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Article
Publication date: 21 November 2016

Batya Rubenstein and Carla Smith Stover

The purpose of this paper is to examine the role of co-parenting, childhood experiences, and satisfaction with fathering in a sample of men in a long-term residential drug…

Abstract

Purpose

The purpose of this paper is to examine the role of co-parenting, childhood experiences, and satisfaction with fathering in a sample of men in a long-term residential drug rehabilitation program.

Design/methodology/approach

A paper and pencil survey was completed by 128 men between the ages of 18 and 68 (M age=30.42 years) in a court ordered residential rehabilitation center for drug misuse. Of the 128 respondents, 40.625 percent (n=52) were fathers and completed a longer survey to assess their co-parenting relationships.

Findings

The percentage of men with positive role models did not differ between the fathers and non-fathers, with 40.4 percent of fathers having had a positive role model growing up, χ2(1, n=127)=0.54, p=0.816. Fathers were more likely to report witnessing IPV between their parents during childhood than non-fathers, χ2(1, n=125)=4.7888, p=0.029. Linear regression models examining factors associated with co-parenting agreement and exposure to conflict were significant, but witnessing IPV as a child was the only significant individual predictor.

Practical implications

Exposure to IPV in childhood was a common experience for fathers in residential treatment for substance misuse. Fathers reported significant problems in their co-parenting relationships indicating a need for fatherhood and co-parenting focused services available within residential treatment programs.

Originality/value

There is little research about fathers with co-occurring histories of substance misuse and IPV in residential treatment. This paper is the first to examine co-parenting in this specific population.

Details

Advances in Dual Diagnosis, vol. 9 no. 4
Type: Research Article
ISSN: 1757-0972

Keywords

Article
Publication date: 12 September 2016

Brie Turner and Frank Patrick Deane

Longer length of stay (LOS) in residential alcohol and other drug treatment has been associated with more favourable outcomes, but the optimal duration has yet to be determined…

Abstract

Purpose

Longer length of stay (LOS) in residential alcohol and other drug treatment has been associated with more favourable outcomes, but the optimal duration has yet to be determined for reliable change indices. Optimal durations are likely to be a function of participant and problem characteristics. The purpose of this paper is to determine whether LOS in a residential therapeutic community for alcohol and other drug treatment community independently predicts reliable change across a range of psychological recovery and well-being measures.

Design/methodology/approach

In total, 380 clients from Australian Salvation Army residential alcohol and other drug treatment facilities were assessed at intake and three months post-discharge using the Addiction Severity Index 5th ed., The Depression, Anxiety and Stress Scale, The Recovery Assessment Scale, the Mental Health Continuum-Short Form and The Life Engagement Test.

Findings

The findings confirm LOS as an independent predictor of reliable change on measures of well-being and client perceived assessment of recovery. The mean LOS that differentiated reliable change from no improvement was 37.37 days.

Originality/value

The finding of LOS as a predictor of reliable change and the identification of an estimated time requirement may be useful for residential drug treatment providers in modifying treatment durations.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 37 no. 3
Type: Research Article
ISSN: 0964-1866

Keywords

Article
Publication date: 30 November 2012

Gregory A. Aarons, Elizabeth A. Miller, Amy E. Green, Jennifer A. Perrott and Richard Bradway

Evidence‐based practices (EBPs) are increasingly being implemented in real‐world settings. While intervention effectiveness is dependent on fidelity, interventions are often…

965

Abstract

Purpose

Evidence‐based practices (EBPs) are increasingly being implemented in real‐world settings. While intervention effectiveness is dependent on fidelity, interventions are often adapted to service settings according to the needs of stakeholders at multiple levels. This study aims to examine the naturalistic implementation of The Incredible Years (IY) parenting programme in a residential substance abuse treatment programme for pregnant and parenting women.

Design/methodology/approach

The study took place in a residential substance abuse treatment programme serving pregnant and parenting women and their children. Participants included 120 female clients. The primary IY facilitator was a master's level counselling psychologist. In person observations of IY sessions were completed by a trained bachelor's level anthropologist. Ethnographic field notes were collected and then coded in keeping with a priori themes and to identify emergent themes. The Parent Group Leader Checklist was used to evaluate quality and integrity of the IY basic parent programme.

Findings

Quantitative analyses indicate that fidelity varied by type of checklist activity. Specifically, adherence to the IY programme was highest in beginning topic activities, setup, and home activity review, and lowest in role play, vignettes, and wrap‐up activities. Qualitative analyses revealed a number of adaptations in implementation of IY. Adaptations fit into two broad categories: modification of programme delivery and modification of programme content. Within each of these categories modifications included organisation‐driven adaptations, provider‐driven adaptations, and consumer‐driven adaptations.

Practical implications

Changes to evidence‐based practice generally take two forms – adaptations consistent with model intent and theoretical approach and changes that represent drift from core elements of the EBP. The challenge for implementation science is to develop frameworks in which models can be adapted enough to make them viable for the service context (or the service context adapted to fit the model), yet avoid drift and maintain fidelity. Attending to the complexities of adaptation prior to and during implementation in a planned way is likely to help organisations better utilise EBPs to meet their unique needs while maintaining fidelity.

Originality/value

The paper shows that identification of types of intervention adaptations and drift allows for consideration of systematic approaches, frameworks, and processes to increase adherence during EBP implementation in community mental health and substance abuse treatment settings.

Article
Publication date: 8 April 2014

Janetta Astone-Twerell, Keith Morgen and Chu Hsiao

The residential therapeutic community (TC) treatment modality has been shown to effectively reduce drug use and improve psychiatric/medical health among clients who are often…

Abstract

Purpose

The residential therapeutic community (TC) treatment modality has been shown to effectively reduce drug use and improve psychiatric/medical health among clients who are often disproportionately impacted by medical conditions and have a co-occurring psychiatric disorder such as Posttraumatic Stress Disorder (PTSD). Yet not much is known regarding how clients’ health may impact their treatment satisfaction. Using path analysis, the interrelationship between PTSD, perceived health, and treatment satisfaction was examined. The paper aims to discuss these issues.

Design/methodology/approach

A survey including the Posttraumatic Stress Disorder Checklist-Specific (PCL-S), a perceived health rating, and a Treatment Satisfaction Scale was collected from 303 clients at three comparable long-term residential TC treatment programs in New York City.

Findings

Findings indicated that clients with PTSD rated their health significantly worse than those without PTSD. Although no direct relationship between PTSD and treatment satisfaction was found, there was a significant positive correlation between perceived health and treatment satisfaction.

Research limitations/implications

Findings likely constitute a regional sample thus generalizability is limited.

Practical implications

Simultaneously addressing addiction, PTSD, and medical issues can improve clients’ treatment satisfaction, consequently increasing treatment retention and producing greater positive post-treatment outcomes.

Originality/value

Few if any studies have examined the extent to which PTSD and perceived health impact treatment satisfaction within residential substance abuse treatment programs.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 35 no. 1
Type: Research Article
ISSN: 0964-1866

Keywords

Article
Publication date: 14 September 2015

Wallace Mandell, Victor Lidz and James J. Dahl

Retrospective studies of therapeutic community (TC) treatment for drug abuse found reductions in drug use, criminality, and increased work participation after treatment

Abstract

Purpose

Retrospective studies of therapeutic community (TC) treatment for drug abuse found reductions in drug use, criminality, and increased work participation after treatment completion. These studies have also shown treatment benefits, even without completion, are correlated with days of stay in residential treatment. However, others have found that high rates of early leaving from TC treatment reduce the proportion of clients with positive outcomes, raise the total cost per treated client, and lower the treatment benefit-to-costs ratio. The purpose of this paper is to describe an experimental approach to raising the days in residential treatment using earlier vocational access for clients.

Design/methodology/approach

The current study used a random assignment design to compare earlier integration of on-site vocational training in a vocationally integrated therapeutic community to off-site vocational training initiated after one year of residence in a traditional therapeutic community.

Findings

The resulting data support the hypotheses that client expectations and early training in job skills increase rate of treatment affiliation, the proportion of clients having effective lengths of stay, and the rate of treatment completion.

Research limitations/implications

Research limitations/implications include the difficulty of assuring unbiased selection and controlling treatment assignment and conditions.

Practical implications

Practical implications of this research project are to support practitioners striving for longer, more effective lengths of stay, while at the same time attempting to reduce treatment time and increase effectiveness.

Social implications

Social Implications of this project are to encourage social support for addiction treatment and emphasize the value of paired residential treatment and vocational education.

Originality/value

The originality and value of this research project lies in the adoption of a working model at Phoenix House TC (in-house vocational preparation), which utilizes early in-house vocational education as a means to increase residential program participation, increase employment skills and prospects, and decrease overall length of treatment.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 36 no. 3
Type: Research Article
ISSN: 0964-1866

Keywords

Article
Publication date: 24 June 2013

Maria Orlando Edelen, Jennifer L. Cerully, Ken A. Verni, Joan S. Tucker and Eriach Fox

Interest in using mindfulness as a clinical intervention technique has increased, with evidence suggesting that it can be successfully integrated both into treatment for…

Abstract

Purpose

Interest in using mindfulness as a clinical intervention technique has increased, with evidence suggesting that it can be successfully integrated both into treatment for adolescents and for people with substance use disorders. The purpose of this paper is to explore the degree to which mindfulness training can be implemented among adolescents undergoing residential substance abuse treatment.

Design/methodology/approach

Nine adolescent males in a residential therapeutic community (TC) substance use treatment center enrolled in a voluntary mindfulness training program consisting of eight 90 minute sessions, each led by a clinical psychologist trained in mindfulness-based stress reduction. After the training program concluded, a brief participant survey and participant and staff focus groups were conducted.

Findings

Both survey and focus group discussions indicate that the mindfulness training program was perceived as helpful, acceptable, and feasible. Suggestions for integrating mindfulness training into residential treatment facilities for adolescents are discussed.

Originality/value

This study highlights the potential of mindfulness training to augment traditional TC treatment for adolescents, and provides enough information for practitioners to implement mindfulness training in their treatment settings.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 34 no. 2/3
Type: Research Article
ISSN: 0964-1866

Keywords

Article
Publication date: 2 December 2014

Lynne Magor-Blatch, Navjot Bhullar, Bronwyn Thomson and Einar Thorsteinsson

The purpose of this paper is to systematically review quantitative research since 2000 on the effectiveness of residential therapeutic communities (TCs) for the treatment of…

2431

Abstract

Purpose

The purpose of this paper is to systematically review quantitative research since 2000 on the effectiveness of residential therapeutic communities (TCs) for the treatment of substance-use disorders with reference to substance-use, crime, mental health and social engagement outcomes.

Design/methodology/approach

A systematic search with broad inclusion criteria resulted in the review of 11 studies. The studies investigated community-based TCs, as well as TCs modified for prisoners, prisoners transitioning to community living and TCs for individuals with co-occurring substance-use and mental health issues.

Findings

Results were analysed by comparing the findings of the studies under investigation, of which three studies investigated within-subjects outcomes, four compared TC treatment with a no-treatment control condition and four compared TC treatment with another treatment condition. Conclusion: consistent with previous systematic reviews of TCs, outcomes varied across studies but indicated TCs are generally effective as a treatment intervention, with reductions in substance-use and criminal activity, and increased improvement in mental health and social engagement evident in a number of studies reviewed.

Research limitations/implications

Variability in outcomes suggests further TC research and research syntheses focusing on a second key research question in the evaluation of complex interventions – how the intervention works – could play an important role in understanding TC effectiveness, and for whom it is effective and in what contexts.

Practical implications

Although there is some variability in treatment populations included in this review, evidence reported in other studies suggests individuals with severe substance-use disorders, mental health issues, forensic involvement and trauma histories, will benefit from TC treatment. This is supported by the literature which has found a general relationship between severity of substance use and treatment intensity (Darke et al., 2012; De Leon et al., 2008) with outcomes further enhanced by self-selection into treatment and appropriate client-treatment matching (see De Leon, 2010; De Leon et al., 2000, 2008). The weight of evidence gleaned from multiple sources of research, including randomised control trials and field outcome studies (De Leon, 2010) suggests TCs are an important and effective treatment for clients in improving at least some aspects of their quality of life, specifically mental health and social engagement, and in reducing harmful behaviours, including substance-use and crime. Variability in treatment setting and populations reflect the real-world setting in which TC treatment is delivered, providing a multifaceted treatment modality to a complex population in variable circumstances.

Originality/value

The strength of the current study is that it provided a broad evaluation of TC effectiveness across a range of outcomes (substance-use, criminal activity, mental health and social engagement), and is therefore valuable in updating the current literature and providing context for future research in this area. It aimed to address a key question in evaluating complex interventions: whether they are effective as they are delivered. Findings suggest that TC treatment is generally effective for the populations of concern in reducing substance use and criminal activity and contributing to some improvement in mental health and social engagement outcomes.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 35 no. 4
Type: Research Article
ISSN: 0964-1866

Keywords

Article
Publication date: 11 June 2018

Sharon Rabinovitz and Maayan Nagar

The purpose of this paper is to examine pre- to post-change in two components of implicit cognitive functioning following craving induction – attentional bias (AB) and executive…

Abstract

Purpose

The purpose of this paper is to examine pre- to post-change in two components of implicit cognitive functioning following craving induction – attentional bias (AB) and executive control – of patients in a long-term drug-free residential treatment center that incorporated dialectical behavioral therapy (DBT) with usual therapeutic community (TC) practices.

Design/methodology/approach

Three groups of alcohol and cannabis dependent female adolescents were compared: pre-treatment (n=12), following four months of treatment (n=11), and following 12 months of treatment (n=7).

Findings

The results indicate significantly lower AB (as measured by visual probe task) and improved response inhibition (as measured by stop signal task) under craving conditions, after 12 months of DBT.

Research limitations/implications

Naturalistic character of the study did not allow the use of repeated measures design, drug using control groups, randomized clinical trial, or performing a longitudinal follow-up. However, the findings show that DBT for drug abusing female adolescents in a long-term residential setting may be an effective intervention to enhance cognitive and executive functions critical to the risk chain involved in relapse and recidivism, supporting the implementation of DBT in TC residential settings.

Originality/value

This is the first research paper that examined effects of DBT+TC on substance dependent female adolescents’ cognitive mechanisms using well-validated behavioral tasks. The research provides some empirical evidence for the improvement in AB and response inhibition under craving conditions following treatment.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 39 no. 2
Type: Research Article
ISSN: 0964-1866

Keywords

Book part
Publication date: 5 February 2010

Holly Ventura Miller, J. Mitchell Miller, Rob Tillyer and Kristina M. Lopez

Purpose – Treatment for alcohol and drug addiction in correctional settings has become commonplace throughout much of the United States. The delivery of treatment services in…

Abstract

Purpose – Treatment for alcohol and drug addiction in correctional settings has become commonplace throughout much of the United States. The delivery of treatment services in prisons is a promising approach and has certain advantages relative to outpatient and voluntary treatment, including (i) certainty of program enrollment and participation by individuals who would not likely seek treatment on their own (i.e., coerced participation/guaranteed delivery of treatment); (ii) program modalities specific to residential settings as treatment options – in effect, more intensive treatment; and (iii) the parole process ensures participation in post-release aftercare services. During this era wherein reentry is a pronounced theme throughout American corrections, substance abuse treatment is fundamental in terms of rehabilitating offenders, increasing public safety, and lowering recidivism rates and, ultimately, the overall prison population.

Methodology – Using data from a process evaluation of an in-prison alcohol treatment program in Texas, this study examines the environmental barriers to effective recovery present in correctional settings and considers the strengths and weaknesses of coercive treatment, generally.

Findings – Findings indicate that offenders can indeed become motivated to change through coerced treatment. However, study findings also suggested that a certain number of offenders will not become engaged in treatment and fail to develop any internal motivation, which can be problematic for a number of reasons.

Practical implications – The highly coercive and restrictive nature of correctional facilities may negate the overall rehabilitative intent of treatment programs.

Details

New Approaches to Social Problems Treatment
Type: Book
ISBN: 978-1-84950-737-0

Article
Publication date: 14 March 2016

Albert M. Kopak, Steven L. Proctor and Norman G. Hoffmann

Effective substance use treatment is a viable way to reduce criminal justice contact among drug-involved offenders, but there is still a lot to learn about which indicators have…

Abstract

Purpose

Effective substance use treatment is a viable way to reduce criminal justice contact among drug-involved offenders, but there is still a lot to learn about which indicators have the greatest impact on treatment outcomes. The purpose of this paper is to determine which clinical indicators influenced the likelihood of rearrest among male drug-involved offenders.

Design/methodology/approach

This prospective longitudinal study examined indicators of 12-month post-treatment rearrest for male criminal justice-involved substance use treatment patients. Multinomial logistic regression results drawn from a sample of 1,531 adult male patients who were mandated to substance use treatment indicated that there were different factors related to the likelihood of one as well as multiple post-treatment arrests.

Findings

Demographic risk factors, such as age and unemployment, were associated with significant increases in the probability of experiencing an arrest within 12-months of treatment discharge. Substance use relapse was also a significant indicator of the likelihood of rearrest and contributed to an increase in the odds of one post-treatment rearrest as well as multiple rearrests. A drug dependence diagnosis, relative to a diagnosis for alcohol dependence, was associated with an increased likelihood of rearrest. Participation in outpatient treatment was associated with a lower likelihood of rearrest.

Practical implications

These findings emphasize the need for treatment providers to concentrate heavily on demographic risk reduction to minimize the chance that male patients are rearrested after treatment. Relapse prevention, on the other hand, is critical in the effort to minimize the number of post-treatment rearrests in this population.

Originality/value

The results from this study provide evidence to empirically support the refinement of substance treatment programs for male patients involved in the criminal justice system.

Details

Journal of Criminological Research, Policy and Practice, vol. 2 no. 1
Type: Research Article
ISSN: 2056-3841

Keywords

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