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Bennett, J. B., & Lehman, W. E. K. (1997). Employee views of organizational wellness and the EAP: Influence on substance use, drinking climates, and policy attitudes. Employee Assistance Quarterly, 13(1), 55-71.

Abstract: This study examined the influence on substance use of organizational wellness and of attitudes toward the EAP. We developed the Organizational Wellness Scale (OWS) to assess perceptions of healthy (e.g., respectful) and addictive (e.g., workaholic) work climates. Employees from a municipal organization (N = 780) who scored high on the OWS reported less personal and co-worker substance use and enabling behaviors, and more favorable attitudes towards substance use policies. Results suggest that, beyond the influence of the EAP, work site health may effect both individual and work group substance use. Using the OWS, health service providers could benefit from monitoring the impact of organizational wellness on individual and work group health.

Bennett, J. B., & Lehman, W. E. K. (1997). From dual policy to dual attitudes: The social construction of substance use policy. Review of Public Personnel Administration, 17(1), 58-83.

Abstract: Administrators of workplace substance use policies often coordinate many components such as drug-testing, discipline, EAP, and employee awareness. Analyses from two municipalities (ns = 1,068, 1,081) indicated that employees who most disfavor all policy components—particularly drug-testing—report higher frequencies of alcohol drunkenness. In contrast, employees with the most punitive attitudes report the highest levels of exposure to co-worker use. Finally, those who favor an educative approach report higher levels of alcohol use but not alcohol problems or drug use. Policy administrators are likely to benefit from listening to and addressing these differences in policy attitudes.

Broome, K. M., Knight, D. K., Knight, K., Hiller, M. L., & Simpson, D. D. (1997). Peer, family, and motivational influences on drug treatment process and recidivism for probationers. Journal of Clinical Psychology, 53(4), 387-397.

Abstract: Treatment efforts appear to be effective in reducing crime among drug using individuals, but components of the treatment process associated with client improvement need to be identified. Furthermore, these elements of treatment may play an intermediate role in the connection between client background characteristics and later criminal activity. The current study examines a structural equation model including client perceptions of their drug related problems, peer deviance, and family dysfunction as influences upon the formation of therapeutic relationships during treatment and rearrests following treatment. Results showed therapeutic relationships were positively associated with recognition of drug related problems and negatively related to rearrest. Peer deviance also was positively related to rearrest.

Broome, K. M., Knight, K., Joe, G. W., Simpson, D. D., & Cross, D. (1997). Structural models of antisocial behavior and during-treatment performance for probationers in a substance abuse treatment program. Structural Equation Modeling, 4(1), 37-51.

Abstract: Prior research has linked substance abuse and antisocial behavior. This study uses structural models to examine developmental stages of antisocial behavior and their relation to during-treatment performance of probationers in a 4-month inpatient program. Separate childhood and adulthood antisocial functioning components were identified, and each predicted during-treatment psychological functioning and program perceptions. Specifically, adulthood hostility predicted psychological functioning, and adulthood risk-taking predicted program perceptions; the effect of childhood antisocial behavior was completely mediated by adulthood functioning.

Camacho, L. M., Bartholomew, N. G., Joe, G. W., & Simpson, D. D. (1997). Maintenance of HIV risk reduction among injection opioid users: A 12 month posttreatment follow-up. Drug and Alcohol Dependence, 47, 11-18.

Abstract: Study objectives were to examine HIV risk behaviors 12 months following methadone maintenance (MM) treatment termination, and to assess the effects of treatment tenure, cocaine use, and gender on posttreatment HIV risk. Injection and sex risk behaviors were measured at treatment entry and 12 months after leaving treatment among 435 injection opioid users. Multi-way contingency tables for treatment tenure and HIV risk at treatment intake and at 12 month follow-up were analyzed using the GSK weighted least-squares estimation procedure. The effects of treatment tenure, gender, and cocaine use on risk behavior at follow-up, while controlling for intake risk and background variables were tested using a series of multiple logistic regression analyses. Results showed that injection and sex risk behaviors were significantly lower at 12 month follow-up than at treatment entry. Additionally, increased tenure was related to risk reductions, while cocaine use was related to increased risk-taking. Gender was generally unrelated to risk changes. These findings support broader use of MM in helping reduce HIV risks among injection drug users and highlight the need to explore ways to encourage treatment compliance in order to reduce risky practices. [Keywords: HIV; injection opioid user; methadone maintenance treatment]

Chatham, L. R., Rowan-Szal, G. A., Joe, G. W., & Simpson, D. D. (1997). Heavy drinking, alcohol-dependent vs. nondependent methadone-maintenance clients: A follow-up study. Addictive Behaviors, 22(1), 69-80.

Abstract: This study of methadone-maintenance clients interviewed approximately 1 year after discharge from treatment revealed that outcomes differed between heavy-drinking clients who are alcohol dependent and those who are not. Alcohol-dependent clients seem to benefit more from treatment but continue to have severe cocaine-use problems, suggesting they also may be cocaine dependent. The results emphasized the value in differentiating between these types of drinking clients, and they suggest that failure to do so may account for earlier contradictory results about the role alcohol consumption has in treatment outcomes for methadone-maintenance clients.

Conner, D. B., Knight, D. K., & Cross, D. R. (1997). Mothers' and fathers' scaffolding of their 2-year-olds during problem-solving and literacy interactions. British Journal of Developmental Psychology, 15, 323-338.

Abstract:  Building upon Wood & Middleton's (1975) concept of parental scaffolding, the influence of parent-child interactions on children's competence within several tasks was investigated. Thirty-two 2-year-old children visited our lab twice, once with their mothers and once with their fathers. During each session dyads participated in problem-solving and literacy tasks, followed by independent child performance tasks. Although subtle differences were found between mothers' and fathers' contingent behaviours displayed during the interactions, at a global level, parents were equally effective in their ability to scaffold their children's emerging skills. Specifically, parental scaffolding behaviours were associated with children's success measured both during the interaction and independently (i.e. following the interactions). These results have implications for the interpretation of research comparing mothers and fathers, and lend support to the claim that scaffolding can be an effective instructional strategy.

Czuchry, M., Sia, T. L., Dansereau, D. F., & Dees, S. M. (1997). Downward spiral: A pedagogical game depicting the dangers of substance abuse. Journal of Drug Education, 27(4), 373-387.

Abstract: We have developed a pedagogical game called Downward Spiral that illuminates the dangers associated with continued drug use (including alcohol). The game provides facts, quotes, and episodic consequences that can adversely affect each player's mental and physical health, social support, and financial/legal situation over the course of the game. The conceptual and empirical foundations of the game (both a college prevention version and substance abuse treatment version) are discussed. Pilot studies with college students and residents at a substance abuse treatment facility for probationers indicate that Downward Spiral is engaging, informative, and thought provoking. Plans for examining the impact of this game as a preventive technique (for the college setting) and as an approach to increasing motivation for substance abuse treatment are described.

Dees, S. M., Dansereau, D. F., & Simpson, D. D. (1997). Mapping-enhanced drug abuse counseling: Urinalysis results in the first year of methadone treatment. Journal of Substance Abuse Treatment, 14(1), 45-54.

Abstract: Urinalysis (UA) tests for opiates and cocaine were obtained over a 12-month period for a total of 155 long-term clients who participated in treatment in one of three urban methadone centers. At admission, clients were randomly assigned to "node-link mapping" (n=82) or "standard" (n=73) counseling treatment. Node-link mapping is a strategy for visually representing interrelationships between clients’ ideas, feelings, and experiences. These multirelational maps are developed (usually by counselors) during individual and group counseling sessions to clarify clients’ issues and problems. The results revealed that (a) mapping clients had significantly fewer opiate-positive UAs during months 2-6 of treatment and (b) session attendance was a significant predictor of cocaine-positive UAs over months 2-12 for mapping clients. [Keywords: Node-link mapping; cognitive strategy]

Forst, J. K., & Lehman, W. E. K. (1997). Ethnic differences in the workplace environment by employees in two municipal workforces. Hispanic Journal of Behavioral Sciences, 19(1), 84-96.

Abstract: With the Hispanic population becoming the fastest growing ethnic faction in the civilian labor force, research findings from workforces that are predominately Hispanic are becoming greater in number. This raises the possibility that findings from Hispanic research samples may not generalize to workforces that are primarily non-Hispanic, and vice versa. Evidence is presented to suggest that differences between Hispanic and non-Hispanic employees, among responses to several industrial and organizational research scales and personal background variables, are very slight. These findings are advanced from several hundred employees in two municipal workforces, one that was 70% Hispanic and one that was 14% Hispanic.

Joe, G. W., Dansereau, D. F., Pitre, U., &   Simpson, D. D. (1997). Effectiveness of node-link mapping enhanced counseling for opiate addicts: A 12-Month Posttreatment Follow-up. Journal of Nervous and Mental Disease 185(5), 306-313.

Abstract: Drug abuse counseling was enhanced by node-link mapping, a visual representation technique, and evaluated in a posttreatment follow-up study. Clients randomly assigned to receive mapping counseling reported less criminal activity 12 months after treatment than did clients in the standard counseling condition. It was also found that among clients staying less than 6 months in treatment, those in the mapping group had fewer urine samples that tested positive for opiates at follow-up. Thus, mapping-enhanced counseling may be especially beneficial for clients who leave treatment prematurely.

Knight, K., & Hiller, M. L. (1997). Community-based substance abuse treatment: A 1-year outcome evaluation of the Dallas County Judicial Treatment Center. Federal Probation, 61(2), 61-68.

Abstract: The Dallas County Judicial Treatment Center (DCJTC), which began operation in September 1991, is one of the first SATFs to be funded in Texas. Located in Wilmer (immediately south of Dallas), the DCJTC includes a 300-bed community-based residential treatment program based on a modified therapeutic community (TC) approach which incorporates 12-Step programming; 200 beds are designated for primary treatment and 100 beds for aftercare treatment. The SATF is designed to provide up to 6 months of primary substance abuse treatment as an alternative to incarceration for probationers at high risk for recidivism, relapse, and technical violations. The study summarizes data collection procedures, research design issues, and findings from a 1-year evaluation of the DCJTC. Results from follow-up arrest data collected by the Texas Department of Public Safety (DPS) Criminal History Records Inventory (CHRI) are presented.

Knight, K., Simpson, D. D., Chatham, L. R., & Camacho, L. M. (1997). An assessment of prison-based drug treatment: Texas’ in-prison therapeutic community program. Journal of Offender Rehabilitation, 24(3/4), 75-100.

Abstract: In response to increasing problems associated with drug abusing offenders, the 1991 Texas Legislature provided a statutory foundation for the development of a comprehensive drug treatment program within the state's criminal justice system. In an effort to assess the impact of the prison-based treatment component of this legislative mandate, the Texas Commission on Alcohol and Drug Abuse funded the Institute of Behavioral Research at Texas Christian University to conduct a comprehensive prison-based treatment assessment (PTA) including studies of the In-prison Therapeutic Community (ITC) treatment process and posttreatment outcomes. This article provides an overview of the research project and findings from the 6-month follow-up study. Preprison and during-treatment information was collected from 293 ITC program participants. Six-month follow-up interviews were completed with 222 ITC program graduates and compared with a comparison sample of 75 parolees who were eligible but not sent to ITC treatment. Results showed that 80% of the inmates referred to the ITC during this study graduated, and that program graduates demonstrated marked reductions in their criminal and drug use activity from the 6 months before entering prison to the 6 months after leaving prison. Finally, ITC graduates—particularly those who completed the first phase of their aftercare program—had lower relapse and recidivism rates in the 6 months after prison than did the parolees in comparison sample. They also reported highly favorable opinions about both the program and the counselors. Implications of these findings are discussed; and longer term follow-up evaluations are in progress.

Newbern, D., Dansereau, D. F., & Dees, S. M. (1997). Node-link mapping in substance abuse: Probationers' ratings of group counseling. Journal of Offender Rehabilitation, 25(1/2), 83-95.

Abstract: Node-link mapping is a method for visually representing ideas, feelings, and actions. Research has indicated that it can enhance outcomes from drug abuse counseling. The present study extends this research by examining counseling session evaluations collected from probationers participating in 26 group sessions at a residential substance abuse treatment facility (approximately 18 probationers in each session). Sessions were divided into those that involved a large amount of mapping (N = 13) and those that used little or no mapping (N = 13). Participants rated sessions involving more extensive mapping as significantly deeper and as involving more group participation.

Pitre, U., Dansereau, D. F., & Simpson, D. D. (1997). Node-link maps enhance counseling efficiency. EPIKRISIS, 8(12), 2.

No Abstract

Pitre, U., Dansereau, D. F., & Simpson, D. D. (1997). The role of node-link maps in enhancing counseling efficiency. Journal of Addictive Diseases, 16(3), 39-49.

Abstract: Node-link mapping is a counseling tool that helps clients and counselors visualize relationships between ideas, actions, and feelings. Previous research has shown that methadone-maintained clients receiving mapping-enhanced counseling have more positive during-treatment outcomes (e.g., better session attendance and higher probability of clean urines) than those receiving standard counseling. Findings also suggest that mapping enhances the efficiency of counseling sessions by increasing "on task" attention and by reducing communication problems. In this study, mapping counseling was associated with greater coverage of collateral issues (i.e., issues indirectly related to drug use) than standard counseling and lower during-treatment use as indicated by urinalysis results.

Pitre, U., Dees, S. M., Dansereau, D. F., & Simpson, D. D. (1997). Mapping techniques to improve substance abuse treatment in criminal justice settings. Journal of Drug Issues, 27(2), 431-445.

Abstract: Node-link mapping, a graphic representation tool, was used to improve mandated substance-abuse treatment in a 4-month residential criminal justice program. Three hundred eighty probationers (residents) were randomly assigned to either mapping-enhanced or standard counseling. Compared to those in standard counseling, residents receiving mapping gave more favorable evaluations to their group meetings, counselors, co-residents, and security staff. They also rated themselves higher on treatment effort and self-efficacy measures than did their counterparts. These findings suggest that mapping-enhanced counseling fosters more effective communication during meetings, promotes stronger therapeutic alliances, and thus enhances the perceptions of the effectiveness of the program and of the people associated with it.

Rowan-Szal, G. A., Joe, G. W., Hiller, M. L., & Simpson, D. D. (1997). Increasing early engagement in methadone treatment. Journal of Maintenance in the Addictions, 1(1), 49-60.

Abstract: In an effort to enhance early participation and compliance in outpatient methadone treatment, 46 clients were randomly assigned to an incentive group or standard control condition. The use of inexpensive rewards in the first 90 days of treatment increased attendance for individual counseling sessions and reduced the prevalence of dirty urines during that period. In the following 3 months, clients in the incentive group also had fewer cocaine-positive urines than those in the control group and were rated by counselors as having better rapport, more self-confidence, and higher motivation. Thus, the use of simple low-cost rewards early in treatment helped motivate clients to become more engaged, as indicated by session attendance and drug abstinence. [Keywords: Rewards; incentives; program compliance; performance; treatment outcome; contingency contracting]

Simpson, D. D. (1997). A longitudinal study of inhalant use: Implications for treatment and prevention. Substance Use and Misuse, 32(12&13), 1889-1890.

Abstract: A total of 175 Mexican American youth aged 15-17 when they entered a drug prevention program during 1981-1985 were followed up 4 years later. More frequent pre-admission use of inhalant drugs was associated with higher levels of alcohol use, legal problems, and cognitive functioning problems during the same period, as well as more negative outcomes at follow-up. Inhalant use declined over time, but use of other drugs, especially cocaine, increased. Peer, family, and cultural influences on follow-up outcomes were examined. [Keywords: Inhalants; prevention; Mexican-American; peer; family; culture]

Simpson, D. D.  (1997).  Effectiveness of drug abuse treatment:  A review of research from field settings.  In J. A. Egertson, D. M. Fox, & A. I. Leshner (Eds.), Treating drug abusers effectively.  Cambridge, MA:  Blackwell Publishers of North America.

Summary:  There are prominent questions about how to identify drug users who are in need of treatment, and how to assess and engage them in the most appropriate types of services for maximizing their chances of recovery.  This chapter addresses these questions with findings from treatment outcome and process research conducted in naturalistic settings, usually based on large and multisite treatment samples.  The emphasis is on what works in practice, even though control over treatment assignment, and other evaluation design features for studies conducted in representative community programs, is much more limited than in clinical trials or other experimental research settings.  Results of early treatment outcome evaluations using national samples are summarized first, followed by a comprehensive overview of the drug-treatment system to provide a context for later sections.  Several core questions that serve to organize the body of this chapter are then addressed.  These include:  “How are drug users who need treatment identified and recruited?”; “What is the role of motivation and readiness for treatment?”; “How are patients inducted into treatment?”; “How are patients assessed and matched to services?”; “How are patients engaged and retained in treatment?”; and “Can one predict which patients are most likely to improve?”  Finally, some concluding comments and recommendations are offered.

Simpson, D. D., Dansereau, D. F., & Joe, G. W.  (1997).  The DATAR project:  Cognitive and behavioral enhancements to community-based treatments.  In F. M. Tims, J. A. Inciardi, B. W. Fletcher, & A. M. Horton, Jr. (Eds.), The effectiveness of innovative strategies in the treatment of drug abuse (pp. 182-203).  Westport, CT:  Greenwood Press.

Simpson, D. D., Joe, G. W., Broome, K. M., Hiller, M. L., Knight, K., & Rowan-Szal, G. A. (1997). Program diversity and treatment retention rates in the drug abuse treatment outcome study (DATOS). Psychology of Addictive Behaviors, 11(4), 279-293.

Abstract: Stays of 3 months or longer in drug abuse treatment generally predict better follow-up outcomes. In a national sample of community-based programs that participated in the Drug Abuse Treatment Outcome Study, median lengths of stay were 3 months for clients in long-term residential and outpatient drug-free treatments and 1 year for clients in outpatient methadone treatment. However, individual programs within each of these modalities differed widely in how long they kept their clients in treatment as well as their service delivery. Programs treating individuals with heavier cocaine and alcohol use and more psychological dysfunction usually had shorter retention rates. Nonetheless, even after statistically controlling for these client differences, some programs were more effective than others in engaging and retaining clients.

Simpson, D. D., Joe, G. W., & Brown, B. S. (1997). Treatment retention and follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors, 11(4), 294-307.

Abstract: Clients in the national Drug Abuse Treatment Outcome Study reported significant overall improvements in drug use and related measures during a 12-month follow-up period. A quasi-experimental design was used to examine the relationship of treatment duration with outcomes in each of the 3 major modalities represented. Client subsamples with longer retention in long-term residential programs and in outpatient methadone treatment had significantly better outcomes than those with shorter lengths of stay (results were inconclusive for outpatient drug-free programs because of sample limitations). This study used several methodological enhancements and showed general continuity of findings on retention effects from previous national evaluations of treatment effectiveness. It supports the need for more careful study of treatment process in relation to outcomes.

Simpson, D. D., Joe, G. W., Dansereau, D. F., & Chatham, L. R. (1997). Strategies for improving methadone treatment process and outcomes. Journal of Drug Issues, 27(2), 239-260.

Abstract: Major findings are summarized for a program of research focused on therapeutic enhancements to methadone treatment. Cognitive, behavioral, and psychoeducational strategies for improving client engagement and counseling services are described. Evaluations focused on during-treatment performance and follow-up outcomes collected 1 year after discharge, with an emphasis on the impact of services delivered as well as client and counselor perceptions of one another. Interrelations were examined between treatment process components: therapeutic relationship between clients and counselors, service intensity and type, behavioral compliance of clients during treatment, and length of stay. Results showed enhanced counseling and length of time spent in treatment were related to treatment outcomes.

Simpson, D. D., Joe, G. W., & Rowan-Szal, G. A. (1997). Drug abuse treatment retention and process effects on follow-up outcomes. Drug and Alcohol Dependence, 47, 227-235.

Abstract: After finding that retention in methadone treatment for a year or longer was a highly significant predictor of patient outcomes following discharge, measures of pretreatment motivation and early therapeutic engagement were examined as predictors of program retention. Personal interviews were conducted with a sample of 435 patients 12 months after discharge from three methadone treatment programs. Logistic regression results showed several patient attributes—i.e. over 35, lower injection frequency before admission, and higher motivation for treatment—were each associated with twofold increases in the likelihood of having favorable follow-up outcomes on illicit drug use, alcohol use, and criminal involvement. Patients staying in treatment a year or longer, however, were nearly five times more likely to have better outcomes. Further analyses established that length of treatment stay was predicted by higher patient motivation at intake and early program involvement. The findings suggest that more comprehensive models of patient attributes, therapeutic process, and environmental influences are needed, and that treatment enhancement efforts should focus on such during-treatment measures as interim criteria for improving posttreatment outcomes. [Keywords: Methadone maintenance; motivation; treatment process; treatment retention; follow-up outcomes]

Simpson, D. D., Joe, G. W., Rowan-Szal, G. A., & Greener, J. M. (1997). Drug abuse treatment process components that improve retention. Journal of Substance Abuse Treatment, 14(6), 565-572.

Abstract: Background: Longer retention has been the most consistent predictor of favorable drug abuse treatment outcomes, but key therapeutic and patient engagement indicators of treatment process need to be more clearly established. Methods: An integrative model representing treatment dynamics was tested for explaining long-term program retention. It was based on a multisite sample of 527 daily opioid users who remained in methadone maintenance a minimum of 3 months. All had been assigned randomly to a counseling condition at admission (i.e., cognitively enhanced or standard), and information obtained from patient files, as well as periodic assessments completed by patients and their counselors in the first 90 days after admission were the sources of predictors. Results: Counseling enhancements (using node-link mapping, a visual representation tool for improving communication and problem solving) contributed to stronger therapeutic relationships between counselor and patient, which in turn had a positive reciprocal relationship with patient engagement (session attendance). Pretreatment motivation measured at intake was also related to higher engagement. More positive therapeutic relationships (in months 1 and 2) led to lower levels of during-treatment drug use (defined from urinalysis results in months 2 and 3), and better session attendance and therapeutic relationships both predicted longer retention. In addition, lower drug use during treatment was related to longer retention. Conclusions: Major conceptual domains of drug abuse treatment process were identified in community-based programs and their interrelationships with retention specified. As intermediate (during treatment) criteria, they can help guide functional improvements in program effectiveness as illustrated with our counseling enhancements. [Keywords: Retention; treatment process; therapeutic engagement; methadone maintenance]

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