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Results for “RESIDENTIAL TREATMENT”

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PubMed1999

A comparative study of cocaine-treatment completers and dropouts.

This study compared matched groups of completers and dropouts from residential treatment for cocaine abuse on a range of outcome measures, including cocaine and alcohol use, stress, coping, and social support characteristics. The most striking finding of this study was that treatment dropouts differed from treatment completers on only 2 of 14 dependent measures reflecting substance use, stress, coping, and social support characteristics during two 3-month follow-up periods. Both dropouts and completers demonstrated large decreases in cocaine and alcohol use from pretreatment to the first follow-up period. Completers and dropouts did not differ in level of substance use during either follow-up period.

Adaptation, Psychological↗

PubMed1977

Being with madness: personality characteristics of three treatment staffs.

The personality characteristics of the nonprofessional staff of Soteria House, an innovative residential treatment program for schizophrenics, are assessed and compared with characteristics of representative staffs from two more traditional mental health programs for schizophrenics: a university psychiatric ward and a community-based program staffed by a specially trained group of state hospital aides. A battery of self-report personality questionnaires was used. Analysis of the data indicates an over-all similarity of personality profiles in the three groups. All groups demonstrated two sets of characteristics considered desirable for therapists of schizophrenics: the ego-strength qualities of self-assurance, emotional maturity, independence, and autonomy, and the affective qualities of warmth, sensitivity, and empathy. However, within a third set of characteristics, descriptive of cognitive-attitudinal qualities, the Soteria staff possessed significantly more intuition, introversion, flexibility, and tolerance of altered states of consciousness. The authors speculate that it is this last set of characteristics that allows the Soteria staff to function in the program's intensive, unstructured treatment environment.

Adolescent↗

PubMed2004

Treatment of depression in patients with opiate dependence.

Depression is common among opiate-dependent patients and has been associated with worse prognosis. This article reviews the literature on treatment of depressive disorders and symptoms among patients with opiate dependence. Depression bears a complex relationship to opiate dependence and may represent an independent disorder or may be engendered by psychosocial stress or toxic and withdrawal effects of drugs. Primary treatments for opiate dependence (e.g., methadone or buprenorphine maintenance or residential treatment) are associated with substantial improvements in depression. Studies of antidepressant medications have produced mixed results, some positive but more negative. It is not clear what accounts for these differences, and more research is needed to determine how to select opiate-dependent patients most likely to benefit from antidepressants. Fewer studies have examined psychosocial or behavioral interventions, but some of these also show promise. The data suggest a stepped model of care in which depression is evaluated and observed during the outset of treatment for opiate dependence and if it does not improve, specific psychosocial interventions or antidepressant medications tried. Research is needed on such integrated models of care and treatment algorithms to determine their efficacy and cost effectiveness.

Affect↗

PubMed2005

DHEAS and POMS measures identify cocaine dependence treatment outcome.

UNLABELLED: Early attrition is a significant problem in the treatment of cocaine dependence, but it is unclear why some patients succeed in treatment while others relapse or drop out of treatment without a demonstrated relapse. The goal of this study was to determine whether baseline levels of select hormones, including the adrenal hormone and excitatory neurosteroid dehydroepiandrosterone sulfate (DHEAS), would distinguish between treatment outcome groups. Based on the literature, completion of 90 days of treatment was established as a key outcome variable. METHODS: Quantitative urine levels of the cocaine metabolite benzoylecgonine (BE) and other substance of abuse analytes, plasma levels of DHEAS, DHEA, cortisol, and prolactin, and the profile of mood states (POMS) were serially measured in 38 male cocaine-dependent (DSM-IV) patients and in 28 controls of similar gender and age over a six month study. Exclusion criteria for the patients and controls included Axis I mood, anxiety or psychotic disorders. The patients could not manifest substance dependence except to cocaine. The patients and controls received remuneration for urine and blood collection. Blood samples for hormone levels were obtained between 8 and 10 a.m. on days 1, 14 and 21 of a 21-day inpatient treatment program and throughout 6 months of outpatient study visits at 45-day intervals. RESULTS: Attrition from treatment and study appointments occurred predominately at the junction between inpatient and outpatient programs. Forty percent of patients made the transition to outpatient treatment and remained abstinent and in treatment for a median of 103 days (ABST). Forty-two percent of patients dropped out of treatment during the inpatient stay or never returned after completing the inpatient program (DO) and 18% had a documented relapse either during, or within the first week after, the inpatient stay (REL). POMS total scores were elevated at treatment entry for both the ABST and DO groups. Plasma DHEAS levels in the DO patients were decreased compared to controls and increased in the ABST patients. POMS total scores for the REL patients at baseline were at control levels. Baseline cortisol levels were not statistically different between the outcome groups, though they were elevated for all cocaine patient groups. When treatment outcome was collapsed into whether patients completed (ABST) or did not complete 90 days of treatment (90N), ABST plasma DHEAS and cortisol were significantly elevated compared to the 90N patients and controls across the first 3 weeks of cocaine withdrawal. CONCLUSIONS: At treatment entry, each of the three patient outcome groups was identified by levels of circulating DHEAS and distressed mood. In the ABST patients, distressed mood during withdrawal may have been mitigated through antidepressant-like actions of enhanced endogenous DHEAS activity, thus contributing to improved abstinence and treatment retention. Patients, such as the DO group, with high levels of distressed mood at treatment entry and low DHEAS levels may benefit from adjunctive pharmacotherapy that targets DHEAS and POMS measures. Patients, such as the REL group, who lack distressed mood at treatment entry, may require intense application of motivational approaches plus residential treatment.

Adult↗

PubMedDate not supplied

Integration of health care economics for addiction treatment in clinic care.

Over the past decade, radical changes have occurred in the availability and funding of treatment services for individuals with addictive disorders. Traditional inpatient and residential treatments have been replaced by outpatient settings. "Standard" addiction treatments, such as 28-day inpatient hospitalizations, are largely a thing of the past. The process of treatment planning has also changed. Treatment decisions now depend on third-party coverage rather than severity of illness. The procedures for determining eligibility and obtaining authorization for treatment are often ponderous and impersonal and determined through administrative procedures that are external to the treatment facility. The criteria used to determine the type of treatment seem arbitrary rather than clinically based.

Alcoholism↗

PubMed2003

Increased salivary cortisol concentrations during chronic alcohol intoxication in a naturalistic clinical sample of men.

BACKGROUND: Cortisol, the primary glucocorticoid in humans, is intimately involved in the regulation of such varied and critical biological processes as emotion, cognition, reward, immune functioning, and energy utilization. A persistent increase in cortisol concentration as a result of chronic intoxication could therefore result in alcohol-related disorders such as sleep disruption, cognitive deficits, diabetes, and mood disturbances. Although moderate levels of acute alcohol ingestion are reported to produce an increase in cortisol levels, it is uncertain whether cortisol remains persistently increased during long-term chronic intoxication. METHODS: Salivary cortisol and breath alcohol concentrations (BAC) were obtained on 73 subjects with primary alcohol dependence on initial presentation for treatment and 22 alcohol-dependent subjects participating in a residential treatment program. RESULTS: Both intoxicated alcohol-dependent subjects (n = 38) and nonintoxicated subjects in acute alcohol withdrawal (n = 30) demonstrated significantly increased salivary cortisol concentrations compared with abstinent subjects (n = 27; p < 0.001). Nonintoxicated subjects in acute withdrawal demonstrated significantly increased salivary cortisol concentrations compared with highly intoxicated subjects (BAC >100 mg/dl) but were similar to subjects with lower levels of intoxication (BAC, 10-100 mg/dl). CONCLUSIONS: Chronic alcohol-dependent subjects experience continuously increased concentrations of cortisol during both intoxication and withdrawal. Increased levels of cortisol during chronic intoxication seem to progressively increase with the onset of withdrawal. This suggests a daily cycle of hypercortisolemia during the active drinking phase, with further increases on the cessation of drinking and the emergence of withdrawal symptoms. Persistently increased levels of cortisol may extract a costly allostatic load, resulting in significant central nervous system and peripheral organ morbidity.

Adult↗

PubMed2001

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.

Adult↗

PubMedDate not supplied

Residential drug abuse treatment for probationers. Use of node-link mapping to enhance participation and progress.

Node-link mapping, a graphic representation tool, was used to enhance substance-abuse treatment in a 4-month residential criminal justice program. Twelve communities of 30 to 35 probationers ("residents") were randomly assigned to either mapping-enhanced or standard counseling. During group sessions, counselors and residents in the mapping communities collaborated to develop node-link maps representing critical issues. Counselors in standard communities used their own methods. Treatment motivation (i.e., desire for help) was assessed at intake and was used to categorize residents into three levels. Treatment involvement was measured at the middle and at the end of the program. Residents, as well as their counselors, rated those in mapping communities as participating more in group sessions than those in standard communities. Mapping residents also reported better personal progress toward treatment goals, more positive affective responses to treatment, and greater treatment engagement. Residents with higher motivation at intake had higher treatment involvement scores regardless of type of counseling received.

Adolescent↗

PubMed1995

The effectiveness of alternative planned durations of residential drug abuse treatment.

Randomized controlled trials were conducted at two residential drug abuse treatment facilities to compare programs that differed in planned duration. One trial compared a 6-month and a 12-month therapeutic community program (n = 184), and the second compared a 3-month and a 6-month relapse prevention program (n = 444). Retention rates over comparable time periods differed minimally by planned treatment duration, and the longer programs had lower completion rates. There was no effect in either trial of planned treatment duration on changes in psychosocial variables between admission and exit or on rates or patterns of drug use at follow-up between 2 and 6 months after exit.

Follow-Up Studies↗

PubMedDate not supplied

[Psychiatric rehabilitation in a secure treatment setting].

Working with severely mentally ill persons within the locked environment of a secure residential treatment facility presents a provocative challenge in attempting to establish a rehabilitative program. The author describes the mission, goals and methods of one of Oregon's newly organized facilities for "hard to place" former state hospital patients. The value of teaching the residents self-control is emphasized. Clinical vignettes illustrate how the staff involve the residents in real-life tasks, apply natural consequences to problem behaviors, and make attempts at minimizing the potential sources of confrontation.

Commitment of Persons with Psychiatric Disorders↗

PubMed2026

Care Navigation for Methamphetamine Use Disorder: A Randomized Clinical Trial.

IMPORTANCE: Stimulant-involved deaths continue to increase in the US, and methamphetamine use remains a weighty public health concern. Treating methamphetamine use disorders is complicated. Contingency management has demonstrated the best effectiveness but is not widely implemented. OBJECTIVE: To examine the effectiveness of dedicated care navigation in linking patients to treatment. DESIGN, SETTING, AND PARTICIPANTS: This prospective randomized clinical trial was conducted at an integrated safety-net health system in Denver, Colorado, between April 10, 2023, and December 31, 2024. Eligible participants were 18 years or older who had a methamphetamine-related encounter in an acute care setting; those with involuntary treatment holds, substance treatment in past 90 days or actively seeking treatment, and inability to provide consent were excluded. Participants completed baseline, 30-day, and 90-day study visits. INTERVENTION: Dedicated care navigation, incorporating contingency management principles, with a focus on addressing health-related social needs. MAIN OUTCOMES AND MEASURES: Linkage to treatment within 30 and 90 days of enrollment defined as a composite measure of at least 1 of the following: electronic health record data indicating a visit at the health system's substance treatment clinic, a behavioral health encounter at an outpatient clinic, temporary residential treatment, or self-reported treatment on the 30- and/or 90-day follow-up survey. RESULTS: Of 192 participants enrolled in the Beginning Early and Assertive Treatment for Methamphetamine Use trial, 156 (81.3%) were male, and the median age was 39 (IQR, 31-47) years. Most participants were unstably housed (163 [84.9%]), not currently employed (158 [82.3%]), and without regular access to a working phone (94 [49.0%]). Of the 96 participants randomized to the intervention, 60 (62.5%) engaged in 2 or more navigation sessions, 45 (46.9%) completed the 30-day study visit, and 47 (49.0%) completed the 90-day study visit compared with 44 (46.3%) and 37 (38.5%), respectively, of the 96 randomized to the control arm. No statistically significant differences in treatment linkage were observed at 30 days (24 participants [25.0%] in both arms; risk ratio, 1.00 [95% CI, 0.61-1.63]) or 90 days post enrollment, (32 [33.3%] in intervention vs 24 [25.0%] in control arms; risk ratio, 1.33 [95% CI, 0.85-2.09]). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, integrating principles of contingency management into the intervention may have increased engagement with a dedicated care navigator but did not increase likelihood of linkage to treatment for methamphetamine use disorder. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06033365.

Humans↗

PubMed2006

Associations between methamphetamine use and HIV among men who have sex with men: a model for guiding public policy.

Among men who have sex with men (MSM) in Los Angeles County, methamphetamine use is associated with high rates of HIV prevalence and sexual risk behaviors. In four separate samples of MSM who differed in the range of their intensity of methamphetamine use, from levels of recreational use to chronic use to those for MSM seeking drug abuse treatment, the association between methamphetamine use and HIV infection increased as the intensity of use increased. The lowest HIV prevalence rate (23%) was observed among MSM contacted through street outreach who mentioned recent methamphetamine use, followed by MSM who used at least once a month for six months (42%), followed by MSM seeking intensive outpatient treatment (61%). The highest rate (86%) was observed among MSM seeking residential treatment for methamphetamine dependence. The interleaving nature of these epidemics calls for comprehensive strategies that address methamphetamine use and concomitant sexual behaviors that increase risk of HIV transmission in this group already at high risk. These and other data suggest that MSM who infrequently use methamphetamine may respond to lower intensity/lower cost prevention and early intervention programs while those who use the drug at dependence levels may benefit from high intensity treatment to achieve goals of reduced drug use and HIV-risk sexual behaviors.

Amphetamine-Related Disorders↗

PubMed1987

The treatment of schizophrenia: a patient's perspective.

The author chronicles her 20-year battle with schizophrenia and her growing acceptance of her illness. She has committed herself to leading the fullest life her disease will allow and to educating others about mental illness. While she does not deny that hospitals have their place in the treatment and stabilization of acute psychiatric problems, she believes community-based residential treatment programs are most successful in promoting long-term gains because they provide a protected yet flexible environment in which to build confidence and social skills. She believes mentally ill individuals need to be educated about their illnesses and require appropriate supportive psychotherapy, pharmacotherapy, access to support groups, and structured activities, such as working, attending school, and training for a job. She describes her own strategies for preventing relapse.

Adult↗

PubMed1991

Control orientation as a personality dimension among alcoholic and obese adult men undergoing addictions treatment.

Rotter's (1966) I-E Locus of Control Scale was administered to 18 men in residential treatment for alcoholism and 13 men in intensive outpatient treatment for obesity. The obese sample scored significantly higher in internal locus of control, whereas the alcoholic sample was comparatively external in control orientation. These findings contradict currently held assumptions on the directionality of control orientation among both alcoholic and obese adults and suggest that internally oriented obese adults may feel that they have little control over their weight and eating behavior but more control over other aspects of their lives. In contrast, externally oriented alcoholics appear to be aware of their inability to control their drinking and their limited control over many factors influencing their lives. Implications for treatment are also discussed.

Adolescent↗

PubMed1995

[Alcohol abusers after treatment at a clinic--a follow-up study].

Clients from Nord-Trøondelag county that received residential treatment for alcohol problems were interviewed some two years after the index treatment. Treatment programmes were selected by the patients themselves from among those provided at one public and three private clinics, and the costs were covered partially or entirely borne by the municipality. It was possible to interview 80% (133/166) of those treated during the study period. The overall outcome was quite good, with 2/3 being abstinent and over 80% not having a current DSM-IIIR or S-MAST defined alcohol problem at follow-up. Half (13/26) of those who had relapsed and were retreated were not drinking a year later. A survival analysis suggested that there were marked differences in relapse rates among those attending the different clinics. Small size, a warm, home-like atmosphere, and a clear presentation of the "Higher Power" concept were associated with the two clinics with fewer relapses, although the nature of the study does not allow inferences of causality. Other factors did not differentiate the more successful from the less successful clinics.

Adult↗

PubMedDate not supplied

A qualitative study of barriers to formal treatment among women who self-managed change in addictive behaviours.

Alcohol and drug abuse and dependence are common disorders in our society, and the vast majority of those who recover do so without formal treatment. Although this phenomenon appears to be more common among women than men there has been no gender-sensitive research. This qualitative study explored the barriers to formal treatment seeking among women who self-managed change in their alcohol and other drug dependence. The principal barriers identified included social stigma and labelling; lack of awareness of the range of treatment options, concerns about childcare, the perceived economic and time costs of residential treatment, concerns about the confrontational models used by some treatment services, and stereotypical views of clients of treatment services. A number of recommendations were made regarding program reach and content.

Adult↗

PubMed2005

Coerced treatment for methamphetamine abuse: differential patient characteristics and outcomes.

Policymakers have responded to the increase in the prevalence of methamphetamine (MA) use and the associated social costs (such as crime and child abuse and neglect) by mandating a growing number of MA users to substance abuse treatment via the criminal justice system (CJS) and/or child protective service (CPS) agencies. However, empirical evidence remains sparse about treatment outcomes specifically for MA users who report that their treatment admission occurred under such pressures. This analysis uses natural history interview data from 350 clients treated for MA use in Los Angeles County to examine clients' self-reported CJS/CPS pressure to enter treatment, comparing background and treatment characteristics and selected treatment outcomes across groups defined by existence of such perceived pressure and source of pressure. Approximately half the clients reported legal pressure to enter the index (used for sampling) treatment episode. Those reporting pressure were younger, less likely to have received residential treatment, and had longer treatment episodes than those not reporting pressure. Outcomes (treatment completion, relapse within 6 months, time to relapse, and percentage of days with MA use in 24 months following treatment) did not differ significantly in simple comparisons between the pressured and nonpressured groups; however, when client and treatment characteristics were controlled, the short term outcome of relapse within 6 months was worse for those reporting legal pressure. Outcomes did not differ by source of pressure.

Adult↗

PubMed1998

Evolution of wraparound services at The Menninger Clinic.

The authors focus on the development of a wraparound program at The Menninger Clinic. This program explores alternatives to long-term hospitalization and residential treatment and provides comprehensive community-based services. After describing the history and evolution of this program, the authors highlight its current components (i.e., diagnostic understanding; assessment of the client's and family's strengths; identification of helpful functions of hospital or residential placement; crisis planning; family-centered community team; flexible funding; criteria for evaluating the plan's success). Each of these components contributes to a process that provides a high level of individualized treatment outside a hospital or residential setting. This process has provided a format for collaborating with families, community providers, schools, and managed care companies. It also integrates an understanding of developmental psychopathology with solution-focused, pragmatic approaches to behavior change.

Adolescent↗