Residential substance abuse treatment for pregnant and postpartum women and their children: treatment and policy implications

In FY 1993 and FY 1995, the federal government awarded 27 five-year grants that supported 35 residential treatment projects for substance-abusing pregnant and postpartum women and their children. These projects provided comprehensive culturally and gender-specific treatment. Preliminary aggregated data collected in a national cross-site evaluation of 24 of these projects are encouraging with respect to infant mortality and morbidity, treatment retention and completion rates, and behavioral changes in the participating mothers at six months postdischarge. Local evaluations reflect other benefits of treatment. Cost data are expected to demonstrate the efficiencies and benefits of these projects compared to no treatment.     

An exploratory analysis of treatment completion and client and organizational factors using hierarchical linear modeling

Data from the Alcohol and Drug Services Study (ADSS) are used to analyze the structure and operation of the substance abuse treatment industry in the United States. Published literature contains little systematic empirical analysis of the interaction between organizational characteristics and treatment outcomes. This paper addresses that deficit. It develops and tests a hierarchical linear model (HLM) to address questions about the empirical relationship between treatment inputs (industry costs, types and use of counseling and medical personnel, diagnosis mix, patient demographics, and the nature and level of services used in substance abuse treatment), and patient outcomes (retention and treatment completion rates). The paper adds to the literature by demonstrating a direct and statistically significant link between treatment completion and the organizational and staffing structure of the treatment setting. Related reimbursement issues, questions for future analysis, and limitations of the ADSS for this analysis are discussed.     

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.     

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.     

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.     

Effects of Family Involvement on Length of Stay and Treatment Completion Rates with Cocaine and Alcohol Abusers

SUMMARY

Substance abuse is a problem of national concern. This study sought to replicate and further develop findings from a previous study that found cocaine abusers continued in and completed treatment less frequently than alcohol abusers, and that family involvement may influence continuation in and completion of treatment for both cocaine and alcohol abusers.

A sample of 99 primary cocaine abusers and 105 primary alcohol abusers in outpatient treatment were followed during the course of their treatment. Results indicated primary alcohol abusers were significantly more successful in completing treatment than primary cocaine abusers. Family involvement in treatment significantly increased the likelihood that cocaine and alcohol abusers would complete the full course of treatment.

It is possible that treatment could be improved and completion rates increased by coordinating the involvement of the family.     

What Is Valued in Gay and Lesbian Specific Alcohol and Other Drug Treatment?

Little is known about what gay and lesbian clients value about culturally specific alcohol and other drug treatment programs. This study involves a sample of clinical staff and former clients (N = 40) of four culturally specific alcohol and other drug treatment programs to clarify what is addressed and deemed valuable for the specific needs of gay and lesbian clients. Through the lens of the recovery capital conceptual framework, this qualitative research emphasizes resiliency and the supports necessary for long-term recovery. Results indicate three major themes that make this type of treatment valuable: (1) a separate treatment unit or facility, (2) a safe and supportive therapeutic milieu, and (3) specific tailored treatment approaches. Findings are discussed to include implications for ways to improve services for this all too often understudied population of potentially vulnerable individuals who can benefit from culturally sensitive care.     

Planned treatment and outcomes in residential youth care: Evidence from Sweden

A recurring theme in evaluations of Swedish residential youth care is that treatment is often unplanned. Using a data set of teenagers placed in youth care in 1991 (N = 357), we show that planned treatment — in the sense of a known expected duration of treatment — is strongly positively associated with treatment outcomes. In the short term, teenagers with planned treatment are 32% less likely to experience a treatment breakdown and 25% less likely to be reassigned to other forms of residential care after completed treatment. In the long term, teenagers with planned treatment are 21% less likely to engage in criminal behavior and 40% less likely to be hospitalized for mental health problems. The results are robust to controlling for a rich set of potentially confounding factors: Even though observable pre-treatment teenager characteristics explain about one fifth of the variation in criminal behavior 5-10 years after treatment, they have almost no predictive power for whether treatment is planned or unplanned.     

Childhood maltreatment and motivation for treatment in girls in compulsory residential care

The first objective of the current study was to examine the relationship between childhood maltreatment, trauma-related symptoms and motivation for treatment in girls in compulsory residential treatment facilities. The second objective was to examine the extent to which various forms of childhood maltreatment, trauma-related symptoms and motivation for treatment predicted (time to) dropout from these facilities. Participants were 154 adolescent girls recruited from three residential treatment settings in The Netherlands. Multiple linear regression analysis revealed that age and ethnicity were associated with motivation for treatment. Furthermore, emotional abuse contributed to motivation for treatment. In addition, internalizing symptoms (e.g., anxiety and depression) significantly predicted level of distress; symptoms of dissociation predicted doubt about treatment. Logistic regression analyses with multiple imputation and competing risk regression analyses revealed no significant predictors for (time to) dropout. The findings suggest that clinicians and therapists should focus on experiences of emotional abuse, traumatic symptoms and treatment motivation in girls in compulsory residential care settings.     

Dropout and completion of treatment among spouse abusers

This study examines a population of spouse abusers undertaking a treatment program. Its purpose was to identify the variables associated with dropout and completion of treatment and to build a predictive model. Data were collected on 286 men who began group treatment in one of eight community programs in the province of Quebec, Canada. Results show that men who complete treatment are older, better educated and have better economic conditions than men who drop out. They also have a more stable family life, have been in a relationship for a longer period of time and have more children with their actual spouse. Men who completed treatment showed more commitment, better working capacities and a higher level of agreement with their therapists, thus developing a stronger therapeutic alliance. Support provided by people in the environment was significantly related to treatment completion. Social and judicial pressures were not related to completion.     

Environmental assessment and evaluation research: examples from mental health and substance abuse programs.

Evaluation researchers have been broadening the traditional client input--"black box" treatment--client outcome paradigm that has guided many evaluations of mental health, substance abuse treatment, and other intervention programs. The points of expansion are in the areas of treatment implementation and treatment processes, as well as "extratreatment" influences on treatment selection, duration, and, especially, outcome. This review illustrates the application of environmental assessment procedures--particularly social climate measures--in four aspects of evaluation research suggested by the more comprehensive model: (a) evaluating treatment implementation; (b) exploring treatment processes; (c) identifying extratreatment influences on client posttreatment functioning; and (d) operationalizing outcome variables. Conceptual and methodological issues raised by these applications are discussed, and the benefits to be derived from an expanded model of evaluation research--especially the greater potential for program improvement--are considered.     

School connectedness in community and residential treatment schools: The influence of gender, grades, and engagement in treatment

This study compared perceptions of school connectedness to traditional community schools and residential treatment center (RTC) schools for youths between the ages of 12 and 18 receiving treatment within two RTCs. The influence of gender, report card grades, and engagement in treatment were also examined in relation to school connectedness in the RTC schools. Findings indicated that youths reported greater connectedness to the residential schools and that engagement in treatment led to higher levels of school connectedness while in residence. Results are discussed in the context of practices that may increase school connectedness in community and RTC schools.     

Description and pre-post evaluation of a telephone and Internet based treatment programme for pathological gambling in Norway: a pilot study

Although the effectiveness of treatments for pathological gamblers is gaining support, only 10% of pathological gamblers seek treatment. Providing treatment via the Internet may lower the thresholds for treatment seeking. A new telephone and Internet based treatment programme for pathological gamblers is presented in this article, along with a pre-post evaluation of the programme. The participants (N = 112) were problem gamblers who were either self-referred or referred by their general practitioner. Data from post-treatment and 3-month follow-up are evaluated. The results suggest that using Internet and telephone-assisted treatment interventions can significantly reduce symptoms of pathological gambling (measured by the South Oaks Gambling Screen – Revised). The intervention was also associated with improvement on cognitive distortions, measured by the Gamblers Belief Questionnaire, and general psychological distress and psychopathology as measured by the Symptom Checklist-90-Revised. Although Internet-based treatment programmes have been suggested to have advantages compared to traditional face-to-face therapy, research in this area is scarce. This pilot study contributes to the growing literature in this area, and provides tentative support for the effectiveness of Internet based treatment interventions for pathological gamblers.     

Client and program factors associated with dropout from court mandated drug treatment

To examine why court mandated offenders dropout of drug treatment and to compare their characteristics, treatment experiences, perceptions, and outcomes with treatment completers, we analyzed self-reported and administrative data on 542 dropouts (59%) and 384 completers (41%) assessed for Proposition 36 treatment by thirty sites in five California counties during 2004. At intake, dropouts had lengthier criminal histories, lower treatment motivation, more severe employment and psychiatric problems, and more were using drugs, especially heroin. Relatively fewer dropouts received residential treatment and their retention was much shorter. A similar proportion of dropouts received services as completers and the mean number of services received per day by dropouts was generally more, especially to address psychiatric problems, during the first three months of treatment. The most commonly offender-reported reasons for dropout included low treatment motivation (46.2%) and the difficulty of the Proposition 36 program (20.0%). Consequences for dropout included incarceration (25.3%) and permission to try treatment again (24.0%). Several factors predicting drug treatment dropout were identified. Both groups demonstrated improved functioning at one-year follow-up, but fewer dropouts had a successful outcome (34.5% vs. 59.1%) and their recidivism rate was significantly higher (62.9% vs. 28.9%) even after controlling for baseline differences. Understanding factors associated with drug treatment dropout can aid efforts to improve completion rates, outcomes, and overall effectiveness of California's Proposition 36 program. Findings may also aid a broader audience of researchers and policy analysts who are charged with designing and evaluating criminal-justice diversion programs for treating drug-addicted offenders.     

Therapeutic alliance and treatment progress in couple psychotherapy

This study examined the ability of the therapeutic alliance to predict treatment progress on individual- and relationship-level variables from the early to middle phase of couple treatment. Although alliance did not predict progress in individual functioning, it accounted for 5-22% of the variance in improvement in marital distress. Women's mid-treatment alliance uniquely predicted improvement in marital distress, over and above early treatment alliance. When men's alliances with the therapist were stronger than their partners' at session 8, couples showed more improvement in marital distress. Treatment response was also positively associated with women's ratings of their partners' alliance. Results confirm that the therapeutic alliance in conjoint treatment is composed of distinct client subsystems that are useful predictors of treatment progress.     

Rent-seeking and competitive preferences

In this experiment, I examine the extent to which competitive social preferences can explain over-bidding in rent-seeking contests. The Human treatment is a standard two-player contest. In the Robot treatment, a single player bids against a computerized player, eliminating potential social preference motives. The results show no difference in bids between treatments at the aggregate level. Further analysis shows evidence of heterogeneous treatment effects between impulsive and reflective subjects. Moreover, impulsive subjects are more likely than reflective subjects to deviate qualitatively from the shape of the theoretical best response function.     

Unequal Treatment by Mothers and Fathers Matters Differently for Daughters and Sons

Research in attachment has yet to examine the differential effects of unequal treatment by mothers versus unequal treatment by fathers and how unequal treatment affects daughters and sons differently. Moreover, research examining the link between differential treatment and relationship outcomes such as jealousy in romantic relationship has suggested that romantic attachment may mediate this process but has not effectively examined this association. In the current study, researchers found that for daughters, unequal control (but not affection) by mothers (but not fathers) predicted jealousy. For sons, unequal affection (but not control) by mothers (but not fathers) predicted jealousy. For sons, attachment mediated the relationship between differential maternal affection and jealousy in romantic relationships.