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The National Institute on Drug Abuse (NIDA) funded three large-scale national treatment evaluations covering 3 decades, the 1970s, 80s, and 90s. Collectively, these naturalistic studies—known as DARP, TOPS, and DATOS, respectively—examined during treatment performance and predictors of follow-up outcomes for stratified samples of 65,000 admissions to major types of treatment in 272 community-based programs throughout the U.S.  Findings from approximately 250 publications based on this research give broad support for the effectiveness of treatment, particularly for those with an adequate length of stay.  In addition, these treatment evaluation projects contributed directly to research initiatives focused on therapeutic process as well as organizational functioning.

Lead Investigators:  Dwayne Simpson, George Joe, Pat Flynn

Overview of Evidence
by D. D. Simpson and G. W. Joe

Between 1969 and 1970, data for the first NIDA-funded national evaluation were collected from 44,000 clients who received federally-funded treatment in 139 programs located in 35 cities throughout the U.S.  Follow-up interviews extended periodically for 12 years after treatment to help track their long-term outcomes.  The DARP investigations, designed and carried out at IBR and reported in over 150 publications, were the first to use a large-scale naturalistic research design to demonstrate the effectiveness of community-based treatment in reducing drug use and criminal behavior.  In particular, DARP found that treatment tenure (the amount of time spent in treatment) was a key determinant of outcome, with clients who remained in treatment 90 days or longer having significantly more favorable outcomes than early dropouts, regardless of their choice of treatment modality.  DARP further demonstrated that it was indeed possible to do methodologically sound field research with difficult-to-reach drug-user populations.  

Almost a decade after DARP, the Treatment Outcome Prospective Study (TOPS) used a longitudinal design to examine short and long-term treatment outcomes of more than 11,000 clients admitted to 41 treatment programs in 10 major U. S. cities between 1979 and 1981.  TOPS clients completed periodic follow-up interviews for 5 years posttreatment.  Results showed that treatment was effective, both during and after, in reducing heroin and other illicit drug use.  In addition, TOPS proved to be a harbinger of future drug use trends in America by pointing out that heroin-only use was declining and polysubstance abuse was increasing (most notably the combined use of heroin and cocaine or methamphetamines).  TOPS also was instrumental in demonstrating that legal pressure to enter treatment (e.g., court-ordered treatment) was not detrimental to treatment engagement or outcome and could be an effective way to encourage recovery and deter future drug-related crime.  In addition, TOPS studies found that drug treatment was cost effective based on estimates of reductions in crime-related costs and reductions in drug use resulting from treatment.

In 1989, NIDA initiated the Drug Abuse Treatment Outcome Studies (DATOS) project, designed to determine whether the nation's treatment systems and norms were delivering effective services based on current drug abuse patterns and client needs.  Data were collected for over 10,000 clients admitted to 99 treatment programs in 11 U.S. cities between 1991 and 1993.  Twelve-month and 5-year posttreatment follow-ups were conducted.  In addition, data were collected on 3,400 adolescents entering residential and outpatient treatment (DATOS-A).  Reflecting the changing times, the adult treatment modalities studied included methadone maintenance, short-term residential (e.g., 28-day hospital programs), long-term residential (therapeutic communities), and outpatient drug-free.  Also reflecting the times, outside of methadone programs, cocaine replaced heroin as the “drug-of-choice” for new treatment admissions, and within methadone programs themselves, up to 40% of incoming clients also were using cocaine.  Key DATOS findings centered on the emerging impact of cocaine abuse (including crack cocaine) on treatment services delivery in this country.  In general, available treatments for cocaine abuse were found to be cost effective through associated reductions in criminal justice costs and programs with the best outcomes were those that retained clients at least 3 months.

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