Drug misuse treatment services in Scotland: predicting outcomes

Objective. To investigate which aspects of treatment satisfaction are the best predictors of improved health, improved mental health and achievement of abstinence in drug misuse treatment services. Design. Data were collected as part of the Drug Outcome Research in Scotland study, a prospective cohort study designed to evaluate drug misuse treatment provided in Scotland. Data were collected using a structured interview. Participants were recruited between 1 October 2001 and 30 June 2002. Follow-up interviews were carried out similar to 8 months later. Logistic regression analysis is used to explore client satisfaction with treatment on outcomes, using the Treatment Perceptions Questionnaire (discussed in Marsden et al., Assessing client satisfaction with treatment for substance use problems and the development of the Treatment Perceptions Questionnaire (TPQ). Addict Res 2000;8:455-70). Setting. Prison, residential and community facilities. Participants. A total of 841 drug users starting a new episode of drug treatment in Scotland in 2000-01. Interventions. Methadone, substitute drugs other than methadone, residential rehabilitation, residential detoxification and non-clinical. Main outcome measures. Reported improvements in physical health, mental health and abstinence. Results. Client satisfaction predicted positive outcomes, independent of treatment setting. Predicting abstinence and improved physical and mental health were the items: 'I have received the help that I was looking for' and 'The staff have helped to motivate me to sort out my problems'. Conclusions. Feeling that treatment is appropriate, finding staff motivating, and having enough time to sort out problems are important aspects of satisfaction with treatment among users of drug treatment services who achieved positive treatment outcomes. Services should seek to provide more individualized services based on understanding of individual client needs. This may require longer treatment periods and greater client involvement.