Place and Attrition from Substance Abuse Treatment

Abstract

High rates of attrition are one of the greatest problems interfering with the effectiveness of substance abuse treatment programs. Though unexamined to date, this paper argues that where a client lives, where treatment is delivered, and the relationship between these locations may influence both voluntary and involuntary dropout. The notion of a “treatment ecology” is presented, and theories of mechanisms by which location may impact attrition are developed through a review of related literature. In other fields, lack of attention to theory prior to empirical investigations of contextual effects has prompted criticism and made interpretation of empirical results difficult. Neighborhood disadvantage, drug availability, community resources, restorative qualities of the neighborhood, and travel burden are identified as promising areas for study. Current conceptual models of treatment outcomes are first reviewed to identify how they might accommodate attention to place. Policy implications and special considerations for future empirical work on this topic are discussed briefly.