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Article
Publication date: 24 June 2013

Richard D. Chenhall and Kate Senior

The purpose of this paper is to improve current evaluation designs for Indigenous Australian residential alcohol and drug treatment centres, by understanding the context…

Abstract

Purpose

The purpose of this paper is to improve current evaluation designs for Indigenous Australian residential alcohol and drug treatment centres, by understanding the context of treatment in this modified TC context. The aim of the research is to present an analysis of the key features of treatment associated with four Indigenous Australian alcohol and drug treatment centres, as expressed by staff working in these centres.

Design/methodology/approach

Ethnographic observations were made at each site between 2008 and 2009 with the first author attending treatment groups, education sessions, staff meetings and other events. The first author conducted informal conversational discussions with all programme staff and board members. In addition, 23 staff and 15 board members participated in a semi-structured interview with an emphasis on gaining views on the essential elements of residential alcohol and drug treatment, potential barriers to effective treatment delivery and “what works” in residential treatment.

Findings

A number of key themes emerged, including the importance of the flexibility of programmes to include a wide variety of treatment approaches, the importance of culture (although defined differently) in the delivery of appropriate service, provision of safe spaces that allow for clients and staff interaction, the potential for improvement in the provision of effective client case management, the need to reduce job-related stress through staff professional development and organisational culture change and the need to address the difficulties experienced in the provision of effective aftercare.

Originality/value

Currently, there is very little evidence related to Indigenous Australian approaches to the treatment of alcohol and drug misuse. The paper contributes to the understanding of the key features of treatment delivery, as identified by staff employed in drug and alcohol residential treatment. This understanding is vital so that government agencies can provide appropriate funding to areas of need for treatment services.

Details

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

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Article
Publication date: 15 February 2016

John M Majer, Hannah M Chapman and Leonard A Jason

– The purpose of this paper is to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses.

Abstract

Purpose

The purpose of this paper is to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses.

Design/methodology/approach

A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n=39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome.

Findings

Participants randomly assigned to residential conditions reported significant reductions in psychiatric severity whereas those assigned to the usual care condition reported significant increases. There were no significant differences in psychiatric severity levels between residential conditions.

Research limitations/implications

Findings suggest that cost-effective, self-run residential settings such as Oxford Houses provide benefits comparable to professionally run residential integrated treatments for justice involved persons who have dual diagnoses.

Social implications

Results support the utilization of low-cost, community-based treatments for a highly marginalized population.

Originality/value

Little is known about residential treatments that reduce psychiatric severity for this population. Results extend the body of knowledge regarding the effects of community-based, residential integrated treatment and the Oxford House model.

Details

Advances in Dual Diagnosis, vol. 9 no. 1
Type: Research Article
ISSN: 1757-0972

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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…

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

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Article
Publication date: 13 June 2016

Georgina Capone, Thomas Schroder, Simon Clarke and Louise Braham

The purpose of this paper is to review quantitative research since 1999 evaluating the effectiveness of democratic therapeutic community (DTC) treatment for individuals…

Abstract

Purpose

The purpose of this paper is to review quantitative research since 1999 evaluating the effectiveness of democratic therapeutic community (DTC) treatment for individuals with personality disorders (PD) with reference to interpersonal and offending risk outcomes.

Design/methodology/approach

A systematic search resulted in the review of ten studies. All of the studies investigated DTCs treating PD in community, inpatient residential and forensic settings. Only peer-reviewed, English-language articles employing a quantitative design were included.

Findings

The majority of studies were conducted poorly and of low methodological quality, with limitations located in the representativeness of participants, limited use of control and comparison groups, follow up periods and controls for confounders. Heterogeneity remained in use of measures and limited consideration was given to the validity of interpersonal measures used. While improved interpersonal outcomes post DTC treatment were noted in forensic and residential settings, results were mixed in day and mini TC settings. Inconsistent findings in offending risk outcomes were also indicated. A study with increased methodological rigour indicated residential treatment had limited effects on interpersonal outcomes, when compared to combination treatment (residential TC and step-down treatment).

Originality/value

The study provided an evaluation of the limitations of DTC research across a range of settings and highlighted a combination of residential TC and step-down treatment may achieve superior outcomes to residential TC treatment alone in a community inpatient population. Recommendations are made for future research to contribute to the treatment of PD.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 37 no. 2
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 10 May 2013

Mandy Wilson, Sherry Saggers and Helen Wildy

This paper aims to illustrate how narrative research techniques can be employed to promote greater understanding of young people's experiences of progress in residential

Abstract

Purpose

This paper aims to illustrate how narrative research techniques can be employed to promote greater understanding of young people's experiences of progress in residential alcohol and other drug treatment.

Design/methodology/approach

Narrative inquiry is used to explore client understandings of what characterises progress in treatment for young people attending a residential detoxification and a residential rehabilitation service in Perth, Western Australia. This article focuses on stories of progress collected through in‐depth qualitative interviews, observation and participation with clients of the two services, over a five‐month period.

Findings

Analysis of data revealed that young people were able to vividly describe their progress through treatment, and their drug taking trajectories can be conceptualised along five stages. The authors prepared narrative accounts to illustrate the features characteristic of each stage as identified by the young people. These composite narratives, written from the perspectives of young people, are presented in this article.

Practical implications

Clients’ own perceptions of their journeys through drug treatment might enable staff of such services to collaborate with the young person, in shaping and positively reinforcing alternative life‐stories; from those of exclusion and disconnection, to narratives of opportunity, inclusion and possibility.

Originality/value

Harmful adolescent drug and alcohol use is on the rise in Australia and elsewhere. However, our knowledge of how young people experience progress through residential treatment for substance use is limited. This paper highlights how creating narratives from young people's own stories of progress can broaden our knowledge of “what works” in residential youth alcohol and other drug treatment services.

Details

Qualitative Research Journal, vol. 13 no. 1
Type: Research Article
ISSN: 1443-9883

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Article
Publication date: 8 June 2015

Laura Aslan

It is common for people to view dropping out of substance misuse treatment as an unsuccessful attempt at recovery. The existing literature emphasises that those who drop…

Abstract

Purpose

It is common for people to view dropping out of substance misuse treatment as an unsuccessful attempt at recovery. The existing literature emphasises that those who drop out of treatment do worse than those who complete their treatment programme. More recently, however, those who discharge early are faring better than ever before.

Design/methodology/approach

In total, 13 service users who discharged early from three residential therapeutic communities were interviewed over the phone to discuss life after treatment. Interview transcripts were analysed using thematic analysis and found four main themes evidencing that “unsuccessful” really can be successful.

Findings

The study unearthed significant findings in the area of motivation for continued recovery in that 85 per cent of the sample were actively accessing further substance misuse treatment after leaving the service early. Five participants who had entered treatment as opiate users were all abstaining from Class A drugs at the time of interview; indeed 100 per cent of the sample were opiate free. Furthermore, self-reported psychological health had improved following discharge by 78 per cent.

Practical implications

Recent changes in policy and treatment design within drug treatment services may explain such positive outcomes in that a more responsive programme allows people to gain skills and make changes in a shorter time frame.

Social implications

Indeed, improved early discharge procedures and increased links to aftercare and follow on treatment may have impacted on this finding.

Originality/value

This study therefore proposes the notion of “right dose of treatment” as opposed to “time in treatment” and highlights the importance of exit procedures and aftercare.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 36 no. 2
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 12 June 2017

Carolyn Stubley and Garth Popple

Developing therapeutic community (TC) programs in Australia for individuals on opioid substitution treatment (OST) has been a process spanning 16 years for the We Help…

Abstract

Purpose

Developing therapeutic community (TC) programs in Australia for individuals on opioid substitution treatment (OST) has been a process spanning 16 years for the We Help Ourselves (WHOS) organization. Supported reduction of OST and stabilization services for those remaining on OST are offered to this population and continue to break down barriers of discrimination in offering the same services to all drug using populations. The paper aims to discuss these issues.

Design/methodology/approach

A number of research projects have been undertaken with the WHOS Opioid Treatment Program (OTP) TC services profiling clients accessing the services; looking at health benefits whilst in the programs; looking at retention and completion rates and conducting an evaluation post-treatment for one of the two programs currently being offered.

Findings

The excerpts from the research findings are presented identifying the complexity of individuals accessing WHOS services; highlighting the benefits for individuals on OST and assessing the effectiveness of the TC model for the client groups.

Originality/value

Working with multiple complex needs clients on OST in a residential TC environment offers many challenges and opportunity to work with an array of issues that present before during and after the residential stay. Provision of a history and overview of the WHOS OTP TC services and recent enhancements to these programs highlight a continuum of care for the individual on OST.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 38 no. 2
Type: Research Article
ISSN: 0964-1866

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Article
Publication date: 1 March 2002

Susan Morris, Rowdy Yates and Jane Wilson

This article focuses on self‐reported child neglect and abuse in residential drug treatment drawing on data from clients in Scotland collected 1996‐1999. The authors'…

Abstract

This article focuses on self‐reported child neglect and abuse in residential drug treatment drawing on data from clients in Scotland collected 1996‐1999. The authors' findings suggest that the prevalence of childhood abuse histories are higher in female drug users than male drug users but argues that diversity of abuse experiences in drug users negate broad treatment plans for those traumatised by such experiences.

Details

Drugs and Alcohol Today, vol. 2 no. 1
Type: Research Article
ISSN: 1745-9265

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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

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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…

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

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