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“The results can be used to establish a base dropout rate against which existing and new treatments can be compared, allow for more careful planning of clinical trials with respect to dropout expectations, and determine which populations or study design characteristics might be at elevated risk for dropout,” Sara N. Lappan, Ph.D., of the University of Alabama at Birmingham School of Public Health and colleagues wrote.
The researchers used data from 151 studies to estimate dropout rates and identify predictors of dropout. The studies were published between 1969 and 2016, included a total of 26,243 participants, and described treatments for SUDs involving alcohol, cannabis, cocaine, heroin, major stimulants in general, methamphetamine, opioids, tobacco, and use of multiple substances.
When comparing studies on treatments for specific drugs, the researchers found that dropout rates were highest for those that targeted cocaine, methamphetamines, and major stimulants in general. The researchers noted that there are no approved medications for treating stimulant dependence, so symptoms of withdrawal may hinder patients’ ability to complete treatment.
The researchers suggested that one reason for increased dropout in psychosocial SUD treatment studies could be participants’ higher level of disinhibition.
“Indeed, behavioral disinhibition is a predictor of addiction onset, and addictive substances elicit disinhibitory states acutely during the period of … intoxication and chronically via changes to cortical regions implicated in cognitive-behavioral control,” they wrote.
Studies that included a greater number of treatment sessions and longer treatment sessions had higher rates of dropout, as well. Lappan and colleagues noted that the more treatment sessions a program has, the more opportunities there are to drop out.
“Nevertheless, we do not advocate here for fewer and briefer sessions in the treatment of SUD,” they wrote. “Rather, there may be a ‘Goldilocks Zone’ with regard to number of treatment sessions and session length wherein dropout is minimized and efficacy is maximized.”
Lappan and colleagues acknowledged limitations to their meta-analysis, notably that many of the studies were conducted in controlled settings and designed to test the efficacy of treatment in ideal conditions. Therefore, “the current results are unlikely to completely generalize to all real-world populations and settings. Clinical judgement is required to determine the relevance of the present findings to real-world practice,” they wrote.
(Image: iStock/KatarzynaBialasiewicz)
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