![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
Abstract
This study, conducted in 2005 to 2007, presents results that are based on a proscriptive cohort design. The sample consisted of 769 residents in 22 drug user treatment programs who stayed in treatment for at least 30 days to one year; 510 former residents (66%) from 21 programs (95%) were interviewed again at a 6-month post-treatment follow-up assessment. A majority of the participants were male, lived with family or relatives, had completed only primary school, and had a full-time or a part-time job prior to entering treatment. The participating therapeutic community (TC) programs were a mixture of volunteer, compulsory-probation, and prison-based programs. In-person interview data and urine testing showed that the self-reported drug use prevalence rates are reliable. The results show large positive treatment effects on 30-day and 6-month illegal drug use and small to medium effects on the severity of alcohol use and related problems. A multilevel regression analysis suggests that residents’ reduced stigma, adaptation of the TC model, and frequency of alcohol and drug use-related consequences partially predict treatment success. Study limitations and policy implications are discussed.
THE AUTHORS
Knowlton Johnson, Ph.D., is currently a Senior Scientist for the Pacific Institute for Research and Evaluation, Inc. (PIRE)-Louisville Center. During his 40-year career in research, he has conducted drug and alcohol prevention and treatment research at the University of Maryland, University of Alaska-Anchorage, University of Louisville, and PIRE. His current research and development activities focus on prevention of the use of inhalants and other legal products to get high in Alaska; prevention and treatment of alcohol and other drug use/abuse in Afghanistan, Brazil, El Salvador, Peru, and Thailand; HIV/AIDS prevention and care in Thailand and Liberia; and system/organization capacity-building and sustainability of prevention systems both nationally and internationally.
Linda Young, M.A., is Center Director of PIRE's Louisville office and has more than 20 years of research management experience, which includes all phases of the research process from design to proposal development, analysis, report writing, and presentation of findings. Her primary area of expertise is technical plan and survey instrument development, and project implementation including quality control methods and data collection procedures for very large and complex research projects. She currently serves as co-evaluator for training evaluation projects in El Salvador, Afghanistan, and Brazil.
Stephen R. Shamblen, Ph.D., is an Associate Research Scientist at the Pacific Institute for Research and Evaluation. His research interests include meta-analysis, the measurement of severity of population substance use consequences, and the selection of appropriate populations for treatment and prevention efforts. Dr. Shamblen is currently the Principle Investigator on a contract through the Alaska Mental Health Trust Authority examining the efficacy of a treatment program delivering services to rural Alaskan youth in their homes. Dr. Shamblen is also the lead analyst on several substance abuse prevention projects, funded through the Substance Abuse and Mental Health Services Administration and through the Office of Juvenile Justice and Delinquency Prevention.
Geetha Suresh, Ph.D., is an Assistant Professor at the Department of Justice Administration, University of Louisville, KY. Her research interests include crime analysis, urban crime, economic rationality in criminology, analysis of domestic violence, substance abuse and mental health, women and economic development, and women's empowerment. Dr. Suresh has over 15 years of research experience and has published articles in peer-reviewed scholarly journals such as Homicide Studies, Journal of Contemporary Criminal Justice, American Journal of Criminal Justice, Evaluation Review, and Humanity and Society.
Thom Browne, M.A., is Deputy Director of the Office of Anticrime Programs at the US State Department's Bureau of International Narcotics and Law Enforcement Affairs. He is responsible for the formulation, coordination, and implementation of State Department strategies and programs for international crime, drug prevention, and drug treatment. Mr. Browne has 20 years of experience as a leader in establishing antidrug initiatives and training academies for international law enforcement in the United States, Latin America, Southeast Asia, Southern Africa, and Eastern Europe.
Khun Warunee Chookhare, M.B.A., has 22 years of experience in research, analysis, and data management. She specializes in projects relating to financial structure in developing economics, evaluation of medical need in up-country areas, marketing studies for major insurance companies, customer satisfaction analysis for major banks in Thailand, and corporate image studies for major financial institutions.
APPENDIX TABLE A Study measures and data sources
Notes
1 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. ***Editor's note.
2 Treatment can be briefly and usefully defined as a planned, goal-directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help-based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types or heterogeneities—that aren't also used with nonsubstance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model, there is now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Treatment is implemented in a range of environments: ambulatory, within institutions, which can include controlled environments. Treatment includes a spectrum of clinician-caregiver-patient relationships representing various forms of decision-making traditions/models: (1) the hierarchical model in which the clinician-treatment agent makes the decision(s) and the recipient is compliant and relatively passive, (2) shared decision-making which facilitates the collaboration between clinician and patient(s) in which both are active, and (3) the "informed model" in which the patient makes the decision(s). ***Editor's note.
3 This clinical concept relates to a sense of partnership in therapy between therapist and client, in which each participant is actively committed to their specific and appropriate responsibilities and believes that the other is likewise engaged in the planned change process. A client's therapeutic alliance, or engagement, can be and is measured in various studies. Rarely is this reported for the therapist. The reader is referred to Norcross (2002).
4 The Matrix model is an outpatient treatment approach developed during the mid-1980s for the treatment of individuals with cocaine, methamphetamine, alcohol, and opioid disorders. The basic elements of the approach consist of a collection of group sessions (early recovery skills, relapse prevention, family education, and social support) and three individual sessions delivered over a 16-week intensive treatment period. Patients are scheduled three times per week to attend two relapse prevention groups (Monday and Friday) and one family/education group (Wednesdays). During the first four weeks patients also attend two Early Recovery Skills groups per week (these groups occur on the same days as the Relapse Prevention groups just prior to them). After 12 weeks, they attend a social support group on Wednesdays instead of the family/education group. The model has been developed and manualized with funding from NIDA and is listed by NIDA as a scientifically based approach to drug addiction treatment.
5 A number of prominent treatment outcome studies have assessed treatment effectiveness at both 6 months and 6–12 months posttreatment. The National Treatment Outcome Research Study was the first prospective, multisite treatment outcome investigation of drug users in the UK. Substantial improvements in a range of substance use problems were observed at 6-month follow-up among clients in all treatment modalities (1). The EMETYST Project studied treatment outcomes of heroin addicts in Spain prospectively at 6 and 12 months after the onset of treatment. Reductions in drug use, in addition to improvements in psychological, legal, and employment status, were found at both time periods posttreatment.
6 We conducted an attrition analysis and corrected for potential attrition effects in the analysis. Hansen and colleagues’ (1985) analysis technique was used to assess panel attrition. One panel attrition question was posed: “Are those who drop out different from those who stay with respect to baseline characteristics of residents’ TC programs, staff, and illegal drug and alcohol use?” This panel attrition question was addressed using the following steps: first, an analysis of variance procedure was used to assess the statistically significant differences of baseline drug and alcohol use, resident, program, and staff characteristics between a group variable (attrition status: resident dropouts vs. stayers); second, we conducted a stepwise linear and logistic regression analysis, regressing attrition status for residents (dropouts vs. stayers) on statistically significant potential baseline predictors from step 1. (Outcome variables were not included in the attrition models to avoid their circular spurious prediction in the final intervention analysis.) The linear regression results assisted in determining multicollinearity among the predictors, and logistic regression was used to assess the statistically significant predictors of attrition status, which was a dichotomous variable. The results showed that stayers are somewhat biased toward slightly higher-educated residents and those who were living with family prior to treatment; however, the difference is small. Even so, we constructed an attrition bias correction variable to include in the covariate selection stage of the final analysis. The use of an attrition bias correction propensity variable to adjust for possible attrition bias is discussed by D'Agostino (Citation1998) and CitationJohnson et al. (2002).