Tailoring interventions to clients: effects on engagement and retention.

Drug abuse represents a major social and behavioral health problem. National Institute of Drug Abuse (NIDA) statistics suggest that 37 percent of the U.S. population has used illicit drugs (Smith 1992) and as many as 23 percent of the work force regularly do so in the workplace (Barabander 1993). Drug use in the workplace is not limited to benign, recreational drugs. The NIDA estimates indicate that 3 percent of the work force abuse heroin (Browne 1986) and over twice that figure abuse cocaine (Abelson and Miller 1985). Chemical abuse affects family functioning, work performance, and the health of newborn children (Levy and Rutter 1992). Of contemporary concern, opiate and cocaine abuse probably represent the most significant problem because of their severe addictive properties, the high likelihood of polydrug abuse among their users, and the decline of social functioning that accompanies their abuse (Almog et al. 1993). Three tasks face those who attempt to develop treatment programs for drug abuse disorders: (1) developing procedures that facilitate patient engagement in treatment, (2) developing procedures that increase the likelihood of retention of individuals in treatment, and (3) establishing the conditions under which even effective treatments work best and least well. While this chapter will focus on the status of research on the first two of these tasks, the last one cannot be ignored in this process. This is true both because of the necessity of continually testing the relationship between treatment engagement and dropout on one hand and treatment efficacy on the other, and because there are promising developments in the area of treatment efficacy that may improve awareness of the significance of engagement and retention.