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Open Access Research

Factors associated with pretreatment and treatment dropouts: comparisons between Aboriginal and non-Aboriginal clients admitted to medical withdrawal management

Xin Li1, Huiying Sun2, David C Marsh3 and Aslam H Anis24*

Author Affiliations

1 Antai College of Economics & Management, Shanghai Jiao Tong University, 535 Fhuazhen Rd, Shanghai, China

2 Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard Street, Vancouver, B.C. V6Z 1Y6, Canada

3 Northern Ontario School of Medicine, Vancouver, B.C. V6Z 1Y6, Canada

4 School of Population and Public Health, University of British Columbia, Vancouver, B.C. V6Z 1Y6, Canada

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Harm Reduction Journal 2013, 10:38  doi:10.1186/1477-7517-10-38

Published: 10 December 2013

Abstract

Background

Addiction treatment faces high pretreatment and treatment dropout rates, especially among Aboriginals. In this study we examined characteristic differences between Aboriginal and non-Aboriginal clients accessing an inpatient medical withdrawal management program, and identified risk factors associated with the probabilities of pretreatment and treatment dropouts, respectively.

Methods

2231 unique clients (Aboriginal = 451; 20%) referred to Vancouver Detox over a two-year period were assessed. For both Aboriginal and non-Aboriginal groups, multivariate logistic regression analyses were conducted with pretreatment dropout and treatment dropout as dependent variables, respectively.

Results

Aboriginal clients had higher pretreatment and treatment dropout rates compared to non-Aboriginal clients (41.0% vs. 32.7% and 25.9% vs. 20.0%, respectively). For Aboriginal people, no fixed address (NFA) was the only predictor of pretreatment dropout. For treatment dropout, significant predictors were: being female, having HCV infection, and being discharged on welfare check issue days or weekends. For non-Aboriginal clients, being male, NFA, alcohol as a preferred substance, and being on methadone maintenance treatment (MMT) at referral were associated with pretreatment dropout. Significant risk factors for treatment dropout were: being younger, having a preferred substance other than alcohol, having opiates as a preferred substance, and being discharged on weekends.

Conclusions

Our results highlight the importance of social factors for the Aboriginal population compared to substance-specific factors for the non-Aboriginal population. These findings should help clinicians and decision-makers to recognize the importance of social supports especially housing and initiate appropriate services to improve treatment intake and subsequent retention, physical and mental health outcomes and the cost-effectiveness of treatment.

Keywords:
Aboriginal; Housing; Pretreatment dropout rate; Treatment dropout rate; Withdrawal management; Substance use disorders; Detoxification