Attrition of subjects from therapeutic treatment programs, long recognized as a bane of evaluation researchers, is the focus of hundreds of studies purporting to explain, measure or correct it. This article discusses the scope and limitations of research regarding the causes of premature termination from psychotherapeutic and substance abuse programs and examines the applicability of proposed methodological remedies for assessing and countering attrition to the specific problem of research involving dropouts from treatment. By and large, research on the causes of attrition suffers from inadequate conceptualization and weak methodological designs. The researcher’s anticipation and measurement of factors driving premature program termination is key to the effective assessment and correction of problematic attrition in treatment evaluations. The phenomenon of attrition from treatment requires more rigorous attention from the evaluation community.
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References
1.
Anderson, T. R., Hogg, J. A., & Magoon, T. M. (1987). Length of time on a waiting list and attrition after intake. Journal of Counseling Psychology, 34 (1), 93-95.
2.
Armbruster, P., & Kazdin, A. E. (1994). In T. H. Ollendick & R. J. Prinz (Eds.), Advances in clinical child psychology (pp. 81-108). New York: Plenum Press.
3.
Baekeland, F., & Lundwall, L. (1975). Dropping out of treatment: A critical review. Psychological Bulletin, 82 (5), 738-783.
4.
Biglan, A., Severson, H., Ary, D., Failer, C., Gallison, C., Thompson, R., Glasgow, R., & Lichtenstein, E. (1987). Do smoking prevention programs really work? Attrition and the internal and external validity of an evaluation of a refusal skills training program. Journal of Behavioral Medicine, 10 (2) 159-171.
5.
Bleiberg, J. L., Devlin, P., Croan, J. & Briscoe, R. (1994). Relationship between treatment length and outcome in a therapeutic community. The International Journal of the Addictions, 29 (6), 729-740.
6.
Brand& L. W. (1965). Studies of “dropout” patients in psychotherapy: A review of findings. Psychotherapy: Theory, Research and Practice, 2 (1), 6-12.
7.
Brook, J. S., Cohen, P., & Gordon, A. S. (1983). Impact of attrition in a sample in a longitudinal study of adolescent drug use. Psychological Reports, 53 (2), 375-378.
8.
Campbell, D. T., & Stanley, J. C. (1966). Experimental and quasi-experimental designs for research. Chicago: Rand McNally and Company.
9.
Committee for the Substance Abuse Coverage Study, Division of Health Care Services, Institute of Medicine (1990). Treating drug problems, Volume I. Washington, DC: National Academy Press.
10.
Cook, T. D., & Campbell, D. T. (1979). Quasi-Experimentation: Design and analysis issues for field settings. Boston: Houghton Mifflin.
11.
Cook, T. J., & Poole, W. K. (1982). Treatment implementation and statistical power: A research note. Evaluation Review, 6, 425-430.
12.
Craig, R. J. (1985). Reducing the treatment drop out rate in drug abuse programs. Journal of Substance Abuse Treatment, 2 (4), 209-219.
13.
DeLeon, G., & Schwartz, S. (1984). Therapeutic communities: What are the retention rates?American Journal of Drug and Alcohol Abuse, 10 (2). 267-284.
14.
DeLeon, G. (1991). Retention in drug-free therapeutic communities. In R. W. Pickens, C. G. Leukefeld, & C. R. Schuster (Eds.), Improving drug abuse treatment, NIDA Research Monograph 106 (pp. 218-244). Rockville, MD. National Institute on Drug Abuse.
15.
Farrington, D. P. (1983). Randomized experiments on crime and justice. In N. Morris & M. Tonry (Eds.), Crime and justice: An annual review of research (Vol. 4, pp. 257-308). Chicago: University of Chicago Press.
16.
Foster, E. M., & Bickman, L. (1996). An evaluator’s guide to detecting attrition problems. Evaluation Review, 20 (6), 695-723.
17.
Freund, R. D., Russell, T. T., & Schweitzer, S. (1991). Influence of length of delay between intake session and initial counseling session on client perceptions of counselors and counseling sessions. Journal of Counseling Psychology, 38 (1), 3-8.
18.
Garfield, S. L. (1989). Giving up on child psychotherapy: Who drops out? Comment on Weisz, Weiss, and Langmeyer. Journal of Consulting and Clinical Psychology, 57 (1), 168-169.
19.
Garfield, S. L. (1994). Research on client variables in psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 190-228). New York: John Wiley and Sons.
20.
Gartin, P. R. (1995). Dealing with design failures in randomized field experiments: Analytic issues regarding the evaluation of treatment effects. Journal of Research in Crime and Delinquency, 32 (4), 425-445.
21.
Graham, J. W., & Donaldson, S. I. (1993). Evaluating interventions with differential attrition: The importance of nonresponse mechanisms and use of follow-up data. Journal of Applied Psychology, 78(1), 119-128.
22.
Hansen, W. B., Collins, L. M., Malotte, C. K., Johnson, C. A., & Fielding, J. E. (1985). Attrition in prevention research. Journal of Behavioral Medicine, 8 (3), 261-275.
23.
Hansen, W. B., Tobler, N. S., & Graham, J. W. (1990). Attrition in substance abuse research: A meta-analysis of 85 longitudinally followed cohorts. Evaluation Review, 14 (6), 677-685.
24.
Higgins, S. T., Budney, A. J., Bickel, W. K., Foerg, F. E., Donham, F., & Badger, G. J. (1994). Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Archives of General Psychiatry, 51 (7) 568-576.
25.
Howard, K. I., Krause, M. S., & Orlinsky, D. E. (1986). The attrition dilemma: Toward a new strategy for psychotherapy research. Journal of Consulting and Clinical Psychology, 54 (1), 106-110.
26.
Keaney, F., Wanigaratne, S., & Paulin, J. (1995). The use of a structured assessment interview as an intervention to reduce drop-out rates in outpatient relapse prevention groups for “problem” drinkers. The International Journal of the Addictions, 30 (10), 1355-1362.
27.
Lipsey, M. W. (1992). Juvenile delinquency treatment: A meta-analytic inquiry into the variability of effects. In T.D. Cook (Ed.), Meta-analysis for explanation (pp. 83-127). New York: Russell Sage Foundation.
28.
Lipton, D. S. (1995). The effectiveness of treatment for drug abusers under criminal justice supervision. Washington, DC: National Institute of Justice.
29.
Little, R. J. A., & Rubin, D. B. (1987). Statistical analysis with missing data. New York: John Wiley & Sons.
30.
Petrosino A. J. (1995). Specifying inclusion criteria for a meta-analysis: Lessons and illustrations from a quantitative synthesis of crime reduction experiments. Evaluation Review, 19 (3), 274-293.
31.
Roback, H. B., & Smith, M. (1987). Patient attrition in dynamically oriented treatment groups. American Journal of Psychiatry, 144 (4), 426-431.
32.
Sherman, R. T., & Anderson, C. T. (1987). Decreasing premature termination from psychotherapy. Journal of Social and Clinical Psychology, 5 (3), 298-312.
33.
Vach, V. (1994). Logistic regression with missing values in the covariates. New York: Springer-Verlag.
34.
Wade, P., & Bernstein, B. L. (1991). Culture sensitivity training and counselor’s race: Effects on black female clients’ perceptions and attrition. Journal of Counseling Psychology, 38 (1), 9-15.
35.
Weisz, J. R., Weiss, B., & Langmeyer, D. B. (1987). Giving up on child psychotherapy: Who drops out?Journal of Consulting and Clinical Psychology, 56 (6), 916-918.
36.
Wexler, H. K., Falkin, G. P., & Lipton, D. S. (1990). Outcome evaluation of a prison therapeutic community for substance abuse treatment. Criminal Justice and Behavior, 17 (1), 71-92.
37.
Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24 (2), 190-195.
