Managerial capacity and adoption of culturally competent practices in outpatient substance abuse treatment organizations

The field of cultural competence is shifting its primary emphasis from enhancement of counselors' skills to management, organizational policy, and processes of care. This study examined managers' characteristics associated with adoption of culturally competent practices in the nation's outpatient substance abuse treatment field. Findings indicate that in 1995, supervisors' cultural sensitivity played the most significant role in adopting practices, such as matching counselors and clients based on race and offering bilingual services. Staff's exposure to cross-cultural training increased from 1995 to 2005. In this period, positive associations were found between managers' cultural sensitivity and connection with the community and staff receiving cross-cultural training and the number of training hours completed. However, exposure to and investment in this training were negatively correlated with managers' formal education. Health administration policy should consider the extent to which the decision makers' education, community involvement, and cultural sensitivity contribute to building culturally responsive systems of care.     

Tailored treatment in the outpatient substance abuse treatment sector: 1995-2005

Interest in improving the quality of addiction treatment has led to the development of clinical paradigms that emphasize the principle of tailored care-matching treatments to the specific needs of each client or client subgroup. This work analyzes how trends in the provision of tailored treatment practices (TTPs) have changed between 1995 and 2005 across outpatient substance abuse treatment (OSAT) programs in the United States. Categories of interest include measures to capture needs assessment and treatment planning activities, treatment offerings for special populations, and case management activities. Results show that TTPs have diffused in an uneven fashion in the population of OSAT programs between 1995 and 2005. Specifically, needs assessment/treatment planning and case management remain a relatively common practice among OSAT programs, while treatment for special populations (especially same-race therapy) is less widely practiced and, indeed, experienced some decline over the study period. This trend is troublesome given that minority clients constitute a large proportion of those utilizing OSAT programs.     

The value of acupuncture detoxification programs in a substance abuse treatment system

Our purpose is to compare baseline characteristics and detoxification readmission rates of clients treated at outpatient acupuncture programs and at short-term residential programs, two options available to persons seeking substance abuse detoxification. This was a retrospective cohort study using data on clients discharged from publicly funded detoxification programs in Boston between January 1993 and September 1994. Multivariate models were used to examine the effect on 6-month detoxification readmission rates of treatment at residential detoxification programs (used by 6,907 clients) versus at outpatient acupuncture programs (used by 1,104 clients) after adjusting for baseline differences. Acupuncture clients were less likely to be readmitted for detoxification within 6 months (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.53–0.95). Similar results were found when the analysis was performed on a subsample of clients that were relatively similar in terms of baseline characteristics (OR 0.61, 95% CI 0.39–0.94). We determined that acupuncture detoxification programs are a useful component of a substance abuse treatment system.     

Estimating the prevalence of individuals likely to use publicly funded alcohol treatment services: an indirect estimation technique

Introduction and Aims . Determining prevalence estimates of illicit or stigmatised behaviours is problematic, due to under‐reporting and difficulties in sampling adequately populations most at risk of engaging in such behaviours. This has led to the development of indirect prevalence estimation techniques such as multiplier methods, capture–recapture, multivariate indicator methods and back‐calculation. This study reports on the development of a treatment multiplier to estimate the number of clients estimated to seek treatment through publicly funded services annually. Design and Methods. This study uses a multiplier method of indirect prevalence estimation, using the number of clients receiving publicly funded treatment as the benchmark population. Data for the multiplier were collected through a drug and alcohol telephone information and referral helpline. Participants are callers seeking assistance for their own alcohol use. Results . Results indicate that up to 40 200 individuals (95% confidence interval: 34 900, 47 000) may seek treatment at these agencies annually. This estimate represents a 300% increase in current publicly funded treatment provision. Discussion and Conclusion . This method was cost‐effective and resulted in estimates similar to those obtained through a population‐based survey. This method can be adapted easily to areas with a complete registry of clients receiving publicly funded alcohol or drug treatment services and a helpline service with adequate geographic coverage.     

Demarginalizing the marginalized in substance abuse treatment: Stories of homeless,active substance users in an urban harm reduction based drop-in center

This article reports stories of demarginalization in treatment as told by participants of a nonabstinence-based treatment program based on a harm reduction model targeting homeless active users. The stories told are ones where drug users–marginalized due to their drug and/or alcohol use–experienced the treatment setting in a destigmatizing, normalizing, humanizing and nonjudgmental manner. The purpose of this article is to describe the sense of demarginalization that participants experienced and to posit that demarginalization is a critical component in engaging “hard-to-reach” populations in substance abuse treatment. It assumes that listening to consumer voices about what is/is not meaningful to them in treatment can reveal much about program uptake or disconnect.     

Adolescent-only substance abuse treatment: Availability and adoption of components of quality

There are few studies of the availability and quality of adolescent-only treatment programs. Drawing upon existing samples of publicly and privately funded treatment programs, this research considers whether organizational characteristics are associated with the availability of adolescent-only programming and measures components of quality within these programs. Significant organizational correlates of adolescent-only services included organizational size, location within a hospital setting, center accreditation, adherence to a 12-step treatment model, and reliance on public sources of funding. In-depth interviews were then conducted with 154 managers of adolescent-only treatment programs regarding levels of care offered and service quality. The most prevalent levels of care were standard outpatient and intensive outpatient. Analysis of nine domains of treatment quality revealed a medium level of quality. Treatment quality was significantly greater in programs offering more intensive levels of care. These results are largely consistent with other recent research and suggest a need for continued quality improvement efforts in this treatment sector.     

Readiness to change in adults waiting for publicly funded substance abuse treatment

The primary objective of this study was to evaluate the factor structure of a modified version of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) for a sample of indigent adults with alcohol and other drug problems. A community sample of 338 adults on waiting lists for entrance into publicly funded substance abuse treatment completed a 19-item modified version of the SOCRATES. Confirmatory factor analyses were conducted on two structural models of the SOCRATES based on prior literature. The results indicated that a two-factor model of the SOCRATES provided the best fit for the data in this study. Suggestions for future research using a modified version of this measure are discussed.     

Client factors associated with treatment completion in a substance abuse treatment facility

This study examined a sample (n?=?415) of patients initiating short-term substance abuse treatment to determine if demographic factors, personality factors, presenting affect, or presenting symptom severity could predict treatment completion. A logistic regression was conducted and results indicated that men, individuals scoring lower on a measure of neuroticism, and patients who reported higher levels of presenting agitation were all less likely to successfully complete the treatment program; 12% of the variance in completion was accounted for by these constructs. Presenting symptom severity, other indicators of the Big Five personality constructs, and additional negative affect indictors were not significant predictors of treatment completion. The implications for research and practice are discussed.     

Personal networks of women in residential and outpatient substance abuse treatment

This study compared compositional, social support, and structural characteristics of personal networks among women in residential (RT) and intensive outpatient (IOP) substance abuse treatment. The study sample included 377 women from inner-city substance use disorder treatment facilities. Respondents were asked about 25 personal network members known within the past 6 months, characteristics of each (relationship, substance use, types of support), and relationships between each network member. Differences between RT women and IOP women in personal network characteristics were identified using Chi-square and t-tests. Compared to IOP women, RT women had more substance users in their networks, more network members with whom they had used substances and fewer network members who provided social support. These findings suggest that women in residential treatment have specific network characteristics, not experienced by women in IOP, which may make them more vulnerable to relapse; they may therefore require interventions that target these specific network characteristics in order to reduce their vulnerability to relapse.     

Smoking cessation during substance abuse treatment: what you need to know

Patients in substance abuse treatment frequently smoke cigarettes and often die of tobacco-related causes. Substance abuse treatment programs too often ignore tobacco use. Many patients have expressed interest in stopping smoking, although they may be ambivalent about smoking cessation during substance abuse treatment. This article provides a review of tobacco cessation literature and successful methods of intervention. Research supports two key findings: (a) smoking cessation during substance abuse treatment does not impair outcome of the presenting substance abuse problem and (b) smoking cessation may actually enhance outcome success. We will discuss how to incorporate smoking cessation.     

Men's issues: gender role conflict and substance abuse

The present paper aims to explore issues related to men within the context of seeking help for substance abuse. The male gender role is in conflict with help-seeking behaviour and with the fundamental principles of therapy, i.e. introspection, emotional expressivity and acknowledgement of difficulties. This creates a paradox for the male seeking psychological treatment and, it will be argued, particularly for the male substance abuser. It is argued that interventions which address the gender role and challenge men's perceptions of themselves are critical variables in the outcome of therapy, i.e. enabling them to make the necessary changes in order to promote psychological well-being. An examination of the male gender role in relation to intrapsychic issues and family systems will be followed by a brief discussion of therapeutic interventions. Some of the difficulties and issues confronted by workers who work with male substance abusers will be explored.     

Transferring psychological technology into substance abuse treatment: Substance abuse as a psychiatric illness

A model of transferring psychological technology into substance abuse treatment programs based on viewing substance abuse as a psychiatric illness and treating it as such is presented. This theoretical framework integrates disparate technical developments, such as relapse prevention, harm reduction, motivational interviewing/motivational enhancement, and contingency management. Implications for treatment and outcome measurement are described, and an example of how one program used this model is presented.     

Family functioning as a predictor of progress in substance abuse treatment

This study tested the hypothesis that the level of family functioning is related to changes in the patient's progress while in treatment. We studied the relation of family functioning, as measured by the Family Adaptability and Cohesion Scales' (FACES II) dimensions of cohesion and adaptability, to 7 dimensions of the severity of patient drug use, as measured by the Addiction Severity index (ASI). The results indicated that family functioning, the cohesion dimension in particular, predicts severity of patient's dysfunction resulting from drug use and family and psychological problems. In particular, 28% of the variability in the ASI Drug Problems, 52% of the variability in the ASI Family Problems, and 29% of the variability in the ASI Psychological Problems were accounted for by the FACES II cohesion score. Although the study has several limitations, it supports the relevance of family factors in the treatment of drug-addicted patients.     

A brief report on Hispanic youth marijuana use: Trends in substance abuse treatment admissions in the United States

Increases in Hispanic youth admissions to substance abuse treatment programs for marijuana use are a growing public health concern. In this study, we investigated trends in Hispanic youth from 1995 to 2012 utilizing the Treatment Episode Data Set—Admissions of the Substance Abuse Mental Health Services Administration. Hispanic youth marijuana admissions are associated with youth 15–17 years old, in high school, and living in a dependent situation. Notably, female admissions increased at greater rates than males. Results also point to decreasing tolerance of minor marijuana use by schools and community agencies. Findings highlight the need for targeted, culturally specific, and cost-effective treatment and prevention efforts.     

Gender-sensitive therapy : An alternative for women in substance abuse treatment

This article examines internal and external factors that put women at risk of substance use/abuse. Gender-sensitive therapy is suggested as an effective treatment to deal with the intrapsychic causes of problems as well as societal expectations and oppression that contribute to women's thoughts and behaviors. The focus of therapy is on providing a caring, nurturing, and empowering environment for women to become independent decision makers.     

Organizational factors associated with the use of contingency management in publicly funded substance abuse treatment centers

A promising area within technology transfer studies is the identification of organizational factors that influence the adoption of treatment innovations. Although studies have identified organizational factors associated with the adoption of pharmacological innovations, few studies have examined organizational factors in the adoption of psychosocial innovations, among which contingency management (CM) is a significant practice. Using data from a sample (N = 318) drawn from the population of publicly funded treatment centers in the United States, this study modeled organizational factors falling in the domains of structural characteristics, workforce variables, values and norms, and patient characteristics associated with the use of CM. Organizations were more likely to use CM if they embrace a supportive therapeutic approach, are research friendly, offer only outpatient levels of care, or serve drug-court patients. Implications for studying the diffusion and implementation of evidence-based psychosocial interventions are discussed.     

An integrated approach for dually diagnosed patients in a substance abuse treatment program: Case presentation

Patients with co‐occurring psychiatric and substance use disorders experience worse social and clinical outcomes and are in need of adequate and simultaneous treatment for both disorders. The case presented illustrates the diversity of psychosocial, health, and behavioral problems and the complexity of treatment of a dually diagnosed patient. The authors discuss the benefits of using an integrated approach in an addiction treatment setting. The authors also review the importance of an integrated treatment model for populations with inadequate health care resources who are at high risk for medical and psychiatric complications.     

Influence of ownership on access in outpatient substance abuse treatment

Marked changes in ownership and control in substance abuse treatment delivery have garnered the attention of providers and policymakers alike. The proliferation of private for-profit providers and the shift to a delivery system that may be more explicitly influenced by financial incentives are of particular concern for this vulnerable population. This work empirically addresses how treatment unit ownership affected access and retention between 1995 and 2005 in the United States. Regressions show statistically significant associations between unit ownership and both restricted treatment access and shortening of treatment duration for financial reasons. In comparison to private nonprofit and public units, private for-profit units were less likely to provide initial treatment access and reported shortened treatment for a greater percentage of clients unable to pay. Other organization characteristics, such as methadone-maintenance programs and managed care participation, also were associated with limiting treatment accessibility. While this work does not determine the underlying motivation behind access limitations, continued shifts in ownership structure should heighten the attention of policymakers.