Drug dependence, who gets treated?

Despite the fact that decisions about whether or not to admit patients to inpatient facilities are often made on the basis of "clinical judgment," there is little evidence to support the validity of this process. The present study investigates the ability of the staff at a London drug clinic to predict how addicts would behave after admission to an inpatient treatment unit, and the bases upon which decisions were reached. The results indicate that predictions on almost all measures of future behavior showed very little interrater reliability, and there was no way of knowing in advance who would do well and who would do badly. The predictions were not random guesses; they reflected "implicit theories" held by each rater about the sort of factors that they believed to operate in such circumstances. Some implications of these findings for the treatment of addicts are discussed.