Self-reported depression as a predictor of dropout in a hierarchical therapeutic community.

Studies of the importance of depression for treatment outcome in hierarchical therapeutic communities are scarce. Therefore, a total of 144 substance abusers consecutively entering Phoenix House in Oslo were followed prospectively through an entire 18-month program. Using a structured interview and two self-report instruments, Million Clinical Multiaxial Inventory and Symptom Checklist-90, 69% of the clients were depressive cases at the time of application. However, depression alone did not predict dropout during the following 1-year inpatient phase. Of the 36 clients who completed the drug-free inpatient year, 19% were depressive cases at this point. Thus being depressed after 1 year increased the risk for dropout five times compared to being nondepressed. The study demonstrates the need for a modification of the treatment model, which might include the use of antidepressant and/or individual psychotherapy, at least in the outpatient phase.