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Czuchry, M., & Dansereau, D. F. (2003). A model of the effects of node-link mapping on drug abuse counseling. Addictive Behaviors, 28(3), 537-549.

Abstract:  This paper examines the effectiveness of a promising cognitive enhancement technique called node-link mapping.  Maps provide a concrete, visual, and computationally efficient means for exploring personal issues, and have received substantial empirical support.  We introduce two models to provide a framework for understanding how node-link mapping improves substance abuse counseling.  The TCU Process Model reviews the general process of substance abuse treatment.  The second model reflects an effective treatment session.  Implications of the models and node-link mapping findings are discussed, as well as future research directions.

Czuchry, M., & Dansereau, D. F. (2003).  Cognitive skills training:  Impact on drug abuse counseling and readiness for treatment.  American Journal of Drug and Alcohol Abuse, 29(1), 1-18.

Abstract:  As part of an NIDA-sponsored project, the current study investigated the effectiveness of a skills program we developed called the TCU Cognitive Skills Module (CSM).  The program was developed to address cognitive deficits that may impede substance abuse treatment within the criminal justice system.  Probationers in a 4-month residential program (followed by 3 months of aftercare) were randomly assigned (by community) to receive standard treatment or treatment enhanced with the CSM program.  Peer ratings, individual ratings of the community, and counselor assessments revealed that the CSM was effective in increasing perceived treatment effectiveness (particularly midway through the program).  There was also some support for the CSM being especially effective for probationers who enter treatment with lower levels of treatment readiness.  [Keywords: Cognitive skills training; TCU cognitive skills module (CSM); peer ratings; individual ratings of community; counselor ratings; readiness for treatment]

Fletcher, B. W., Broome, K. M., Delany, P. J., Shields, J., & Flynn, P. M. (2003).  Patient and program factors in obtaining supportive services in DATOS.  Journal of Substance Abuse Treatment, 25(3), 165-175.

Abstract:   This study examined patient and program factors that influenced the receipt of scheduled supportive services in the Drug Abuse Treatment Outcome Studies (DATOS).  Patients (N = 2,932) in 21 long-term residential (LTR) programs, 27 outpatient methadone treatment (OMT), and 25 outpatient drug-free programs were interviewed at admission and at 3 months during treatment.  A hierarchical regression analysis was used to examine the relationship between patient-level and program-level factors associated with receiving supportive services in seven categories (medical, psychological, family, legal, educational, vocational, and financial).  LTR patients received more services on average than outpatients (especially OMT), but patients overall received few services in the first 3 months of treatment. The patient-level likelihood of receiving services was related to being female and to having higher problem severity at intake.  At the program level, outpatient clientele with higher problem severity received more services if they entered a program whose other enrolled patients were less troubled on average.  [Keywords: Treatment service utilization; supportive services; patient and program factors]

Flynn, P. M., Joe, G. W., Broome, K. M., Simpson, D. D., & Brown, B. S. (2003).  Looking back on cocaine dependence:  Reasons for recovery.  American Journal on Addictions, 12(5), 398-411.

Abstract:  Factors that contributed to long-term recovery from cocaine dependence were examined as part of a 5-year national follow-up study of 708 patients from 45 treatment programs in eight U.S. cities.  Outcomes from 33% of the sample were highly favorable at follow-up, including no drugs detected in urine or hair specimens, no self-reported use of any drugs, less than daily alcohol use, and no illegal activity or arrests during the past year.  Major reasons cited for these improvements were motivations to change, positive influences of family, strength from religion and spirituality, and help from drug treatment.   “Recovery” was viewed as a continuous process and one that benefits from lessons learned in treatment.  These retrospective attributions affirm many of the same findings from prospective outcome studies and contribute to a conceptual framework for treatment process and recovery.

Flynn, P. M., Joe, G. W., Broome, K. M., Simpson, D. D., & Brown, B. S. (2003).  Recovery from opioid addiction in DATOS.  Journal of Substance Abuse Treatment, 25(3), 177-186.

Abstract:   Patient attributions for their own long-term recovery were obtained in a 5-year followup of 432 admissions to 18 outpatient methadone treatment programs.  Subjects were classified into two groups – recovering and non-recovering – strictly defined and based on both biological and self-report measures of no opioid or cocaine use, less than daily use of alcohol, and no arrests or illegal activity during the year prior to interview.  The 28% who were in recovery at Year 5 reported that they had relied primarily upon personal motivation, treatment experiences, religion/spirituality, family, and their job/career.  Particular value was placed on the support from family and close friends, indicating the importance of stronger efforts to develop social networks for support of drug-free functioning, especially among patients who lack these resources or need them strengthened.  [Keywords: Recovery; opioids; addiction; methadone treatment; treatment outcomes]

Flynn, P. M., Porto, J. V., Rounds-Bryant, J. L., & Kristiansen, P. L. (2003). Costs and benefits of methadone treatment in DATOS - Part 1: Discharged versus continuing patients. Journal of Maintenance in the Addictions, 2(1/2), 129-149.

Abstract: Longer lengths of stay in methadone treatment have been associated with greater treatment benefits such as reductions in heroin use and criminal activity. In this paper, the first of two concentrating on costs of methadone treatment, the positive monetary returns from investments in longer-term methadone treatment for opioid users who participated in NIDA's Drug Abuse Treatment Outcome Studies (DATOS) are demonstrated. Part 1 focuses on crime cost savings for discharged patients (patients who left their index DATOS treatment program before completing 1 year of treatment) and continuing patients (those who continued in treatment for 1 year or longer). It was hypothesized that methadone treatment benefits from tangible crime cost savings during treatment and at follow-up would be greater for the continuing patients. Subjects were 394 methadone patients from 8 medium to large cities and 16 programs; overall 37% were women, 33% African American, with an average age of 37.2. Results supported the hypothesis; longer retention or greater lengths of stay in treatment were associated with greater crime cost savings. It is concluded that methadone treatment provides significant returns on treatment investments for both discharged and continuing patients. However, greater net economic benefits were rea1ized from continuing patients. Cost-containment and ideological practices opposed to methadone maintenance and longer lengths of stay in treatment, if acted upon, may diminish the benefits from averted crime associated with methadone treatment. [Keywords: Methadone treatment; cost-benefits; maintenance; discharges]

Flynn, P. M., Porto, J. V., Rounds-Bryant, J. L., & Kristiansen, P. L. (2003). Costs and benefits of methadone treatment in DATOS - Part 2: Gender differences for discharged and continuing patients. Journal of Maintenance in the Addictions, 2(1/2), 151-169.

Abstract: Greater economic benefits have been associated with longer lengths of stay in methadone treatment. Little is known about whether the costs and benefits of methadone treatment differ for women and men. This paper examines the costs of outpatient methadone treatment (OMT) in NIDA's Drug Abuse Treatment Outcome Studies (DATOS) for women and men, and estimates the economic benefit from avoided crime costs during and after treatment. Women and men are also grouped according to length of time in treatment and costs are examined for discharged patients (patients with less than 1 year of treatment in their index DATOS OMT program) and continuing patients (patients who remained in their index treatment for at least 1 year). It was hypothesized that methadone treatment benefits in the form of costs of crime to society before, during, and after treatment would differ by gender, and crime cost savings would be greater for both women and men who remained in treatment for 365 days or longer. Subjects were 144 women and 250 men from 8 cities and 16 programs. Female subjects were 30% African American, 43% Caucasian, and 26% Hispanic with an average age of 35.5 years. Male subjects were 35% African American, 40% Caucasian, and 24% Hispanic with an average age of 38 years. Women had greater reductions in crime costs than men. Greater net economic benefits to society were accrued by women than men. [Keywords: Gender differences; methadone treatment; cost-benefits; maintenance; discharges]

Hood., P., Knight, D. K., & Logan, S. M.  (2003).  Mutually beneficial collaboration:  Using evaluation to improve service delivery.  Lessons learned:  Residential substance abuse treatment for women and their children (DHHS Publication No. SMA 03-3787).  Rockville, MD:  Center for Substance Abuse Treatment.

Abstract:  Increasingly, collaborative relationships are forming between substance abuse treatment agencies and research institutions.  The purpose of this paper is to illustrate how a collaborative relationship between a treatment agency and research institution can be mutually beneficial, particularly for monitoring and improving service provision.  The chapter describes how research protocols were integrated into the program and how a reciprocal exchange of information resulted in a collaborative analysis plan, culminating in a series of reports designed to address fundamental questions posed by program administration.  Questions addressed by the team (and reported on in this chapter) include:  (1) Is the program reaching the women who need treatment? (2) Are women receiving services as intended? (3) What can be done to improve the quality of services provided? and (4) How can communication be improved (both within the treatment agency and between the provider and research teams)?  The issues that arose regarding evaluation findings and how this new knowledge was utilized by the agency to modify existing treatment components are discussed.

Knight, D. K., & Wallace, G. (2003).  Where are the children?  An examination of children's living arrangements when mothers enter residential drug treatment.  Journal of Drug Issues, 33(2), 305-324.

Abstract:  Although providing child care and family residency options has become central to substance abuse treatment for women with dependent children, research documenting status of child coresidence prior to, during, and following treatment is currently unavailable.  The purpose of this study is to examine the degree to which mothers are successful in maintaining or reestablishing their role as parents during the course of treatment.  The sample included 152 female clients admitted to a residential drug treatment program for women with dependent children.  Findings document an increase in child coresidency from admission to follow-up.  Women who entered treatment with all children or who were reunited with children previously in others' care at admission were over five times more likely to coreside with all children at follow-up.  At follow-up, mothers who reported complete coresidence were more likely to be 30 years old or younger, live independently, and have fewer than two parenting challenges.

Reynolds, S. G., & Lehman, W. E. K. (2003).  Levels of substance use and willingness to use the Employee Assistance Program.   Journal of Behavioral Health Services and Research, 30(2), 238-248.

In a study of 793 municipal employees who completed anonymous questionnaires on personal drinking and drug use, attitudes toward drug policies, work group cohesion, trust in management, and willingness to use the EAP, those with higher rates of substance use were less willing to use the EAP than nonusers. However, substance users who were aware of the EAP, who were favorable toward policy, and who reported low tolerance for coworkers who abused substances were as willing to use EAP services as nonusers. Overall, awareness of EAP services, support for workplace policy, and perceptions of work group cohesiveness were significant factors in employee willingness to use the EAP. As previous research has shown that individuals with drinking and drug problems may be particularly reluctant to seek help, this study supports workplace prevention efforts that target environmental and social contexts as a way to buffer substance users' reluctance to seek help.

Simpson, D. D.  (2003).  Introduction to 5-year followup treatment outcome studies.  Journal of Substance Abuse Treatment, 25(3), 123-124

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