A Counseling Program for Clients in Substitution Treatment: Effects and Dropout Prediction

The present research reports the evaluation of a counseling program for substance abusers in outpatient substitution treatment. Clients were assessed at two time points to evaluate their development on various variables such as psychosocial functioning and substance abuse. Importantly, central outcome variables were assessed via self-reports and ratings by the primary counselor. Methodologically, the challenge was to estimate program impact without a control group as by German law any client in outpatient substitution treatment must be provided with psychosocial counseling. While results suggest that the program positively influences psychosocial functioning, the level of substance abuse did not significantly decrease during the course of the study (N = 101). Furthermore, because program dropout is a major problem in interventions for substance abusers, logistic regression analysis was employed to identify relevant preconditions which predict future program dropout (N = 172). Although several significant predictors were identified, they only provide a modest increase in prediction performance. 1. Introduction The assessment of the quality and effectiveness of methadone maintenance treatment (MMT) programs for substance abusers is a long-standing topic in research on addiction treatment. While research consistently demonstrates that MMT for opioid abuse is the most effective way of addressing long-term opioid addiction [1], it has also been shown that the effectiveness is boosted if additional psychosocial counseling programs accompanying outpatient substitution treatment are offered (e.g., [2, 3]). Patients in MMT are typically burdened with a host of problems and lack the resources and coping strategies to even deal with everyday-life situations such as organizing their daily routines. Often they are impaired in their psychosocial functioning, and missing support increases the probability of relapses and dropouts of the MMT program. Thus, counseling programs accompanying MMT typically focus on stabilizing the psychosocial condition of patients and provide support and counseling regarding homelessness, applying for unemployment benefits and other welfare programs. However, studies assessing the net impact of such psychosocial counseling programs are rare. The reasons for this lack of systematic research are manifold. First, counseling programs are diverse and rather heterogeneous with regard to the services offered which makes an overall assessment of their effectiveness difficult. Furthermore, in Germany where the present evaluation took place, federal