A higher percentage of participants in substance abuse programs complete
treatment than the public may realize, according to a recent federal
An annual report on discharges at state- and federal-funded treatment
facilities in 34 states found that treatment was completed by 41 percent of
the nearly 1.5 million people admitted for treatment since 2002.
Among those who did not complete treatment, 13 percent were transferred to
a hospital residential treatment program for further care, 24 percent dropped
out of treatment, 8 percent had treatment terminated by the facility staff, 2
percent had treatment terminated because of incarceration, less than 1 percent
died, and 7 percent failed to complete treatment for other reasons. The reason
for discharge was unknown for 6 percent of program participants.
The relatively high rate of overall treatment completion stood out among
the findings of the report—titled "Treatment Episode Data Set
(TEDS): 2005"—to Petros Levounis, M.D., M.A., chair of APA's
Corresponding Committee on Treatment Services for Patients With Addictive
"This is significantly higher than what the general public and a lot
of psychiatrists have predicted," Levounis said. "We usually think
about patients who suffer from substance use disorders as noncompliant with
The report, compiled by the Substance Abuse and Mental Health Services
Administration, aims to help clinicians and public-health policymakers better
understand the scope and nature of treatment episodes to better tailor their
The treatment completion rate was highest among those in hospital
residential treatment (67 percent), detoxification (65 percent), and
short-term residential treatment (56 percent) programs, according to the
report. Lower completion rates were found among those in longer-term and
less-structured settings. The treatment completion rate was 39 percent in
long-term residential programs and 36 percent in "intensive"
outpatient plans and other outpatient treatment.
The relatively high completion rates were striking to Levounis because many
of those are from long-term treatment programs that require a sustained
commitment of months or even years.
The lowest completion rate was among discharges from opioid-replacement
therapy programs (19 percent). Among addicts in these programs, treatment
completion rates ranged from a high of 35 percent of participants in
opioid-replacement detoxification programs to a low of 11 percent in
outpatient opioid-replacement therapy plans.
The relatively low rate of success in opioid-treatment programs may be
driven by the overall approach among many such programs, which maintain that
long-term maintenance is more realistic than substance use elimination,
according to Levounis.
Among the surprising findings of the report was that people who were using
drugs and alcohol on a daily basis were more likely to complete treatment than
were less-frequent users.
"One would expect that if you didn't use daily perhaps you would
suffer from a less severe form of addiction and you would have a higher rate
of completion," Levounis said.
Other factors associated with higher rates of completion included alcohol
rather than drug use, being over age 40, having 12 or more years of education,
referral to treatment by the criminal-justice system, being employed, and
The strongest predictor of treatment completion was the use of alcohol
rather than other drugs. Patients who were in all types of treatment programs
combined were 82 percent more likely to complete treatment or transfer to
further treatment if their primary substance of abuse was alcohol, after
taking into account other possibly confounding characteristics.
The findings were derived using an episode-based system, which means the
data used to evaluate discharges do not directly correspond to the number of
individuals discharged from treatment programs in a given year. The data do
not include all admissions to substance abuse treatment programs, rather only
those licensed or certified by state substance abuse agencies. Most of these
facilities receive state or federal block-grant funds.
A copy of "Treatment Episode Data Set (TEDS): 2005" is