Correlates of Underreporting of Post-Discharge Cocaine Use among Therapeutic Community Clients

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Abstract
This study had two goals: first, to assess the validity of self-reported recent cocaine use at follow-up among therapeutic community (TC) clients and second, to identify pre- and post-admission factors that are related to underreporting of cocaine use. Research interviews and urinalyses were used from the follow-up sample of 307 people participating in the District of Columbia Treatment Initiative (DCI) study 19 months after treatment discharge. Results show that the type of measure used to assess validity is very important to determining the results. Overall percentage agreement between self-reports and urinalysis was greater than 70 percent; however, after restricting the sample to include only those clients who were cocaine positive, the agreement decreased to 35 percent. Bivariate analyses revealed no pre-admission correlates of underreporting cocaine use at follow-up and a few post-admission correlates. We conclude that it is not possible to identify in advance clients who are likely to underreport cocaine use. To avoid underestimating cocaine use, treatment outcome studies should use objective measures of drug use along with self-reports.