External influences on community-based drug treatment program outcomes have not been adequately accounted by either treatment providers or evaluators. In 2001–2003, a cohort of 197 African American and Latino crack cocaine and heroin users was interviewed at intake into the Free-at-Last's treatment program in East Palo Alto, California.
Objective: The goal of this research was to identify, and then measure, the impact of a series of theory-based, hypothesized external influences on 3 client treatment outcomes: (1) program completers, (2) dropouts, and (3) referrals to more intensive inpatient treatment.
Methods: All program clients were interviewed using the Government Performance and Results Act and the California Alcohol and Drug Data System questionnaires. Supplemental questions hypothesized the external influences and were based on prior research and staff focus groups.
Results: There were statistically significant differences in treatment outcomes based on employment status, homelessness, living situation, and jail time. Regression analyses indicated that the strongest outcome predictors were treatment intensity, followed by prior crack use, homelessness, income, and number of illegal drugs used. Path analysis showed that former crack use and time in jail formed a particularly strong cluster of external influences on treatment outcomes. This cluster was the result of court-mandated treatment of arrested crack users who chose treatment over incarceration. If users failed treatment, they went back to jail. In a community such as East Palo Alto, court-mandated referrals had a powerful external influence on treatment and, therefore, need to be considered when evaluating a treatment program.
From the Department of Sociology and Social Services (BPB), California State University East Bay, Hayward; Free-at-Last (DL), East Palo Alto; and Glide Community House (DD), San Francisco, CA.
Received for publication February 11, 2010; accepted May 30, 2010.
Send correspondence and reprint requests to Benjamin Paul Bowser, PhD, Department of Sociology and Social Services, California State University East Bay, 25800 Carlos Bee Boulevard, Hayward, CA 94542. E-mail: Benjamin.firstname.lastname@example.org.
Supported by Centers for Substance Abuse and Treatment (CSAT), TCE grant number H79 TI11599-01, and The Hewlett Foundation.