Predictors of retention in the 'voluntary' and 'quasi-compulsory' treatment of substance dependence in Europe

Background Policies and practices related to the quasi-compulsory treatment (QCT) of

substance-dependent offenders are currently implemented in many countries, despite the

absence of reliable knowledge about significant predictors of treatment retention. This study

aimed to identify such predictors in QCT and voluntary treatment.

Methods Participants were treated in one of 65 institutions in 5 European countries. They

were interviewed at intake on substance use, committed crimes, perceived pressure for

treatment, self-efficacy, stage of change, employment, and health-related variables. Binary

logistic regression models were computed to identify predictors of treatment retention at an

18-month follow-up. Moderator analyses were computed to investigate whether these

predictors vary by treatment condition (quasi-compulsory vs. voluntary).

Results A higher number of working days in the previous month was positively associated

with treatment retention, while use of heroin, crack, and multiple drugs, psychiatric problems

in the previous month, and lifetime depression were negatively associated with treatment

retention. Higher perceived medical pressure resulted in higher treatment retention rates only

for participants in QCT.

Conclusion Predictors of substance abuse treatment retention are quite similar across both

the quasi-compulsory and voluntary treatments. Perceived medical pressure is of higher

relevance than the often-believed legal pressure for treatment retention in QCT.