Effective drug treatment. Testing the distal needs hypothesis.

A long-standing view held by many drug abuse treatment providers, researchers, and policy makers is that maximally effective drug treatment needs to attend to the employment, health, housing, and other "distal needs" of the client. This paper tests the distal needs hypothesis by determining the effects of resolved, unresolved, and emergent family, housing, health, legal, emotional, and vocational needs on treatment engagement and treatment outcomes. Findings from a prospective, longitudinal study of 330 clients in 26 outpatient programs in the Los Angeles metropolitan area indicate little support for the distal needs hypothesis. Specifically, those with unresolved or emergent distal needs were not less likely to engage in treatment or use drugs during and after treatment. Treatment and research implications of these findings are addressed.