Detoxification as a gateway to long-term treatment: assessing two interventions

Two interventions designed to increase the likelihood of entry into long-term treatment upon discharge from hospital detoxification are compared in a randomized controlled trial. The 279 study participants were treated for heroin and/or cocaine dependence on detoxification wards in two hospitals in a poor, predominantly Hispanic, neighborhood in New York City. One-third of the participants entered and remained in long-term treatment for the first 30 days after discharge from detoxification, 23% were in treatment for 1-29 days, and 43% received no treatment in the 30 days. Neither of the interventions--one, a brief motivational psychotherapy, the other, a series of treatment-related videos--is found to be significantly superior to treatment as usual in increasing the likelihood of utilization of long-term treatment. While weaknesses in the interventions themselves need to be examined, it is also concluded that conditions on the detoxification wards may hamper effective intervention.