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Sells, S. B. (1975). The DARP research program and data system. American Journal of Drug and Alcohol Abuse, 2(1), 1-14.

Abstract:   The evaluation research on the effectiveness of treatments for drug abuse, which is the subject of several papers in this journal issue, is a multi-faceted program of data base management and substantive research involving the Drug Abuse Reporting Program (DARP). The DARP was established in 1969 by the National Institute of Mental Health (NIMH) at the Institute of Behavioral Research (IBR), Texas Christian University, to provide a data base for research on the evaluation of treatments for drug abuse. One major set of research reports, completed in 1973, has already been published (Sells, 1974) and is related to outcomes during treatment of a cohort of 11,385 patients admitted to treatment at 23 Federally supported treatment agencies during June 1969 to June 1971. This and the following papers focus mainly on the second wave of studies, completed in 1974. They involve a cohort of 15,831 patients admitted to 36 agencies during June 1971 to June 1972. The present report describes the context for the following papers by explaining the DARP research program and the data system on which it is based.

  
Simpson, D. D., Curtis, M. A., & Butler, M. A. (1975).   Description of drug users in treatment: 1971-1972 DARP admissions.   American Journal of Drug and Alcohol Abuse, 2(1), 15-28.

Abstract:   Although the Drug Abuse Reporting Program (DARP) patient population is not a randomly drawn epidemiological sample of American drug users, it does represent a large segment of patients who entered community-centered programs for drug treatment and offers one of the most complete sources of information currently available for assessing demographic and background characteristics of contemporary drug users. Several of the most prominent attributes of the 1971-1972 DARP patient samples are summarized in this report, providing a picture of the drug users on which the Cohort 2 DARP treatment evaluation research was based. Between June 1971 and June 1972, the DARP included 36 treatment agencies; 16 were in the Northeast United States, 5 were in the South, 10 in the Midwest, 4 in the West, and 1 in Puerto Rico. The final research sample of the 1971-72 DARP cohort included 12,297 patients from 31 of these agencies. The major types of treatment included methadone maintenance (41% of the patients), therapeutic communities (16%), other drug-free therapy (17%), detoxification (23%), and other less frequent or mixed treatment approaches (3%).

 
Joe, G. W., & Simpson, D. D. (1975).  Research on patient classification for drug users in the DARP.   American Journal of Drug and Alcohol Abuse, 2(1), 29-35.

Abstract:   Results of a cluster analysis was used to isolate groups of patients defined by the cross-classification of factors identified in a principal component analysis. One implication of the findings for the design of the DARP Cohort 2 evaluation research was that if patient categories must be restricted to only a relatively small number, and if every patient must be assigned to one of the categories adopted, then only major cross-classification categories could be represented and a substantial proportion of the patients would therefore be placed in categories that would not be fully appropriate. Thus, based on the current set of descriptive variables, the definition of an analytically manageable number of homogeneous patient categories could not be achieved without sacrificing relevant classificatory information.

  
Cole, S. G., & James, L. R. (1975).   A revised treatment typology based on the DARP. American Journal of Drug and Alcohol Abuse, 2(1), 37-49.

Abstract:   The literature on treatment for drug abuse identifies four major modalities that differ in major dimensions, but offers little information or theory to guide differentiation of approach within the several modalities. The four modalities are generally referred to as methadone maintenance, outpatient drug free, therapeutic community, and detoxification. Within these modalities, the design variations among most of the addiction treatment programs that have reported to the DARP appear to have been guided by a few salient principles and programs have been developed in individual situations according to the views of their founders on these dimensions, along with their interpretation of local requirements. In contemplating the development of a treatment classification scheme and the task of placing programs in the appropriate categories, not only the major dimensions but the variations on various themes had to be taken into account. The study presented here is our second effort to establish a methodology and develop a taxonomy of treatments for the programs of 23 agencies that participated in the DARP during the first two years of its operation (Cohort 1). The present study is a modification and extension of the Watson et al. study on the 36 agencies included in the DARP during year 3 (Cohort 2).

  
Demaree, R. G., & Neman, J. F. (1975).   Outcome measurement for drug treatment in the DARP: During-treatment criterion scales.   American Journal of Drug and Alcohol Abuse, 2(1), 51-61.

Abstract:   To intelligently pursue many of the questions often asked about the effectiveness of treatment for drug abuse, behavioral measures of pretreatment status, during-treatment progress, and posttreatment outcomes are needed. However, during-treatment studies serve as the groundwork and provide hypotheses for the later and more comprehensive evaluations of treatment effectiveness. It is to be the measures and related criteria for during-treatment studies that the present report is addressed. Criterion variables to measure outcomes during treatment in the Drug Abuse Reporting Program (DARP) were developed from information available for the 2-month period preceding admission to treatment (from Admission Reports) and for each 2-month period during treatment (from Status Evaluation Reports). These 26 variables cover the areas of employment, alcohol consumption, illicit opiate and nonopiate use, criminality indicators, and stability of life situations.

 
Joe, G. W., & Simpson, D. D. (1975).   Retention in treatment of drug users: 1971-1972 DARP admissions.   American Journal of Drug and Alcohol Abuse, 2(1), 63-71.

Abstract:   The “holding power” of different approaches to treatment and how certain patient characteristics are involved were examined. In all treatments, rate of termination prior to completion of treatment was high, particularly for the treatments not involving methadone maintenance. Almost three-fourths of the patients in these treatments terminated prior to treatment completion, and most of the terminations were due to quitting. Furthermore it was found that of the patients who terminated, a large number left within a month after admission and over half were gone within 3 months. In terms of patient characteristics related to retention, older patients in all types of treatment were less likely to terminate than younger patients. Even among patients who terminated during the first 12 months after admission, older ones tended to stay longer before leaving. Thus, age was related in a consistent manner with maintenance as well as drug-free oriented programs. Other more treatment-specific relationships involved the trend for females to have higher rates of termination from therapeutic communities, and the tendency for patients who used opioids daily prior to treatment to be less likely than nondaily users to remain in drug-free programs.

  
Gorsuch, R. L. (1975).   The impact of drug treatments on during-treatment criteria: 1971-1972 DARP admissions.   American Journal of Drug and Alcohol Abuse, 2(1), 73-98.

Abstract:   Several general conclusions appear warranted from the three linear model analyses of the outpatient treatments. First, all modalities showed a reduction of illicit use of opioids and nonopioids, criminal activities, and alcohol use. However, methadone maintenance was the principal treatment modality associated with improvement in productive activities or decrease in unemployment, possibly because it retains patients longer. In the realm of employment, the blacks and Mexican-Americans showed the least change; in part this reflects the fact that the Mexican-Americans had higher pretreatment employment levels and in part the fact that employment changed least of all variables. Younger patients appeared to improve less than older patients, although this effect did not occur in all analyses. They were less likely to be heavy drinkers than were older patients. However, it is of interest that these results, as well as those for unemployment, are in agreement with those found for the first cohort of DARP admissions.

   
Watterson, O., Simpson, D. D., & Sells, S. B. (1975).   Death rates and causes of death among opioid addicts in community drug treatment programs during 1970-1973. American Journal of Drug and Alcohol Abuse, 2(1), 99-111.

Abstract:  Death rates and causes of death among opioid addicts in 52 community treatment programs in the DARP network were compared for 3 consecutive years. The greatest proportion of patients in the base samples were male, 21 to 25 years old, black, and in MM programs. The 275 patients in the deceased sample presented essentially the same profile, with the exception that older patients were more highly represented among the deceased. Death rates were particularly high during each year for patients over 30 years old. Over the 3 years, death rates increased for whites, addicts 21 to 25 years old, and patients in outpatient DF programs. Consistent decreases in rates each year were found for blacks, patients in the 26 to 30 age range, and patients in MM programs.

   
Sells, S. B. (1975).   Evaluation of treatment for 1971-1972 DARP admissions: Comments and conclusions.   American Journal of Drug and Alcohol Abuse, 2(1), 113-121.

Abstract:   The American taxpayer has received good value for his investment dollar from the Federal treatment system represented by the DARP agencies. The aim of this concluding discussion is to summarize and interpret the research results and to relate them to the concerns of policy makers as well as clinicians, taking into account the limitations of the data and the analyses performed. With this in mind, it should be noted that the emphasis in the DARP has been on specified outcomes for defined treatments for specified categories of patients. Using this strategy it is hoped that whatever has been learned may be applied in the future toward planning of new programs and modification of those currently in operation.

  
Long, G. L., & Demaree, R. G. (1975).   Indicators of criminality during treatment for drug abuse.   American Journal of Drug and Alcohol Abuse, 2(1), 123-136.

Abstract:   The present study of an illegal means of support, arrests, and time in jail as indicators of criminality during drug treatment revealed no trends of significant change over the first year in treatment. Higher levels of criminality was found, however, for males, Mexican-Americans, and 23-25 year old patients than for other groups.

   
Ball, J. C., Levine, B. K., Demaree, R. G., & Neman, J. F. (1975).   Pretreatment criminality of male and female drug abuse patients in the United States. Addictive Diseases: an International Journal, 1(4), 481-489.

Abstract:   Standard data collection procedures were employed to study the prior criminality of male and female drug abuse patients in the United States. It was found that the male drug abusers were more pervasively and seriously involved in criminal behavior than the females. At the same time, the research shows that both sexes had extensive histories of involvement in a criminal life-style. It is concluded that the treatment of persistent drug abusers requires considerable attention to correctional rehabilitation as well as to the illicit consumption of drugs.

1976

Simpson, D. D. (1976).   Pretreatment drug use by patients entering drug treatment programs during 1971-1973.   Journal of Drug Education, 6(1), 53-71.

Abstract:   Patterns of pretreatment drug abuse are described for 28,419 drug users who entered community-based treatment centers that participated in the national Drug Abuse Reporting Program during 1971-1973. Daily heroin use was reported by 60 percent of the patients; one-third used daily heroin but no nonopioids, one-third used daily heroin and either cocaine, marihuana, or both, and the remainder used other nonopioids (particularly barbiturates) with daily heroin. Polydrug use (three or more nonopioids) was common among the patients who used no heroin or used it infrequently. As expected, polydrug use was most frequent among younger individuals, while daily heroin use (especially without other drugs) was increasingly prevalent among older age groups. Although alcohol use in at least moderate amounts was reported by only a third of the sample, it was most frequent among polydrug users, and was least frequent among daily users of heroin only. Within groups categorized by general patterns of illicit drug use, however, prevalence of alcohol use was higher among males than females, and increased with age.

    
Sells, S. B., Simpson, D. D., Joe, G. W., Demaree, R. G., Savage, L. J., & Lloyd, M. R. (1976).   A national follow-up study to evaluate the effectiveness of drug abuse treatment: A report on Cohort 1 of the DARP five years later. American Journal of Drug and Alcohol Abuse, 3(4), 545-556.

Abstract:   Preliminary findings for the first cohort of a national follow-up study of drug users admitted to treatment in the Drug Abuse Reporting Program (DARP) during 1969-1971 are reported. From a sample of 1,853 selected for follow-up, 87% were located and interviews were completed for 77%. Gross tabulations are shown comparing several outcome measures based on pre-DARP treatment, the posttreatment period, and for the 2 months before interview. Sixty-one percent of all patients returned to treatment at some time after DARP termination. Decreases in drug use, especially of opioids, were substantial and were generally accompanied by improvements in other outcome measures as well. Plans for more detailed and informative analysis of these and related DARP data are addressed.
   

1977

Sells, S. B., Demaree, R. G., Simpson, D. D., Joe, G. W., & Gorsuch, R. L. (1977).   Issues in the evaluation of drug abuse treatment.   Professional Psychology, 8(4), 609-640.

Abstract:   Significant concepts bearing on the methodological model offered for conducting research on the effectiveness of drug abuse treatment include (a) the definition of treatment, (b) the meaning of treatment effectiveness and implications for definition of criteria, (c) the state of being at risk with respect to behavioral criteria, (d) expected sources of variance in outcome (criterion) measures, (e) temporal perspectives and risks in evaluation research, and (f) confidentiality, privacy, and reactive versus nonreactive data. The methodological issues considered encompass reliability and validity of data, comparability of measures over time, sampling (including the vexing issue of randomization in patient assignment to treatment and in the selection of individuals for study samples), and data management. The major emphasis methodologically involves the presentation of analytic models for treatment evaluation research in which treatment effects per se are to be distinguished from effects attributable to other relevant factors.

   
Sells, S. G. (1977).   Methadone maintenance in perspective.   Journal of Drug Issues, 7(1), 13-22.

Abstract:   After ten years since its introduction by Dole and Nyswander methadone maintenance remains a controversial treatment for opiate addiction. In a historically oriented examination of the sources of controversy, changes over time, and evaluation evidence, the present status of methadone maintenance treatment reflects the influence of a complex mixture of pressures and counterpressures in the political, economic, social, law enforcement, and medical domains. Both social control aspects, representing official concern with “the addiction problem,” and medical-rehabilitational aspects are merged in the system that makes methadone available as an experimental drug for maintenance treatment. Evaluation results show that this treatment has overall been highly effective and that in cost benefit terms, even if it were structured to include all of the staff and rehabilitation services required for optimal results, it would still compare favorably with residential, inpatient, and comparable outpatient treatments.

   
Curtis, B., & Simpson, D. D. (1977).   Differences in background and drug use history among three types of drug users entering drug therapy programs. Journal of Drug Education, 7(4), 369-379.

Abstract: The 26,316 patients who entered drug therapy programs participating in the DARP from June, 1971, to March, 1973, and who had used drugs for at least two years were grouped into three drug use categories: daily users of opiods, less-than-daily users of opioids, and non-users of opioids. Differences were observed among these three groups regarding the first drug used daily and the age at first drug use. A multiple discriminant analysis including demographic, drug history, and personal background variables indicated that the major differences among these types of drug users revolved around ethnic and age-related variables.

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