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PubMed2002

Do patients' perceptions of their counselors influence outcomes of drug treatment?

This prospective longitudinal study examined the influence of patients' perceptions of their counselors on their lengths of stay in treatment and subsequent treatment outcomes. Patients (N = 511) were recruited from 19 substance abuse treatment programs in Los Angeles County. While in treatment, patients rated their counselors on 14 aspects (e.g., empathy, directiveness); 1 year later they were interviewed for follow-up outcomes. Multiple regression analyses were conducted using patients' ratings of their counselors to assess the impact of these ratings on treatment retention and follow-up outcomes (i.e., severity of alcohol use, drug use, and psychiatric status as measured by the Addiction Severity Index). Results revealed that patients' positive perceptions of their counselors were significantly associated with a longer length of stay in treatment for the outpatient drug free/day treatment and residential treatment subsamples. Patients' positive perceptions were also significantly associated with better psychiatric functioning at follow-up, but had a limited relationship to severity of alcohol use and no relation to severity of drug use.

Adult↗
PubMed2005

Correlates of therapeutic involvement among adolescents in residential drug treatment.

The current study addresses the critical need for research on the therapeutic involvement among adolescent substance users in treatment. Although therapeutic involvement (TI) and the services that clients receive during treatment are among the best predictors of treatment retention and through retention associated with better posttreatment outcomes, there are relatively few empirical studies of therapeutic involvement among adolescents in drug treatment. Using data on N=185 adolescent clients in five adolescent residential drug-treatment programs in New Jersey, factor analyses used maximum likelihood extraction and oblique rotation. Pearson's correlation coefficients and multivariate linear regression were used to explore the utility of using existing measures of TI developed on adult populations to examine the correlates of therapeutic involvement among adolescents. The majority of subjects (85%) were between 16 and 18 years of age, with an average age of 17 years. Seventy-nine percent were male, 20% were Hispanic, 36% were African-American, and 46% were Caucasian. Working alliance, self-esteem, spirituality, deviance, and substance use problem severity were associated with therapeutic involvement and there is evidence that there may be important subgroup differences associated with gender and ethnicity. Further research on the interplay between these factors, therapeutic involvement, and recovery among adolescents can inform the development of strategies to enhance the engagement and retention of adolescents in drug treatment.

Adolescent↗
PubMed1995

People with physical disabilities admitted to a residential addiction treatment program.

This exploratory study used data on admissions to a 28-day residential addiction treatment program to explore differences between disabled and nondisabled cases with respect to patterns of substance use and other characteristics. Relationships between length and type of disability, substance use, and other characteristics were also explored. The focus was on cases aged 18 to 65 identified as having physical disabilities that limit participation in the work force. The results showed that 5.3% of the sample reported disabilities which prevented them from working, and a further 8.6% reported that physical disabilities limited their participation in the work force. The results also showed that self-identified problems with tranquilizers were more common among the disabled than the nondisabled and that more severely disabled people are more likely to report attempting suicide and to express the need for mental health counseling. Having prescriptions as a main source of drugs was also more common among females with major disabilities than among other groups. Priorities for further research are suggested.

Adult↗
PubMedDate not supplied

A day treatment program in a therapeutic community setting: six-month outcomes. The Walden House Day Treatment Program.

Although not well represented in the literature, day treatment programs targeting substance abuse problems have increased in both number and acceptability in recent years. This article reports on a day treatment program based on the Therapeutic Community (TC), and on outcomes for a sample of substance abuse clients (n = 66) entering the program. Participants were interviewed early in treatment and 6 months after admission using the Addiction Severity Index (ASI) and other measures. Clients entering day treatment were demographically diverse, with serious substance-abuse problems and psychiatric morbidity. Median retention in day treatment was about 5 weeks, but many clients received a contiguous episode of residential treatment, so that the median for total time in treatment was 18 weeks. Clients located and interviewed at 6-month follow-up (n = 38) showed significant improvement in alcohol and drug use, legal and social problems, and psychiatric symptoms. Findings suggest that day treatment can be used effectively as a precursor to residential treatment and that some clients applying for residential treatment can be treated effectively in day treatment alone.

Adult↗
PubMed1985

"Mom and dad": views on the relationship between direct-care staff and therapists in residential, adolescent treatment facilities.

Some of the common conflicts that occur between therapists and direct-care staff in residential, adolescent treatment facilities are highlighted. These conflicts often parallel those occurring between an adolescent's parents. Common issues include the amount of time spent with the adolescent patient, questions of authority, and communication difficulties. These conflicts can have positive consequences, if each party recognizes that the other brings a needed perspective to adolescent treatment.

Adolescent↗
PubMed1996

Parent satisfaction with children's mental health services in a children's mental health managed care demonstration.

This article presents findings from a quasi-experiment that included the use of satisfaction scales to compare parent's satisfaction with the services their children received through two different mental health care delivery systems. Satisfaction with the following three types of service were compared: (1) intake assessment during the admission process to any service setting, (2) outpatient services, and (3) residential treatment including inpatient hospitalization and residential treatment centers (RTCs). Additionally, satisfaction with several areas of care (e.g., access, treatment process, therapist relationship, parent and family services, discharge and transition planning), as well as global satisfaction, was assessed. In general, parents whose children received services through an innovative continuum of care system reported significantly higher satisfaction with intake assessment and outpatient services than did parents whose children received care in a traditional fee-for-service system. Fewer differences were found in satisfaction with residential services.

Adolescent↗
PubMed2000

Predicting retention in a residential drug treatment alternative to prison program.

One hundred and fifty felony drug offenders diverted from prison to community-based, residential drug treatment alternative to prison program completed a comprehensive interview as part of a longitudinal study. Treatment completion predictors were sought examining intake data (demographics, family, social, employment, medical, psychological, criminal, sexual behavior, drug use and treatment histories). Logistic regression results found completers had more social conformity and close friends, and less need for employment counseling, felony drug convictions, drug dealing income, and unprotected sex than dropouts. Completers were also less likely to encounter recent problems with significant other, have a psychiatric history, experience gunshot or stabbing, and commenced heroin use at older ages than dropouts. However, completers reported higher alcohol use than counterparts. Further analyses explored subcategory models: "life choice" (substance use, criminal and sexual behavior), static (background and dispositional), and dynamic situational influences (employment, psychological state, recent and past encounters). Treatment implications considering findings are discussed.

Adult↗
PubMed1988

Interactional variables associated with retention and success in residential drug treatment.

The present study was designed to identify variables associated with client retention and success at the Rocco Antenucci Memorial Adult Residential Drug Treatment Center in Akron, Ohio. Multiple stepwise regressions were utilized to evaluate the variance contributed by demographic, psychological, and interactional variables associated with client retention for 100 program participants. Degree of social support and employment at discharge accounted for 63% of the variance. Factors related to successful treatment completion, identified using the Kruskal-Wallis one-way analysis of variance, included: involuntary admission, family involvement in treatment, degree of social support, and employment at discharge.

Adolescent↗
PubMed1999

A randomized trial comparing day and residential drug abuse treatment: 18-month outcomes.

Extending an earlier report of 6-month outcomes, this study reports 12- and 18-month follow-up data for clients (N = 188) entering a therapeutic community drug treatment program who were randomly assigned to day or residential treatment conditions. Outcomes included Addiction Severity Index composite scores and measures of depression, psychiatric symptoms, and social support. Both groups showed significant change over time. The pattern of change indicated decreased problem severity in the 1st 6 months and then maintenance of lowered problem severity. Comparisons between groups indicated greater improvement for residential treatment clients on social problems and psychiatric symptoms but no differences on the remaining outcomes. Although residential treatment may offer some specific advantages, the conclusion here is that improvement among day treatment clients was not significantly different from that of residential treatment clients.

Adult↗
PubMed1997

Residential behavior therapy for children with conduct disorders.

Children with conduct disorders are often referred to residential treatment centers (RTCs). RTCs shorten the length of treatment and thus feel they need to reconceptualize the purpose and process of treatment. Two intervention strategies have been found to affect conduct disorder in outpatient settings: parent training programs that are based on operant learning principles and cognitive-behavioral programs that focus on the relation between cognition and behavior. These strategies should not be transferred to the RTC but adapted to the characteristics of residentially treated conduct disordered children and their parents. These methods should be used together to integrate and strengthen the various learning processes that residential treatment can foster. An outline is given of a comprehensive and integrated residential treatment program based on behavioral methods that have been proven to affect conduct disorder.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed2005

Economic benefits of substance abuse treatment: findings from Cuyahoga County, Ohio.

We estimated long-term economic benefits and treatment costs for a sample of substance abuse clients who received treatment in Cuyahoga County, Ohio, using health, criminal activity, and earnings data from the Persistent Effects of Treatment Studies. Clients were interviewed at baseline and 6, 12, 24, and 30 months following baseline. We find positive benefits from substance abuse treatment, almost of all of which were derived from reduced criminal activity and increased real earnings, with overall benefit-to-cost ratios ranging from 2.8 to 4.1. The reductions in costs to society were found to be persistent over the long-term, 30-month follow-up period. On average, treatment was found to be cost beneficial regardless of the number of times a client entered treatment in the baseline or follow-up periods. Clients who entered residential treatment and then step down to less intensive care showed greater treatment benefits than clients who only received residential treatment.

Adolescent↗
PubMed2004

Assessing the effectiveness of community-based substance abuse treatment for adolescents.

The Adolescent Treatment Models initiative, a 10-site, multimodality, prospective study, was designed to evaluate adolescent substance abuse treatment outcomes and to assess the relative efficacy of different treatment models. Based upon longitudinal data gathered at multiple assessment points using a standardized instrument, treatment outcome trajectories were determined for a cohort of 1,057 adolescents from entry into substance abuse treatment until 12 months post-intake. Client outcomes on substance use and program effectiveness were explored across individual treatment programs and levels of care. Strong treatment effects, defined as a significant reduction in alcohol and other drug use at three months post-intake, were found. The reductions of greatest magnitude in relation to pretreatment use occurred among adolescents in residential treatment. Within level of care, few significant differences in treatment effects were found between programs. Relapse effects, defined as an increase in substance use at 12 months relative to three months, were observed across nearly all programs, but varied in relation to treatment modality. This is most evident among those entering residential treatment, with the highest rate of relapse occurring among adolescents in long-term residential treatment care. Despite strong evidence of treatment effectiveness, continuing care is vital to maintenance of treatment benefit.

Adolescent↗
PubMed2002

Factors associated with antidepressant treatment in residential care: changes between 1990 and 1997.

BACKGROUND: Depression is common among older people living in residential and nursing homes. Detection and treatment of late life depression may be sub-optimal in these settings. AIM: To report the changes in, and factors associated with, antidepressant use among residents in care homes in 1990 and 1997. METHOD: Censuses of those aged 65 years and over in any type of residential care in the county of Leicestershire, UK, on 27 November 1990 and 30 November 1997. Care staff were asked to complete an assessment form for each resident which included a rating of depression and use of antidepressants. RESULTS: The use of antidepressants increased from 11% (484/4415) in 1990 to 18.9% (777/4111) in 1997. Severity of depression as assessed by care staff, gender, younger age, better cognitive functioning, and use of other medications were consistently associated with antidepressant treatment. Antidepressant use was associated with better physical functioning (p = 0.001) in 1990 and frequency of falls in 1997 (p = 0.044). CONCLUSIONS: Increased use of antidepressants appears to be due to the wider range of antidepressant drugs available since 1990. However there is a need for better methods for care staff to detect depression in residents, and for appropriate action to be taken by those responsible for their medical management.

Aged↗
PubMed1986

Personality and demographic characteristics of dropouts and completers in a nonhospital residential alcohol treatment program.

This study investigated the relationship of scores on the Psychopathic Deviate, Denial, Dependency, and MacAndrew Scales of the MMPI; intelligence; age; income; and education to continuance in a residential alcohol treatment program. Dropouts scored higher on the Psychopathic Deviate Scale than completers did. For completers, Psychopathic Deviate scores were correlated with age and Denial scores were correlated with intelligence. These relationships did not occur for dropouts. Findings were compared to research done in hospital settings.

Adult↗
PubMed2002

Substitution in a Medicaid mental health carve-out: services and costs.

The objective is to empirically test the incentives associated with a Medicaid capitated mental health carve-out contract, whether outpatient services (less expensive, inside the contract) and residential treatment center care (costly care, outside of the contract) were substituted for inpatient psychiatric hospitalization used by children and adolescents. Data sources include Medicaid fee-for-service (FFS) claims for the non-capitated comparison sites and for residential treatment center use, and "shadow billing" encounter data for the experimental capitated managed care sites that provided public mental health services for children and adolescents with Medicaid insurance statewide in Colorado from September 1994 to June 1997. Two part least squares regression models are used to decompose services. Managed care sites are compared to sites that remained under FFS financing, before and in two post-periods after the carve-out. Principal findings show that children and adolescents who received mental health services from a capitated managed care provider were significantly less likely to receive inpatient care, and significantly more likely to receive residential treatment center care. In addition, insurance contract design contains financial incentives that affect the amount and mix of clinical care provided to clients by risk-bearing provider agencies. Findings provide evidence of cost substitution from inpatient care both inside the specialty system and outside the carve-out to other child-serving systems.

Adolescent↗
PubMed1996

Reliability of self-reported human immunodeficiency virus risk behaviors in a residential drug treatment population.

This study examined test-retest reliabilities of self-reported human immunodeficiency virus (HIV) sexual and drug injection behaviors among 246 prior drug users admitted to either of two residential drug treatment programs in Westborough, Massachusetts, and Providence, Rhode Island, between June 1990 and September 1992. Participants, selected by their date of admission, were administered admission and reliability questionnaires pertaining to HIV risk behaviors, the latter at approximately 2 weeks after admission. Estimated reliabilities (kappa coefficients) of the sexual behaviors ranged from 0.72 to 0.91; those for the drug injection variables ranged from 0.63 to 0.98. These results were consistent across groups defined by sex and injection of drugs. The consistently good reliabilities are significant to the design of independent studies of drug treatment populations utilizing self-report measures of sexual and drug behaviors.

Female↗