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Clinical and field-based studies that indicate “treatment works” have led to questions about the active ingredients or components that determine its effectiveness. Understanding treatment dynamics is essential to issues of quality control and improvement.  The TCU Treatment Model, as described in this section, provides a conceptual framework for describing stages of treatment and how they relate to recovery.  This research has yielded a broad array of assessment instruments for assessing client and program performance, established foundations for systematic treatment monitoring and management strategies, and developed evidence-based interventions that improve treatment quality.

Lead Investigators:  Dwayne Simpson, George Joe

Large studies based on nationwide samples have repeatedly demonstrated the effectiveness of drug abuse treatment in natural settings and the importance of retention.   In response to recurring calls for studying “the black box” and the need to know more about how treatment works, completion of the 20-year DARP project was followed by a series of 4 phases of our DATAR project.  Its first phase, entitled Improving Drug Abuse Treatment for AIDS-Risk Reduction (DATAR-1), began in 1989 as a NIDA treatment research demonstration grant and in 1995 was continued for another 5 years, entitled Improving Drug Abuse Treatment Assessment and Research (DATAR-2).  These projects were based on the premise that treatment services research should have practical objectives, be carried out in real-world settings, and be assessed for monitoring client progress over time (with routine feedback to treatment staff).  Under DATAR-1&2, over 1,500 opioid users were treated in four outpatient methadone treatment programs in Texas during 1990 to 1999, with the general goal of improving therapeutic interventions as well as understanding the treatment dynamics involved.

These are the foundations for a body of research that now define elements of a model for effective drug treatment.  It is a framework for integrating findings about how client and program attributes interact to influence the degree to which clients become engaged in treatment and remain long enough to show evidence of recovery while in treatment and at follow-up.  This TCU Treatment Model likewise portrays how specialized interventions as well as health and social support services promote stages of recovery change (see Fig. 1).  The DATAR-1&2 projects have led to the development of a comprehensive set of cognitive and behavioral-based interventions with demonstrated effectiveness as part of a stage-based model of treatment.

Figure 1.  TCU Treatment Model (Simpson, 2004)

Particularly important for increasing early engagement in treatment is a set of TCU cognitive and behavioral-based interventions.  The cognitive interventions (especially those related to increasing levels of treatment readiness for low-motivated clients) have proven useful for improving therapeutic relationships and retention.  These have become the focus of another TCU project entitled “Cognitive Enhancements for the Treatment of Probationers” (CETOP; PI, Don Dansereau) for correctional populations where treatment readiness and motivation are commonly low.  TCU interventions are manual-guided and evidence-based, making them well suited for dissemination into field practice.

Along with counselor attributes and skills, other organizational factors are recognized as impacting the client engagement process and needing additional research.  Thus, the third 5-year phase of our DATAR project, entitled Transferring Drug Abuse Treatment and Assessment Resources (DATAR-3), was funded in 1999 to address these issues.  This third phase concentrated on studying major factors seemingly involved in transferring new treatment innovations into practice.  (See Organizational Readiness for Change.)

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