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99spring.html
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This
Spring 1999 issue is also available in Adobe(R) PDF format.
(PDF; 58KB / 6 pages)
Using treatment process to improve retention
by Dwayne Simpson, IBR Director
In preparing for a recent conference presentation on the expansion of drug treatment research and practice, I felt encouraged by the scientific progress our field has made over the last 10 years related to the age-old question "what makes treatment work?" We know, for example, that length of stay in treatment is a principal indicator of treatment effectiveness—the longer a client stays, the better the outcome. About 3-months is the usual threshold for achieving therapeutic benefits, although clients entering treatment with more severe psychosocial problems benefit from longer stays, such as opioid addicts who opt for methadone maintenance. However, the active ingredient for successful treatment is not retention per se, but what happens while the person is in a treatment program.
Studies from TCU and other NIDA-funded research centers have found support for a model that takes into account the interrelatedness of elements of effective drug treatment. This model identifies a sequence of factors such as client motivation and attributes at intake, program characteristics, the therapeutic relationship, client participation and compliance during early treatment, counseling and skills training strategies, social support issues, and aftercare. This type of treatment process model is useful for guiding and evaluating interventions to improve treatment effectiveness.
However, as researchers, we are concerned not only with
the elements of "what happens," but also with how we can best
measure therapeutic components and systematically relate them to treatment
retention and outcome. Figure 1 below outlines the series
of TCU Treatment Process Assessments that have evolved over the course
of several large-scale research projects to meet the challenges of measuring
and monitoring treatment process and outcome. These represent key domains
and provide a use- ful framework for better assessing client needs and
delivering appropriate treatment services. As we move toward identifying
better ways to translate research findings to real-world practice, it
would seem that improving the measurement and monitoring of treatment
process dynamics and client responses to the elements of treatment should
be an important goal for technology transfer studies. Evaluation
forms for TCU Treatment Process Assessments can be downloaded at the
IBR Web site. n
Workplace training project enters year 2
Researchers with IBR’s Workplace Project have completed the first phase of development and field testing of a team-oriented training program designed to increase work group cohesiveness and reduce attitudes and behaviors that contribute to alcohol and drug use on the job. An "enhanced" work-team approach, which emphasizes team-building and problem-solving skills, was piloted and compared to a "standard" approach, which provides didactic information on substance abuse policy and EAP benefits, and preliminary study data were collected. Workers in a mid-sized suburban municipality in the Southwest were randomly assigned to participate in one of the two types of training or to be part of a control group. The pre-and posttraining measures collected for this study focus on organizational climate, working conditions, self-reports of substance use and perceived substance use among co-workers, attitudes toward policy, EAP utilization, and job performance indicators. Six-month follow-up data on parti-cipants also will be collected to help assess whether training is associated with a reduction in substance abuse and related problems for workgroups. Figure 2 below shows the breakdown of employees who participated in this study.
During the next phase of the project, workers from several "high risk" departments in a larger, urban municipality will take part in the training. Based on participant feedback and the identified needs of this larger workforce, several revisions in the training curricula are underway. The final program will be evaluated in terms of specific training goals such as individual awareness of substance abuse policy and available EAP services, less tolerant work-team attitudes toward substance use, and the willingness of employees to use communication skills to reduce enabling behaviors and encourage impaired co-workers to seek help. In addition, several secondary goals also will be evaluated including identification of strategies that encourage voluntary participation by workers (e.g., incentives, flexible training schedules) and strategies that address the logistical demands (e.g., time, place, employee work loads) of this type of large-scale workplace study. n
Surveys highlight Internet utilization
A recent survey of counselors, clinicians, and researchers who responded to an informal questionnaire card distributed at conferences and via the Research Summary newsletter found frequent use of the Internet, both for information and downloading materials. In addition, Web-based abstracts and research highlights were endorsed as frequently as published journal articles for preferred methods of staying current in one’s field. Newsletters also were endorsed as a good way to learn about new information; training videos and regional workshops were less strongly endorsed. Among Internet users, the utility of downloadable Web-based counseling materials and training modules/tutorials was supported. These responses are similar to those from a more extensive survey of users of TCU counseling manuals conducted recently by Drs. Lois Chatham and Jack Greener in which a majority of respondents reported using the Internet both at work and at home. Among Net users, Web-based information and counseling materials were strongly endorsed as preferences for staying current. Although informal, these surveys point to a growing utilization of the Internet by drug treatment professionals and highlight the Net’s potential for dissemination of new findings and information. n
Research Highlights
Reports in press
The role of both client and program attributes in determining therapeutic engagement in drug treatment was examined in this study based on a sample of DATOS clients. Programs better able to engage clients used more ancillary services, averaged better counseling attendance, and had more heterogeneous clients. Higher motivation at intake, better rapport with counselors, and more frequent counseling attendance were attributes of clients who stayed in treatment at least 3 months. Patient and Program Influences on Treatment Process Indicators, Kirk Broome, Dwayne Simpson, & George Joe. In Press: Drug and Alcohol Dependence.
Now Published: Broome, K. M., Simpson, D. D., & Joe, G. W. (1999). Patient and program attributes related to treatment process indicators in DATOS. Drug and Alcohol Dependence, 57, 127-135. [Abstract]
In a related study, a model incorporating treatment process and client background factors to explain treatment retention was tested using data from different DATOS treatment modalities. Across all modalities, positive reciprocal effects were found between therapeutic involvement and counseling session attributes, which in turn were found to have a direct positive effect on treatment retention. Client motivation at intake helped determine therapeutic involvement. Retention and Patient Engagement Models for Different Treatment Modalities in DATOS, George Joe, Dwayne Simpson, & Kirk Broome. In Press: Drug and Alcohol Dependence.
Now Published: Joe, G. W., Simpson, D. D., & Broome, K. M. (1999). Retention and patient engagement models for different treatment modalities in DATOS. Drug and Alcohol Dependence, 57, 113-125. [Abstract]
Integrative models of client and treatment program characteristics were tested in a sample of methadone clients. Pretreatment motivation had positive effects on engagement during the first 6 months of treatment and components of engagement (rapport, session attendance) were related to lower drug use throughout treatment. The results suggested group counseling had greater impact than individual counseling on reducing drug use during treatment. Integrative Modeling of Client Engagement and Outcomes During the First 6 Months of Methadone Treatment, George Joe, Dwayne Simpson, Jack Greener, & Grace Rowan-Szal. In Press: Addictive Behaviors.
Now Published: Joe, G. W., Simpson, D. D., Greener, J. M., & Rowan-Szal, G. A. (1999). Integrative modeling of client engagement and outcomes during the first 6 months of methadone treatment. Addictive Behaviors, 24(5), 649-659. [Abstract]
An integrative model developed to predict treatment retention was expanded to examine posttreatment outcomes in a sample of methadone clients. Pre- and early-treatment measures of motivation, engagement, and therapeutic relationship were examined in relation to measures of social and family influences, drug use, and criminality in the year after treatment. Support was found for both models and for the importance of including of social network variables as predictors of outcome. Modeling Year 1 Outcomes with Treatment Process and Posttreatment Social Influences, Dwayne Simpson, George Joe, Jack Greener, & Grace Rowan-Szal. In Press: Substance Use and Misuse.
Now Published: Simpson, D. D., Joe, G. W., Greener, J. M., & Rowan-Szal, G. A. (2000). Modeling year 1 outcomes with treatment process and post-treatment social influences. Substance Use & Misuse, 35(12-14), 1911-1930. [Abstract]
The effectiveness of a group intervention for men dealing with communication, relationships, and sexuality ("Time Out! For Men") was examined using clients in a court-mandated residential treatment program. Participation in these groups resulted in increases in knowledge and social conformity and reductions in attitudes associated with rigid gender role socialization. Effectiveness of Communication and Relationship Skills Training for Men in Substance Abuse Treatment, Norma Bartholomew, Matthew Hiller, Kevin Knight, Diane Nucatola, and Dwayne Simpson. In Press: Journal of Substance Abuse Treatment.
Now Published: Bartholomew, N. G., Hiller, M. L., Knight, K., Nucatola, D. C., & Simpson, D. D. (2000). Effectiveness of communication and relationship skills training for men in substance abuse treatment. Journal of Substance Abuse Treatment, 18(3), 217-225. [Abstract]
The relationship between exposure to co-worker substance use, negative consequences, and work group level characteristics (job safety, drinking climate, cohesiveness) were examined in two samples of municipal employees. Work groups involved in higher risk jobs and those with higher levels of drinking climate were most vulnerable to negative consequences, even after controlling for individual risk factors (such as personal drinking and job stress). Employee Exposure to Coworker Substance Use and Negative Consequences: A Multi-Level Model and Assessment of Work Groups, Joel Bennett & Wayne Lehman In Press: Journal of Health and Social Behavior.
Now Published: Bennett, J. B., & Lehman, W. E. K. (1999). Employee exposure to coworker substance use and negative consequences: The moderating effects of work group membership. Journal of Health and Social Behavior, 40, 307-322. [Abstract]
Conference presentations
Dr Grace Rowan-Szal will present "Contingency Management and Relapse Prevention Training in a Sample of Cocaine-Using Methadone Clients" in June at the College on Problems of Drug Dependence annual meeting in Acapulco, Mexico. In April, Dr. Rowan-Szal presented "Assessment of Cocaine and Alcohol Dependent Methadone Clients" at the Texas Research Society on Alcoholism in Dallas.
In April, Dr. Danica Knight gave presentations at the Society for Research in Child Development meeting in Albuquerque on "Parental Responsibility as a Predictor of Retention Among Women in Substance Abuse Treatment" and "Correlates of Victimization Among Children of Substance-Abusing Women."
Dr. Joel Bennett chaired a symposium entitled "Beyond Drug-Testing: Recent Innovations in Workplace Substance Use Prevention" at an interdisciplinary conference sponsored by the American Psychological Association and the National Institute for Occupational Safety and Health held in March in Baltimore. Dr. Bennett and Dr. Wayne Lehman also presented papers on "The Team-Based Approach to Substance Abuse Prevention Training in the Workplace" and "The Team Risk Management Approach: Research Review and Previous Models."
Dr. Kevin Knight will present "Therapeutic Community Outcome Research: An Overview" at the Office of Justice Programs Therapeutic Community Program Design and Implementation meeting in May in Washington, DC. In April, Dr. Knight was an invited presenter for the First National Addiction Technology Transfer Center (ATTC) Research to Practice Teleconference on Domestic Violence and Criminal Justice in Albany, NY.
Dr. Knight and Dr. Matthew Hiller gave presentations at the annual Academy of Criminal Justice Sciences in Orlando in March. Dr. Knight participated in an National Institute of Justice sponsored round-table on "Residential Substance Abuse Treatment Programs" and Dr. Hiller presented "Predicting Retention in Corrections-Based Treatment."
New project
The National Institute of Justice is funding Process Assessment of Correctional Treatment (PACT), a project to conduct follow-up evaluations on probationers who received residential substance abuse treatment at the Dallas County Judicial Treatment Center in Wilmer, TX. Kevin Knight is Principal Investigator for the project. n
What's new on the Web
Forms Section updated:
The Forms Section has been reorganized based on user input to help make form categories easier to locate and download.
New data forms available:
Both parent and child form sets from TCU's Women & Children Project are now available. These forms measure individual functioning of women and their children entering treatment. Included are measures of family functioning and treatment process.
Updated lists of recent publications
IBR Newsletters
Research
Summaries on
Special Topics
Treatment
Process
and Outcomes
(September 2002)
(PDF;
240K/4 pgs)
Organizational
Change
(September 2002)
(PDF; 251K/4 pgs)
Treatment
Assessment
(September 2002)
(PDF; 270K/4 pgs)
Counseling
Manuals for
Special Interventions
(September 2002)
(PDF; 99K/4 pgs)
Treatment
Mapping
(September 2002)
(PDF; 411K/4 pgs)
Treatment
Readiness
and Induction
Strategies
(September 2002)
(PDF; 99K/4 pgs)
Correctional
Treatment
(December 2002)
(PDF; 664K/4 pgs)
Using the
TCU Drug Screen (TCUDS)
(December 2002)
(PDF; 451K/4 pgs)
Contingency
Management
(June 2000)
(PDF; 113K/4 pgs)
Research Reports from IBR
(updated newsletter)
Summer 2008
(PDF; 422K/4 pgs)
Spring 2008
(PDF; 181K/4 pgs)
Winter 2006-07
(PDF; 154K/4 pgs)
Fall 2006
(PDF; 290K/4 pgs)
Spring-Summer 2006
(PDF; 202K/4 pgs)
Research Roundup (back issues and archives)
Winter 2005-06
HTML (PDF; 518K/6 pgs)
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HTML (PDF; 121K/4 pgs)
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