The
Narconon Drug Rehabilitation Program: Ongoing
Program Evaluation
September
11-12, 1997
Presentation by Shelley L. Beckman. Ph.D.
International Conference on Human Detoxification
Introduction
During the
past three years, there has been an ongoing
evaluation of the Narconon program at two
Narconon facilities in the United States.
These facilities are located in Los Angeles,
California, and Chilocco, Oklahoma. This
ongoing evaluation is aimed at both monitoring
some of the factors involved in delivery
of the Narconon program and at assessing
the long term results of this comprehensive
socio-educational approach.
The purpose
of this evaluation was three-fold:
- The first
goal of this evaluation was to monitor
ongoing delivery to the clients at both
Narconon facilities. Daily and weekly
reports provided information on each
client on the program. This ongoing
evaluation afforded a detailed picture
of what it takes to deliver rehabilitation
service to hard core drug addicts.
- The second
goal of this study was to evaluate the
success of the Narconon program in retaining
clients through the full treatment regimen.
- The third
goal of this study was to assess the
long term efficacy of the Narconon program.
Efficacy measures included ability to
stay off of drugs, criminal behavior
and educational or career progress
Study
Design
The client
population included every client who started
the Narconon program at either Narconon
Los Angeles or Narconon Chilocco during
the study period. By including every client
we avoided bias in the selection.
The initial
evaluation included a comprehensive interview
based on the widely used "Addiction Severity
Index" and quantitative testing for drugs
of abuse in a urine sample, taken on arrival.
(The severity index has been used in many
evaluations of drug rehabilitation programs.)
The progress
of each client was then monitored throughout
the study via a daily report and periodic
urine testing.
A total of
273 clients participated in this study.
Demographics
The clientele
at different Narconon facilities do vary
considerably. Factors such as regional problems
with drug abuse and governmental support
for drug rehabilitation play important roles.
To apply the results of this study, it is
important to know something about the clients
at the two Narconon facilities that were
being evaluated.
- 81% of
the clients participating in this study
were male, 19% were female.
- The average
age was 30.7 +/- 8.6 years. (Range 14-66
years).
- 67% were
Caucasian, 13% Hispanic, 9% American
Indian, 8% African-American and 3% other.
Education
and Employment
The educational
level was comparable to some other drug
rehabilitation programs. 20% of these clients
had not completed high school. 80% had completed
high school or above, 14% had gone to trade
school or junior college after high school,
9% had completed college and 2% had post-graduate
degrees such as a masters in business or
science or a doctorate degree.
Work
Patterns
About half
of these clients were currently working.
60% report their usual pattern is to work
full time, yet:
- 46% did
not work in the last 30 days.
- Only 37%
were currently employed.
Many clients
had recently lost their jobs - being fired
or leaving work due to their drug abuse
problems.
Legal
Involvement
Of the clients
participating in this study:
- 22% admitted
having engaged in illegal activity for
profit in the last 30 days.
- On average,
those who were currently engaged in
illegal activities admitted to having
done so 13 of the last 30 days.
From
a longer term view
- 81% of
these Narconon clients had been incarcerated
in their lifetime.
- 33% of
these clients had been incarcerated
for greater than a month.
- 13% had
been incarcerated for greater than a
year in their lifetimes.
- On average,
they had been in jail 4.3 +/- 10.5 months
in their lifetimes.
There is
a major problem with illegal activities
in this group. As described later, the Narconon
program does have a very positive effect
on these statistics.
Drugs
of Abuse
The preferred
drug of abuse does vary considerably among
clients participating in the Narconon program.
The primary drug of abuse for clients in
this study was the following:
| Crack
Cocaine |
65
(24%) |
| Alcohol |
52
(19%) |
| Other
Forms of Cocaine |
36
(13%) |
| Heroin |
34
(12%) |
| Amphetamines |
33
(12%) |
| Marijuana |
33
(2%) |
| LSD
|
06
(2%) |
| PCP |
04
(1%) |
| Inhalants |
02
(1%) |
| Mixtures |
36
(13%) |
During the
time frame of this study, the most prevalent
drug of abuse for the clients at the Los
Angeles and Chilocco facilities was crack
cocaine. Other prevalent drugs, in order,
were alcohol, other forms of cocaine, heroin
and other opiates, amphetamines, and some
marijuana, LSD, PCP and inhalants.
Mixtures
of drugs were a problem for a large percentage
of this study population. On average, these
clients had used more than one drug in 8
days of the prior month. No primary drug
of abuse could even be named by 13% of this
study’s clients. About half of these
were mainly cocaine and heroin addicts,
with a wide variety of other combinations
as well.
Abuse at
the two facilities - Chilocco and Los Angeles
- varied and these facilities had different
drugs of abuse then the facilities in Europe.
For example the American Indian population
at Chilocco was far more likely to abuse
alcohol than other drugs and only the Chilocco
facility dealt with inhalant addicts. Similarly,
the primary drug of abuse in the Italian
facilities was heroin rather than cocaine
or crack during this time period.
On average,
these clients began using alcohol at age
15 and drugs at age 15 and a half . They
had been using drugs, on average, for 15
years.
Prior
Attempts at Drug Rehabilitation
Prior drug
or alcohol rehabilitation attempts were
prevalent in this study population.
22% of the
clients had previously done an alcohol rehabilitation
program and 56% had previously attempted
drug rehabilitation. For those who had tried
rehab, the average was over three previous
attempts.
12% had been
in some other form of rehab in the last
30 days.
As a general
statement, Narconon clients have had a long
term addiction to drugs or alcohol and have
encountered multiple prior failures in treatment.
This is consistent
with Narconon’s reputation for handling
the hard core, so-called "intractable" drug
addict.
The long
term efficacy study was designed to evaluate
individuals who came for the first time
to do the full Narconon program. Of the
273 clients monitored during this study,
184 qualified for this group.
Results
Drug Tests
During Program Delivery
Urine samples
were taken on intake, at two weeks, at one
month and at two months into the program
for a subset of the full study population.
The clients were not warned that samples
were to be taken.
88 clients
comprise this study group. 68 of these 88
clients, or 77%, tested positive for drug
metabolites in urine on intake. The portion
testing positive for drug metabolites did
vary by primary drug of abuse.
100% of the
clients whose major drug was crack cocaine
had positive urine tests. Other forms of
cocaine showed 62% of clients with positive
tests for drug metabolites. Almost 70% of
amphetamine users had positive urine tests,
85% of opiate users and 50% of alcoholics.
As clients
progressed through the program, there was
a steady decrease in both the percentage
of clients testing positive for drugs of
abuse and the level of drug found in urine.
Testing in this case was occurring during
the withdrawal and detoxification treatment
periods. Minute but detectable levels of
drug metabolites were found in a significant
proportion of these clients for several
weeks.
On intake,
77% of clients tested positive for drug
metabolites. By two weeks, 35% tested positive
for drugs of abuse, though the majority
of tests were in the low range.
At one month
15% still tested positive for drug metabolites.
The levels of drugs found at this time were
quite low, not indicative of recent drug
use.
At two months,
slightly higher levels of drug metabolites
were found in four clients while two demonstrated
low levels of metabolites. Two of those
with the higher levels were clients who
staff had suspected of drinking alcohol
and they did test positive.
For most
follow-up samples, the level of drug metabolites
was less than 1/20th of that found at intake.
Although this does not preclude continuing
drug use, the low levels suggest that what
we are seeing is ongoing elimination of
drug metabolites in most of these clients,
particularly given the fact that they were
on the detoxification program at the time.
This portion
of the overall study demonstrates that several
weeks may be required for elimination of
drug metabolites in some clients. Detectable
levels of drugs continue to be eliminated
for some weeks in at least a third of the
Narconon clients tested.
Monitoring
Program Delivery
Daily and
weekly reports were made throughout the
study period. These assisted Narconon management
to isolate specific problem areas in delivery
and correct or improve the quality of the
program.
Among the
improvements implemented during this study
were:
- Specific
drills to help the Narconon client gain
control over his addiction.
- Staff training
enhancements in the area of detecting
clients not qualified for the Narconon
program.
- Increased
follow-up contact with graduates to
help them stay off drugs and apply what
they gained from Narconon to their everyday
lives.
Weekly then
monthly calls from staff helped clients
through minor difficulties before they turned
into major ones.
Measures
of Efficacy
Program Retention
An important
factor in judging the success of any program
is whether or not it can keep its clients.
Retention can refer to both the number of
days at a facility and the amount of work
completed. The most important point as regards
retention is whether the client completed
the program.
Of the 273
clients who participated in this study,
66% completed the Narconon program. Similarly,
of the 184 clients doing the full program
for the first time, 67% completed their
Narconon programs.
Within this
population, program completion did vary
by drug of abuse. Of the 184 doing the full
program for the first time, crack cocaine
users had the poorest rate of program completion
(60%) while users of other forms of cocaine
had the highest completion rate.
Reduction
in Criminal Behavior (initial findings)
There are
123 graduates of the full program in this
study population. So far, 48 of these have
been interviewed two years after program
completion.
For the 48
graduates who have been interviewed, results
indicate a marked improvement in criminal
behavior.
- The number
of days participating in illegal activities
for profit was, on average, 2.8 of the
last 30 days before the
Narconon program and 0.4 after
This is a direct comparison
of the behavior for these clients before
the program (not the whole group) to
their behavior after program completion.
This change represents an 86% improvement
in reported criminal activity.
- The length
of the last incarceration was 3.6 months
(108 days) for this group prior
to Narconon. The average for
this follow-up group was less than one
day after the program.
(Over 99% improvement)
- Finally,
the average for days incarcerated in
the last 30 was 1.9 prior to
Narconon and less than 0.05 after
the program. (A 97% improvement)
Conclusion
The Narconon
program is designed to assist the hard-core
drug addiction. The program deals with individuals
having a variety of addictions. Most clients
have a long term addiction with multiple
prior attempts at rehabilitation.
Drugs are
gradually eliminated over the first several
weeks of the Narconon program. This is concurrent
with participation by the clients in the
detoxification component of the program.
Approximately
two-thirds of the clients who start the
program do complete it. Preliminary results
indicate the program graduates demonstrate
marked improvements in their criminal behavior.
Interviews also indicate significant improvements
in their use of drugs.
The long
term evaluation of this program is ongoing.
Initial results as reported herein give
reason for optimism regarding the effectiveness
of this approach in recovering the drug
abuser and stably improving his behavior
and ability to live within the mores of
civilized society.
