Evaluation of the Effectiveness of Intensive Confrontation in Changing the Behavior of Alcohol and Drug Abusers

Abstract

A type of confrontation session, called a “Special Feedback Session” (SFS), was evaluated to determine whether it facilitated therapeutic changes in the behavior of alcohol and drug abusers. The SFS was derived from a type of intensive confrontation session called a “haircut” at Synanon, Daytop, and Phoenix House. The SFS was used within a highly structured, behavior modification program; it was a short-term therapeutic community program, called “Feedback,” because it was derived from a collection of feedback and behavior modification principles and techniques. In this paper the term “Feedback” represents two types of behavior modification programs: a Feedback-Behavior Modification Program and a Token Economy Program. This study is the first one utilizing a token economy program to treat drug and/or alcohol abusers within a military setting.

The scope of this paper covers three areas: (1) evaluate the consequences of 63 SFS's, (2) distinguish between SFS's based on staff evaluations of their relative effectiveness, and (3) determine if SFS's judged to be more effective lead in fact to more therapeutic changes in behavior later than less effective ones. The main purpose of this paper is to evaluate the effectiveness of the “Special Feedback” procedure in therapeutically changing the behavior of the recipient of a SFS, It is the first time a study has been designed to objectively evaluate the effects of a “haircut-type” procedure within any treatment setting.

The results of this study clearly indicated that the SFS's definitely influenced the clinical decision-making process. Although the SFS's were punitive in nature (with regard to the reasons for their administration and content), they clearly had a therapeutic function and effects. With regard to the short-term effects of the SFS's on clients' individual performances within the residential program, both the type of substance abused and the type of treatment program used needed to be considered. For drug abusers, the Feedback-Behavior Modification Program was most effective in reducing the frequency of undesirable behaviors (for 7/30 vs 1/8 clients), but both programs were equally effective in facilitating increases in the frequency of desirable behaviors (15/30, 4/8 clients). For alcohol abusers, the Token Economy Program was most effective in reducing the frequency of undesirable behaviors (for 2/4 vs 0/5 clients), but both programs were less effective in facilitating increases in the frequency of desirable behaviors than with the drug abusers (2/5, 1/4 clients). However, the more immediate effects of the SFS's (within the 3- and 7-day time periods after the SFS's) were obtained regardless of the type of substance abused or treatment program utilized.

It was demonstrated that SFS's vary in their effectiveness in “reaching” clients, and this was taken into account in analyzing the frequency data of individuals. SFS's judged to be more effective did facilitate greater therapeutic changes, i.e., decreases in the frequency of Irresponsible behaviors and increases in the frequency of Outstanding behaviors. The data indicated that these therapeutic effects decreased over a short period of time (i.e., even before clients are discharged from the residential treatment program).