Outcome of a unique youth drug abuse program: A follow-up study of clients of Straight, Inc.

A unique feature of the 12-hour per day Straight, Inc., program is temporary placement of the client with the family of a client who has progressed further in the program. Eighty-five (85) percent of the clients reported that their drug use was less at follow-up than when they started in the program. Follow-up reports by parents indicated their impression of a statistically significant decrease in the proportion of clients who were still involved in substance use. Statistically significant improvement at follow-up was also reported by the clients on seven of eight other selected outcome criteria (e.g., suicidal thoughts, physical violence, number of arrests, etc.). The majority of the clients reported that they were “satisfied” with the program (70%), that the program “helped” them (74%), and, specifically, that the program helped them with their relationship with their parents (69%).     

Predicting the therapeutic alliance in alcoholism treatment

OBJECTIVE: Prediction of the therapeutic alliance in alcoholism treatment (as rated by the client and by the therapist) was examined in light of a range of potentially relevant factors, including client demographics, drinking history, current drinking, current psychosocial functioning and therapist demographics. METHOD: The data were gathered in Project MATCH. The present analyses were based on data from 707 outpatients and 480 aftercare clients assigned to one of the three Project MATCH treatments. Potential predictor variables were evaluated by first examining bivariate linear relationships between the variables and ratings of the alliance, and then entering blocks of these predictors into multiple linear regression equations with alliance ratings as the dependent variables. All analysis incorporated adjustments for the nonindependence of ratings pertaining to clients seen by the same therapist. RESULTS: In simple regressions evaluating bivariate relationships, outpatients' ratings of the alliance were positively predicted by client age, motivational readiness to change, socialization, level of perceived social support and therapist age, and were negatively predicted by client educational level, level of depression, and meaning seeking. Therapist ratings in the outpatient sample were positively predicted by the client being female and by level of overall alcohol involvement, severity of alcohol dependence, negative consequences of alcohol use, and readiness to change. Among aftercare clients, ratings of the alliance were positively predicted by readiness to change, socialization and social support, and were negatively predicted by level of depression. Therapist ratings of the alliance in the aftercare sample were positively predicted by the client being female and therapist educational level, and were negatively predicted by pretreatment drinks per drinking day. Of the variables having significant bivariate relationships with alliance scores, only a few were identified as significant predictors in multiple regression equations. Among outpatients, client age and motivational readiness to change remained positive predictors and client education a negative predictor of client ratings of the alliance, while client gender remained a significant predictor of therapist ratings. Among aftercare clients, readiness to change and level of depression remained significant predictors of client ratings, while none of the variables remained a significant predictor of therapist ratings. CONCLUSIONS: While the data indicate that several client variables predict the nature of both the client's and therapist's perception of the therapeutic alliance, the significant relationships are of modest magnitude, and few variables remain predictive after controlling for causally prior variables. The strongest relationship identified in both the outpatient and aftercare samples is that between clients' motivational readiness to change and their ratings of the alliance.     

A prospective study of treatment outcome with a group of male problem drinkers

The present study was a follow-up of a group of young male problem drinkers (N = 96) presenting to a community-based treatment facility. Clients were assessed before and a minimum of twelve months after a set of brief treatment programs using a number of drinking- and nondrinking-related measures of functioning and corroborative information from a collateral. Regular contact was maintained with clients and collaterals throughout the follow-up period. Follow-up assessment data were available for 80 (83.3%) clients and collateral information for 84 (88%) clients. There were no significant differences found at follow-up between treatments used. There were, however, significant improvements evident on all measures of functioning in the total client group. Using stepwise discriminant analyses, clients classified as problem drinkers at follow-up were found to have higher scores on indices of problem drinking (including alcohol consumption, blackouts and legal charges) at their pretreatment assessment. Multiple regression analyses revealed that the best pretreatment predictors of client functioning at follow-up were measures of alcohol-related problems (accidents, jail, hangovers, morning drinking and deterioration). Factors limiting the interpretability and generalizability of these findings are discussed with particular reference to sample size and idiosyncrasies.     

The differential effect of a set of brief interventions on the functioning of a group of “early-stage” problem drinkers

The present study evaluated the effectiveness of different treatment conditions on the functioning of a group of male problem drinkers (N = 96) presenting to a community agency for treatment. Clients were randomly assigned to one of three treatment conditions and assessed before treatment and again a minimum of twelve months after using a number of drinking and non-drinking-related measures of functioning. Corroborative information was obtained from a person nominated by each client. Contact was maintained with clients and their collaterals throughout the follow-up period. Follow-up assessment data were available for 80 (83%) clients; and collateral information for 84 (88%) clients. At follow-up, using self-report data, 38 clients (40% of initial sample) were classified as improved, 5 were abstinent and 33 non-problem drinkers. Analyses of variance and discriminant analyses were used to ascertain the effects of treatment on client status at follow-up. Treatment was not found to exert a differential effect on outcome. Significant improvements were found on numerous measures of functioning irrespective of treatment conditions. The limitations of the study particularly in reference to sample size and characteristics are discussed and recommendations are made concerning the importance of incorporating client follow-up into treatment regimens.     

The influence of the therapeutic relationship in treatment for alcohol dependency

The substance abuse field has been slow to embrace research into the impact of the therapeutic relationship on treatment outcome. Limited previous research has demonstrated that therapist factors such as unconditional regard and empathy are associated strongly with treatment outcome. This study examined the relationships between client perception of the therapist and client characteristics; client response to out-patient relapse prevention treatment; and client outcome 3 months following treatment for alcohol dependence. One hundred and sixty-one male clients of a 3-week relapse prevention programme participated in the research, completing questionnaires assessing their perception of therapist regard, empathy, congruence, attractiveness, expertness and trustworthiness.Treatment outcome was measured at the conclusion of treatment, and 3 months post-treatment. Clients who were more anxious and those with poorer cognitive functioning appeared to perceive therapists as showing less unconditional regard, empathy and congruence. Self-efficacy and coping skills acquisition measured at the end of treatment correlated significantly with clients' perceptions of the therapist as empathic, congruent and displaying high regard for them. Treatment outcome at 3 months was associated significantly with degree of perceived therapist expertness and empathy. These relationships held when cognitive functioning and skills acquisition were controlled for. Self-efficacy moderated the relationships between regard and empathy and outcome, but not perceived therapist expertness. A lower than desirable follow-up rate limits the generalizability of the findings. The quality of the therapeutic relationship as perceived by clients appears to be associated with client characteristics, response to treatment and treatment outcome.     

Change in psychosocial functioning and social relations among women in residential substance abuse treatment

Purpose: The purpose of this study was to examine the degree to which psychosocial functioning and social relationships changed during the first 3 months of treatment among women in a residential substance abuse program that emphasizes the importance of developing healthy relationships. Methods: Participants included 77 female clients admitted to the Salvation Army First Choice (FC) Program in Fort Worth, TX. Assessments of psychological functioning, family relations, and peer relations were administered at treatment entry and again after 3 months. Relationships with clients in treatment and friends outside treatment were measured separately. Results: Repeated-measures analyses of variance (ANOVA) indicated that interpersonal relationships improved. Family networks increased, family cohesion increased, and family conflict decreased. Peer networks changed as well, due in part to new relationships with other clients in treatment. The number of drug-using friends decreased, peer deviance and negative influence decreased, and social conformity among friends increased. There was a corresponding improvement in psychosocial functioning. Implications: Results suggested that relationship-centered treatment for women was effective. Clients reestablished connections with family members, disassociated from drug-using peers, and improved the quality of relationships with family members and friends. Further research is needed in order to examine the influence of specific treatment components and the potential long-term effects of changes in women's relationships.     

A family outreach intervention for engaging young out-of-treatment drug users: Pre- versus post-treatment comparison

Only a small fraction of drug users worldwide enter treatment each year. We evaluated the efficacy of a systemic family outreach intervention (SFOI) for young, untreated drug users, using a quasi-experimental design in which the experimental group (EG) received SFOI and the control group (CG) received traditional outreach work (OW). Both pre- and post-treatment, we administered the Addiction Severity Index–6 (ASI-6), the Family Environment Scale (FES), and tests of parental practices and risky behavior. Post-treatment, there was a fivefold improvement on the ASI-6 and a significant worsening on the conflict sub-scale of the FES in the EG as compared with the CG. SFOI was more efficacious than OW in reducing drug use in the drug user's home environment. The increased conflict in the EG might be explained by parents' increased awareness of abnormal behaviors and implementation of strategies to protect their children.     

Comparative Cocaine Abuse Treatment Strategies:

The current investigation explores the clinical utility in providing a series of enhanced clinical services to a sample of 303 cocaine-abusing clients (primarily crack smokers) relative to a standard group therapy treatment program. In addition to examining the comparative impact of six varying psychosocial treatment approaches for cocaine abuse on client retention and treatment exposure rates, an additional emphasis has been to examine the ability of fixed and dynamic client variables in predicting client outcome in this regard. No fixed (e.g., sex, income, marital status, income level, or employment status) or dynamic (e.g., recent alcohol use, antisocial personality disorder diagnoses, or motivational variables) client characteristics were useful in predicting client client retention or treatment exposure rates. Program characteristics, however, or the frequency, intensity, and/or type of treatment services offered, were related to client retention and treatment exposure. Treatment exposure and retention were significantly enhanced by providing clients with more frequent and intensive group therapy, or by adding individual treatment services to a standard group therapy treatment regimen. With a population such as cocaine abusers, who typically have an extremely high treatment dropout rate, an obvious strategy is to focus efforts on engaging and retaining clients in treatment, and maximizing levels of treatment exposure. The current findings suffest that one successful approach towards enhancing psychosocial treatments for cocaine abuse is to increase the frequency, intensity, and/or types of treatment services offered.     

THE IMPACT OF A FAMILY EMPOWERMENT INTERVENTION ON JUVENILE OFFENDER HEAVY DRINKING: A LATENT GROWTH MODEL ANALYSIS*

We report the results of a growth model analysis of the impact of a Family Empowerment Intervention (FEI) on the heavy drinking over a 36-month follow-up period among youths processed at the Hillsborough County Juvenile Assessment Center. Families involved in the project were randomly assigned to either receive an Extended Services Intervention (ESI) or the FEI. Families in the ESI group received monthly phone contacts and, if indicated, referral information; FEI families received three one-hour, home-based meetings per week for approximately 10 weeks from a clinician-trained paraprofessional. By seeking to improve family functioning by empowering parents, it was hypothesized that target youths' behavior and psychosocial functioning would improve. Although the difference between FEI and ESI was not significant, the reported frequency of getting very high or drunk on alcohol declined more over time for FEI completers than FEI noncompleters. The results provide support for the impact of the FEI services.     

Engaging resistant adolescents in drug abuse treatment

In the first phase of a two-part treatment development study, families with a treatment-resistant drug-abusing adolescent (n = 42) were offered 12 sessions of Community Reinforcement and Family Training (CRAFT). This parent-focused intervention was designed to help parents facilitate their adolescents' entry into treatment, to support adolescents' subsequent behavior change, and to improve parent and family functioning. In the second phase, successfully engaged adolescents (n = 30) were offered 12 sessions of a multicomponent individual cognitive-behavioral therapy (CBT) targeting substance use and related problem behaviors. For parents and adolescents, measures were collected on pretreatment and posttreatment, with an additional follow-up assessment for parents at 3 months after treatment. Parents on CRAFT intervention experienced a significant reduction in negative symptoms, and 71% of parents were successful in engaging their resistant youths in treatment. The CBT intervention for engaged youths was associated with a statistically significant, but not clinically significant, reduction in marijuana use.     

男性酒依赖患者家庭环境、父母教养方式调查研究

目的：探讨男性酒依赖患者的家庭环境、父母教养方式的特点,为干预提供依据。方法：采用家庭环境量表中文版（FES—CV）、父母养育方式评价量表（EMBU）对48例男性酒依赖患者进行问卷调查,并与健康成人对比。结果：与正常对照组相比,男性酒依赖者家庭表现为低亲密度、低情感表达、低成功性、高矛盾性和控制性差（P〈0．05或P〈0．01）。在教育方式上,酒依赖患者父母亲表现为低情感温暖、高惩罚严厉、过分干涉和拒绝否认（P〈0．01）。结论：男性酒依赖患者的家庭环境、父母教养方式方面存在诸多方面的问题,可能对男性酒依赖患者的酒精依赖的发生起着重要的作用。     

Prediction of Successful Response to Multimodality Treatment among Heroin Addicts

In an effort to identify predictor variables associated with successful response to multimodality treatment among heroin addicts, this investigation compared addict-clients classified by means of behavioral ratings into success and failure groups on 16 social history and 18 psychological variables using stepwise discrimination techniques. Statistical analyses correctly classified 100% of the treatment failure group and 92% of treatment successes. Successful clients were characterized by more advanced educational achievement at intake, later onset of opiate use, higher scores on MMPI Scales Es and L, and lower scores on MMPI Scale 7. Results suggest that collection and analyses of such data at intake may provide a reliable basis for prediction of treatment outcome as well as an objective means for early identification of “high risk” individuals who may require a more concentrated and individualized therapeutic effort.     

Is Image Everything? The Role of Self-Image in the Relationship Between Family Functioning and Substance Use Among Hispanic Adolescents

This cross-sectional self-report study examined (1) whether family functioning (Family Functioning in Adolescence Questionnaire, FFAQ) and self-image (Piers–Harris Children's Self-Concept Scale) have independent associations with smoking and alcohol use and (2) whether self-image mediates the relationship between family functioning, smoking, and alcohol use among 1,598 Hispanic males and females in grades 7 through 12 in Los Angeles County, California, in 2001. The findings supported the main effects and, to some degree, the mediational effects that were hypothesized. Limitations and implications for this study are discussed, and directions for future research are suggested. This study was funded by the California Tobacco Related Disease Research Program.     

Development of a Brief Treatment Instrument for Routine Clinical Use with Methadone Maintenance Treatment Clients: The Methadone Treatment Index

Routine measurement of treatment outcome between clinician and client in alcohol and drug user treatment services is an important quality improvement initiative. It is particularly important for clients receiving long-term treatment such as methadone maintenance treatment, as fluctuations in substance use, functioning, and health are to be expected. Although there are a number of standardized alcohol and drug user treatment outcome instruments available for research and clinical use, a key challenge is to develop clinical instruments that will actually be used routinely in busy practice settings by a range of staff. Such instruments need to be brief, acceptable to staff and clients, easy to use, provide immediate feedback, and meet adequate psychometric requirements. This report describes development work undertaken in three studies of the Methadone Treatment Index (MTI). The MTI is a brief instrument comprising measures of recent substance use, aspects of social and behavioral functioning, and physical and psychological health. The MTI was designed in consultation with clinicians and clients for use in monitoring treatment progress with clients receiving methadone maintenance treatment. Key findings were that the MTI was acceptable to clients, produced clinically relevant information, and has satisfactory psychometric properties, although it was not used to measure change in this study. Further evaluation of the MTI on a longitudinal basis is supported.     

Development of a brief treatment instrument for routine clinical use with methadone maintenance treatment clients: the methadone treatment index

Routine measurement of treatment outcome between clinician and client in alcohol and drug user treatment services is an important quality improvement initiative. It is particularly important for clients receiving long-term treatment such as methadone maintenance treatment, as fluctuations in substance use, functioning, and health are to be expected. Although there are a number of standardized alcohol and drug user treatment outcome instruments available for research and clinical use, a key challenge is to develop clinical instruments that will actually be used routinely in busy practice settings by a range of staff. Such instruments need to be brief, acceptable to staff and clients, easy to use, provide immediate feedback, and meet adequate psychometric requirements. This report describes development work undertaken in three studies of the Methadone Treatment Index (MTI). The MTI is a brief instrument comprising measures of recent substance use, aspects of social and behavioral functioning, and physical and psychological health. The MTI was designed in consultation with clinicians and clients for use in monitoring treatment progress with clients receiving methadone maintenance treatment. Key findings were that the MTI was acceptable to clients, produced clinically relevant information, and has satisfactory psychometric properties, although it was not used to measure change in this study. Further evaluation of the MTI on a longitudinal basis is supported.     

Family Experience and the Motives for Drinking

Family socialization experience as reported by 128 students was posited to be related (both linearly and curvilinearly) to the seriousness of the reasons or motives for drinking. A correlational analysis, following orthogonalization of the independent variables, indicated that the frequency of intoxication by the mother was linearly and positively related to the number of reasons checked by students for drinking. Extreme closeness and extreme distance between the parents was related to drinking for personal effects (i.e., to improve self-esteem), while neutral or ambiguous attitudes toward drinking by the father were related principally to moderately serious personal and interpersonal reasons for drinking. The findings suggest that college students are at risk of becoming problem drinkers to the extent their family socialization experience included maternal deviant drinking, weak or fuzzy paternal norms about drinking, and extreme closeness or distance between parents. Family conditions that lead to poor self-esteem were seen as a necessary but not sufficient cause of problem drinking. Suggestions are made for future research and for a new, conceptually related alcoholism-prevention program.     

Working It Out: Development and Testing of a Multimedia,Vocational Education Program

A self-administered, CD-ROM-based, interactive multimedia psychoeducational intervention, called Working It Out, was developed to improve employment functioning for clients in substance dependency treatment. The computer-based program's effectiveness was tested in comparison with printed material. During 2000–2001 194 clients with employment concerns in six treatment programs were randomly assigned to a CD-ROM or print material condition and evaluated at baseline and 6 months later. A main effect for improvement was observed on employment indices, but there was no condition-by-time interaction. Results suggest that clients are willing and able to use vocational rehabilitation information presented in any format, although the CD-ROM-based program received significantly better satisfaction ratings than did the print material.     

Association Among Outcomes in a Naturalistic Statewide Assessment of Substance User Treatment

Substance user treatment outcome measurement is important for research and policy questions, yet little literature has addressed the relationships among outcome measures of treatment success. Ideally, treatment outcomes would correlate to at least a moderate degree. The Iowa Department of Public health requires substance user treatment programs receiving public funds to provide client information. Demographic information, “substance abuse” history, current use, arrests, and hospitalizations were ascertained at admission and a 6-month follow-up for 1374 clients (from January 1999 to December 2000). Abstinence, arrests, and hospitalizations were good outcome measures of substance user treatment success. Reduction in frequency of use was negatively associated with arrests, substance use-related hospitalizations, and increased income. Full-time employment at follow-up produced different results depending on the client's sex. However, all associations among outcomes were modest. Specificity may be reasonable in some instances; however, other situations might require a broad-spectrum approach that ideally would produce a wide range of benefits.     

Interaction of Counseling Rapport and Topics Discussed in Sessions with Methadone Treatment Clients

Therapeutic rapport between counselors and clients in drug user treatment has been shown to be an important predictor of follow-up outcomes. This naturalistic study investigated the relationship of counseling rapport to drug-related topics discussed in counseling sessions in a sample of 330 clients and nine counselors. These voluntary clients had been admitted to a private, for-profit outpatient methadone treatment in Texas between September 1995 and August 1997 and received no-fee services for a year for participation in this study. The data were gathered using forms in the TCU community treatment assessments (www.ibr.tcu.edu) that measured intake information, counseling session topics, and counselor evaluation of the client. A majority were males, Hispanic, had a pending legal status and the average age was 39. Co-occurring drug dependence for these heroin users included cocaine (38%) and alcohol (31%). The results supported the hypothesis that higher rapport would be associated with addressing clients in a more “supportive approach” that emphasized relapse prevention and strengths-building while lower rapport would be associated with a punitive counseling style that stressed program rules and compliance. The influences of client background, counselor differences, and during-treatment positive urines were also examined. Although counselors differed in their general manner of dealing with clients, each also showed flexibility determined in part by client behavior (such as continued cocaine use). The findings indicate that focusing on constructive solutions is the preferred counseling approach.     

Relational Skills and Client Language Predict Outcome in Smoking Cessation Treatment

Background: We currently lack insight into the predictive processes of Motivational Interviewing (MI) in smoking cessation treatment. More knowledge is necessary to be able to further enhance the treatment effect in smoking cessation interventions. Objectives: To examine certain hypothesized active components of MI in smoking cessation treatment delivered in an ordinary clinical setting. Methods: Audio-recordings of 106 smoking cessation treatment sessions were analyzed using the Motivational Interviewing Sequential Code for Observing Process Exchanges (MI-SCOPE) Coder's Manual and the Motivational Interviewing Treatment Integrity code (MITI) Manual, version 3.1. The outcome measure was self-reported 6-month continuous abstinence at 12-month follow-up. Results: Client Activation utterances in favor of change were positively associated with smoking cessation at follow-up. The combined category of client language expressing a Desire or a Need to continue to smoke was negatively predictive of smoking cessation. In addition, we found preliminary support for a negative interaction effect between counselors' demonstration of the spirit of MI and clients Activation utterances in favor of change. Conclusions/Importance: Our data suggest that if smoking cessation counselors cultivate client Activation utterances in favor of abstinence and softening client utterances expressing desire or perceived need to smoke, this could contribute to higher rates of treatment success. In addition, counselors' demonstration of the spirit of MI was a statistically significant predictor of outcome when the negative interaction effect between Activation utterances in favor of change and MI spirit was taken into account. These findings should be evaluated in larger studies in the future.