Predictors and treatment outcomes of perceived ward atmosphere among therapeutic community residents

Knowledge discovery of patients reviews on breast cancer drugs: Segmentation of side effects using machine learning techniques

Breast cancer stands as the most frequently diagnosed life-threatening cancer among women worldwide. Understanding patients' drug experiences is essential to improving treatment strategies and outcomes. In this research, we conduct knowledge discovery on breast cancer drugs using patients' reviews. A new machine learning approach is developed by employing clustering, text mining and regression techniques. We first use Latent Dirichlet Allocation (LDA) technique to discover the main aspects of patients' experiences from the patients' reviews on breast cancer drugs. We also use Expectation-Maximization (EM) algorithm to segment the data based on patients' overall satisfaction. We then use the Forward Entry Regression technique to find the relationship between aspects of patients' experiences and drug's effectiveness in each segment. The textual reviews analysis on breast cancer drugs found 8 main side effects: Musculoskeletal Effects, Menopausal Effects, Dermatological Effects, Metabolic Effects, Gastrointestinal Effects, Neurological and Cognitive Effects, Respiratory Effects and Cardiovascular. The results are provided and discussed. The findings of this study are expected to offer valuable insights and practical guidance for prospective patients, aiding them in making informed decisions regarding breast cancer drug consumption.

The prison-based Therapeutic Community: Resident recommendations for program improvement

INTRODUCTION

The prison-based Therapeutic Community (TC) is widely used within correctional institutions to address substance use disorders (SUDs). While most evaluations of the prison-based TC find the program to be effective, recent mixed evidence and the continued surge of the opioid crisis call for deeper investigation into program operations, barriers to engagement, and sources of treatment effect heterogeneity. Notably lacking from prior evaluations, and critical to our understanding of variable program engagement, is first-hand experiences and perceptions from program participants.

METHODS

To assess prison-based TC resident perceptions of the program and their recommendations for improvement, we utilize data from the Therapeutic Community Prison Inmate Network Study (TC-PINS), a longitudinal data collection effort conducted in one prison-based TC unit within a Pennsylvania state prison. Specifically, we assess resident responses to the open-ended item "What can the TC do better?" Analyzing 470 responses to this question by 177 residents, two independent coders identified seven substantive categories of recommended changes or improvements to their TC program.

RESULTS

Residents provided tangible recommendations for improvement of their prison-based TC program based on their experiences and perceptions. Importantly, a number of their recommendations directly counter the intended model of the TC, which highlights imperative issues underlying the translation of the TC model within the prison environment. Resident suggestions include enhanced structure, increased individualization, expanded curriculum, stricter enforcement of rules, and improved or more experienced staff. Additionally, many question the coercive nature of TC program participation within this prison system.

CONCLUSIONS

Resident recommendations for program improvement unveil important sources of treatment effect heterogeneity and highlight tangible program changes that can be implemented to reduce barriers to treatment engagement. We provide suggested changes to this prison-based TC based on resident perceptions and discuss both the importance and relative ease of eliciting this critical participant feedback.

A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment

Introduction

This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions.

Materials and Methods

Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUC_G). A multivariate logistic regression analysis was performed to find an association between dropout rates and the biopsychosocial variables.

Results

The results suggest a lower dropout odds for patients with high motivation (OR = 0.76, p = 0.022) and patients admitted to short-term treatment (OR = 0.06, p = 0.005). An interaction with stimulant SUD and DCS (OR = 13.74, p = 0.024) also revealed higher dropout odds. No statistical significance was found for psychological distress, WAS, and cortisol AUC_G.

Conclusion

The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.

What Client Demographic, Substance Use, Mental Health, Treatment, and Psychological Variables Predict Residential Treatment Completion for Substance Use Disorders?

Residential treatment is a common option for individuals with moderate to severe substance use disorders. In a cohort of individuals who accessed residential treatment, we investigated client demographic, substance use, mental health, treatment, and psychological predictors of treatment completion. Participants were a retrospective cohort of 1056 (15–69 years) individuals admitted to residential treatment facilities across Queensland, Australia, from January 2014 to December 2016. Participant characteristic information was obtained at admission, including the Depression Anxiety Stress Scale 21 (DASS-21). A multiple logistic regression model was conducted with treatment completion as the outcome. The overall rate of treatment completion was 14.3%. Mild to moderate (aOR = 0.48 [0.28–0.84], p = .010) and severe to extremely severe (aOR = 0.35 [0.17–0.74], p = .006) stress on the DASS-21 at service entry was significantly associated with a lower likelihood of treatment completion. Participants with higher levels of stress at service entry were less likely to complete treatment, representing a missed opportunity to provide targeted support during high-risk periods for individuals with substance use disorders. Further research investigating the nature and causes of stress in-between, during, and following presentations to residential treatment is needed.

Eigenvector centrality defines hierarchy and predicts graduation in therapeutic community units

INTRODUCTION

Therapeutic communities (TCs) are mutual aid based residential programs for the treatment of substance abuse and criminal behavior. While it is expected that residents will provide feedback to peers, there has been no social network study of the hierarchy through which feedback flows.

METHODS

Data for this study was drawn from clinical records of peer corrections exchanged between TC residents in six units kept over periods of less than two to over eight years. Four of the units served men while two served women. Hierarchy position was measured using eigenvector centrality, on the assumption that residents who were more central in the network of corrections were lower in the hierarchy. It was hypothesized that residents would rise in the hierarchy over time. This was tested using Wilcoxon paired samples tests comparing the mean and maximum eigenvector centrality for time in treatment with those in the last month of treatment. It was also hypothesized that residents who rose higher in the hierarchy were more likely to graduate, the outcome of primary interest. Logistic regression was used to test hierarchy position as a predictor of graduation, controlling for age, race, risk of recidivism as measured by the Level of Services Inventory-Revised (LSI-R) and days spent in the program.

RESULTS

Residents averaged a statistically significantly lower eigenvector centrality in the last month in all units, indicating a rise in the hierarchy over time. Residents with lower maximum and average eigenvector centrality both over the length of treatment and in the last month of treatment were more likely to graduate in four of the six units, those with lower maximum and average eigenvector centrality in the last month but not over the length of treatment were more likely to graduate in one of the six units, while eigenvector centrality did not predict graduation in one unit. However, this last unit was much smaller than the others, which may have influenced the results.

CONCLUSION

These results suggest that TC residents move through a social network hierarchy and that movement through the hierarchy predicts successful graduation.

Resident interactions when affirming and correcting peers in a therapeutic community for women

Purpose –

While recent years have seen a number of studies of social networks in therapeutic communities (TCs) and other residential settings, these have primarily focused on male residents. This paper aims to conduct a longitudinal social network analysis of interpersonal interactions in a TC for women.

Design/methodology/approach –

The data consists of a longitudinal directed social network of instances of feedback between 56 residents of a 16 bed TC for women over a period of 611 days. Mean age of the participants was 33.1 years, mean length of stay was 133.9 days and 91% of the participants were female. Feedback consisted of written affirmations for prosocial behavior and written corrections for contravening TC norms. Data was analyzed using a latent factor longitudinal social network model.

Findings –

Residents react to peer intervention in complex ways. Residents reciprocated affirmations (B = 0.14, 95% confidence interval = 0.10, 0.18) and corrections (B = 0.20, 95% CI = 0.13, 0.25). Controlling for reciprocity, participants who received affirmations were more likely to affirm and correct peers (B = 0.10, 95% CI = 0.06, 0.15; B = 0.17, 95% CI = 0.10, 0.23), suggesting that the encouragement offered by affirmations leads to increased activity. Homophily by admission time occurred in both affirmations and corrections (B = 0.23, 95% CI = 0.10, 0.37; B = 0.51, 95% CI = 0.29, 0.74).

Originality/value –

While affirmations and corrections serve as vehicles for behavioral reinforcement and social learning, they also allow residents to interact in ways that strengthen social bonds.

Social and programmatic interactions in a therapeutic community for women: an exponential random graph model analysis

Purpose

To analyze networks of social interactions between the residents of a therapeutic community (TC) for women and the way, in which such interactions predict the discussion of issues that arise in treatment.

Design/methodology/approach

In total, 50 residents of a corrections-based TC for women were surveyed on the peers with whom they socialized informally, shared meals, shared letters from home and discussed issues that arose in treatment over a 12 h period. The data were analyzed using exponential random graph models (ERGM).

Findings

Reciprocity occurred in all networks while transitivity (a tendency of two residents who are connected to both connect to a third peer) occurred in all networks measuring informal social interactions. When controlling for reciprocity and transitivity, residents avoided spending social time or sharing meals with the same peers. There was no evidence of homophily by race, age or years of education. Homophily by entrance time and case manager occurred in social time. Case manager homophily occurred in the discussion of treatment issues but disappeared when controlling for social time and sharing letters from home.

Research limitations/implications

Social networks in this TC arise from factors endogenous to the TC itself. It should be possible to determine the characteristics of optimal social networks in TCs. External validity is limited.

Practical implications

It should be possible to intervene to optimize the social networks of TC residents.

Originality/value

This is the first ERGM analysis of both informal and formal interactions in a TC.

Building the community: Endogenous network formation, homophily and prosocial sorting among therapeutic community residents

BACKGROUND

Researchers have begun to consider the ways in which social networks influence therapeutic community (TC) treatment outcomes. However, there are few studies of the way in which the social networks of TC residents develop over the course of treatment.

METHODOLOGY

We used a Temporal Exponential Random Graph Model (TERGM) to analyze changes in social networks totaling 320,387 peer affirmations exchanged between residents in three correctional TCs, one of which serves men and two of which serve both men and women. The networks were analyzed within weekly and monthly time-frames.

RESULTS

Within a weekly time-frame residents tended to close triads. Residents who were not previously connected tended not to affirm the same peers. Residents showed homophily by entry cohort. Other results were inconsistent across TC units. Within a monthly time-frame participants showed homophily by graduation status. They showed the same patterns of triadic closure when connected, tendency not to affirm the same peers when not connected and homophily by cohort entry time as in a weekly time frame.

CONCLUSIONS

TCs leverage three human tendencies to bring about change. The first is the tendency of cooperators to work together, in this case in seeking graduation. The second is the tendency of people to build clusters. The third is homophily, in this case by cohort entry time. Consistent with TC clinical theory, residents spread affirmations to a variety of peers when they have no previous connection. This suggests that residents balance network clustering with a concern for the community as a whole.

Treatment engagement in a prison-based Therapeutic Community: A mixed-methods approach

Given the high proportion of inmates with histories of substance use disorders in the era of mass incarceration, many correctional institutions have integrated the prison-based Therapeutic Community (TC) into their programming. While most evaluations provide evidence of lowered rates of relapse and recidivism, the majority of TC graduates still have negative outcomes post-release. Filling an important gap in the TC treatment literature, we analyze quantitative measures of treatment engagement alongside qualitative narratives from prison-based TC residents, providing an essential look into the black box of TC treatment mechanisms. Quantitative results show more between-person variation than within-person change, reflecting trivial increases in treatment engagement throughout time in the program. Qualitative results unpack these findings, pointing to processes of selection bias, heterogeneous treatment effects, and program fidelity lapses. In combination, our mixed data identify tangible modifications to program implementation that could strengthen desired post-release outcomes.

The recovery-oriented therapeutic community for addictions (ROTC): a response to contemporary substance use disorder treatments in the Philippines

Purpose

The Philippines’ nationwide campaign on drugs has been under the limelight due to its controversial approaches in dealing with the problem of addiction. Despite the government’s current efforts, substance use disorders continue to persist within the population. The purpose of this paper is to provide recommendations for addressing the issue of substance use disorder treatment through a modification of the therapeutic community (TC) in the Philippine context.

Design/methodology/approach

This conceptual paper reviews the existing facts about the Philippines’ campaign against drugs, the approaches implemented by the government, current state and research developments of TCs, and its resulting impact on contemporary evidence-based treatment for addiction in the country.

Findings

A treatment framework outlining a recovery-oriented therapeutic community (ROTC) is presented. The ROTC aims to address addiction as a chronic, relapsing disease. This alternative approach for addiction treatment in the Philippines is based on the concept of recovery, principles of effective substance use disorder treatment, and recent developments in TC best practices from the international community.

Originality/value

This paper discusses different recommendations for policy development, interventions and research, aimed at improving the odds of securing recovery for people suffering from addiction.

Relapse after inpatient substance use treatment: A prospective cohort study among users of illicit substances

AIMS

The main aim was to investigate the relative roles of mental distress and intrinsic motivation for relapse after inpatient substance use disorder (SUD) treatment, while adjusting for demographics and treatment variables.

METHODS

The study is based on a prospective multicenter study with a baseline gross sample of 607 patients with SUD (response rate = 84%) admitted to an inpatient stay at one of five specialized SUD treatment centers in Norway. The analytical sample consisted of patients with illicit drug use (n = 374) who took part in a follow-up interview three months after discharge from inpatient treatment (n = 249) (retention rate = 67%). Data were collected using information from electronic medical records, a self-report questionnaire at treatment entry, and a follow-up interview.

RESULTS

Relapse occurred among 37% of the sample by three-month follow-up. Results of multivariable analysis showed that younger age and having a psychiatric diagnosis were associated with an elevated relapse risk. Patients who received treatment at a short-term clinic (2-4 months), as opposed to a long-term clinic (>6 months) were also at increased risk of relapse, regardless of their length of stay. Reduced risk of relapse was predicted by having completed the inpatient treatment stay.

CONCLUSION

Identifying the treatment needs of young patients and patients with co-occurring psychiatric diagnoses during and following inpatient SUD treatment may contribute to reduced post-treatment relapse rates. Further research is needed to illuminate the treatment-related factors that contribute to reduced risk of relapse after inpatient SUD treatment.

Completion rates and psychosocial intervention effectiveness in an Australian substance use therapeutic community

BACKGROUND

Program attrition is a major problem in substance use treatment. It is not clear which client and treatment variables are related to successful completion. This study aimed to identify client variables associated with Therapeutic Community (TC) completion. A secondary aim was to investigate changes in entry and exit scores on psychosocial outcome measures.

METHODS

Retrospective quantitative analysis of data collected from 193 Australian TC residents, over 3.5 years. Variables measured included: demographics; Depression, Anxiety, Stress Score (DASS-21) and World Health Organisation Quality of Life 8 questions (WHOQOL-8).

RESULTS

Completion rates were 30.6%. High Money WHOQOL-8 scores, suggestive of minimal financial stressors, positively predicted completion. Multivariate analyses showed that negative predictors of completion were: amphetamine being primary substance of concern, aggression, high Relationship WHOQOL-8 scores, suggestive of positive relationships, and younger or older age. Those in the program demonstrated clinically significant psychological improvement and significant improvement in all quality of life scores over time. The degree of psychometric improvement was most pronounced in those who completed the course, with the exception of depression, stress, and money problems.

CONCLUSION

The findings provide an understanding of specific predictors of program completion which may help to identify high-risk clients and inform program improvement. Early attrition rates may be reduced by monitoring and supporting high-risk clients. Overall, psychometric improvement occurred amongst both completers and non-completers overtime but is most prominent amongst course completers, with the exception of depression, stress, and money problems. Future research could potentially focus on amphetamine users and shortened TC programs, focusing on acute psychosocial intervention.

"I just feel comfortable out here, there's something about the place": staff and client perceptions of a remote Australian Aboriginal drug and alcohol rehabilitation service

BACKGROUND

The need for effective, culturally safe residential rehabilitation services for Aboriginal people is widely acknowledged, however the combination of treatment components that is optimally effective, is not well defined. Most existing Aboriginal residential rehabilitation research has focused on describing client characteristics, and largely ignored the impact of treatment and service factors, such as the nature and quality of therapeutic components and relationships with staff.

METHODS

This qualitative study was undertaken as part of a three-year mixed methods community-based participatory research (CBPR) project that aimed to empirically describe a remote Aboriginal drug and alcohol rehabilitation service. Researchers utilised purposive sampling to conduct 21 in-depth, semi-structured interviews. The interviews used a 'research yarning' approach, a form of culturally appropriate conversation that is relaxed and narrative-based. The interview transcripts were thematically coded using iterative categorization. The emerging themes were then analysed from an Interpretative Phenomenological Analysis, focusing on how participants' lived experiences before and during their admission to the service shaped their perceptions of the program.

RESULTS

A total of 12 clients (mean age 35 years, SD 9.07, 91% Aboriginal) and 9 staff (2 female, 7 male, mean age 48 years, SD 8.54, 67% Aboriginal) were interviewed. Five themes about specific program components were identified in the interview data: healing through culture and country; emotional safety and relationships; strengthening life skills; improved wellbeing; and perceived areas for improvement. This research found that Aboriginal drug and alcohol residential rehabilitation is not just about length of time in treatment, but also about the culture, activities and relationships that are part of the treatment process.

CONCLUSION

This study highlights that cultural elements were highly valued by both clients and staff of a remote Aboriginal residential rehabilitation service, with the country or location being fundamental to the daily practice of, and access to, culture. Developing reliable and valid assessments of the program components of culture and treatment alliance would be valuable, given this study has reinforced their perceived importance in achieving positive treatment outcomes. Further, strengthening the aftercare program, as part of an integrated model of care, would likely provide greater support to clients after discharge.

Saving My Life: Dynamics of Peer and Staff Corrections Among Therapeutic Community Residents

BACKGROUND

Therapeutic communities (TCs) maintain order and encourage behavior change through a system of peer corrections. This study is the first quantitative analysis of the dynamics of the exchange of peer corrections at TCs.

OBJECTIVES

We applied longitudinal social network analysis to compare the reactions of TC residents to peer versus staff intervention, while analyzing dynamics of correction exchange among residents.

METHOD

The data consisted of a large database of staff and peer affirmations and corrections at four therapeutic community units that occurred between the years 2006 and 2008. We modeled the data as a directed temporal social event network, using a generalized linear mixed effects model to analyze predictors of corrections among residents.

RESULTS

Residents were more likely to send a correction following peer affirmations and corrections than following staff affirmations and corrections. Residents reciprocated corrections to individual peers. Autocorrelation was evident in both sending and receiving corrections and residents were more likely to send a correction after having sent an affirmation. Residents who arrived at roughly the same time were more likely to exchange corrections. Residents tended to send and receive more corrections in the middle 3 months of their treatment. European American residents and those with higher scores on the LSI-R were more likely to receive corrections than others.

CONCLUSIONS

TC residents respond more strongly and more positively to peer than to staff intervention. The pattern of exchange of peer corrections in TCs is complex. This suggests possible paths to improved outcomes.

Attachment, motivation, and clinical progress in a Filipino therapeutic community: a mediation analysis

Purpose

The therapeutic community (TC) is a widely used intervention program in treating substance use disorders. Despite its documented utility, researchers and practitioners are still perplexed on how it exactly works. The purpose of this paper is to suggest the role of attachment styles and treatment motivation in the TC process.

Design/methodology/approach

Applying an explanatory correlational research, this notion was tested by examining the responses of 200 patients with substance use disorder in a TC using mediation analysis.

Findings

The results revealed that attachment styles indirectly affect client’s clinical progress by the path of treatment motivation. Although the current study cannot conclude causality, the results provide empirical evidence suggesting that attachment activates motivation in treatment within the social dynamics of the TC, thus influencing clinical progress.

Originality/value

From these findings, recommendations for the modification of TCs along with considerations for further research, and socio-political implications are discussed.

A network of helping: Generalized reciprocity and cooperative behavior in response to peer and staff affirmations and corrections among therapeutic community residents

BACKGROUND

Clinical theory in therapeutic communities (TCs) for substance abuse treatment emphasizes the importance of peer interactions in bringing about change. This implies that residents will respond in a more prosocial manner to peer versus staff intervention and that residents will interact in such a way as to maintain cooperation.

METHOD

The data consist of electronic records of peer and staff affirmations and corrections at four corrections-based therapeutic community units. We treat the data as a directed social network of affirmations. We sampled 100 resident days from each unit (n = 400) and used a generalized linear mixed effects network time series model to analyze the predictors of sending and receiving affirmations and corrections. The model allowed us to control for characteristics of individuals as well as network-related dependencies.

RESULTS

Residents show generalized reciprocity following peer affirmations, but not following staff affirmations. Residents did not respond to peer corrections by increasing affirmations, but responded to staff corrections by decreasing affirmations. Residents directly reciprocated peer affirmations. Residents were more likely to affirm a peer whom they had recently corrected. Residents were homophilous with respect to race, age and program entry time.

CONCLUSION

This analysis demonstrates that TC residents react more prosocially to behavioral intervention by peers than by staff. Further, the community exhibits generalized and direct reciprocity, mechanisms known to foster cooperation in groups. Multiple forms of homophily influence resident interactions. These findings validate TC clinical theory while suggesting paths to improved outcomes.

Examining Treatment Climate Across Prison-Based Substance Abuse Treatment Groups

BACKGROUND

With notable exceptions, few studies have looked critically at the role and effects of factors other than individual or programmatic differences that contribute to the climate within substance abuse treatment programs. De Leon's work on the therapeutic community, however, indicates that factors beyond the individual and program can contribute to the overall functioning of similarly situated communities.

OBJECTIVES

In this study, we introduce and examine the concept of the "treatment group," the level of aggregation between the individual who participates in treatment and the organization that provides it. The treatment group refers to the social context and dynamics that operate among treatment participants, and we sought to study differences in treatment climate across 12 prison-based treatment groups within a single prison.

METHODS

Using data from 604 participants who were assigned at random to one of the 12 groups, we analyzed differences on seven treatment climate indicators from one month and six months into the program across the treatment groups.

RESULTS

No differences were found among the treatment groups at after one month; however, after 6 months, significant differences emerged across the groups on three treatment climate variables: program structure, counselor rapport, and counselor competence.

CONCLUSIONS/IMPORTANCE

This study is among the first of its kind to conceptualize and examine treatment climate across otherwise similar groups and find that differences emerge on several indicators of climate. As such, we argue that the treatment group may be important to consider in both the delivery and evaluation of substance abuse treatment.