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Yang Y, Gray J, Joe GW, Flynn PM, Knight K. Treatment Retention Satisfaction, and Therapeutic Progress for Justice-Involved Individuals Referred to Community-Based Medication-Assisted Treatment. Subst Use Misuse 2019; 54:1461-1474. [PMID: 31030611 PMCID: PMC10695041 DOI: 10.1080/10826084.2019.1586949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Limited research has examined factors associated with medication-assisted treatment for justice-involved individuals. Objectives: The current study used a mixed-method design to examine the influence of client- and counselor-level factors on 90-day treatment retention, satisfaction, and progress for justice-involved individuals referred to medication-assisted treatment. Methods: The effects of co-occurring disorders (i.e., psychiatric symptoms, anxiety, depression), social functioning (i.e., social support, self-esteem), substance use severity, and treatment motivation on treatment retention, treatment satisfaction, and treatment progress while controlling for counselor-level variance were assessed through multilevel modeling. Results: Fewer co-occurring disorders and more social support were related to greater treatment satisfaction and progress. A higher level of treatment motivation was associated with greater treatment progress. Mediation of treatment satisfaction on the relationship between client-level factors and treatment progress also was tested. Depression was negatively associated with treatment satisfaction, which in turn led to lower ratings of treatment progress. Social support was positively correlated with treatment satisfaction, which in turn was positively correlated with treatment progress. The association of client substance use severity with treatment retention differed between counselors, so did the association of co-occurring disorders and treatment motivation with treatment satisfaction. Qualitative analyses that were derived from counselors' perception of factors relating to recovery success underscored the importance of integrated interventions, social support, treatment motivation, and therapeutic alliance, and their associations with treatment outcomes. Conclusions/Importance: The current findings highlight the importance of integrated treatment services, collaborating with community corrections, and teaching clients strategies for dealing with deviant peers as to facilitating recovery.
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Affiliation(s)
- Yang Yang
- Department of Psychology, University of Louisiana, Lafayette, Louisiana, USA
| | - Julie Gray
- Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA
| | - George W. Joe
- Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA
| | - Patrick M. Flynn
- Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA
| | - Kevin Knight
- Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA
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Pullmann MD, Ague S, Johnson T, Lane S, Beaver K, Jetton E, Rund E. Defining engagement in adolescent substance abuse treatment. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 52:347-58. [PMID: 24046184 DOI: 10.1007/s10464-013-9600-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Youth engagement in substance use treatment is an important construct for research and practice, but it has been thinly and inconsistently defined in the literature. Most research has measured engagement by initiation, attendance, and retention in treatment. Because youth generally enter substance use treatment as a result of compliance with external requirements, defining engagement in this way might be insufficient. This qualitative participatory research study describes five focus groups with 31 adults working with youth in substance use treatment. Focus groups were designed and conducted by youth researchers in collaboration with university-based partners. We categorized participants' descriptions of engagement into five domains, identified as "CARES": Conduct, Attitudes, Relationships, Empowerment, and Social Context. These domains represent a comprehensive and ecologically-based definition of engagement that situates engagement in the context and trajectory of youth development, has clear implications for assertive clinical practice, and provides a foundation for developing an operationalized measure.
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Affiliation(s)
- Michael D Pullmann
- Division of Public Behavioral Health and Justice Policy, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 2815 Eastlake Avenue East, Seattle, WA, 98102, USA,
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3
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Benishek LA, Carter M, Clements NT, Allen C, Salber KE, Dugosh KL, Kirby KC. Psychometric assessment of a self-administered version of the Significant Other Survey. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 26:986-93. [PMID: 23067309 DOI: 10.1037/a0030378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
While there are a number of general measures that assess interpersonal and psychological distress experienced by individuals who are in a close relationship with a substance abusing adult, until recently the field has lacked a psychometrically sound, self-administered multidimensional measure explicitly designed to measure the problems of non-substance-abusing adults who are concerned about a substance using loved one. This study examined the psychometric properties of a 54-item, self-administered (SA) version of the Significant Other Survey (SOS), a measure designed to address this gap. The SOS-SA assesses problems across seven problem domains (emotional, relationship, family, financial, physical violence, legal, health). Coefficient alpha estimates (N = 168) were good to excellent for five of the domains, the test-retest reliability (N = 83) across a 7-day time frame was fair to excellent for all seven domains. Similar reliability coefficients were identified regardless of whether the item queried about the problem frequency or perceived severity. There was preliminary support for the construct and discriminant validity of the SOS-SA. The SOS-SA appears to be a promising instrument given that it is brief, requires no specialized training to administer, and has good psychometric properties.
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Affiliation(s)
- Lois A Benishek
- Treatment Research Institute, Philadelphia, PA 19106-3475, USA.
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McKiernan P, Shamblen SR, Collins DA, Strader TN, Kokoski C. Creating Lasting Family Connections. ACTA ACUST UNITED AC 2012. [DOI: 10.1177/0887403412447505] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is increasing evidence of the effectiveness of continued care after reentry for those who have participated in prison-based substance abuse treatment. This article presents results from analyses of program and comparison group data from two community-based programs that implemented a culturally adapted version of the Creating Lasting Family Connections (CLFC) curriculum. Both programs sought to strengthen individuals (and their families) recently reentering the community after incarceration. Results suggested that the first program had effects on increasing HIV knowledge and spirituality, while reducing intentions to binge drink and recidivism. The second program similarly showed effects on recidivism, and participants also showed an increase in nine separate relationship skills. The policy implications of the results are discussed.
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Affiliation(s)
| | | | - David A. Collins
- Pacific Institute for Research and Evaluation, Louisville Center, KY, USA
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Santis R, Hidalgo CG, Jaramillo A, Hayden V, Armijo I, Lasagna A. A family outreach intervention for engaging young out-of-treatment drug users: pre- versus post-treatment comparison. J Subst Abuse Treat 2012; 44:61-70. [PMID: 22520275 DOI: 10.1016/j.jsat.2012.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 03/16/2012] [Accepted: 03/19/2012] [Indexed: 11/26/2022]
Abstract
Only a small fraction of drug users worldwide enter treatment each year. We evaluated the efficacy of a systemic family outreach intervention (SFOI) for young, untreated drug users, using a quasi-experimental design in which the experimental group (EG) received SFOI and the control group (CG) received traditional outreach work (OW). Both pre- and post-treatment, we administered the Addiction Severity Index-6 (ASI-6), the Family Environment Scale (FES), and tests of parental practices and risky behavior. Post-treatment, there was a fivefold improvement on the ASI-6 and a significant worsening on the conflict sub-scale of the FES in the EG as compared with the CG. SFOI was more efficacious than OW in reducing drug use in the drug user's home environment. The increased conflict in the EG might be explained by parents' increased awareness of abnormal behaviors and implementation of strategies to protect their children.
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Affiliation(s)
- Rodrigo Santis
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Av. Camino El Alba 12351, Las Condes, 7620002 Santiago, Chile.
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Landau J. Communities that care for families: the LINC Model for enhancing individual, family, and community resilience. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2010; 80:516-24. [PMID: 20950292 DOI: 10.1111/j.1939-0025.2010.01054.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The resilience of families and communities is inextricably linked. Their healthy functioning relies on a balance of stressors and resources. Both can be jeopardized by major challenges such as socioeconomic change or natural and man-made disasters. Such events can cause increased incidences of physical and mental problems such as addiction, posttraumatic stress syndrome, and heart disease. Trauma breeds marginalization, abuse of power, and prejudice. How these stressors are handled is profoundly influenced by the degree of connectedness-attachment-to family and culture of origin. Connectedness can be enhanced by mobilizing support systems, facilitating access to resources, strengthening family, community and cultural ties, and fostering resilience. The LINC Model increases connectedness at the individual, family, and community levels. This article includes methods for designing interventions, studies and clinical vignettes that illustrate the application of the LINC Model, and examples of communities that have overcome major stress.
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Agani F, Landau J, Agani N. Community-building before, during, and after times of trauma: the application of the LINC model of community resilience in Kosovo. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2010; 80:143-9. [PMID: 20397999 DOI: 10.1111/j.1939-0025.2010.01017.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A family's heritage and values have profound bearing on the stressors they encounter and how they cope. Socioeconomic change, natural and man-made disasters, and international migration are major influences on the integrity of society. In these times of global financial crisis, communities around the world are in danger of losing their intrinsic structure and protective factors. Connectedness or attachment to family and culture of origin correlate with reduced risk-taking behaviors and a reduction in family and societal violence, posttraumatic stress, addiction, depression, suicidality, sexual risk taking, and other chronic and/or life-threatening health problems and illnesses. Facilitating these families' cultural and community ties and enhancing their access to extended-family and community resources can thus be protective against trauma. These relationships foster resilience and reduce the short- and long-term effects of stress on families and communities. Targets of interventions may be individuals, families, or communities. Assessment of vulnerabilities, protective factors, goals, and resources encourages and facilitates collaboration across natural and artificial support systems. Such collaboration is important in building resilience rather than perpetuating vulnerability and long-term problems for individuals, their families, and the communities in which they live. The recent Kosovar experience in implementing the LINC Model of Community Resilience illustrates these principles, as applied in the context of substance abuse services and community rebuilding in the period soon after armed conflict.
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Landau J, Garrett J, Webb R. Assisting a concerned person to motivate someone experiencing cybersex into treatment: application of invitational intervention: the arise model to cybersex. JOURNAL OF MARITAL AND FAMILY THERAPY 2008; 34:498-511. [PMID: 19017188 DOI: 10.1111/j.1752-0606.2008.00091.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cybersex and Internet pornography addiction are new problem areas confronting couples and families. A most significant experience inducing family members to reach out to a therapist or an Interventionist for help with their addicted member is the realization that the individual they are living with has become a stranger. This article focuses on the changes in the attitude, emotions, and behaviors of the addicted individual from compulsive Internet pornography use and cybersex. Identifying these changes for the family members validates their experience of now living with a stranger. This article then presents the three-level empirically based, manual-driven method of Invitational Intervention, A Relational Intervention Sequence for Engagement (ARISE) as an effective tool for helping families to get their loved ones into treatment.
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Landau J, Mittal M, Wieling E. Linking human systems: strengthening individuals, families, and communities in the wake of mass trauma. JOURNAL OF MARITAL AND FAMILY THERAPY 2008; 34:193-209. [PMID: 18412826 DOI: 10.1111/j.1752-0606.2008.00064.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article presents an overview of the philosophy and practical principles underlying the Linking Human Systems Approach based on the theory of resilience in individuals, families, and communities facing crisis, trauma, and disaster. The Link Approach focuses on tapping into the inherent strength of individuals and their families and emphasizes resilience rather than vulnerability. It has been successfully used in combating critical public health problems, such as addiction, HIV/AIDS, and recovery from major trauma or disaster. Also, three specific models of Link intervention aimed at the individual, family, and community levels are discussed, with special emphasis on the family-level intervention. These interventions are directed toward mobilizing resources for long-term physical, emotional, psychological, and spiritual healing.
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Affiliation(s)
- Judith Landau
- Linking Human Systems, LLC, and LINC Foundation, Boulder, CO 80301, USA.
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Invitational Intervention: The ARISE Model for Engaging Reluctant Alcohol and Other Drug Abusers in Treatment. ALCOHOLISM TREATMENT QUARTERLY 2008. [DOI: 10.1300/j020v26n01_08] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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11
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Working with Family Members to Engage Treatment-Refusing Drinkers: The CRAFT Program. ALCOHOLISM TREATMENT QUARTERLY 2008. [DOI: 10.1300/j020v26n01_09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fernandez AC, Begley EA, Marlatt GA. Family and peer interventions for adults: past approaches and future directions. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2006; 20:207-13. [PMID: 16784367 DOI: 10.1037/0893-164x.20.2.207] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Through the use of published literature and empirical research, the authors explore the differing conceptual frameworks, techniques, and effectiveness of various family interventions for change-resistant, substance-abusing adults. The 2 dominant programs in place to help families and friends deal with the addiction of an adult loved one are the Johnson Intervention and Al-Anon. Research on these 2 programs is presented, followed by an outline of promising alternative approaches. These include A Relational Intervention Sequence for Engagement, Community Reinforcement Training, Community Reinforcement and Family Training, Unilateral Family Therapy, and Pressures to Change. The effectiveness and appropriateness of these approaches in different situations are discussed. In addition, areas in need of further study are pointed out.
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Affiliation(s)
- Anne C Fernandez
- Addictive Behaviors Research Center, University of Washington, Seattle, 98195-1525, USA
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Soyez V, De Leon G, Broekaert E, Rosseel Y. The impact of a social network intervention on retention in Belgian therapeutic communities: a quasi-experimental study. Addiction 2006; 101:1027-34. [PMID: 16771894 DOI: 10.1111/j.1360-0443.2006.01441.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although numerous studies recognize the importance of social network support in engaging substance abusers into treatment, there is only limited knowledge of the impact of network involvement and support during treatment. The primary objective of this research was to enhance retention in Therapeutic Community treatment utilizing a social network intervention. AIMS The specific goals of this study were (1) to determine whether different pre-treatment factors predicted treatment retention in a Therapeutic Community; and (2) to determine whether participation of significant others in a social network intervention predicted treatment retention. DESIGN, SETTING AND PARTICIPANTS Consecutive admissions to four long-term residential Therapeutic Communities were assessed at intake (n = 207); the study comprised a mainly male (84.9%) sample of polydrug (41.1%) and opiate (20.8%) abusers, of whom 64.4% had ever injected drugs. Assessment involved the European version of the Addiction Severity Index (EuropASI), the Circumstances, Motivation, Readiness scales (CMR), the Dutch version of the family environment scale (GKS/FES) and an in-depth interview on social network structure and perceived social support. Network members of different cohorts were assigned to a social network intervention, which consisted of three elements (a video, participation at an induction day and participation in a discussion session). FINDINGS Hierarchical regression analyses showed that client-perceived social support (F1,198 = 10.9, P = 0.001) and treatment motivation and readiness (F1,198 = 8.8; P = 0.003) explained a significant proportion of the variance in treatment retention (model fit: F7,197 = 4.4; P = 0.000). By including the variable 'significant others' participation in network intervention' (network involvement) in the model, the fit clearly improved (F1,197 = 6.2; P = 0.013). At the same time, the impact of perceived social support decreased (F1,197 = 2.9; P = 0.091). CONCLUSIONS Participation in the social network intervention was associated with improved treatment retention controlling for other client characteristics. This suggests that the intervention may be of benefit in the treatment of addicted individuals.
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Affiliation(s)
- Veerle Soyez
- Ghent University, Department of Orthopedagogics, Ghent, Belgium.
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Landau J, Stanton MD, Brinkman-Sull D, Ikle D, McCormick D, Garrett J, Baciewicz G, Shea RR, Browning A, Wamboldt F. Outcomes with the ARISE approach to engaging reluctant drug- and alcohol-dependent individuals in treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2005; 30:711-48. [PMID: 15624546 DOI: 10.1081/ada-200037533] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Our goal was to explore, through a Stage I NIH clinical study, the effectiveness of a manual-driven, timely response method for helping the "concerned other" get resistant substance abusers into treatment/self-help with minimum professional time/effort. A manual-driven protocol, "A Relational Sequence for Engagement (ARISE)," was applied with 110 consecutive, initial calls/contacts from concerned others; no cases excluded for research, refusal, or other reasons. The research was conducted at two upstate New York outpatient drug/alcohol clinics. Participants were concerned others who called regarding a cocaine, alcohol, or "other drug" abuser (N = 110); participating family/friends: 11 ARISE clinicians; and 110 substance abusers. ARISE is a graduated continuum starting with the least demanding option/stage, increasing effort as needed to engage substance abusers in treatment/self-help. Stage I: Coaching the concerned other to arrange a meeting of significant others, inviting the substance abuser; Stage II: 1 to 5 additional meetings (median = 2); Stage III: A modified Johnson "Intervention." Primary outcome variables were substance abuser engagement (or not) in treatment/self-help; days between first call and engagement; clinician time/effort. Predictors were concerned other, substance abuser, and clinician demographics; number of participants per case; and Collateral Addiction Severity Index. ARISE resulted in an 83% success rate (55% at Stage I). Median days to engagement was 7 (IQR = 2 to 14). Average total time (telephone, sessions) per case was 1.5 hours. Treatment/self-help chosen was 95% treatment and 5% self-help. Number of family/ friends involved correlated 0.69 with a success/efficiency index. Conclusions. A call from a family member or concerned other for help in getting a loved one into treatment is a rich opportunity for treatment professionals and agencies to engage substance abusers in treatment. These initial calls are similar to referral calls from EAPs or probation officers looking to get an individual started in treatment. ARISE provides an effective, swift, and cost-efficient option for engaging substance abusers in treatment or self-help. The more significant others involved, the greater the success of treatment engagement.
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Brown BS, O'Grady KE, Battjes RJ, Katz EC. The Community Assessment Inventory--client views of supports to drug abuse treatment. J Subst Abuse Treat 2004; 27:241-51. [PMID: 15501377 DOI: 10.1016/j.jsat.2004.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Revised: 08/12/2004] [Accepted: 08/14/2004] [Indexed: 10/26/2022]
Abstract
A measure assessing client views of the community supports available to them was developed and tested with entrants to outpatient drug free treatment. Items for a Community Assessment Inventory (CAI) fell into four areas of potential social support for treatment entry and engagement: (1) partner and/or family with whom living; (2) family living outside the home; (3) friends; and (4) the community itself. Based on 241 study participants, it was found that internal consistency alphas for the four scales ranged between .79 and .88. Both total CAI score and individual scales assessing support from friends and from partner/spouse were found capable of predicting treatment readiness as assessed using the TCU Motivation Scale. Evidence of construct validity was suggested by differences in CAI total score between participants reporting and not reporting involvement in discussions with others regarding crime and regarding drugs. Findings are also provided regarding leisure time activities and social relations of treatment entrants.
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Affiliation(s)
- Barry S Brown
- Social Research Center, Friends Research Institute, Inc., Baltimore, MD 21201, USA.
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17
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Simpson DD. A conceptual framework for drug treatment process and outcomes. J Subst Abuse Treat 2004; 27:99-121. [PMID: 15450644 DOI: 10.1016/j.jsat.2004.06.001] [Citation(s) in RCA: 198] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Revised: 05/02/2004] [Accepted: 06/15/2004] [Indexed: 01/20/2023]
Abstract
Evidence from specialized treatment evaluations and large-scale natural studies of treatment effectiveness is organized conceptually into a "treatment model" for summarizing how drug treatment works. Sequential relationships between patient and treatment program attributes, early patient engagement, recovery stages, retention, and favorable outcomes are discussed--along with behavioral, cognitive, and skills training interventions that have been shown to be effective for enhancing specific stages of the patient recovery process. Applications of the treatment model for incorporating science-based innovations into clinical practice for improving early engagement and retention, performance measurements of patient progress, program monitoring and management using aggregated patient records, and organizational functioning and systems change also are addressed.
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Affiliation(s)
- D Dwayne Simpson
- Institute of Behavioral Research, Texas Christian University, TCU Box 298740, Fort Worth, TX 76129, USA.
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Stanton MD. Getting reluctant substance abusers to engage in treatment/self-help: a review of outcomes and clinical options. JOURNAL OF MARITAL AND FAMILY THERAPY 2004; 30:165-182. [PMID: 15114946 DOI: 10.1111/j.1752-0606.2004.tb01232.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This review examines the results from 19 outcome studies, involving 1,501 cases, within 10 different clinical approaches to getting alcohol or drug abusers to engage in treatment or self-help. Each approach is summarized and its "success rate(s)" presented. Comparisons are made across various subcategories, such as alcohol vs. drug abusers, adolescents vs. adults, and experimental conditions vs. controls. A distinction is drawn between "Dual-Purpose" approaches, which combine engagement with counseling of the concerned person who originally sought help for the substance abuser, and "Engagement-Primary" approaches, which generally confine their efforts (through working with family members and others) to getting the substance abuser into treatment/self-help. "Best bet" clinical options are presented in terms of which particular approach appears to have the edge with which kind of substance abuser.
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Affiliation(s)
- M Duncan Stanton
- Morton Center, School of Professional Psychology, Spalding University, Louisville, Kentucky, USA
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Abstract
Liddle and Dakof's (1995) comprehensive review of the status of family-based treatment for drug abuse concluded that this modality offered a "promising, but not definitive" approach to treating drug abuse among adolescents and adults. Less than a decade later, significant progress can be seen in the treatment of drug abuse problems using family-based approaches, particularly with adolescents. Family-based treatments are currently recognized as among the most effective approaches for adolescent drug abuse. Family-based treatment of adult drug abuse problems has also advanced in important ways with the recent systematic application and testing of engagement techniques and behavioral couples therapy approaches. The current review characterizes and discusses the developmental status of this subspecialty and outlines areas in which continued research attention is needed.
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Affiliation(s)
- Cynthia L Rowe
- Center for Treatment Research on Adolescent Drug Abuse (M711), P.O. Box 019132, Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, Florida 33101, USA.
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Abstract
We reviewed 38 controlled studies of marital and family therapy (MFT) in alcoholism treatment. We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, (a) Al-Anon facilitation and referral help family members cope better; (b) Community Reinforcement and Family Training promotes treatment entry; and (c) the popular Johnson intervention apparently does not effectively promote treatment entry. Once the alcoholic enters treatment. MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. BCT also reduces social costs, domestic violence, and emotional problems of the couple's children. Future studies need to specifically evaluate: MFT with women and with minority patients, mechanisms and processes of change, and transportability of evidence-based MFT approaches to clinical practice settings.
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Affiliation(s)
- Timothy J O'Farrell
- Harvard Families and Addiction Program, Harvard Medical School Department of Psychiatry at the VA Boston Healthcare System, VAMC-116B1, 940 Belmont St., Brockton, Massachusetts 02301, USA.
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Landau J, Cole RE, Tuttle J, Clements CD, Stanton MD. Family connectedness and women's sexual risk behaviors: implications for the prevention/intervention of STD/HIV infection. FAMILY PROCESS 2000; 39:461-475. [PMID: 11143599 DOI: 10.1111/j.1545-5300.2000.39406.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The present study explores the relationship between connectedness with the intergenerational family and women's sexual risk-taking as a guide to the development of family-focused prevention and intervention. Cross-sectional interview data from a pilot study were analyzed for correlations between a number of self-reported, risky sexual practices, the range of extended family members with whom the respondent was in contact, and awareness of stories pertaining to intergenerational family history. Structured interviews were administered by female interviewers to 56 women from two contexts: a STD (sexually transmitted disease) Clinic (N = 26), and an inner-city, Hispanic Community Organization (N = 30). Knowledge of stories about grandparents or great-grandparents was a robust predictor of lower sexual risk-taking in the STD Clinic sample. This relationship persisted, but only at the trend level in the Community Organization sample. In both the total sample and the STD subsample, the number of categories of extended family members with whom a respondent was in at least monthly contact was correlated with less sexual risk-taking. Given the fundamental importance of the family system as the primary social unit, these findings argue for further family theory-based research and for its potential application in the development of health prevention and intervention. Implications for practice and future research are discussed.
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Affiliation(s)
- J Landau
- Division of Adult Psychosocial Medicine, Department of Medicine, National Jewish Medical and Research Center, Denver, CO, USA.
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