Three subgroups of drug dependent women (N = 78) were identified through cluster analysis on MCMI-II scores. Group 1 (26%) presented a relatively benign clinical picture. In contrast, Group 2 (37%) evidenced severe addiction, psychiatric (Axis I), and personality (Axis II) problems. Group 3 (37%) was characterized by fewer Axis I problems, prominent addiction and externalizing (Cluster B) personality deficits. Group membership was significantly associated with retention in a gender-specific day treatment program. Group 2 experienced rapid attrition, with only 36% completing treatment, compared to 57% for Group 1 and 76% for Group 3. Results indicate that drug-dependent women with externalizing psychopathology can be retained in treatment when environmental barriers are removed and an adequate “holding environment” is maintained. However, women with severe psychiatric problems, unstable mood, and interpersonal deficits are less likely to complete treatment. Early identification of women at risk for drop-out affords an opportunity to intervene to prevent its occurrence.
Environmental barriers such as inadequate childcare and lack of transportation are contributing factors to treatment drop-out among drug-dependent women Howard & Beckwith, 1996, Howell et al., 1999, Laken & Ager, 1996 and Lewis et al., 1996. The inability of mothers to bring young children into treatment with them is another obstacle to treatment participation Hughes et al., 1995 and Szuster et al., 1996. Conversely, provision of desired, gender-sensitive services such as parenting classes and vocational training can facilitate retention (Howell et al., 1999). The impact of program setting/intensity on treatment retention is less clear. Roberts and Nishimoto (1996) found higher attrition rates for women attending outpatient or residential treatment compared to day treatment. Another study observed higher drop-out rates among women attending day treatment with their children vs. those residing in supportive, drug-free housing while attending the same day treatment program (Haller, Knisely, Elswick, Dawson, & Schnoll, 1997). Thus, treatment variables may interact to influence retention rates.
Psychopathology also influences treatment retention. For example, women with Axis I comorbidity, especially those with severe mental illness, have a tendency to leave treatment prematurely Brown et al., 1995 and Brown et al., 1999. In addition, several investigators have reported that psychological symptoms including depression, somatization, and hostility are associated with drop-out Petry & Bickel, 2000, Strantz & Welch, 1995 and Williams & Roberts, 1991. Although little has been written about the impact of character pathology on retention, both Brown et al. (1999) and Haller et al. (1997) reported surprisingly high retention of women with Cluster B (American Psychiatric Association, 1994) personality disorders.
The ability to apply findings from previous studies to improve retention of women in drug treatment has been limited by small sample sizes, inconsistent measurement strategies, and the fact that most studies have focused on a limited range of psychological problems. Additionally, the relationship between attrition and character pathology has not been examined, with the exception of Cluster B disorders such as antisocial and borderline personality. Accordingly, the purpose of the present study was to identify psychiatric (Axis I) and personality (Axis II) problems associated with treatment drop-out and retention among drug-dependent women. When environmental barriers known to mediate retention in drug treatment (e.g., childcare, transportation) were controlled for through participation in a “model” treatment program, the present study was able to better examine the relationship between psychiatric morbidity and treatment drop-out among drug-dependent women.
