| Substance Abuse Treatment, Prevention, and Policy | |
| Fixed and dynamic predictors of treatment process in therapeutic communities for substance abusers in Belgium | |
| Eric Broekaert2  Stijn Vandevelde1  Wouter Vanderplasschen2  Ilse Goethals2  | |
| [1] Faculty of Education, Health and Social Work, Department of Orthopedagogics, University College Ghent, Voskenslaan 362, 9000, Ghent, Belgium;Faculty of Psychology and Educational Sciences, Department of Orthopedagogics (Special Education), Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium | |
| 关键词: Demographics; Psychological distress; Motivation; Treatment process; Therapeutic communities; | |
| Others : 834468 DOI : 10.1186/1747-597X-7-43 |
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| received in 2012-07-21, accepted in 2012-10-05, 发布年份 2012 | |
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【 摘 要 】
Background
Research on substance abuse treatment services in general reflects substantial attention to the notion of treatment process. Despite the growing popularity of process studies, only a few researchers have used instruments specifically tailored to measure the therapeutic community (TC) treatment process, and even fewer have investigated client attributes in relation to early TC treatment process experiences. The aim of the current study is to address this gap by exploring clients’ early in-treatment experiences and to determine the predictors that are related to the treatment process, using a TC-specific multidimensional instrument.
Methods
Data was gathered among 157 adults in five TCs in Flanders (Belgium). Descriptive statistics were used to explore clients’ early in-treatment experiences and multiple linear regressions were conducted to determine the fixed and dynamic predictors of Community Environment and Personal Development and Change (two indicators of TC treatment process).
Results
Clients reveal a more positive first-month response to TC social processes than to personal-development processes that require self-reflection and insight. The variance in clients’ ratings of Community Environment was primarily due to dynamic client factors, while the variance in clients’ ratings of Personal Development and Change was only related to fixed client factors. Suitability for treatment was the strongest predictor of Community Environment ratings, whereas a judicial referral more strongly predicted Personal Development and Change scores.
Conclusions
Special attention should be devoted to suitability for treatment as part of motivational assessment as this seems to be a very strong predictor of how clients react to the initiation stage of TC treatment. To help improve clients’ (meta-)cognitive skills needed to achieve insight and self-reflection and perhaps speed up the process of recovery, the authors suggest the introduction of (meta-)cognitive training strategies in the pre-program and/or the induction stage of a TC program.
【 授权许可】
2012 Goethals et al.; licensee BioMed Central Ltd.
【 预 览 】
| Files | Size | Format | View |
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| 20140715071948553.pdf | 379KB | ||
| Figure 1. | 35KB | Image |
【 图 表 】
Figure 1.
【 参考文献 】
- [1]De Leon G: The therapeutic community: theory, model and method. Springer, Publishing Company, Inc, New York; 2000.
- [2]Bale RN, Van Stone WW, Kuldau JM, Engelsing TMJ, Elashoff RM, Zarcone VP: Therapeutic communities vs. methadone-maintenance: prospective controlled study of narcotic addiction treatment: design and one year follow-up. Arch Gen Psychiatry 1980, 37:179-193.
- [3]Inciardi JA, Martin SS, Butzin CA: Five-year outcomes of therapeutic community treatment of drug-involved offenders after release from prison. Crim & Del 2004, 50:88-107.
- [4]Messina N, Wish E, Nemes S: Predictors of treatment outcomes in men and women admitted to a therapeutic community. Am J Drug Alcohol Ab 2000, 26:207-227.
- [5]Ogborne AC, Melotte C: An evaluation of a therapeutic community for former drug users. Brit J Addict 1977, 72:75-82.
- [6]Wilson S, Mandelbrote B: Reconviction rates of drug dependent patients treated in a residential therapeutic community. 10 year follow-up. Br Med J 1985, 291:105-105.
- [7]De Leon G, Swartz S: The therapeutic community: what are the retention rates? Am J Drug Alcohol Ab 1984, 10:267-284.
- [8]Stark MJ: Dropping out of substance abuse treatment: a clinically oriented review. Clin Psychol Rev 1992, 12:93-116.
- [9]Poulopoulos C, Tsiboukli A: Socio-demographic differences, patterns of use and drop-out from Greek drug-free treatment programmes. Drug-Educ Prev Polic 1999, 6:99-110.
- [10]López-Goñi JJ, Fernández-Montalvo J, Illescas C, Landa N, Lorea I: Determining socio-demographic predictors of treatment dropout: results in a therapeutic community. Int J Soc Welfare 2008, 17:374-378.
- [11]Drake S, Campell G, Popple G: Retention, early dropout and treatment completion among therapeutic community admissions. Drug Alcohol Rev 2012, 31:64-71.
- [12]Simpson DD, Joe GW, Broome KM, Hiller ML, Knight K, Rowan-Szal GA: Program diversity and treatment retention rates in the Drug Abuse Treatment Outcome Study (DATOS). Psychol Addic Behav 2007, 11:279-293.
- [13]Etheridge RM, Hubbard RL, Anderson J, Craddock SG, Flynn PM: Treatment structure and program services in the Drug Abuse Treatment Outcome Study (DATOS). Psychol Addic Behav 2007, 11:244-260.
- [14]Holland S: Residential Drug Free Programs for Substance Abusers: The Effect of Planned Duration on Treatment. Gateway Foundation, Chicago; 1982.
- [15]De Leon G, Jainchill N: Circumstance, motivation, readiness and suitability as correlates of treatment tenure. J Psychoactive Drugs 1986, 18:203-208.
- [16]Melnick G, De Leon G: Clarifying the nature of the therapeutic community: a survey of essential elements. J Subst Abuse Treat 1999, 16:307-313.
- [17]Kressel D, De Leon G, Palij M, Rubin G: Measuring client clinical progress in therapeutic community treatment: the therapeutic community client assessment inventory, client assessment summary, and staff assessment summary. J Subst Abuse Treat 2000, 19:267-272.
- [18]Orlando M, Wenzel SL, Ebener P, Edwards MC, Mandell W: The dimensions of change in therapeutic community treatment instrument. Psych Assessment 2006, 18:118-122.
- [19]De Leon G: Residential therapeutic communities in the mainstream: diversity and issues. J Psychoactive Drugs 1995, 27:3-15.
- [20]McLellan AT, Alterman AI, Cacciola J, Metzger D, O’Brien CP: A new measure of substance abuse treatment: initial studies of the treatment services review. J Nervous and Mental Disease 1992, 180:101-110.
- [21]De Leon G, Melnick G, Schoket D, Jainchill N: Is the therapeutic community culturally relevant? Findings on race/ethnic differences in retention in treatment. J Psychoactive Drugs 1993, 25:77-86.
- [22]Simpson DD: Modeling treatment process and outcomes. Addiction 2001, 96:207-211.
- [23]Hiller ML, Knight K, Leukefeld C, Simpson DD: Motivation as a predictor of therapeutic engagement in mandated residential substance abuse treatment. Criminal Justice Behav 2002, 29:56-75.
- [24]Broome KM, Simpson DD, Joe GW: Patient and program attributes related to treatment process indicators in DATOS. Drug Alcohol Depen 1999, 57:127-135.
- [25]Broome KM, Joe GW, Simpson DD: Engagement models for adolescents in DATOS-A. J Adolescent Res 2001, 16:608-623.
- [26]Welsh WN, McGrain PN: Predictors of therapeutic engagement in prison-based drug treatment. Drug Alcohol Depen 2008, 96:271-280.
- [27]Melnick G, De Leon G, Thomas G, Kressel D, Wexler HK: Treatment process in prison therapeutic communities: motivation, participation and outcome. Am J Drugs Alcohol Ab 2001, 27:633-650.
- [28]Orlando M, Wenzel SL, Ebener P, Edwards MC, Mandell W, Becker K: The dimensions of change in therapeutic community treatment instrument. Psych. Assessment 2006, 18:118-122.
- [29]Paddock SM, Edelen MO, Wenzel SL, Ebener P, Mandell W, Dahl J: Measuring changes in client-level treatment process in the therapeutic community with the dimensions of change instrument. Am J Drugs Alcohol Ab 2007, 33:537-546.
- [30]Edelen MO, Tucker JS, Wenzel SL, Paddock S: Treatment process in the therapeutic community: associations with retention and outcomes among adolescent residential clients. J Subst Abuse Treat 2007, 32:415-421.
- [31]Mandell W, Edelen MO, Wenzel SL, Dahl J, Ebener P: Do Dimensions of TC Treatment predict retention and outcomes? J Subst Abuse Treat 2008, 35:223-231.
- [32]Miles JNV, Wenzel S, Mandell W: The relationship between the dimensions of change instrument and retention in therapeutic community treatment: the moderating influence of time in treatment. Am J Drugs Alcohol Ab 2007, 34:667-672.
- [33]Chan KS, Wenzel S, Orlando M, Montagnet C, Mandell W, Becker K, Ebener P: How important are client characteristics to understanding treatment process in the therapeutic community? Am J Drug Alcohol Ab 2004, 30:871-891.
- [34]Chan KS, Wenzel S, Mandell W, Orlando M, Ebener P: Are prison characteristics associated with therapeutic community treatment process? Am J Drugs Alcohol Ab 2007, 33:267-279.
- [35]Condelli WS, De Leon G: Fixed and dynamic predictors of client retention in therapeutic communities. J Subst Abuse Treat 1993, 35:11-16.
- [36]Klag SML, Creed P, O’Callaghan F: Early motivation, well-being, and treatment engagement of chronic substance users undergoing treatment in a therapeutic community setting. Subst Use Misuse 2010, 45:1112-1130.
- [37]Melnick G, De Leon G, Hawke J, Jainchill N, Kressel D: Motivation and Readiness for therapeutic community treatment among adolescents and adult substance abusers. Am J Drugs Alcohol Ab 1997, 23:485-506.
- [38]Prochaska JO, DiClemente CC, Norcross JC: In search of how people change: applications to addictive behaviors. Am Psychol 1992, 47:1102-1114.
- [39]Mc Lellan AT, Kushner H, Metzger D, Peters R, Smith I, Grissom G, Pettinati H, Argeriou M: The fifth edition of the Addiction Severity Index. J Subst Abuse Treat 1992, 9:199-213.
- [40]Kokkevi A, Hartgers C, EuropASI: European adaptation of a multidimensional assessment instrument for drug and alcohol. Eur Addict Res 1995, 1:208-210.
- [41]Koeter M, Hartgers C: European Addiction Severity Index: Preliminary procedure for the computation of the EuropASI composite scores. Amsterdam Institute for Research Addiction, Amsterdam; 1997.
- [42]Soyez V, De Leon G, Rosseel Y, Broekaert E: Motivation and readiness for therapeutic community treatment: psychometric evaluation of the Dutch translation of the Circumstances, Motivation, Readiness and Suitability scales. J Subst Abuse Treat 2006, 30:297-308.
- [43]De Beurs E: Brief Symptom Inventory, handleiding. PITS BV, Leiden; 2006.
- [44]Derogatis LR, Melisaratos N: The brief symptom inventory: an introductory report. Psychol Med 1983, 13:595-605.
- [45]Schotte C, De Doncker D: ADP-IV Questionnaire: Manual and norms. University Hospital Antwerp, Antwerp; 1996.
- [46]Schotte CKW, De Doncker D, Van Kerckhoven C, Vertommen H, Cosyns P: Self-report Assessment of the DSM-IV personality disorders: measurement of trait and distress characteristics. The ADP-IV. Psychol Med 1998, 28:1179-1188.
- [47]Schotte CKW, De Doncker D, Dmitruk D, De Valck E, Van Mulders I, Onderzoek naar de begripsvaliditeit van de ADP-IV: Bevindingen betreffende discriminante validiteit, convergentie met de semi-gestructureerde interviewmethode en therapeutische bruikbaarheid. Tijdschrift Klinische Psychol 2002, 32:187-205.
- [48]Dees SM, Dansereau DF, Simpson DD: A visual representation system for drug abuse counselors. J Subst Abuse Treat 1994, 11:517-523.
- [49]Miller WR, Rollnick S: Motivational interviewing: Preparing people for change. Guilford Press, New York; 1991.
- [50]Harrison SR, Toriello P, Pavluck A, Ellis R, Pedersen E, Gaiennie R, Kissinger P: The impact of a brief induction on short-term continuation in a therapeutic community. Am J Drugs Alcohol Ab 2007, 33:147-153.
- [51]De Leon G, Hawke J, Jainchill N, Melnick G: Therapeutic communities. Enhancing retention in treatment using “Senior Professor’ staff. J Subst Abuse Treat 2000, 19:375-382.
- [52]Alterman AI, McLellan T, Shifman RB: Do substance abuse patients with more psychopathology receive more treatment? J Nervous and Mental Disease 1993, 181:576-582.
- [53]Moos RH, King JK: Participation in community residential treatment and substance abuse patients’ outcomes at discharge. J Subst Abuse Treat 1997, 14:71-80.
- [54]Hawkins EJ, Baer JS, Kivlahan DR: Concurrent monitoring of psychological distress and satisfaction measures as predictors of addiction treatment retention. J Subst Abuse Treat 2008, 35:207-216.
- [55]Farabee D, Nelson R, Spence R: Psychosocial profiles of criminal justice- and noncriminal justice-referred substance abusers in treatment. Crim Justice Behav 20:336-346.
- [56]Marshall GN, Yih-Ing H: Characteristics of criminal justice and noncriminal justice clients receiving treatment for substance abuse. Add Behav 2002, 27:179-192.
- [57]Colman C, De Wree E, De Ruyter B: Alternatieve maatregelen: keerpunten voor druggebruikers. In Actualia strafrecht en criminologie: update in de criminologie V. 1st edition. Edited by Pauwels L, Vermeulen G. Maklu, Antwerpen; 2010:287-312.
- [58]Simpson DD, Joe GW, Broom KM, Hiller ML, Knight K, Rowan-Szal GA: Program diversity and treatment retention rates in the Drug Abuse Treatment Outcome Study (DATOS). Psychol of Addictive Behav 1997, 11:297-293.
- [59]Soyez V, De Leon G, Broekaert E, Rosseel Y: The impact of social network intervention on retention in Belgian therapeutic communities: a Quasi-experimental study. Addiction 2006, 101:1027-1034.
- [60]Edelen MO, Miles JNV, Osilla KC, Wenzel SL: Further validity evidence for the dimensions of change in therapeutic community treatment instrument. Am J Drugs Alcohol Ab 2008, 34:285-292.
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