Volunteer assistance in the treatment of chronic alcoholism.

Chronic alcoholics often have great difficulty in adjusting their lifestyle to accommodate the goals agreed upon in treatment. A 16-week behavioral self-management program, which emphasized creating lifestyle changes in the community, was offered to 193 clients. To assist in the process of treatment delivery, half of the clients were offered the support of trained community volunteers during the treatment program. To give volunteers a time period in which to to meet and start working with their clients, only those clients who completed at least the first 4 weeks of the 16-week program (N = 106) were included in the evaluation. Independent follow-up was conducted over a 12-month period. A significant reduction in alcohol consumption was found for clients of both the volunteer-support (VS; N = 52) and the office-based (OB; N = 54) groups; this reduction was maintained over the 12 months of review, with no major differences found between groups. Volunteers rated high on particular characteristics assisted the client more effectively during treatment than those rated low. The variability in hours spent between volunteer-client pairs appeared to mask any main effects, and also the length of the contact period with the volunteer was too short. It is recommended that the use of volunteers be evaluated further by extending the client contact time into the follow-up period.     

Effectiveness of a Comprehensive Lifestyle Modification Program for Asthma Patients: A Randomized Controlled Pilot Trial

Objective. The aim of the study was to investigate the effectiveness and feasibility of conducting a complementary 8-week comprehensive lifestyle modification program (CLMP) compared to standard care in patients with bronchial asthma over a 6-month period. Methods. This was a randomized controlled pilot trial with two groups: intervention (N = 15) group and attention-placebo control (N = 14) group. The intervention group received an 8-week CLMP in addition to standard care. Quality of life, asthma control, lung function, reduction of rescue medication, perceived stress, and psychosocial and spiritual status were measured at the end of the intervention and at the 4-month follow-up. Results. In the intervention group, there was a statistically significant difference in the improvements of quality of life, asthma control, lung function, and the reduction of rescue medication intake at both the end of the intervention and at the 4-month follow-up, with no change being observed in the control group. Significant stress reduction and greater psychosocial and spiritual well-being were observed during the 8-week CLMP in the intervention group. At the end of the intervention, the measures of stress and psychological and spiritual well-being reached statistical significance. Conclusions. Preliminary findings suggest that adding a CLMP to standard care in patients with bronchial asthma offers greater clinical benefit than standard care alone and also suggest that conducting a large randomized clinical trial is feasible.     

"Outings to your taste": a nutrition program for the elderly

"Outings to Your Taste" is an innovative program that aims to improve the nutritional status and social network of elderly people who receive home-delivered meals. This article examines participation in one of the program's components, outings to community restaurants. Participation data were collected on-site and information about client characteristics was collected in at-home interview surveys of targeted clients (n = 144). While about half of the clients had tried at least one outing, more than 25% of them participated in at least one third of the outings offered to them. Results indicate that the program attracted a variety of clients in terms of sociodemographic, health, and social isolation characteristics.     

Characteristics of Problem Drinkers in E-therapy versus Face-to-Face Treatment

Background: The availability of online treatment programs offers the potential to reach more problem drinkers. This study compared the client populations of an e-therapy program (asynchronous client–therapist communication via the Internet) and a face-to-face treatment program. Objective: To determine whether e-therapy and face-to-face groups differed from each other and changed over time. Methods: We compared the baseline characteristics of four naturalistic groups (N = 4593): two e-therapy groups (2005–2006 and 2008–2009) and two consecutive series of ambulant face-to-face clients admitted for treatment as usual. The characteristics we were interested in were gender, age, education level, working situation, and earlier treatment for drinking problems. Results: The results showed that the baseline characteristics of e-therapy and face-to-face clients differed by gender, education level, work situation, prior alcohol treatment, and age. We also found that both e-therapy groups differed over time by gender, work situation, and prior alcohol treatment. Conclusions: The e-therapy program successfully attracted clients who were different from those who were represented in regular face-to-face alcohol treatment services. This indicates that e-therapy decreases the barriers to treatment facilities and enhances the accessibility. However, the e-therapy population changed over time. Although the e-therapy program still reached an important new group of clients in 2008–2009, this group showed more overlap with the traditional face-to-face group of clients probably as a result of improved acceptance of e-therapy in the general population. Scientific Significance: Although e-therapy seems to be better accepted in the general population, anonymous treatment seems necessary to reach a broader range of problem drinkers.     

Substance Involvement and the Trajectory of Criminal Offending in Young Males

The relationship between prisoner client characteristics and Therapeutic Community treatment process was examined in a male program (N = 164) and a female program (N = 195). Analyses were based on client reports on a multidimensional measure of treatment process and administrative data. Prisoner clients who are older or are poly-substance users had better Community Environment scores. Clients with children and fewer lifetime arrests had better scores on Personal Development and Change. Treatment process scores were comparable for clients in the female program and the male program. However, the association of treatment process with client characteristics appears stronger in the male program.     

Are prisoner characteristics associated with therapeutic community treatment process?

The relationship between prisoner client characteristics and Therapeutic Community treatment process was examined in a male program (N = 164) and a female program (N = 195). Analyses were based on client reports on a multidimensional measure of treatment process and administrative data. Prisoner clients who are older or are poly-substance users had better Community Environment scores. Clients with children and fewer lifetime arrests had better scores on Personal Development and Change. Treatment process scores were comparable for clients in the female program and the male program. However, the association of treatment process with client characteristics appears stronger in the male program.     

The relationship of drug program environmental variables to treatment outcome

The Moos Community Oriented Program Environment Scale (COPES) was administered to 244 adolescent clients and 131 drug counselors in 30 "drug-free" outpatient drug treatment programs. Four of the COPES factor scores were found to predict significantly to treatment outcome (as measured by reduction in drug use): client ratings of "Spontaneity", and staff ratings of "Personal Problem Orientation", "Practical Problem Orientation", and "Order and Organization". The more positive the ratings of the program environments, the greater the reduction in client-reported drug use from admission to discharge. The "discrepancies" (differences) between staff and client perceptions of the programs on two of the COPES factors ("Autonomy" and "Staff Control") were also found to predict significantly to treatment outcome (as measured by reduction in drug use). The greater the discrepancy, the less successful was the treatment outcome. In the programs in which the clients tended to perceive the staff as less encouraging of client autonomy and as exercising more control over the clients relative to the staff's perceptions of these relationships, the clients tended to have less successful treatment outcomes. One possible interpretation of this finding might be that in the programs which have client populations that are more poorly motivated and more resistant to treatment, the clients will not only tend to have poorer treatment outcomes but will also perceive the program environment more negatively and thus will tend to disagree more with the staff's perceptions of the program.     

Setting and counselor type as related to program retention

Study was made of the relationship between successful treatment outcome and staff:client ratios in two types of treatment settings. Successful treatment was defined as retention in treatment for at least 6 months and program completion. Using a total sample of 5,405 discharged clients, it was found that there were no differences in outcome between community mental health centers and dedicated drug abuse treatment programs for clients whose primary drug of abuse was either an opiate or a nonopiate exclusive of marijuana. Community mental health centers were significantly more likely to retain minority group marijuana clients 6 months or more to treatment completion while dedicated drug abuse programs were significantly more likely to retain White marijuana clients 6 months or more to treatment completion. No differences in outcome were found for any of the three client groups in relation to program emphasis on advanced-degreed professionals as compared to paraprofessionals.     

Uses of individualized client goals in the evaluation of drug and alcohol programs

The issue of accountability increasingly places demands on administrators to evaluate program results. This paper attempts to show that individualized goal setting by clients can provide information which can be used (1) to compare stated program goals to actual client goals, and (2) as a realistic, individualized set of outcomes for follow-up evaluation. Evaluation of many drugs and alcohol programs is often based on the premise that abstinence is the goal of all treatment programs for all clients. While this may be a proper ultimate goal, it may not be sufficiently precise for more specific or short-term evaluations. A technique recently developed in the mental health field is Goal Attainment Scaling (GAS). In this approach, individual goals are usually developed through negotiations between client and counselor and provide individualized measurement of client success in treatment. GAS was tested on a sample of clients entering public and private drug and alcohol treatment facilities: (1) nearly all clients in the sample chose to set goals, although they were not required to do so; (2) a content analysis aggregated individual goals into a group profile of percent of clients writing goals in each of 17 goal areas; (3) goal content changed over successive interviews; and (4) there were differences in goal content between age and facility subgroups.     

A client-developed methadone maintenance program.

A realistic methadone maintenance program is a continuum of four related areas: intake, rehabilitation with on-going evaluation, detoxification, and postdetoxification followup, each jointly administered by client volunteers and professional staff. In the early stages of client treatment, pharmacists have more frequent contact with program participants than do other staff professionals. At the Minneapolis Pilot City Health Center, 31 of 69 participants in the methadone maintenance program were interviewed by their pharmacist to determine client understanding of program objectives, interpretation of program effectiveness, and suggestions for program improvement. Client understanding of the objectives or program elements ranged from 30 to 97 %. Client evaluation of the effectiveness of program elements ranged from 0 to 65%. The client-developed program included intake procedures to establish for each client the program objectives, rules, evaluation, guidelines, client goals, dismissal guidelines, and a review of supportive services. Rehabilitation would be continuous with consistent on-going evaluation to measure goal attainment, a decline in disruptive behavior, and freedom from illicit drug use. Detoxification should be undertaken after the client's behavior has stabilized and he has developed a marketable skill. Monitoring of the client to assure a drug-free state would be an important element of the postdetoxification follow-up.     

HIV prevention case management in San Francisco: barriers to successful implementation

Prevention case management (PCM) is the most labor-intensive HIV prevention intervention for persons at risk for acquiring or transmitting HIV. However, it has not been thoroughly evaluated. We abstracted client charts (n = 290) from 12 San Francisco PCM programs and interviewed current and former program directors (n=16), case managers (n = 17) and contract managers (n = 4) regarding client characteristics, services delivered, barriers to care, cost and organizational structure, policies and procedures. Most agencies lacked protocols and data collection forms, had high staff turnover, inadequate staff training and supervision, experienced difficulty recruiting and retaining clients and could not implement PCM guidelines. Half the clients lacked behavioral risk assessment, 39% were low or no risk, a third received HIV prevention education and a third received referrals. Including time spent directly with clients and working on their behalf, PCM cost almost four-fold more per client contact than the next most costly individual level prevention intervention. Local PCM guidelines, reimbursement ties to providing and documenting services and increased collaboration between the health department and agencies has greatly improved the situation. Outcome evaluations and cost-effectiveness assessments comparing PCM to less costly prevention interventions are needed.     

Project Match treatment participation and outcome by self-reported ethnicity

BACKGROUND: There is a lively ongoing debate concerning the need for culturally congruent alcohol treatment, with the assumption that such treatment would meaningfully address treatment outcome disparities among ethnic minorities. Although valid on the face of it, no randomized clinical trials have yet prospectively investigated and documented whether, in fact, different ethnic groups actually fare better or worse from one another when offered mainstream, culturally "incongruent" treatment. The purpose of this study was to contrast Hispanic, black, and white client treatment engagement and outcome in an effort to identify potential health disparities related to client ethnicity. METHODS: The Project Match outpatient (N = 952) and aftercare (N = 774) samples were divided according to self-reported ethnicity: Hispanic (n = 141; 8%), black (n = 168; 10%), and white (n = 1380; 80%). Controlling for socioeconomic status using the Hollingshead Occupational scale, the three ethnic groups were contrasted on pretreatment characteristics, rates of treatment attendance, three scales of therapeutic alliance, satisfaction with treatment, and drinking outcomes for the 12 months after treatment. RESULTS: Ethnic differences in rates of therapy attendance were not robust and dissipated after controlling for socioeconomic status. No mean ethnic differences in ratings of therapeutic bonding and agreement with therapy goals were obtained, but blacks and Hispanics reported higher agreement on the value of therapeutic tasks relative to whites. Nevertheless, whites reported significantly higher global satisfaction with treatment relative to Hispanics and blacks. No ethnic main effect was found in drinking intensity during the 12-month follow-up. In contrast and only in the outpatient sample, blacks (n = 51) reported significantly higher rates of monthly abstinence relative to whites (n = 679). CONCLUSIONS: Pretreatment characteristics predictive of positive treatment outcome favored white clients relative to Hispanic and black clients, but Hispanic and black clients fared at least as well as white clients during the 12-month follow-up, at least on two measures of drinking behavior. The absence, then, of poorer drinking outcomes for the ethnic minorities suggests that they may mobilize (1). different behavior change strategies and/or (2). additional social resources to achieve comparable drinking outcomes with white clients. Specific recommendations for future research are made.     

The daily progress system: A proof of concept pilot study of a recovery support technology tool for outpatient substance abuse treatment

Background: Illicit substance use remains highly prevalent in the US, and epidemiological surveillance surveys estimate that in 2015, over 27 million individuals (10.1% of the US population) 12 years of age or older used illicit drugs in the past 30 days.¹ Outpatient treatment delivered in community-based settings is the dominant modality for addiction treatment, typically involving weekly psychosocial counseling sessions in an individual and/or group format.^2,3 Unfortunately, relapse and premature treatment discontinuation are quite common in outpatient treatment.^3–5 Objectives: This is a pilot proof of concept feasibility study involving clients presenting for outpatient SUD treatment. This study sought to examine the feasibility and acceptability of the Daily Progress System (DPS), a telephone-based software program, using interactive voice response (IVR), designed to enhance quality care and improve client outcomes. Methods: Individuals who presented at the participating treatment clinic, who met study eligibility criteria, and who provided written informed consent to participate were included in the study (N = 15; 53.3% females). Incentives were paid to participants for calls completed. Results: Participants completed 65% of scheduled daily call-ins, representing 273 person-days of data on client cravings, mood, substance use, and involvement in recovery support activities. The average call duration was approximately 2 minutes and 42 seconds. There was a high degree of client and counselor acceptance and satisfaction using the system. Conclusions and Clinical Significance: Findings suggest that the DPS appears to be a feasible means of potentially addressing relapse and treatment engagement issues based on client and counselor engagement and satisfaction with the system.     

Long-term follow-up of psilocybin-facilitated smoking cessation

Background: A recent open-label pilot study (N = 15) found that two to three moderate to high doses (20 and 30 mg/70 kg) of the serotonin 2A receptor agonist, psilocybin, in combination with cognitive behavioral therapy (CBT) for smoking cessation, resulted in substantially higher 6-month smoking abstinence rates than are typically observed with other medications or CBT alone. Objectives: To assess long-term effects of a psilocybin-facilitated smoking cessation program at ≥12 months after psilocybin administration. Methods: The present report describes biologically verified smoking abstinence outcomes of the previous pilot study at ≥12 months, and related data on subjective effects of psilocybin. Results: All 15 participants completed a 12-month follow-up, and 12 (80%) returned for a long-term (≥16 months) follow-up, with a mean interval of 30 months (range = 16–57 months) between target-quit date (i.e., first psilocybin session) and long-term follow-up. At 12-month follow-up, 10 participants (67%) were confirmed as smoking abstinent. At long-term follow-up, nine participants (60%) were confirmed as smoking abstinent. At 12-month follow-up 13 participants (86.7%) rated their psilocybin experiences among the five most personally meaningful and spiritually significant experiences of their lives. Conclusion: These results suggest that in the context of a structured treatment program, psilocybin holds considerable promise in promoting long-term smoking abstinence. The present study adds to recent and historical evidence suggesting high success rates when using classic psychedelics in the treatment of addiction. Further research investigating psilocybin-facilitated treatment of substance use disorders is warranted.     

Pilot evaluation of the Making Employment Needs [MEN] Count intervention: Addressing behavioral and structural HIV risks in heterosexual Black men

Few community-based HIV interventions exist for Black men at heterosexual risk for HIV. None focus on structural HIV risks such as unemployment and unstable housing. This study involved a pilot evaluation of the MEN (Making Employment Needs) Count HIV intervention, a three session peer counselor-delivered program of HIV risk reduction and gender-equity counseling, and employment and housing case management. A single-arm intervention trial of MEN Count was conducted with Black men recruited from a community men's clinic and social services program. Eligible men were those who reported two or more sex partners in the past six months and current unemployment and/or recent homelessness. Most participants (68%) had a history of incarceration. Participants (N = 50) were surveyed on outcomes at baseline (Time 1), posttest (Time 2; 60–90 days after baseline), and two-month follow-up (Time 3). The majority of participants were retained in the program (86%) and the final follow-up survey (76%). McNemar tests revealed significant reductions in the past 30-day unprotected sex from Time 1 (74%) to Time 2 (47%) and to Time 3 (47%), and in homelessness from Time 1 (58%) to Time 3 (32%). Significant increases in employment from Time 1 (8%) to Time 2 (29%) and Time 3 (32%) were also seen. Participants completed a brief participant satisfaction survey at posttest. Most (n=28, 65%) rated the program as excellent, and an additional 10 (23%) rated it as good. Although there was no significant reduction in multiple sex partners, a trend was observed from Time 1 (56%) to Time 2 (44%) and Time 3 (42%). Findings suggest that the MEN Count model is a feasible and promising HIV prevention program for Black men at heterosexual risk for HIV. Larger scale implementation and more rigorous evaluation of MEN Count are needed to confirm the study findings.     

Assertive Outreach: An Effective Strategy for Engaging Homeless Persons with Substance Use Disorders into Treatment

The purpose of this study was to examine substance abuse treatment referrals that were made by outreach workers in a homeless outreach project. Ten outreach workers completed questionnaires on each of their clients who they had referred to a substance abuse treatment program over the previous year. Additional data was collected on the client's motivation level at the point the referral was made, which agencies the client was referred to, and if the client was rejected from any of the treatment programs. Bivariate correlation analyses were used to examine relationships between the variables. Of 73 project clients who were referred to substance abuse treatment in a one-year period of time, 41% successfully entered treatment. As might be expected, there was a statistically significant relationship between clients' motivation level and completed referral, and between referrals made and program acceptance. This study provides evidence that assertive outreach is effective in engaging and linking homeless persons with substance use disorders to substance abuse treatment services.     

Improving Mental Health in the Community: Outcome Evaluation of a Geriatric Mental Health Day Treatment Service

Objectives: This program evaluation reviewed the outcomes of a new 10-week multi-modal mental health day treatment program for elderly clients with mood and anxiety disorders.

Methods: A retrospective chart review of clients admitted during the first 3 years of the program (N = 255) was conducted. Paired sample t-tests were used to compare admission and discharge data. Focus groups were run with clients who attended the program during the previous months, to delineate the strengths of the program and to identify areas for improvement.

Results: Analyses showed statistically and clinically significant improvements in client symptomatology, as evidenced by reductions on the Geriatric Depression Scale and the Clinical Outcomes in Routine Evaluation Outcome Measure in clients who completed the program. Focus group participants overwhelmingly described the program as very beneficial, but the desire for on-going follow-up was clearly articulated.

Conclusions: A practice model employing group-based cognitive-behavioural and interpersonal strategies that emphasizes behavioral activation and socialization is associated with a reduction in depressive symptoms and psychological distress in a large sample of elderly adults in a day treatment service with mild to moderate symptoms of depression and anxiety.

Clinical Implications: In the future, a mechanism for on-going mental health support should be included. Many clients want to remain connected to the system, but there is not always a clear path along the continuum of care, particularly for clients who no longer meet criteria for a psychiatric disorder.