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PubMed1998

Is instrumental variability abnormally high in children exhibiting ADHD and aggressive behavior?

To test whether instrumental behavior of some children with attention deficit hyperactivity disorder (ADHD) is more variable than control subjects, the sequences of responses by three groups of children were compared: (i) those diagnosed with ADHD who lived in a residential treatment facility for children demonstrating aggressive behavior; (ii) age-matched children from the same facility who did not have an ADHD diagnosis but who had also demonstrated abnormal levels of aggression; and (iii) normal children from a local school. The experiment consisted of rewarding children for responding in a computer 'game' on two keys of a keyboard during each of three phases. In phase 1, rewards were provided independently of sequence variability (IND). In phase 2, rewards depended upon highly variable sequences of left and right responses. Phase 3 was a return to the IND contingencies. The results showed that sequence variability was higher in the sequence variability (VARY) phase than in the preceding IND phase, but remained high when the contingencies returned to IND, thus replicating previous findings. In none of the phases did the ADHD children respond more variably than the controls. However, ADHD subjects made more off-task responses than did controls. Thus, although the present research showed differences between ADHD and control subjects, there was no evidence to support higher behavioral variability in the ADHD subjects.

Aggression↗
PubMed1989

Predicting rapid relapse following treatment for chemical dependence: a matched-subjects design.

Explored the prognostic significance of treatment and posttreatment variables on rapid relapse following residential treatment for chemical dependence. 54 persons were identified as 3-month treatment failures by the criteria of 1-3 months of alcohol/drug use in combination with alcohol/drug-related consequences and poor life adjustment. To limit heterogeneity, these persons were matched on MMPI scores with persons who were 3-month outcome successes. Additionally, these MMPI patterns were classified as near normal or indicative of psychiatric symptoms. Multivariate statistics revealed a high level of outcome predictability; continued emotional turmoil (depression, anxiety, and sleep problems) posttreatment was strongly related to failure among the psychiatric MMPI group. Failure to engage in a continuing posttreatment aftercare plan was associated with failure among persons in the near-normal MMPI group. Research approaches that attempt to limit heterogeneity among alcoholics appear to have promise in uncovering powerful prognostic indicators.

Alcoholism↗
PubMed2002

Ethical issues involved in the implementation of a differential reinforcement of inappropriate behaviour programme for the treatment of social isolation and ritualistic behaviour in an individual with intellectual disabilities.

The present case study describes an adult male with a 28-year history of institutional care underpinned by a moderate intellectual disability (ID), and ritualistic behaviour congruent with features of autism or obsessive-compulsive disorder. The subject's ID was recognized early in life and he was provided with a special educational placement at 6 years of age, although his increasingly disturbed behaviour had resulted in several psychiatric admissions by early adolescence, and by the age of 20, his presentation necessitated long-term secure psychiatric care. The present report describes the application and ethical issues pertaining to a differential reinforcement of inappropriate behaviour (DRI) programme for the reduction of ritualistic behaviour and social isolation, the latter being a direct consequence of the former, one year after the subject was admitted to a medium-secure assessment and treatment residential facility. The results suggest that, although the treatment was successful in targeting ritualization and reducing social isolation, ethical concerns extended to care staff concerns about the reinforcer adopted for the programme and the lack of informed consent from the subject. The former resulted in inconsistent application of the programme and its eventual termination. A follow-up assessment of the subject's extent of social isolation and ritualistic behaviour suggested a return to a pre-DRI level of morbidity. Limitations and suggestions for the future treatment of such cases are outlined.

Adult↗
PubMed1977

An investigation of the feasibility of predicting outcome indices in the treatment of heroid addiction.

An exploratory study employing multiple linear regression techniques was conducted to investigate the feasibility of predicting outcome indices in the treatment of heroin addiction. Demographic and biographic intake variables were obtained for heroin addicts prior to treatment in one of two different types of residential treatment programs. Length of treatment, further categorized into "split-stay" categories, was chosen as the criterion because of its importance from the standpoint of program management. Subsequent stepwise regression procedures resulted in 11 variables of sufficient predictability to account for approximately 30% of the variability in the split-stay criterion. The employment of the derived equation resulted in correct classification in approximately 75% of the cases. This was beyond what could have been predicted by chance alone or from the knowledge of the observed split-stay ratio. A clear demonstration of the feasibility of the model was obtained; however, as to its utility, implementation in the actual treatment setting would be required. Implications for the use of this type of prediction model were discussed.

Black or African American↗
PubMed2004

Effects of forgiveness therapy on anger, mood, and vulnerability to substance use among inpatient substance-dependent clients.

Anger and related emotions have been identified as triggers in substance use. Forgiveness therapy (FT) targets anger, anxiety, and depression as foci of treatment. Fourteen patients with substance dependence from a local residential treatment facility were randomly assigned to and completed either 12 approximately twice-weekly sessions of individual FT or 12 approximately twice-weekly sessions of an alternative individual treatment based on routine drug and alcohol therapy topics. Participants who completed FT had significantly more improvement in total and trait anger, depression, total and trait anxiety, self-esteem, forgiveness, and vulnerability to drug use than did the alternative treatment group. Most benefits of FT remained significant at 4-month follow-up. These results support FT as an efficacious newly developed model for residential drug rehabilitation.

Adult↗
PubMedDate not supplied

Depressive symptoms and mentally ill chemical abusers' perception of the treatment environment in residential settings.

In assessing the socioenvironmental characteristics of psychiatric treatment programs, researchers typically assume that their measurements are unaffected by client characteristics. However, our analysis among mentally ill chemical abusers in a therapeutic community and community residences found significant associations between subscales of the Community Oriented Program Evaluation Scale (COPES) and depressive symptoms, as measured by the CES-D, after 2, 6, and 12 months of treatment. Investigators of treatment environments should consider depressive symptoms as a possible threat to the validity of their findings.

Adult↗
PubMedDate not supplied

The Indian Health Service approach to alcoholism among American Indians and Alaska Natives.

The transfer to the Indian Health Service (IHS) of 158 alcohol treatment programs that had been administered by the National Institute on Alcohol Abuse and Alcoholism began in 1978. Today, approximately 300 alcohol and substance abuse treatment programs offer services to American Indians, among them primary residential treatment, halfway houses, outreach, and aftercare. This system provides a national network upon which additional activities may be established. Along with increasing its attention to health promotion and disease prevention, the IHS has moved toward the prevention of alcoholism. A variety of preventive programs are in place that emphasize improved self-image, value and attitude clarification, decision-making, and physical and emotional effects of alcohol and substance abuse. Many begin as Head Start programs and continue through adulthood. In 1986, after consulting with both academic and tribal experts, the IHS devised a strategic plan for alcoholism control that stresses comprehensive care and prevention activities; it serves as a guide for further program development. The Secretary of Health and Human Services created a Task Force on Indian Alcoholism in 1986 to serve as a coordinating body for activities carried out by the IHS and other agencies and units of the Department. Passage of the Anti-Drug Abuse Act in 1986 added resources for the development of adolescent treatment centers and, more importantly, for community-based pre- and post-residential care for youths and their families. Concomitant with these initiatives have been several instances of increased attention by various tribes to the problem of alcoholism. The IHS strategic plan, together with the Secretary's initiative, the Anti-Drug Act, and tribal actions, has added substantial momentum to efforts directed at controlling alcoholism among American Indians. Although the mortality rate from alcoholism is about four times greater for the American Indian population than for the entire U.S. population, it decreased from 54.5 per 100,000 population to 26.1 between 1978 and 1985-a reduction of 52 percent.The philosophy of the IHS in emphasizing prevention of disease and promotion of wellness provides an opportunity for continuing the considerable progress already made. The critical and decisive role played by the Indian communities themselves will determine whether ultimate success can be achieved.

Adolescent↗
PubMed2004

Risk-taking propensity and risky sexual behavior of individuals in residential substance use treatment.

In the current study, a battery of self-report measures of impulsivity, self-esteem, and depressive symptoms, as well as a behavioral measure of risk-taking propensity, was administered to 76 residents of two inner-city substance use residential treatment programs to determine the unique relationship between risk-taking propensity and risky sexual behavior (RSB). Results indicated that impulsivity, self-esteem, and risk-taking propensity were independently related to RSB. In a subsequent regression analysis, risk-taking propensity evidenced incremental validity, suggesting a relationship between risk-taking propensity and RSB, above and beyond that provided with the other relevant variables. The potential importance of risk-taking propensity the better understanding HIV risk through engagement in RSB is discussed.

Adult↗
PubMed1980

Parents as treatment partners in residential care.

Full benefits in the use of parents as treatment partners in the residential care program are predicated upon involving them fully in the many aspects of assessment, treatment and discharge decisions for their children.

Adult↗
PubMed1976

The parent-therapist program: an innovative approach to treating emotionally disturbed children.

The authors describe the parent-therapist program, an innovative alternative to residential treatment for emotionally disturbed children. In the program, which is based on the extended family model, couples not only provide a residential milieu for a child placed with them, but also are trained to be therapists who can deal with specific emotional and behavioral problems. The parent-therapists work together in three treatment teams, each consisting of five couples. Education and supervision are ongoing. A total of 27 children have been treated in the program since it got under way in May 1972. Clinical impressions indicate that the children have made substantial gains in developing social and interpersonal skills and in their academic acievement.

Canada↗
PubMed2006

Employed men and women substance abusers: job troubles and treatment outcomes.

The majority of U.S. adults with substance abuse or dependence are gainfully employed. However, little is known about outcomes among stably employed people in treatment for substance dependence. Participants (N = 212) entering a residential treatment program completed the Addiction Severity Index (ASI) at intake and 6 and 12 months follow-up. Significant improvements were seen in absenteeism, number of employment problem days, and whether their job was in jeopardy 12 months later. Overall, 65% were retained by their original employer. ASI composite alcohol, drug, legal, family, and psychiatric scores also improved significantly. Continuous abstinence was achieved by 65% and 51% at 6 and 12 months, respectively. Although less likely to be referred to treatment by their employer, women responded to treatment as well as men, reporting similar abstinence rates and overall quality of life during the year following discharge from treatment.

Absenteeism↗
PubMed1977

Institutions without walls for emotionally disturbed children. Chedoke Child and Family Centre, Hamilton, Ontario.

The parent-therapist program was developed as an alternative to residential treatment centers for severely emotionally disturbed children. Five healthy nuclear families function in a group as an extended family. Each family receives a salary and is responsible for the care and protection of an emotionally disturbed child. Mental health professionals provide the parents with education and supervision. By the end of 1976 a total of 36 children ranging in age from six to 15 had been treated by 20 different parent-therapist couples for periods ranging from nine to 26 months. A comparison of the program with those of two residential centers showed that there was no difference in treatment outcome but that costs for the parent-therapist program were half those for the residential centers.

Achievement↗
PubMed1988

Using treatment plans for quality assurance monitoring in a residential center.

Treatment plans for children in residential centers are required for accreditation and reimbursement, and they can provide important insights to the quality of care. One residential center has developed a system for reviewing treatment plans as part of its quality assurance (QA) monitoring. QA staff use checklists to review plans to assure that they are complete and technically correct and to evaluate the quality and appropriateness of care as revealed in the treatment strategy.

Adolescent↗
PubMed2003

Does retention matter? Treatment duration and improvement in drug use.

AIM: This study examines whether there is a minimum threshold, continuous or non-linear relationship between the duration of addiction treatment and improvements in drug use. DESIGN: Longitudinal cohort study of 62 drug treatment units and 4005 clients in the US National Treatment Improvement Evaluation Study, fielded from 1993 to 1995. SUBJECTS: Baseline and 1-year follow-up interviews with clients in methadone maintenance, out-patient non-methadone, short-term residential and long-term residential treatment programs. MEASURES: Improvement in drug use is the difference between the client-reported peak frequency of drug use (in days per month) in the year prior to the baseline interview minus the peak frequency in the year after discharge. Primary drug, and overall use of the major illicit drugs (heroin, cocaine powder, crack cocaine, and marijuana) are considered separately. RESULTS: Controlling for multiple factors, treatment duration had a positive linear relationship with primary drug use improvement among methadone clients and an inverted-U-shaped relationship with overall and primary drug use improvements among out-patient and long-term residential clients. Improvement with longer duration is greatest for long-term residential clients. CONCLUSIONS: Contrary to previous arguments for a sharp retention threshold for onset of treatment effects, we find smooth curves relating treatment duration to drug use improvements in methadone maintenance, out-patient non-methadone and long-term residential modalities. These relationships are effectively linear for durations typically observed in single treatment episodes, but unusually long retention in out-patient non-methadone and long-term residential units appear steadily less predictive of improvement.

Adolescent↗
PubMed2001

Outcomes of a comprehensive treatment program for adolescents with a substance-use disorder.

Outcomes of a multimodal residential treatment program for adolescents were compared with usual care. The quasiexperimental design included pretest, 3-month posttest, and 6-month follow-up of program referrals (mean age 16; 53% male). The intervention group (IG) comprised referrals who entered the program (n=61) and the comparison group (CG) comprised referrals who did not enter the program (n=60). The six outcomes (substance use, criminal behavior, social functioning, psychological distress, physical health, and HIV risk-taking behavior) were assessed using the Opiate Treatment Index and the Symptom Checklist-90-Revised. The study groups demonstrated equivalent improvement on all six outcomes. Multiple factors are likely to have influenced these results, including inadequate program implementation and differential drop-out. There was, however, a higher prevalence of multiple improvements among the IG than the CG. It is concluded that adolescents with a PSUD can improve, however, a superior means of achieving this improvement has yet to be demonstrated.

Adolescent↗