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Dropout rates of in-person psychosocial treatment programs for substance use disorders: A systematic review and meta-analysis.

Sara N. Lappan,Andrew W. Brown,P. Hendricks

Published 2020 in Addiction

ABSTRACT

BACKGROUND AND AIMS Relapse rates for psychosocial substance use disorder (SUD) treatments are high, and dropout is a robust predictor of relapse. This study aimed to estimate average dropout rates of in-person psychosocial SUD treatment and to assess predictors of dropout. DESIGN A comprehensive meta-analysis of dropout rates of studies of in-person psychosocial SUD treatment. Studies included RCTs and cohort studies. SETTING Studies conducted anywhere in the world that examined SUD treatment and were published 1969 to 2016, inclusive. PARTICIPANTS/CASES 151 studies, 338 study arms, and 299 dropout rates including 26,243 participants. MEASUREMENTS Databases were searched for studies of SUD treatment that included an in-person psychosocial component. Meta-analyses and meta-regressions were conducted to estimate dropout rates and identify predictors of dropout, including 22 participant characteristics, two facilitator characteristics, and 15 treatment characteristics. Pooled estimates were calculated with random-effects analyses accounting for the hierarchical structure of study arms nested within studies. FINDINGS The average dropout rate across all studies and study arms was 30.4% (95% CI=27.2-33.8, and 95% PI=6.25-74.15) with substantial heterogeneity (I2 =93.7%, p<0.0001). Studies including a higher percentage of African Americans and lower-income individuals were associated with higher dropout rates. At intake, a greater percentage of heroin use days and cigarettes/day were associated with lower dropout rates, whereas heavier cocaine use was associated with higher dropout rates. Programs characterized by more treatment sessions and greater average session length were associated with higher dropout rates. Dropout rates were highest for studies targeting cocaine, methamphetamines, and major stimulants (broadly defined), and lowest for studies targeting alcohol, tobacco, and heroin, though there were few studies on methamphetamines, major stimulants, and heroin. Facilitator characteristics were not significantly associated with dropout. CONCLUSIONS On average around 30% of participants drop out of in-person psychosocial substance use disorder treatment studies but there is wide variability. Drop-out rates vary with substance being treated, characteristics of the treatment and the treated population.

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