Outpatient cocaine abuse treatment: predictors of success

In 1990 more than 238,000 patients in the United States entered treatment, with cocaine as their primary diagnosis. This represented 36 percent of the treatment admissions for substance abuse. This research project uses data from the U.S. Army's Alcohol and Drug Abuse Prevention and Control Program to analyze which treatment and demographic variables have an effect on cocaine treatment outcomes. The sample included 3602 soldiers entered into treatment between 1983 and 1992 for cocaine abuse. The logistical regression results suggested the following treatment variables had an effect on outcomes: the type of treatment provided, the length of time in treatment, the number of different types of drugs being abused prior to treatment, and the length of time since the patient had abused cocaine prior to entering treatment. Race of the patient had an impact on treatment outcomes, but gender, educational level, age, rank of the soldier, marital status, and length of time in the military did not have an impact on treatment outcomes.     

Alcohol Use and Prior Substance Abuse Treatment in Relation to Gambling Problem Severity and Gambling Treatment Outcome

Recent research has made it clear that problematic gambling is often accompanied by problematic alcohol use. Unfortunately, little is known about the nature of this association, especially as it relates to gambling treatment outcome. The purpose of this study is to explore the effect of current alcohol use level and previous substance abuse treatment on the symptoms of a large cohort of pathological gamblers as well as on their response to treatment for pathological gambling. The sample included 464 men and 301 women recruited at six gambling treatment programs in Minnesota. Gambling treatment patients were assessed on a number of gambling problem severity and related clinical variables using the Gambling Treatment Outcome Monitoring System (GAMTOMS). Patients with frequent alcohol use had greater gambling involvement at baseline than infrequent alcohol users. Patients with a previous history of substance abuse treatment had more severe psychosocial problems, ostensibly resulting from their gambling behavior, than patients without past substance abuse treatment. A MANOVA with repeated measures showed that neither pretreatment alcohol use, nor past substance abuse treatment exerted significant effects on gambling treatment outcome. While the level of pretreatment alcohol use and a history of substance abuse treatment are markers for greater gambling problem severity, treatment outcome for pathological gambling was not adversely impacted by these variables.     

Methodological Problems in Research on Treatments for Pathological Gambling

These common methodological problems affect the usefulness of pathological gambling (PG) treatment research: (1) Most PG etiological models derive from substance abuse; (2) Most PGs recover on their own and few seek treatment, so PGs in treatment studies may not be representative; (3) Data on treatment-seeking PG women, older adults, and minority group members, or on group, marital, and psychodynamic approaches to PG, are sparse; (4) Little research has examined the impact of comorbidity on PG treatment response; (5) Design deficiencies burden many PG treatment studies.     

Treatment provider awareness of the possible impact of the internet on the treatment of sex offenders: an alert to a problem

This study evaluated treatment providers' perceptions of the impact of the Internet on the treatment of sex offenders. This study surveyed all of the agencies in South Carolina that provide treatment services for sex offenders. Analysis indicated that (a) most treatment providers were unaware of the potential negative impact of the Internet on their treatment efforts with clients, (b) most treatment providers had no policy restricting their clients' Internet use, (c) the overwhelming majority of treatment providers felt that they were poorly equipped to deal with this issue, and (d) almost all of the treatment providers felt that probation and parole would be of little assistance in helping them monitor their clients' use of the Internet. Implications of the findings for improving treatment services for sex offenders were explored and discussed.     

An individual treatment programme for sexually abused adult males: description and preliminary findings

Growing recognition of male sexual abuse and its potentially debilitating effects has underscored the need to develop effective treatment interventions for this population. The present study describes an individual treatment programme that was developed for adult males who have experienced childhood sexual abuse. The treatment programme focused on three areas related to sexual abuse, specifically feelings of self‐blame, anger and anxiety. The study also presents preliminary findings on treatment effects, using self‐report measures that five participants completed prior to treatment and at various assessments following treatment termination. Overall findings indicated improvements in behavioural self‐blame, anger, state anxiety and trait anxiety. Treatment did not appear to have an effect on characterological self‐blame over the long term. The study's findings are limited by the reliance on self‐report data and the absence of a comparison group. As such, our findings should be viewed as an initial contribution to the currently limited empirical data on treatment effects for sexually abused adult males. Copyright © 2005 John Wiley & Sons, Ltd.     

Child Sexual Abusers’ Views on Treatment: A Study of Convicted and Imprisoned Adult Male Offenders

In spite of an increasing focus on the assessment and treatment of sexual offenders over the past two decades, much debate persists as to the effectiveness of treatment in reducing recidivism. Given the dearth of research on offenders' perspectives in this area and the potential for offenders' views to inform the development of effective treatment, we consider the views of 35 adult male child sexual abusers on the prison treatment program. Focusing on a number of key themes, namely victim empathy, strategies for desistence, group or individual treatment, motivation, and postprogram support. In doing so, the extent to which this work furthers knowledge in this area and future research directions was considered.     

The “Other” Effects of Psychotropic Medication: Social Workers’ Perspectives on the Psychosocial Effects of Medication Treatment on Adolescent Clients

This study explores social workers’ perspectives on the psychosocial effects of psychotropic drug treatment of their adolescent clients. Using a mail survey, we asked a national sample of experienced clinical social workers to answer questions about their perceptions of the effects of such treatment on the sense of self and social well-being of an adolescent client. The survey questions also explored associations between perceived psychosocial medication effects and characteristics of the client and the treatment. The findings suggested that social workers viewed medication treatment as having greater beneficial than harmful psychosocial effects on their adolescent clients, but that both effects existed simultaneously. The most important factors associated with the perceived effects of medication that emerged from social workers’ reports included the etiology of the disorder, the type of drug treatment and its effectiveness in addressing symptoms, the client’s “competence,” and the quality of the relationship between the client and the treating social worker. This study provides direction for future research on a neglected but important question. It would be helpful to broaden the scope of professional discourse on the advantages and disadvantages of psychopharmacologic treatment for youth beyond the effectiveness or safety of the treatment to include questions concerning clinicians’ perceptions of the effects of drug treatment on youths’ sense of self and social well-being.     

Barriers in Access to the Treatment for People with Gambling Disorders. Are They Different from Those Experienced by People with Alcohol and/or Drug Dependence?

A prevalence of gambling disorders is diversified depending on the region of the world. Almost three quarters of pathological gamblers had never sought a professional treatment as well as an assistance in self-help groups. Reasons why they do not initiate a treatment are complex. The aim of the article is to compare barriers to the treatment for people with gambling disorders found in presented study and barriers to alcohol and drug treatment identified in the available literature. The semi structured interviews were applied and conducted with people with gambling disorders, social workers, therapists employed in the addiction treatment facilities, General Practitioners and psychiatrists. Selection of the respondents was based on purposive sampling. In total, 90 interviews were completed. Respondents identified individual barriers as well as structural ones. Individual barriers include internal resistance and a fear of the treatment. In turn structural barriers apply to the organization of the therapy, infrastructure, personnel, and the therapeutic program. A comparison of barriers experienced by people with gambling disorders and substance use disorders showed that they are largely similar, but people with gambling disorders also experience specific barriers. Empirical studies focused specifically on treatment needs of people experiencing gambling disorders may improve an offer of help for them. More adequate treatment options could contribute to the increasing in the number of people who start the treatment. It can result in improving their quality of life and may have positive impact on public health.     

Significant Others and Gambling Treatment Outcomes

Aims This study investigates the effect of significant others on treatment outcomes among treated pathological gamblers. Design This is a cohort study of individuals who received gambling treatment. Setting Oregon Problem Gambling Services (OPGS) for gamblers and their family members. Participants 4,410 adult gamblers who were discharged from treatment between August, 2001 and April, 2007. Measurements OPGS enrollment forms provided gambler gender, age, ethnicity, education level, employment status, gambling-related debt, and whether the gambler had a significant other at the time of enrollment. Termination forms provided information on the type of discharge (successful/unsuccessful) and treatment length (in days). Participation of the gambler’s significant other in the family treatment program was identified. Findings Results showed that age, ethnicity, gambling debt, and having a significant other are associated with the odds of successful treatment. Education level moderates the effect of having a significant other on treatment success. Age, ethnicity, education, employment, and having a significant other participate in treatment significantly impacted gamblers’ length in treatment. Conclusions These findings indicate that there may be a benefit to integrating significant others in gambling treatment methods. Significant others may act as social supports for gamblers seeking treatment, and involving loved ones in gambling treatment models may positively affect gambler treatment outcomes.     

Enhancing adolescents' motivation for treatment in compulsory residential care: A clinical review

Youths in compulsory residential care show a high prevalence of various mental health problems but often lack motivation to engage in therapeutic treatment. Although the self-determination-theory (SDT) and the transtheoretical model of change (TTM) offer a useful framework for treatment motivation, they do not describe which interventions therapists can use to improve treatment motivation in juveniles, nor do they focus specifically on treatment motivation in a compulsory residential care setting. This article provides an overview of opportunities to enhance adolescents' motivation for treatment in compulsory residential care. Results show that in the reviewed literature, increasing autonomy and competence has received relatively little attention compared to relatedness. In addition, results show that treatment motivation can be enhanced in several different ways, ranging from interventions on an individual to an organizational level. This may indicate that enhancing motivation for treatment in a residential setting needs intervention on multiple levels, involving youths, therapists, group workers and parents. Scientific evidence, however, is limited. Regarding the lack of studies that examine the need for autonomy and competence, future studies should focus on these basic needs for motivation.     

Examining Outpatient Treatment Dropout in Adolescents: A Literature Review

This literature review explores the research to date on adolescent mental health treatment drop out. As many as one in five adolescents in the United States has been diagnosed with an Axis-I psychiatric disorder. Adolescents with Axis-I psychiatric disorders face significant short- and long-term consequences if they do not obtain mental health treatment. However, treatment dropout research has focused on child and adult populations with little focus on the unique issues that are likely to impact adolescents. The theoretical underpinnings for understanding adolescent mental health treatment are explored in relation to adolescent psychological development and the therapeutic alliance. The review concludes with suggestions for future research to extend our understanding of adolescent treatment drop out.     

“Discrimination” versus “Unfair Treatment”: Measuring Differential Treatment and its Association with Health

There is consistent evidence of the health‐harming effects of discrimination. However, it remains unclear whether discrimination contributes to persistent racial and ethnic health disparities. One hindrance to documenting the association between discrimination and health disparities is ongoing methodological issues, particularly the role of question wording in assessing self‐reports of discrimination. Using two nationally representative surveys, we investigate whether the prevalence, distribution, and mental and physical health consequences of differential treatment vary by question wording—”discrimination” versus “unfair treatment.” We find that “unfair treatment” yields greater reports of everyday forms of differential treatment relative to reports of “discrimination,” while the latter yields greater reports of major forms of differential treatment. In addition, the negative effect of “unfair treatment” on mental health is stronger than that of “discrimination,” while the latter has a stronger negative effect on physical health. However, the effect of question wording on reports of differential treatment and its association with health is largely unique to non‐Hispanic whites. We conclude that unfair treatment and discrimination reflect distinct concepts that should not be used interchangeably.     

Treatment foster parent satisfaction: Survey validation and predictors of satisfaction,retention, and intent to refer

Treatment foster parents are invaluable for youth in treatment foster care, therefore it is imperative for programs to measure their satisfaction in their role. However, the concept of treatment foster parent satisfaction is not fully developed, and there is a need to develop measurement tools specifically for treatment foster parents. Based on previous research and available foster parent satisfaction surveys, we developed a brief 28-item scale that measures four constructs related to overall treatment foster parent satisfaction: Professional Parenting Role, Treatment Foster Parent Efficacy, Support from Staff, and Quality of Training. Additionally, the scale assesses overall satisfaction, likelihood to continue as a treatment foster parent, and likelihood to refer others to become treatment foster parents. We also assessed which of the four constructs predict high and low scores on these three metrics. Results can be used to target interventions to improve treatment foster parent satisfaction.     

An Evaluation of a Group Treatment for Sexually Abused Young Children

ABSTRACT

The present study measured outcomes of a group treatment for five-to eight-year-old sexually abused children. Although research completed in the last 10 years has produced some outcome studies on the effectiveness of group treatment for this population, no previous research has measured the effectiveness of psychoeducational interventions, such as the teaching of sexual information and abuse prevention strategies which are often included in this type of treatment. Also, the effects of different lengths of treatment have not been studied. The results of the current study found that children improved significantly from pre-treatment to mid-treatment on measures of problematic behavior, sexual information and abuse prevention. The children also made significant improvements from mid-treatment to post-treatment and from pre-treatment to post-treatment on all of the outcome measures with the exception of mid-treatment to post-treatment changes on the maternal acceptance self-esteem subscale. These results suggest that young children do benefit from a sexual abuse group treatment and that a longer treatment may be more beneficial.     

Evaluation of an employee assistance program at a transportation company

The purpose of this study was to determine the effectiveness of an Employee Assistance Program (EAP) in terms of selected work performance indicators and treatment outcomes. Three primary data sources were utilized: a questionnaire administered to EAP users, reports from EAP counsellors on treatment diagnoses and outcomes, and employee records on absenteeism and other performance criteria over a five year time period. On the whole, EAP clients reported very favourable outcomes regarding the quality of services and improved well being, and the counsellors reported successful treatment outcomes. However, employee records on performance outcomes indicated that EAP clients had higher rates of problems before, during and after treatment, compared to a matched control group. Additionally, rates of sick days significantly increased from before to after treatment among EAP users.     

Self psychologyand cognitive treatment: An integration

Although self psychology and cognitive treatment appear, on the surface, to represent diametrically-opposed models of treatment, they can be integrated in clinical social work treatment. A theoretical framework for this integration is presented. Adapting self psychology treatment through the use of cognitive techniques may allow clinicians to help clients with narcissistic disorders within the framework of shorter-term, less-intensive treatment which is increasingly required by programs and reimbursement sources.     

Treatment of adult sexual offenders: a therapeutic cognitive-behavioural model of intervention

Recent research indicates that, of the various forms of treatment available to sexual offenders, cognitive-behavioural methods are likely to have the greatest impact in reducing rates of sexual re-offending. Cognitive-behavioural treatment typically targets attitudes that support sexual offending, anger management, victim empathy, deviant sexual arousal, and relapse prevention. More recently, treatment has targeted cognitive processes more generally, management of other emotional states in addition to anger, intimacy deficits, and risk self-management (Marshall, Anderson, & Fernandez, 1999; Yates, Goguen, Nicholaichuk, Williams, & Long, 2000). This article describes the components of cognitive-behavioural treatment with sexual offenders, including recent developments, assessment, treatment methods, and the importance of therapist characteristics on the therapeutic process and on treatment outcome.     

Models,methods and network topology: Experimental design for the study of interference

How should a network experiment be designed to achieve high statistical power? Experimental treatments on networks may spread. Randomizing assignment of treatment to nodes enhances learning about the counterfactual causal effects of a social network experiment and also requires new methodology (ex. Aronow and Samii, 2017a, Bowers et al., 2013, Toulis and Kao, 2013). In this paper we show that the way in which a treatment propagates across a social network affects the statistical power of an experimental design. As such, prior information regarding treatment propagation should be incorporated into the experimental design. Our findings justify reconsideration of standard practice in circumstances where units are presumed to be independent even in simple experiments: information about treatment effects is not maximized when we assign half the units to treatment and half to control. We also present an example in which statistical power depends on the extent to which the network degree of nodes is correlated with treatment assignment probability. We recommend that researchers think carefully about the underlying treatment propagation model motivating their study in designing an experiment on a network.     

Providing sexual education to victims of child sexual abuse:what is a clinician to do?

Despite the large body of research on childhood sexual abuse, virtually no one has examined the coverage of sexual education in treatment. Agencies from across the United States that specialize in treating child and adolescent victims of sexual abuse were surveyed. The results indicate that sexual education is covered in treatment with children of all ages, with male and female clients, and in both individual and group therapy. There was a statistically significant difference in the coverage of sexual education based on clients' age, but not based on gender or treatment modality. Parents are often included in treatment; however, the amount of parental involvement varies. Published materials, such as children's books and videos, are frequently used. Participants (i.e., clinicians) are satisfied with their coverage of sexual education in treatment even though clients often experience negative reactions. Results suggest that covering sexual education in treatment helps decrease some of the negative effects of sexual abuse. This study also serves as a test of Dillman's Total Design Method of conducting mail surveys.