Treatment Motivation and Therapeutic Engagement in Prison-Based Substance Use Treatment

Abstract

Studies of community-based substance use treatment show that motivation for treatment is critical for clients becoming therapeutically engaged. Little research, however, has been conducted on therapeutic engagement in corrections-based substance use treatment. The current study examines the association between internal treatment motivation and therapeutic engagement for a sample of 220 male substance-using offenders enrolled in a corrections-based treatment program. Findings showed that problem recognition and desire for help were associated with cognitive indicators of therapeutic engagement, specifically confidence in and commitment to treatment. Increased focus on internal motivation for treatment may lead to more effective treatment for substance-using offenders. Pretreatment motivational interventions therefore are recommended for substance-using offenders with low internal motivation for treatment.     

One Dozen Considerations When Working with Women in Substance Abuse Groups

Abstract

Women and men have different histories, presentations, and behaviors in substance abuse groups. Twelve considerations are offered for the beginning group leader when encountering women with substance abuse issues. These include understanding sexism, what brings women to treatment, and how women behave in group treatment. Implications for clinical practice with women in single-gender and mixed-gender groups are included.     

Effective Treatment for Substance Abuse:

No abstract available for this article.     

Examining Gender Differences in Adolescent Substance Abuse Behavior: Comparisons and Implications for Treatment

ABSTRACT

This study investigates gender differences in adolescent substance abuse behavior, treatment effectiveness, and the associated relationships with pre-, during-, and post-treatment groups of variables. Analyses were performed using 6-month post-treatment follow-up data from over two thousand subjects. T- test analysis showed that females exhibited more psychological difficulties, family-related problems, and sexual abuse experiences, whereas males exhibited worse school and legal problems before treatment. Females also showed better attendance in aftercare or self-help groups and better treatment outcomes than males. Discriminant function analyses indicated that school problems, legal problems, lack of religious involvement, and substance abuse before treatment could discriminate abstinence status for females at 6-month follow-up. Substance abuse before treatment, length of stay, and parental participation in treatment could differentiate abstinence status for males at 6-month follow-up. Limitations in applying research findings and implications for adolescent substance abuse treatment are also discussed.     

Identifying United States Substance Abuse Treatment Programs

ABSTRACT

An accurate national listing of substance abuse treatment programs is essential for reporting data about the nation's treatment system and the clients entering that system. The National Survey of Substance Abuse Treatment Services (NSSATS) is thought to provide the most comprehensive list of treatment providers. Therefore, we report a partial test of the concurrent validity of the NSSATS in a single mid-sized city. Using operational definitions of “substance abuse treatment” and “substance abuse treatment programs” derived from prior work by the Center for Substance Abuse Treatment; and working within the defined geographic boundaries of a single, mid-sized city, we compared the NSSATS list with an independently developed compilation of programs from 5 sources: (1) the Yellow Pages; (2) the Internet Infospace Directory; (3) a State directory of licensed substance abuse treatment services; (4) the Office of Applied Studies Directory; (5) the National Master Facility Inventory.

With all sources, including NSSATS, we identified 96 separate listings that met the operational definition of adult treatment within the geographic bounds of the city. The NSSATS identified 70 of those 96 programs (73%), the 5-source compilation identified a sample of 83 (86%). While these findings from a single city cannot be considered a full test of the validity of the NSSATS, the data presented offer at least one partial but promising indication that the NSSATS may be a valid national listing and may serve as satisfactory national frame.     

Substance Abuse/Dependence Treatment: A European Perspective

ABSTRACT. During the past decade, substantial progress has been made in the field of addiction medicine in Europe, particularly regarding the development of new treatment interventions, resulting in a wide range of therapeutic options for patients with substance use disorders. However, not all interventions are evidence based. Patients with cannabis and cocaine/amphetamine use disorders and special patient populations especially lack evidence-based treatment recommendations. Many patients undergo treatment that has not been scientifically evaluated for quality and efficacy. Moreover, there are large disparities regarding availability and treatment access across Europe, with the new member states of the European Union (EU) reporting long waiting lists and low treatment coverage. Even in Austria, which ranks among the countries with relatively high treatment coverage and good diversification of treatment in opioid maintenance therapy due to the availability of methadone, buprenorphine, and slow-release oral morphine (SROM), a considerable population of untreated or inadequately treated patients exists. Treatment for substance use disorders in Europe still has scope for improvement in terms of treatment availability and access, which is ideally provided by further development and implementation of evidence-based interventions.     

Measuring Behaviors of Individual Adolescents During Group-Based Substance Abuse Intervention

ABSTRACT

Background: Group treatment is delivered in youth correctional facilities, yet groups may be iatrogenic. Few measures with demonstrated psychometric properties exist to track behaviors of individuals during groups. The authors assessed psychometrics for the Group Process—Individual Level measure (GP-IL) of group treatment. Methods: N = 152 teens were randomized to 1 of 2 groups (10 sessions each). Adolescents, counselors, and observers rated teen behaviors at sessions 3 and 10. GP-IL assesses reinforcement for deviancy and positive behaviors, member rejection, and counselor connection and praise. Results: Internal consistency and 1-month stability were demonstrated. Concurrent validity is supported by correlations with measures expected to be associated with group behavior (e.g., coping skills). Counselors and observers rated more deviancy during interactive skills-building groups versus didactic psychoeducational groups (P ≤ .005). Scales evidenced incremental validity. Conclusions: GP-IL offers a sound method of tracking adolescent behaviors for professionals working with groups. Counselors ratings were most reliable and valid overall.     

An Holistic Approach to Substance Abuse Treatment

Abstract

The purpose of this article is to describe a model outpatient substance abuse treatment program. This program is designed to provide patients with not only traditional modalities of treatment such as individual, group, and family therapy, but also to provide an opportunity for patients to express thoughts and feelings through holistic modalities. These modalities include dance/movement therapy, Tai Chi, art therapy, leisure and recreational skills, spiritual growth and development, cultural awareness and appreciation, vocational services, psychiatric care and physical health. The authors describe features of this program that they believe to be unique and that focus on ways to help patients develop a stronger sense of self-identity, self-esteem and self-confidence.     

Service Utilization of Asians and Other Racial-Ethnic Groups: Comparisons in a State Substance Abuse Treatment System

Based on an administrative data base of 410,000 substance abuse treatment clients in New York State, Asians are a small minority who differ significantly from other racial–ethnic groups on income, primary language, treatment setting, substance of abuse, referral source, and discharge status. In particular, relative to other race-ethnicity groups such as whites, blacks, and Hispanics, significantly greater percentages of Asians are referred from drinking–driving programs and completed treatment. However, most of the significant differences between Asians and other groups are found among clients with a first admission, and tended to attenuate among clients with a second or third admission.     

Gender-Sensitive Substance Abuse Treatment and Arrest Outcomes for Women

The present study links an empirically-developed quantitative measure of gender-sensitive (GS) substance abuse treatment to arrest outcomes among 5109 substance abusing women in mixed-gender short-term residential programs in Washington State. Frailty models of survival analysis and three-level hierarchical linear models were conducted to test the beneficial effects of GS treatment on decreasing criminal justice involvement. Propensity scores were used to control for the pre-existing differences among women due to the quasi-experimental nature of the study. Men's arrest outcomes were used to control for confounding at the program level. Results show that women in more GS treatment programs had a lower risk of drug-related arrests, and women in more GS treatment programs who also completed treatment had a significant reduction in overall arrests from 2 years before- to 2 years after treatment, above and beyond the reduction in arrests due to treatment alone. Implications and directions for future research are discussed.     

Anxiety and Suicidal Ideation Predict Successful Completion of Substance Abuse Treatment in a Criminal Justice Sample

The goal of this study was to identify predictors of successful substance abuse treatment in an out-patient clinic for individuals being monitored under community corrections supervision. Of the 615 participants, 117 (19%) successfully completed treatment. The results of a multivariate logistic regression analysis indicated that successful treatment was associated with several baseline characteristics including: older age, White race, having greater than a high school education, lower level of care, meeting criteria for an anxiety disorder, reporting suicidal ideation, and not having a history of opioid use. The value of self-report of problems and its influence on treatment in the culture of the criminal justice population is discussed in this article.     

Substance User Treatment Dropout from Client and Clinician Perspectives: A Pilot Study

Reasons for premature termination of outpatient substance user treatment were evaluated from client and clinician perspectives using qualitative (focus groups) and quantitative (survey) methods in a pilot study (N = 44). The sample consisted of clients (n = 22), the majority of whom were male (73%) and African American (50%) or Caucasian (41%). The sample of clinicians (n = 22) were predominantly female (64%), and Caucasian (52%) or African American (24%). The most frequently endorsed reasons for leaving treatment were related to individual rather than program characteristics with heavy drug or alcohol use, transportation or financial problems, and ambivalence about abstinence being highly rated by both clinicians and clients. Survey results indicated that clinicians more frequently attributed treatment dropout to individual- or client-level factors than did clients. Focus group ratings indicated that clinicians felt client motivation and staff connection issues were primary reasons for dropout, whereas clients indicated social support and staff connection issues. The findings suggest that the development of early therapeutic alliance and active problem solving of potential barriers to treatment attendance may influence treatment retention.     

Community-Based Substance Abuse Training

Abstract

Elementary school staff requested and were provided with strategies for helping students and a resource guide to services for students living with substance-abusing adults.     

Drug-Abusing Homeless Clients in California's Substance Abuse Treatment System

Abstract

As many as one-half to three-fourths of homeless persons have diagnoses of alcohol or other drug dependence. Rates of alcohol and other drug use disorders, and the social costs associated with untreated substance disorder, are higher among homeless than nonhomeless persons. Despite the high level of need for treatment, relatively few substance-abusing homeless individuals receive treatment for their drug problems, suggesting difficulties in accessing treatment. This study addresses access by focusing on the select group of homeless drug users who have overcome barriers to enter the substance abuse treatment system in California and by examining differences between these homeless treatment clients and nonhomeless drug-using clients. Major findings from bivariate and logistic regression analyses performed on 187 homeless and 1,820 nonhomeless treatment clients are that homeless clients were more likely than nonhomeless clients to have a primary drug problem of cocaine/crack and to be injecting methamphetamine and other amphetamines, and that they were no less likely to complete their treatment program. An implication of this study is that homeless persons with primary drug problems appear to have no less commitment to achieving treatment goals than their nonhomeless counterparts.

     

An Effective Web Presence for Substance Abuse Treatment Facilities

Background: Website development for health care has only been prevalent in the last two and a half decades. The first websites were electronic versions of brochures providing hardly any interaction with the consumer or potential consumer. The percentage of consumers that use the internet during the decision-making process for health care providers continues to rise. As a result, the websites of health care providers are becoming more of a representation of the facility and creating an organizational image rather than a brochure-like informational page. Objectives: The purpose of this study was to analyze substance abuse treatment center's websites in the State of California with the goal of informing the management of substance abuse centers regarding an effective and inexpensive means to closing the marketing gaps in the industry. Methods: This brief research report presents the results of employing an automated web-crawler to assess website quality along five dimensions: accessibility, content, marketing, technology, and usability score. Results: The sample mean scores for all dimensions were between 4 and 6 on a 10-point scale. On average larger facilities had higher quality websites. Conclusions: The low mean scores on these dimensions indicate that that substance abuse centers have significant room for improvement of their website's. Efficiently spending marketing funds to increase the effectiveness of a treatment center's website can be a low cost way for even small facilities to increase market competitiveness.     

Adolescents' Experiences of a Strengths-Based Treatment Program for Substance Abuse

ABSTRACT

Possibly through its effects on glia, the peroxisome proliferator-activated gamma receptor (PPARγ) agonist pioglitazone (PIO) has been shown to alter the effects of heroin in preclinical models. Until now, these results have not been assessed in humans. Heroin-dependent participants were randomized to either active (45 mg, n = 14) or placebo (0 mg, n = 16) PIO maintenance for the duration of the three-week study. After stabilization on buprenorphine (8 mg), participants began a two-week testing period. On the first to fourth test days, participants could self-administer drug or money by making verbal choices for either option. On the fifth day, active heroin and money were administered and participants could work to receive heroin or money using a progressive ratio choice procedure. Test days 6–10 were identical to test days 1–5 with the exception that, during one of the test weeks, placebo was available on the first four days, and during the other week heroin was available. PIO failed to alter the reinforcing or positive subjective effects of heroin, but it did reduce heroin craving and overall anxiety. Although we were unable to replicate the robust effects found in preclinical models, these data provide an indication of drug effects that deserves further exploration.