The first step in assisting an individual with a drug problem is getting them into a substance abuse treatment program. Once they are there, the question becomes, how do you keep them there? What is necessary to prevent individuals from leaving treatment? Furthermore, are there specific factors that increase attrition rates from programs? The answer to these questions are complex and will not be satisfied without looking at all the different components included in who is receiving drug treatment.

Socioeconomic Status and Work Situation

How affluent an individual is will yes, affect their drug of choice, their length of consistent abuse and will also affect their recovery. How much money an individual has in effect dictates the options one has available in life. True, being affluent does not by any means guarantee recovery. A good amount of addicts are heavy into the drug scene because they can afford to purchase whatever they would like and maintain the habit. However, if not careful, this can and does backfire and affluence can be lost due to drug use. In regards to recovery, having money has been correlated with sustainable drug treatment. Those who cannot stop working and focus solely on drug rehab have a more difficult time becoming ex-users.

Health Status

Drug use is correlated with positive HIV status. Research has shown that individuals infected with the virus, do not list HIV as their main concern on their respective ‘list of worries’. The reason for this being, the majority of this population has other concerns such as: paying rent, buying food, taking care of children and in many cases supporting a drug habit. If an HIV positive individual is trying to kick a habit, he or she may be held back, again, because of socioeconomic status but also because of a preexisting health condition which can monopolize time in the form of doctor’s appointments, not feeling well, among other things. These same principles relate to any chronic illness.

Ethnic Background

When providing treatment to any group, one must keep in mind that his or her cultural background will determine what kind of treatment they respond to. In one paper in which Caucasian and African Americans were compared in terms of success of substance abuse treatment, researchers found that the groups had the same expectations of substance abuse treatment.

Expectations of Treatment

• “I can do this.”
• “I will be clean after three months…one month…one year…of treatment.”
• “This will be the time this works.”

All of these statements are ones a potentially clean individual may or may not make when going through treatment. They are all expectations of treatment and whether such statements are accurate or feasible can and will effect whether treatment works or not. These statements are examples of self-efficacy.

Self-Efficacy and Substance Abuse Retention

Self efficacy is defined as an individual’s perception of his or her ability to complete a certain task. How self-efficacious an individual feels, will determine whether he or she sticks to treatment.

There are four sources from which self-efficacy are obtained according to Albert Bandura, the father of social cognitive theory. They are:

1. Experience: good experiences raise self-efficacy, bad ones lower it.
2. Modeling or vicarious experience: looking at someone else’s experiences and using those as a way to determine his or her ability to perform a task.
3. Social Persuasions: what others think can increase or decrease an individual’s self-efficacy. As a general rule, it is easier to decrease than increase.
4. Physiological Factors: when nervous or in a stressful situation, anxiety can manifest in physiological symptoms such as:
   • Pains
   • Fatigue
   • Aches
   • Fear
   • Nausea

Watching someone go through this can cause an individual’s efficacy to be unshaken. Likewise, feeling these effects of nerves can cause an individual to question his or her own ability.

Social Support

Is the individual going through this alone, or with someone? The answer to this question can also affect how efficient the substance abuse treatment is. These tie into coping self-efficacy. How much support a person has can determine whether they stay in substance abuse treatment and how well they do when they get out. If an individual leaves treatment and goes back into a situation where they are not receiving the positive attention they need to stay clean, relapse can and most likely will occur. Support when in a program, from other individuals going through the same treatment can make the difference between whether an individual goes or stays in a program.

Conclusion

In order to effectively treat an individual undergoing substance abuse treatment, all the above factors need to be considered. Otherwise, a component will be missed and individuals will either drop out of treatment, or not be able to maintain sobriety when they leave from inpatient treatment.

Rachel Hayon, MPH, RN

References
Abbott, P. & Chase, D.M. (2008). Culture and substance abuse impact of culture affects approach to treatment. Psychiatric Times. Volume 25:No. 1.
Bandura, A. (1997). Self-Efficacy: The exercise of control. New York: WH Freeman and Company.
Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, 1-26.
Baron, A. Robert (2004). Social Psychology, Tenth Edition.
Pringle JL, Hubbard RL, Kirisci L., Balavage, VK. (1999). The effect of supportive services on outpatient substance abuse treatment retention and outcome. Abstract Book Association Health Service Meeting. 16:84-5.