Indonesia has been implementing methadone maintenance treatment (MMT) since January 2003 as a strategy to minimize HIV transmission among injecting drug users (IDU). Previous studies have shown the effectiveness of the program and also showed that the program had attracted many IDU to participate. However, the dropout rate, particularly in Jakarta clinics, was relatively high. The first aim of this study was to investigate the MMT retention rate and its predictive variables. The second aim was to examine the effects of remaining in the program on treatment outcomes. A six-month longitudinal prospective cohort study was conducted at the client level and a cross-sectional survey was carried out at the clinic level. Information from this study provides significant inputs for developing drug treatment policy and improving its quality of service in Indonesia. It also contributes to a better understanding of the substitution treatment implementation in Indonesia. The average 3-month treatment retention rate was 74.2 percent and the 6-month retention rate was 61.3 percent. There was no significant difference in retention rates between clinics. Significant predictors of treatment retention in MMT in Indonesia were size of dose, the interaction between take-home dose and clinic experience, age of participant, participant’s belief towards the program and perceived accessibility, while a variable representing perceived peer support unexpectedly predicted an increased likelihood of prematurely leaving the treatment. This study showed a marked reduction in the use of heroin and depression status and a significant improvement of self-efficacy at the follow up times among participants who continued in treatment. There were no significant differences in criminal involvement and physical health status between those who remained in treatment and the treatment dropouts in both follow-up interviews. Nevertheless, there was a significant improvement in physical health from baseline to follow-up in both groups. The study concluded that retention rates of MMT in Indonesia were comparable to those of similar programs in other countries. As previously reported in other settings, dose was the primary predictor of treatment retention in Indonesia. A policy of providing take-home doses, prescribed in experienced clinics,was also found to be a significant predictor of remaining in treatment. Further research, however, is still needed to explain some of the unexpected observations. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1522114 / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2010

Two groups of therapist characteristics were explored as predictors of working alliance (WA) with African American women substance abusers (n = 102). This study tested the hypotheses that Population Sensitive Therapist Characteristics (PSTCs; i.e. multicultural competence [MC], egalitarianism [EG], and empowerment [EM]) would explain an additional and significant amount of the variance in WA beyond that explained by general therapist characteristics (GTCs; i.e. empathy, regard, and genuineness); and that GTCs partially mediate the effect of each individual PSTC on WA. Hierarchical multiple regression revealed that PSTCs explained an additional 12% of the variance in WA, after controlling for GTCs. Bootstrapping analyses demonstrated that GTCs fully mediated the effect of MC and EM on WA, and partially mediated the effect of EG on WA. Together, these findings suggest therapists can facilitate a stronger WA with the target population through demonstration of PSTCs and that these characteristics are facilitative in whole or in part, because they increase the likelihood the therapist is perceived as demonstrating GTCs (i.e. empathy, regard, and genuineness).

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Magister Psychologiae - MPsych / Cape Town is suffering from high rates of alcohol and other drug (AOD) problems. Despite the need for effective treatment, there are insufficient AOD treatment facilities available, with barriers to AOD treatment being particularly pronounced among historically disadvantaged communities (HDCs). In addition, the high drop-out rate of patients from AOD treatment, and the finding that retention in treatment is predictive of positive outcomes, increases the necessity of retaining people who enter AOD treatment.This study therefore aimed to identify those patient-level factors impacting on the successful completion of and retention in AOD treatment. In particular, the study aimed to describe the relationship between treatment process factors (therapeutic alliance,motivation, treatment satisfaction, social support), demographic and psychological variables, and treatment completion and retention. The Texas Christian University (TCU) Treatment Model, which conceptualises the AOD treatment process, provided the theoretical framework for the study. Using a quantitative design, secondary data analysis was conducted on a section of data that was originally collected by the Medical Research Council (MRC) via a cross-sectional survey. The sample consisted of 434 individuals from HDCs who had previously entered AOD treatment. Multiple regression analyses revealed that the therapeutic alliance, treatment satisfaction, abstinence-specific social support and depression were significant predictors of treatment completion, while race,therapeutic alliance, abstinence-specific social support and anxiety were predictive of the time spent in treatment. These predictors were positively associated with treatment completion and time in treatment. Black Africans spent significantly less days in treatment than Coloured individuals, although both groups were equally likely to complete treatment. The results suggest that by strengthening the therapeutic alliance,social support and treatment satisfaction, treatment completion and retention can be improved. This can be achieved by training, ongoing monitoring of these factors during treatment, and greater involvement of supportive social networks in a patient’s recovery. The findings also point towards the need for improved service delivery for Black Africans, who confront many barriers to accessing inpatient AOD treatment.