"I already stopped": abstinence prior to treatment

AIMS: To determine pre-treatment abstinence rates among treatment seekers and identify factors associated with pre-treatment abstinence. To evaluate the association between pre-treatment abstinence and subsequent outcome. DESIGN: An observational study using data collected for a randomized, experimental design. SETTING: Conducted with participants immediately after assessment for publicly funded substance abuse treatment at the King County Assessment Center (KCAC) in Seattle. PARTICIPANTS: People referred for outpatient or inpatient treatment by KCAC who had illicit drug use in the previous 90 days (N = 565). Participants waited a median of 12 days (range = 0-108 days) until either treatment entry or waiting-list dropout. MEASUREMENTS: A modified Drug History Questionnaire quantified drug use at baseline, treatment entry or waiting-list dropout and 3 months later. Other measurement methods: Stages of Change Readiness and Treatment Eagerness Scale, participant confidence ratings and KCAC chart review. FINDINGS: Sample-wide, 45% of participants reported abstinence from initial assessment to when they entered or failed to enter treatment. Higher rates of abstinence were associated with shorter waiting periods, less substance use prior to initial assessment and higher scores on change readiness. Pre-treatment abstinence was not associated with either treatment entry or completion. There was a non-significant trend towards less improvement in substance use with pre-treatment abstinence, with the greatest effect observed for short waits. CONCLUSIONS: Participants can become abstinent prior to treatment, but this is not a good predictor of treatment entry, completion or outcome. A decisional balance strategy may be a more productive use of client and treatment program energy.