From the initial clinic contact to aftercare: a brief review of effective strategies for retaining cocaine abusers in treatment.

Psychosocial and pharmacological treatments for cocaine abuse are associated with high rates of attrition (e.g., Gawin et al. 1989; Higgins et al. 1993; Kang et al. 1991; Weddington et al. 1991). This is particularly unfortunate because poor drug abuse treatment retention is associated with poor outcomes. For example, several studies report that longer treatment duration predicts improved outcome: the Drug Abuse Reporting Program (DARP) (Simpson 1984), the Treatment Outcome Prospective Study (TOPS) (Hubbard et al. 1984), programbased evaluation research in therapeutic communities (DeLeon 1984), and research on the efficacy of methadone maintenance treatment (Ball and Ross 1991). Definitions of outcome varied across these studies, but typically included drug abstinence. Across all of these data sets, treatment durations of 3 months or more predicted improved outcome, and in some reports the degree of improvement was proportional to the length of time spent in treatment (Simpson 1984).