social problems, including the spread of infectious diseases. This systematic review assesses critically the efficacy of pharmacotherapy for treating cocaine dependence. METHODS: The literature search strategy included: electronic searches of Cochrane Library holdings, EMBASE, MEDLINE, PsycLIT, Biological Abstracts and LILACS; scans of reference lists of relevant articles, personal communications, conference abstracts, unpublished trials from the pharmaceutical industry and book chapters on the treatment of cocaine dependence. Randomized controlled trials (RCTs) focusing on the use of antidepressants (ADs), carbamazepine (CBZ), dopamine agonists (DAs) and other drugs used in the treatment of cocaine dependence were included. The reviewers extracted data independently, and relative risks (RR) with 95% confidence interval (CI) were estimated. Qualitative assessments were carried out using a Cochrane validated checklist. Where possible, analysis was carried out according to 'intention-to-treat' principles. FINDINGS: The search strategy generated 45 different trials. Most studied drugs were ADs (20 studies), DAs and CBZ. Data were very heterogeneous, with dropout rates within the studies between 0 and 84%. A non-significant trend favoring CBZ was found in terms of dropouts (RR 0.88; 95% CI 0.75-1.03) and results from one trial suggest that fluoxetine patients are less likely to drop out. The main efficacy outcome reported in the studies was the presence of cocaine metabolites in the urine. No significant results were found, regardless the type of drug or dose used for all relevant outcomes assessed. CONCLUSIONS: There is no current evidence supporting the clinical use of CBZ, antidepressants, dopamine agonists, disulfiram, mazindol, phenytoin, nimodipine, lithium and NeuRecover-SA in the treatment of cocaine dependence. Larger randomized investigation must be considered, while taking into account that these time-consuming efforts should be reserved for medications showing more relevant and promising evidence. Given the high dropout rate among the test population, clinicians may wish to consider adding psychotherapeutic supportive measures aimed at keeping patients in treatment programs.

Antidepressive Agents↗