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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: The current study assesses: (1) whether the relationship between individual exposure to coworker substance use and negative consequences resulting from exposure depends on work group membership, and (2) whether group-level characteristics moderate the relationship between exposure and consequences. At the group-level, we assessed occupations involving safety risk or high mobility and social factors of drinking climate and group cohesiveness. We conducted Hierarchical Linear Modeling (HLM) across two samples of municipal employees (ns = 650, 878; n of groups = 50, 49). Our results revealed that groups with higher proportions of jobs involving risk (e.g., machine work) and, to a lesser extent, groups with a higher level of drinking climate were those most vulnerable to consequences under conditions of exposure. Importantly, our findings controlled for individual risk factors (e.g., personal drinking, job stress). Our discussion examines the implications of this study for theory and policy related to workplace substance abuse.

Bennett, J. B., & Lehman, W. E. K. (1999).  The relationship between problem co-workers and quality work practices:  A case study of exposure to sex, drugs, violence, and stress.  Work & Stress:  An International, Multidisciplinary Quarterly of Stress, Health, and Performance, 13(4), 299-311.

Abstract: The current study examined employees' exposure to co-worker behavioural problems (violence/hostility, sexual harassment and substance abuse) and organizational climate factors that support total quality management (TQM) work practices. Utilizing survey data from a municipal organization in the southwestern USA (n = 764), regression analyses (a) assessed whether exposure to problems was associated with climate (teamwork, customer orientation, empowerment), and (b) compared problem co-workers with other job-stress indices (e.g. conflict, strain). Analyses controlled for personal (e.g. job commitment) and organizational factors. Relationships were found between employee emotional reactions to witnessing violence/harassment and both teamwork and empowerment. Job strain also correlated with empowerment. Results suggest that researchers may benefit from further study of co-worker exposure and from creating links between behavioural risk management and quality work practices. [Keywords: Problem co-workers; sexual harassment; substance abuse; violence; job stress]

Bennett, J. B., Lehman, W. E. K., & Forst, J. K. (1999). Change, transfer climate, and customer orientation: A contextual model and analysis of change-driven training. Group & Organization Management, 24(2), 188-216.

Abstract: The success of large-scale or "paradigm change" training programs often hinge on work climate factors that support transfer of training. Focus groups (N = 70) and survey data from both trained (N = 564) and untrained (N = 345) municipal employees were used to assess perceptions related to change (e.g., role ambiguity) and transfer climate that constrained or facilitated their use of Total Quality (TQ) training. Employees who felt blocked from applying training reported significantly less customer orientation than untrained employees, whereas those reporting a helpful transfer climate reported significantly more customer orientation than the untrained group. Regression analyses suggested that controlling for contextual factors (e.g., department affiliation), both a change and stress climate and, to a lesser extent, transfer climate (e.g., supervisor and coworker support) predicted customer orientation. Results have implications for organizational development practitioners and managers who seek to improve transfer of training in the midst of organizational change and stress.

Blankenship, J., Dansereau, D. F., & Simpson, D. D. (1999). Cognitive enhancements of readiness for corrections-based treatment for drug abuse. The Prison Journal, 79(4), 431-445.

Abstract: Motivational readiness for engaging in drug treatment is a common problem for probationers mandated to criminal justice programs, particularly for those with limited educational experience. This study presents initial findings on the impact of a new four-session treatment readiness program that includes an array of cognitive engagement strategies. Probationers in a 4-month mandated residential program were randomly assigned to receive a standard (n = 244) or enhanced treatment readiness program (n = 249). The enhanced program was given favorable overall ratings, and the low education group in this condition rated their midterm improvements in motivation and confidence as being higher than did the group receiving the standard program.

Broome, K. M., Flynn, P. M., & Simpson, D. D. (1999). Psychiatric comorbidity measures as predictors of retention in drug abuse treatment programs. Health Services Research, 34(3), 791-806.

Abstract: Objective. To examine lifetime and current psychiatric comorbidity measures as predictors of drug abuse treatment retention, and to test the generalizability of results across treatment agencies in diverse settings and with varying practices. Data Sources/Study Setting. The national Drug Abuse Treatment Outcome Studies (DATOS), a longitudinal study of clients from 96 treatment agencies in 11 U.S. cities. Study Design. The design is naturalistic and uses longitudinal analysis of treatment retention in long-term residential, outpatient drug-free, and outpatient methadone treatment modalities; client background (including psychiatric comorbidity) and program service provision are predictors. Clinical thresholds for adequate treatment retention were 90 days for long-term residential and outpatient drug-free, and 360 days for outpatient methadone. Psychiatric indicators included lifetime DSM-III-R diagnoses of depression/anxiety and antisocial personality, and dimensional measures of current symptoms for depression and hostility. Data Collection/Extraction Methods. Data include structured interviews with clients, a survey of treatment program administrators, and program discharge records. Principal Findings. Dimensional measures of current psychiatric symptoms emerged as better predictors than lifetime DSM-III-R diagnoses. In addition, the predictive association of hostility with retention varied significantly across treatment agencies, both in the long-term residential and outpatient drug-free modalities. Other notable findings were that on-site mental health services in long-term residential programs were associated with better retention for clients with symptoms of hostility. Conclusions. Assessment issues and stability of results across programs are important considerations for treatment research and practice. [Keywords: Drug treatment; retention; psychiatric comorbidity; ancillary services]

Broome, K. M., Joe, G. W., & Simpson, D. D. (1999). HIV risk reduction in outpatient drug abuse treatment: Individual and geographic differences. AIDS Education and Prevention, 11(4), 293-306.

Abstract: In the national Drug Abuse Treatment Outcome Studies (DATOS), many clients in outpatient methadone treatment (OMT) and outpatient drug-free (ODF) modalities were admitted with multiple sex and needle-risk behaviors, but they reduced these risks significantly during treatment. Using hierarchical linear model regression analysis, we examined client and treatment program characteristics as predictors of initial risk levels and of reductions over time. Clients who used cocaine frequently before treatment or had antisocial personality disorder entered treatment with elevated risks. In both modalities, cocaine users reduced risky behaviors significantly, but antisocial clients did so only in OMT. Treatment programs located in cities with higher prevalence rates of HIV/AIDS admitted clients with lower baseline levels of risk behavior than found in other cities. OMT programs in lower prevalence cities achieved higher rates of risk reduction than programs in higher prevalence cities. Reduction of sex and needle risks in both the OMT and ODF modalities indicates the importance of outpatient drug abuse treatment to national HIV prevention policy.

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: Patient ratings of their personal confidence in treatment and commitment to recovery were examined in a national sample of long-term residential, outpatient drug-free, and outpatient methadone programs. It was found that patients expressing greater confidence and commitment after 3 months of treatment generally began with higher motivation at intake, had formed better rapport with counselors, and attended counseling sessions more frequently. In addition, overall levels of patient involvement (as indicated by confidence and commitment) varied across programs; those programs with higher average involvement by patients used more social and public health services, maintained more consistent attendance at counseling sessions, and served patients who collectively had more similar kinds of needs. Thus, patient and program attributes both play a role in determining therapeutic engagement of persons who enter drug treatment. [Keywords: Treatment engagement; motivation; program differences; Drug Abuse Treatment Outcome Studies]

Chatham, L. R., Hiller, M. L., Rowan-Szal, G. A., Joe, G. W., & Simpson, D. D. (1999). Gender differences at admission and follow-up in a sample of methadone maintenance clients. Substance Use & Misuse, 34(8), 1137-1165.

Abstract: Although one-third of clients enrolled in methadone treatment in the United States are female, few studies have looked at gender differences at admission and follow-up. Using interview data from 435 clients (31% female) collected at admission and approximately 1 year after discharge, females were found to have more dysfunctional families of origin and greater prior and current psychological and medical problems. Both genders improved following treatment, as evidenced by reduced illicit drug, tobacco, and alcohol use, criminal involvement, and HIV/AIDS-risky behaviors. Females were more likely to seek further help for both drug misuse and psychological problems subsequent to discharge. [Keywords: Gender; methadone; outcomes; family dysfunction]

Czuchry, M., & Dansereau, D. F. (1999). Node-link mapping and psychological problems: Perceptions of a residential drug abuse treatment program for probationers. Journal of Substance Abuse Treatment, 17(4), 321-329.

Abstract: The current study examined program perceptions of 367 probationers admitted to a 4-month residential drug abuse treatment facility that focuses on group counseling. Prior research has shown that many individuals within the criminal justice system have both psychological and drug abuse problems, and that they often have limited success in drug abuse treatment programs. The current study examined whether the benefits of node-link mapping, a visual representation counseling technique that is especially beneficial in group counseling environments, would extend to individuals with psychological problems. Probationers were randomly assigned to mapping-enhanced or standard counseling. Those residents who had higher levels of psychological problems (based on a global indicator of psychological problems), and who received mapping-enhanced counseling, had more favorable perceptions of their counselors and fellow community members over time than their counterparts who received standard counseling. [Keywords: Psychological problems; node-link mapping; counselor effectiveness; community effectiveness; treatment effectiveness]

Czuchry, M., Sia, T. L., & Dansereau, D. F. (1999). Preventing alcohol abuse: An examination of the “Downward Spiral” game and educational videos.  Journal of Drug Education, 29(4), 323-335.

Abstract:  Downward Spiral is a board game developed by the authors to illustrate the dangers of continued substance abuse. Previous work has found that college students and probationers find the game interesting, enjoyable, useful, and realistic [1]. In the current study, college students either played Downward Spiral, watched educational videos on substance abuse, or completed a set of questionnaires unrelated to alcohol and drug abuse. Those students who either played the game or watched the videos rated both as beneficial. However, students who watched videos had somewhat higher levels of consumer satisfaction. Students who played the game rated it as smoother, and they felt more positive following the session than students who watched videos. Both videos and the game increased students' intentions to limit alcohol consumption compared to students who served as controls. Individuals in the game group also indicated significantly greater intentions to change their alcohol behavior than those in the other groups.

Farabee, D., Prendergast, M., Cartier, J., Wexler, H., Knight, K., & Anglin, M. D. (1999). Barriers to implementing effective correctional drug treatment programs. The Prison Journal, 79(2), 150-162.

Abstract: During the past several years, a number of aggressive federal and state initiatives have been undertaken to expand substance abuse treatment within correctional settings. These efforts have been fueled by the high rates of substance involvement among offenders and the growing body of research literature suggesting that intensive, prison-based treatment efforts can significantly reduce postprison substance use and recidivism. However, the rapid expansion of these programs increases their vulnerability to common implementation problems that could lead to pessimistic, and erroneous, assumptions about their effectiveness. This article summarizes both the research literature and the experiences of the authors regarding six common barriers to developing effective correctional treatment programs and offers potential solutions for each.

Griffith J. D., Hiller, M. L., Knight, K., & Simpson, D. D. (1999). A cost-effectiveness analysis of in-prison therapeutic community treatment and risk classification.  The Prison Journal, 79(3), 352-368.

Abstract: Policy makers need scientifically based information to help them to determine which correctional treatment alternatives are effective and economically viable. Three-year outcome data from 394 parolees (291 treated, 103 untreated comparison) were examined to determine the relative cost-effectiveness of prison-based treatment and aftercare, controlling for risk of recidivism. Findings showed that intensive services were cost-effective only when the entire treatment continuum was completed, and that the largest economic impact was evident among high-risk cases. Therefore, assignments to correctional treatment should consider an offender's problem severity level, and every effort should be made to engage them in aftercare upon release from prison.

Hiller, M. L., Knight, K., & Simpson, D. D. (1999). Prison-based substance abuse treatment, residential aftercare and recidivism. Addiction, 94(6), 833-842.

Abstract: Aims. This study examined the impact of residential aftercare on recidivism following prison-based treatment for drug-involved offenders. Design. A matched group quasi-experimental design. Survival regression analyses were used to predict time until rearrest. A logistic regression model was constructed for predicting aftercare completion. Setting. A 9-month in-prison therapeutic community (ITC) and several community-based transitional therapeutic communities (TTCs). Participants. Data were collected from 396 male inmates (293 treated, 103 untreated). Measurements. Background information (gender, ethnicity, age, education level, criminal history and risk for recidivism) was abstracted from the state criminal justice databases and a structured interview led by clinical staff. During treatment process measures were based on inmate self-ratings of their counselors, program and peers. A post-treatment interview conducted by field research staff assessed satisfaction with transitional aftercare. Post-release recidivism was based on state-maintained computerized criminal history records. Findings. ITC treatment, especially when followed by residential aftercare, was effective for reducing post-release recidivism rates. Lower satisfaction with transitional aftercare treatment was associated with not completing the residential phase of community-based aftercare. Conclusions. Corrections-based treatment policy should emphasize a continuum of care model (from institution to community) with high quality programs and services.

Hiller, M. L., Knight, K., & Simpson, D. D. (1999). Risk factors that predict dropout from corrections-based treatment for drug abuse. The Prison Journal, 79(4), 411-430.

Abstract: Early dropout or failure to engage in drug abuse treatment is a common problem in correctional settings. This study presents findings from 339 felony probationers mandated to a 6-month modified therapeutic community in lieu of imprisonment. Early dropout was related to cocaine dependence, having a history of psychiatric treatment, being unemployed before adjudication to treatment, and to higher levels of depression, anxiety, and hostility. Dropout rates also were higher for probationers with deviant peer networks and lower ratings of self-efficacy. However, multivariate analyses showed that scoring high on a criminality risk index was the strongest predictor of leaving treatment early and appears to represent a good composite risk measure. These findings can help identify who needs residential treatment, and who is at greatest risk for not completing it.

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: A model to explain treatment retention in terms of process components – therapeutic involvement and session attributes for the 1^st month – and patient background factors were tested in long-term residential (LTR), outpatient drug free (ODF), and outpatient methadone (OMT) treatments. The data was collected in the national Drug Abuse Treatment Outcome Studies (DATOS), and included 1362 patients in LTR, 866 in ODF, and 981 in OMT programs. Structural equation models showed there were positive reciprocal effects between therapeutic involvement and session attributes in all three modalities, and these variables had direct positive effects on treatment retention. Motivation at intake was a strong determinant of therapeutic involvement. Other patient background factors were significantly related to retention, including pretreatment depression, alcohol dependence, legal pressure, and frequency of cocaine use. [Keywords: Treatment process; therapeutic engagements; treatment retention; motivation; DATOS]

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: Integrative models containing client and treatment components were tested in a sample of 396 daily opioid users from three methadone maintenance treatment sites. Measures included client motivation at intake as well as repeated assessments of therapeutic engagement (relationships between clients and their counselors, session attendance, and results of urine testing) during the first 6 months of treatment. There was a positive effect of pretreatment motivation on greater engagement and a reciprocal positive relationship between components of engagement and their effects on lowering drug use throughout treatment. Further analyses addressed differential effects of group versus individual counseling and showed that group session attendance was associated with higher rates of drug-negative urines.

Knight, D. K., Hood, P. E., Logan, S. M., & Chatham, L. R. (1999). Residential treatment for women with dependent child: One agency's approach. Journal of Psychoactive Drugs, 31(4), 339-351.

Abstract: The Salvation Army First Choice Program, located in Fort Worth, Texas, provides comprehensive - as well as gender-specific - treatment for addicted women while providing child care and therapeutic services for children. Specific program attributes (including therapeutic interventions, community linkages, and staffing patterns) are described, and the five-year evaluation initiative, designed to examine relationships between client characteristics, program participation, and client progress is outlined. Findings from initial analyses examining correlates of 90-day dropout suggest a complex interaction among specific problems a woman brings to treatment, her level of dysfunction at treatment entry, how much social support is available to her, and what services she receives. [Keywords: Early drop-out; evaluation; residential treatment; retention; substance abuse; women with children]

Knight, D. K., & Simpson, D. D.  (1999).  Family assessment.  In P. J. Ott, R. E. Tarter, & R. T. Ammerman (Eds.), Sourcebook on substance abuse:  Etiology, epidemiology, assessment, and treatment (pp. 236-247).  Boston, MA:  Allyn & Bacon.

Abstract:  When studying factors important in the etiology and treatment of substance abuse, various socializing influences must be examined.  Since individuals learn social behaviors (including substance use) through interaction with family members, the addict’s family system should be considered.  Family assessment encompasses a variety of issues ranging from the quality of childhood parent-child interaction to family member participation in drug treatment.  With such a host of issues and topics considered part of “family assessment,” determining which domains of family functioning should be of focus and how best to measure each are often challenging prospects.  The purpose of this chapter is to outline issues that should be considered when assessing various domains of family functioning.  Components of family functioning that are considered important in the etiology and recovery from substance abuse are identified, methodological issues to consider when assessing family functioning are discussed, and examples of assessment tools available to measure various domains of family functioning are provided.

Knight, K., Hiller, M. L., & Simpson, D. D. (1999). Evaluating corrections-based treatment for the drug-abusing criminal offender. Journal of Psychoactive Drugs, 31(3), 299-304.

Abstract: The recent increase in drug abusers in the criminal justice system has led to the expansion of corrections-based drug treatment facilities. Although three key evaluations have provided consistent support for the effectiveness of drug treatment within the criminal justice system, direct comparisons of outcomes across these evaluations are limited by variations in their measurement systems and the structure of official records on which they are based. This article addresses some of the issues relating to the assessment of treatment outcomes for the drug-abusing offender and provides several recommendations for future research. [Keywords: Correctional treatment; drug abuse treatment; prison-based treatment]

Knight, K., Simpson, D. D., & Hiller, M. L. (1999). Three-year reincarceration outcomes for in-prison therapeutic community treatment in Texas.  The Prison Journal, 79(3), 337-351.

Abstract: Longer term in-prison therapeutic community (ITC) outcome studies are needed, along with more attention on who benefits most from these programs. This study examined reincarceration records for 394 nonviolent offenders during the 3 years following prison. Those who completed both ITC and aftercare were the least likely to be reincarcerated (25%), compared to 64% of the aftercare dropouts and 42% of the untreated comparison groups. Furthermore, high-severity aftercare completers were reincarcerated only half as often as those in the aftercare dropout and comparison groups (26% vs. 66% and 52%). The findings support the effectiveness of intensive treatment when it is integrated with aftercare, and the benefits are most apparent for offenders with more serious crime and drug-related problems.

Newbern, D., Dansereau, D. F., & Pitre, U. (1999). Positive effects on life skills motivation and self-efficacy: Node-link maps in a modified therapeutic community. American Journal of Drug and Alcohol Abuse, 25(3), 407-423.

Abstract: In recent years, one response to drug abuse problems has been to provide treatment in prison and probation settings. Results are promising, although the need for improving mandated treatment has been expressed. The Cognitive Enhancements for Treatment of Probationers (CETOP) project is investigating cognitive enhancements in a modified therapeutic community (TC) setting. One enhancement is node-link mapping, a visual graphing strategy. Map "nodes" contain ideas, actions, and feelings; these are connected by links that illustrate meaningful relationships. Current findings indicate increases in group participation, ratings of session depth, and positive ratings of coresidents, counselors, and security staff. The present study extends this research by comparing mapping-enhanced counseling to standard counseling on self-efficacy and motivation for basic psychosocial skills (e.g., emotional control). Probationers (n = 381) in a 16-week residential program were assigned randomly to conditions in 12 TCs (n = 30-35). Motivation and self-efficacy were assessed by two self-report questionnaires, one midway and one at the end of treatment. A five-factor solution was produced from each questionnaire. With community as the unit of analysis, means of enhanced counseling were higher in all cases. Wilcoxen tests indicated four significant differences at midterm for mapping on motivation and self-efficacy of communication and emotional control (p < .05). At the end of treatment, mapping was higher for motivation of cognition and emotional control and self-efficacy was higher for communication. Discussing Bandura’s model, these findings provide evidence that maps may enhance psychosocial skills, which have been associated with maintaining recovery (25, 37).

Sia, T. L., Czuchry, M. L., & Dansereau, D. F.  (1999).  Considering personal strengths:  The effect of three different methods on mood, arousal, and self-esteem.  Journal of Applied Social Psychology, 29(6), 1151-1171.

Abstract:  One hundred twenty-eight college students were randomly assigned to one of the following conditions:  (a) open-ended generation of personal strengths, (b) cued generation of strengths using 7 Divisions of Self (social, cognitive, behavioral, physical, emotional, motivational, spiritual; Dees, Dansereau, Peel, Boatler, & Knight, 1991) as cues, and (c) selection of strengths using the Tower of Strengths Activity (Sia & Czuchry, 1997).  After all 3 conditions, students reported an increase in specific aspects of self-esteem and positive mood, and a decrease in global self-esteem.  Students’ arousal decreased after both open-ended generation and cued generation, whereas after the selection of strengths, students’ arousal remained the same.  Applications of the strength activities are discussed.

Simpson, D. D., Joe, G. W., Fletcher, B. W., Hubbard, R. L., & Anglin, M. D. (1999). A national evaluation of treatment outcomes for cocaine dependence. Archives of General Psychiatry, 56, 507-514.

Abstract: Background: This national study focused on posttreatment outcomes of community treatments of cocaine dependence. Relapse to weekly (or more frequent) cocaine use in the first year after discharge from 3 major treatment modalities was examined in relation to patient problem severity at admission to the treatment program and length of stay. Methods: We studied 1605 cocaine-dependent patients from 11 cities located throughout the United States using a naturalistic, nonexperimental evaluation design. They were sequentially admitted from November 1991 to December 1993 to 55 community-based treatment programs in the national Drug Abuse Treatment Outcome Studies. Included were 542 patients admitted to 19 long-term residential programs, 458 patients admitted to 24 outpatient drug-free programs, and 605 patients admitted to 12 short-term inpatient programs. Results: Of 1605 patients, 377 (23.5%) reported weekly cocaine use in the year following treatment (dropping from 73.1% in the year before admission). An additional 18.0% had returned to another drug treatment program. Higher severity of patient problems at program intake and shorter stays in treatment (<90 days) were related to higher cocaine relapse rates. Conclusions: Patients with the most severe problems were more likely to enter long-term residential programs, and better outcomes were reported by those treated 90 days or longer. Dimensions of psychosocial problem severity and length of stay are, therefore, important considerations in the treatment of cocaine dependence. Cocaine relapse rates for patients with few problems at program intake were most favorable across all treatment conditions, but better outcomes for patients with medium- to high-level problems were dependent on longer treatment stays.

Simpson, D. D. & Brown, B. (Eds.) (December, 1999). Special issue on treatment process and outcome studies from DATOS. Drug and Alcohol Dependence.

Editors' Summary:  This year's last issue of the journal Drug and Alcohol Dependence (December 1999) features a collection of new studies from the Drug Abuse Outcome Treatment Studies (DATOS) project, a collaborative research effort funded by the National Institute on Drug Abuse (NIDA) from 96 treatment programs in 11 U.S. cities.   IBR at TCU, NDRI (National Development and Research Institutes), and the Drug Abuse Research Center at UCLA joined with NIDA in this 5-year project, which continued in the spirit of earlier national multi-site studies such as DARP (Drug Abuse Reporting Program) and TOPS (Treatment Outcome Prospective Study). The issue also reports on recent findings from a national treatment outcome study in England.
 

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