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Problematic substance use is associated with adverse outcomes that extend beyond the individual, resulting in significant cost to the community through health care, criminal justice and other psychosocial factors, including child protection and family support. These factors create concerns for treatment services, with an increasing demand for cost‐effective solutions to this problem. This paper seeks to address these issues.

This prospective cohort study examined the effect of client variables on retention within a short‐term (56 days) modified therapeutic community (MTC) in the Australian Capital Territory. A total of 28 residents (17 males, 11 females) took part in the study, which included quantitative and qualitative measures.

Results demonstrate a trend in favour of dynamic client variables as effective predictors of retention, with substance use severity being a significant predictor (p=0.023, d=0.91). Content analysis demonstrates that those with severe substance use have more intentions to engage in aftercare.

Short term treatments are seen as providing a gateway to further treatment, especially for chronic substance‐using clients.

The purpose of this paper is to summarize research conducted in long-term residential rehabilitation centers, including therapeutic communities (TCs), in order to further clarify the effectiveness of this treatment approach and to evaluate the quality of TC research conducted in the period 2000-2013.

The composite search engine UQ database Summon were used to find articles with “Therapeutic Community” as title words, and the search was limited to adult participants, peer-reviewed articles, published between January 2000 and June 2013 in the English language. The review was conducted using Cochrane Collaboration methods and reported under the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines.

In total, 25 studies met inclusion criteria for the review and represented data from n=5,923 participants in the USA, Australia, Spain, England, and Belgium. Evidence supports the TC approach for a diverse range of individuals who misuse a range of substances. Several studies reported a relationship between retention and outcomes however dropout from treatment is a widespread issue. A paucity of research using multiple time points precludes any firm conclusions regarding the optimal length of treatment in a TC. There is a lack of research on the interplay between individual and community-level factors on client well-being, retention, and longer term outcomes.

This review highlights the need for TC research that includes multiple time points and follow-up assessments, and measures of change in theoretically meaningful constructs alongside standard measures of demographics, substance use, and psychiatric symptoms.

The reporting format of TC research should be better standardized in order to create a better basis for research comparison. More standardized reporting would also allow for effect size analysis, and create a more efficacious evidence base.

This updates the systematic review body of research.

The study evaluated the introduction of naltrexone in an Australian prison system for imprisoned male heroin users. Treatment outcomes were analysed for two sub‐samples taken from an unsuccessful randomised controlled trial. The first sample comprised 68 participants who were randomly allocated to naltrexone treatment. The second sample comprised 47 participants who commenced opioid pharmacotherapy during the study period. Thirteen per cent of subjects started naltrexone, with only 7% retained in treatment at six months. Six‐month retention was significantly lower in naltrexone compared to methadone (p = 0.0007). Poor patient acceptability and retention did not support oral naltrexone maintenance in this treatment group.

The purpose of this paper is to summarize the main findings and conclusions of four separate studies on treatment in therapeutic communities (TCs) for addictions.

The first two studies address the core characteristics of the TC approach: a study on the workable and destructive elements of the Synanon model; and a comparative study on the essential elements of TCs for addictions in Europe and in the USA. The final two studies highlight clients’ perceptions of the TC treatment process in relation to retention: a study on clients’ first month perceptions of the TC treatment process and the influence of fixed and dynamic client factors; and a longitudinal study on changes in clients’ perception of the TC treatment process and the impact of motivation, psychological distress and cluster B personality traits.

The first study showed that Synanon’s therapeutic and pedagogical methods are still highly valued despite its negative reputation. The results of the second study suggest that while traditional TCs operate as concept-based TCs in Europe, modified TCs might differ in the extent to which they apply the core principles and elements of the TC approach. The third study provides evidence that suitability for treatment is a very important predictor for clients’ first month perceptions of the community environment. The fourth study shows that with time in treatment clients develop more profound perceptions regarding the essence of TC treatment.

Finally, implications for clinical practice, general limitations and some concrete recommendations for future research are presented in this paper.

The PhD summary study contributes to the existing literature on TC treatment.

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.

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.

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.

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.

This is the second in a series of papers focused on alcohol and substance abuse rehabilitation centers. Centers face the ongoing challenge of validating outcomes to meet the burden of evidence for insurance companies. In the first paper, data mining was used to establish baseline patterns in treatment success rates, for the Futures: Palm Beach Rehabilitation Center, that have a direct impact on a client’s ability to receive insurance coverage for treatment programs. In this paper, we examine 2016 outcomes and report on facility efficacy, alumni progression and sobriety, and forecast treatment success rates (short and long term) in support of client insurability. Data collection has been standardized and includes admissions data, electronic medical records data, satisfaction survey data, post-discharge survey data, Centers for Disease Control (CDC) data, and demographic data. Clustering, partitioning, ANOVA, stepwise regression and stepwise Logistic regression are applied to the data to determine statistically significant drivers of treatment success.

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.

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 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.

Findings likely constitute a regional sample thus generalizability is limited.

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

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

This chapter summarizes findings and conclusions from recent studies exploring the role of motivation-readiness factors in drug abuse treatment. The research focuses on populations entering drug treatment, particularly therapeutic community programs in community- and prison-based settings. However, findings from studies in other modalities and from samples not entering treatment are also discussed. Issues addressed include (1) the nature of the motivational concept in recovery, (2) motivation as a variable affecting treatment retention and outcomes, (3) motivation in the treatment process, (4) differences in motivation across treatment populations and modalities, (5) client correlates of motivation, and (6) motivational enhancement. Conclusions highlight the critical role of motivation-readiness factors in understanding treatment-seeking, retention, and outcomes. Key implications are discussed for research, theory, treatment practice, and health care policy. These implications underscore issues relating to the interaction of motivation and treatment processes, the interaction of motivation and treatment demands, differences in motivation among special populations, client correlates of motivation, and self-selection and study designs.

To evaluate the effectiveness of an adaptation of Interpersonal Group Psychotherapy (IPT-G), in facilitating short- and longer-term improvements in eating disorder symptomology, psychosocial impairment, anxiety, depression and attachment difficulties among adults living with overweight and diagnosed with binge eating disorder (BED).

In total, 24 participants completed measures at the start of IPT-G, mid-treatment, discharge and six-month follow-up. Quantitative outcomes were analysed utilising one-way repeated measures analysis of variance.

Treatment retention was 100%. Significant improvements in binge-eating frequency, psychosocial impairment and depression were achieved at mid-treatment and maintained at post-treatment and six-month follow-up, and with large effect sizes. Attachment anxiety had reduced significantly at post-treatment and was maintained at six-month review. Body mass index (BMI) had stabilised by mid-treatment and was maintained at post-treatment and six-month follow-up. All hypotheses were supported, with the exception that attachment avoidance did not improve significantly and following a post-treatment reduction, anxiety symptoms deteriorated slightly by six-month follow-up, such that they were no longer significantly different from pre-treatment levels.

Despite being the most prevalent of the eating disorders (compared to anorexia nervosa and bulimia nervosa), BED is under-recognised and under-treated in clinical settings. Results indicate the sustained effectiveness of IPT-G in improving eating disorder and comorbid symptomology associated with BED.

This is the first UK study to investigate the effectiveness of IPT-G at treating BED. Unlike previous studies in the field, this study did not exclude participants based on age, BMI or psychiatric comorbidity.

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.

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.

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.

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.