PAC 499 Module 3 Literature Review Example

What We Know About Keeping New Clients: A Literature Review on Early Dropout, Prompting and Peer Contact

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 499: Senior Capstone

Instructor Name

Month Day, Year

What We Know About Keeping New Clients: A Literature Review on Early Dropout, Prompting and Peer Contact

Jordan's capstone, introduced in the first two modules, tests whether a phone call from a peer recovery specialist the day after admission goes along with more clients still attending a month later at Bluegrass Recovery Services, an outpatient program in Lexington, Kentucky. Like the student and the program, the project's data are invented for this course, while every study discussed here is real. This literature review asks what is already known about why new clients leave treatment early, what helps them stay and what peer support contributes.

Choosing the Type of Review

Grant and Booth (2009) analyzed fourteen types of literature reviews, including systematic reviews, scoping reviews, rapid reviews and traditional narrative literature reviews, and described their methods, strengths and weaknesses. Systematic reviews use exhaustive searches and formal appraisal and are suited to answering focused questions definitively, but they require substantial time and often a team. Narrative literature reviews are more flexible and can draw together evidence on a topic for a particular purpose, at the cost of less transparency about how sources were chosen. For a one-semester capstone with a practical aim, Jordan chose a focused narrative review, built on existing systematic reviews where available and on key primary studies.

How Sources Were Found

Three databases were searched, PsycInfo, PubMed and Google Scholar, pairing phrases such as treatment dropout, retention, engagement, substance use disorder, outpatient, reminder, prompting, peer support and recovery coach. Systematic reviews and randomized trials came first in the reading order, followed by large observational studies. Sources were limited to studies of adults in substance use treatment. Jordan also followed the bibliographies of the main reviews back to studies the database searches had missed.

Theme One: What Predicts Early Dropout

Brorson et al. (2013) systematically reviewed more than a hundred studies of risk factors for dropout from addiction treatment. Surprisingly few factors predicted dropout consistently across studies. Those that held up most often were being younger, having cognitive impairments or a personality disorder and having a weaker working alliance with staff. Many factors often assumed to matter, such as gender, education and the primary substance, did not predict dropout consistently. The authors emphasized that the alliance, unlike age or personality, is something programs can influence.

For Jordan's project, the finding suggests that efforts to build a connection between new clients and the program early on target one of the few modifiable predictors of dropout.

Theme Two: What Raises Attendance

Lash et al. (2007) tested an intervention to increase participation in continuing care after intensive treatment. Patients were randomly assigned to standard care or to an intervention that combined a behavioral contract to attend, prompts such as reminder letters and calls before sessions and social reinforcement, such as recognition for attendance. Patients in the intervention group attended more continuing care sessions and had better substance use outcomes than those in standard care. The study shows that relatively simple contact and reminders can change attendance, a finding consistent with earlier reviews of dropout that pointed to personal contact in the early weeks.

Theme Three: What Peers Contribute

Eddie et al. (2019) systematically reviewed peer recovery support services and recovery coaching. Across the studies they found, clients with peer support tended to engage and stay in treatment better and to report stronger ties with providers, satisfaction and, in some studies, reduced substance use and relapse. The authors noted that the evidence base was limited by small samples, few randomized trials, inconsistent definitions of peer roles and limited description of what peers actually did. Studies of peers making brief early contact with new clients, as in Jordan's project, were especially scarce.

What the Search Found

The searches returned several hundred records, most of them about inpatient or residential treatment, methadone programs or continuing care after an intensive phase. Fewer than twenty concerned the first weeks of outpatient treatment directly, and only a handful tested any contact between intake and the second visit. Jordan kept the sources that were systematic reviews, randomized trials or large studies of adults in community programs and set aside opinion pieces and studies of adolescents. The imbalance in what the search found is itself a finding: researchers have studied what happens after people settle into treatment far more than the fragile days when they decide whether to come back.

Comparing the Studies

Weighing the Evidence

Not every source carries the same weight. Lash and colleagues' study is a randomized trial, so its finding that prompting raised attendance is the strongest causal evidence in the review, though it concerns veterans moving from intensive treatment into continuing care rather than new outpatient admissions. Brorson and colleagues' review is broad, but the studies it pooled were mostly observational, so it identifies predictors rather than causes. Eddie and colleagues' review is the most relevant to peers but the least certain, because so many of its studies lacked comparison groups. Reading the sources this way keeps the capstone from promising more than the research can support.

Gaps

Three gaps stand out. First, most research on improving attendance concerns continuing care after intensive treatment, not the first days of outpatient treatment, when dropout is highest. Second, research on peer support has rarely isolated a single, brief peer contact such as a welcome call. Third, little research describes how peers deliver such contacts and what clients experience. Jordan's three research questions, on retention, client experience and delivery, address each gap at one site.

How the Review Shaped the Project

The review changed the project in two ways. Lash and colleagues' finding about prompts led Jordan to add a short reminder of the client's next appointment to the peer call's guide. And Eddie and colleagues' criticism that peer roles are poorly described led Jordan to write the call guide in detail and to plan interviews with peers about how they deliver it, so that the project could add a clear description of the intervention to a literature that often lacks one.

Conclusion

The research reviewed points to the first days of treatment as both the period of greatest risk and the period least studied. Brorson and colleagues identify the alliance as a modifiable predictor of dropout, Lash and colleagues show that prompts and reinforcement can raise attendance and the peer literature gathered by Eddie and colleagues looks hopeful yet thin in places. Grant and Booth's typology justifies a focused narrative review. Together, the sources support testing a brief, well-described peer contact in the first day after admission.

References

Brorson, H. H., Ajo Arnevik, E., Rand-Hendriksen, K., & Duckert, F. (2013). Drop-out from addiction treatment: A systematic review of risk factors. Clinical Psychology Review, 33(8), 1010-1024. https://doi.org/10.1016/j.cpr.2013.07.007

Eddie, D., Hoffman, L., Vilsaint, C., Abry, A., Bergman, B., Hoeppner, B., Weinstein, C., & Kelly, J. F. (2019). Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching. Frontiers in Psychology, 10, Article 1052. https://doi.org/10.3389/fpsyg.2019.01052

Grant, M. J., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26(2), 91-108. https://doi.org/10.1111/j.1471-1842.2009.00848.x

Lash, S. J., Stephens, R. S., Burden, J. L., Grambow, S. C., DeMarce, J. M., Jones, M. E., Lozano, B. E., Jeffreys, A. S., Fearer, S. A., & Horner, R. D. (2007). Contracting, prompting, and reinforcing substance use disorder continuing care: A randomized clinical trial. Psychology of Addictive Behaviors, 21(3), 387-397. https://doi.org/10.1037/0893-164X.21.3.387