Hopeless patients? : A study of illicit opiate users who drop out from in-patient detoxification

• Individual and treatment-related factors associated with early self-discharge were studied among illicit opiate users consecutively admitted for hospital detoxification (ITT=68, n=45). Only 20% of the drop-outs had a detailed treatment plan, 20% participated in their own treatment planning, and none were enrolled in a methadone/buprenorphine programme at admission (compared with 60, 80, and 66%, respectively, of those retained in treatment). Having a treatment plan at intake improved the odds for planned discharge by 13 and perceiving fewer positive aspects of drug use increased the odds for drop-out by 12.6. A configural frequency analysis (CFA) showed one significant type: patients with sketchy or no treatment planning at intake, no maintenance treatment, and a low score on positive aspects of drug use were 7.5 times more likely to drop out than expected. Lacking a close maternal relationship characterized patients in this type (83% compared with 31% of non-types). Drop-outs seem to have insecure attachment patterns, which make contact difficult with social services and substance abuse treatment providers. Future research should devise ways of establishing a working alliance with patients likely to drop out, as well as investigating management policies for this patient group.

Nyckelord

Detoxification

drop-out

attachment

MEDICINE

MEDICIN

Publikations- och innehållstyp

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