A new study published in JAMA Network Open points at a different problem. Of 40,732 patients who started individual therapy, 28.4 percent stopped after three sessions or fewer.
This is important for anyone researching rehab facilities or dual diagnosis treatment. The same pattern that ends psychotherapy early often ends addiction treatment early.
What the Study Measured
Researchers analyzed electronic health record data collected between 2008 and 2022. The data spanned across two large academic medical centers, six community hospitals and their affiliated outpatient networks in Massachusetts.
Of 423,636 individuals who had depression in the system, the team narrowed down to 40,732 patients. They were aged 18 to 80 who had at least one individual psychotherapy session plus a documented visit in both the year before and the year after that session.
Dropout meant stopping therapy after three sessions or fewer. A total of 11,571 patients dropped out. The authors describe psychotherapy dropout as an issue that “poses a significant public health problem.” They cited its links to depression relapse and illness persistence.
Which Patients Left Early
The team trained two prediction models, a logistic regression and a random forest. They were trained on demographics, medical conditions and service records including prescription, diagnostic and procedural codes.
Predictive accuracy was modest. Area under the curve reached 0.64 for logistic regression (95 percent CI, 0.63 to 0.65) and 0.66 for the random forest model (95 percent CI, 0.65 to 0.67).
Two factors predicted lower odds of dropping out. A prior mental health encounter, such as a group psychotherapy session or a psychiatric evaluation, was protective. So was identifying as white or non-Hispanic.
Two factors predicted higher odds. One was a mental disorder attributed to a physiological condition. The other was a prior medical admission. This is when the psychotherapy referral came during or shortly after a hospital stay.
The authors read that second finding as a systems problem and not a failure of the patient. A referral given at discharge when someone is still recovering and managing follow-up appointments, has a weak foundation.
Their proposed fix is integrated care models that embed brief behavioral health interventions inside medical settings. This would mean the first contact happens before the patient leaves.
Why This Connects to Addiction Risk
The study runs through what happens when depression goes untreated. Depression and substance use disorders co-occur at high rates and untreated depressive symptoms are a recognized driver of both first-time substance use and relapse.
When someone stops therapy after two sessions and their depression persists or returns, alcohol and other substances become an available way to manage symptoms that nothing else is managing.
The protective factor in the data is worth sitting with. Patients who had already been in a room with a mental health clinician, even briefly, were more likely to stay. Knowing what to expect appears to make continuing treatment easier.
What This Means for Treatment Seekers
For anyone starting therapy or addiction treatment, the first three sessions are an important stretch of the recovery process. Programs that schedule the first session and intake close together and follow up after any missed appointments can help break the pattern.
If a therapy or treatment referral comes from a hospital discharge, extra follow-up may be needed rather than referral alone.
Calling to confirm the first appointment before leaving the hospital is a small step that addresses the gap the researchers identified.
Exploring Treatment Options
People comparing rehab centers can use this research as a set of questions. Ask how the program handles early dropouts and whether it offers an orientation or group session before individual therapy. Ask whether behavioral and medical care are integrated or handled through referrals. Ask what happens after a missed session.
Confirm insurance coverage for addiction and mental health treatment before the first visit. An unexpected bill can make people stop attending.
Rehab.com’s directory lets you compare verified treatment centers by level of care, insurance accepted and dual diagnosis capability. Call
800-985-8516
( 
Sponsored Helpline )
to learn more about your treatment options.
