The Relationship between the Dimensions of Change Instrument and Retention in Therapeutic Community Treatment: The Moderating Influence of Time in Treatment

Abstract

Objectives: The Dimensions of Change Instrument (DCI) (1) assesses aspects of the therapeutic community treatment process. More positive scores on two of the eight dimensions of treatment process assessed at the beginning of treatment, Clarity and Safety, and Resident Support, Sharing and Enthusiasm predict retention in treatment at 30, 90, 180, and 270 days as well as overall length of stay. This study explored whether these process subscales assessed at different phases predicted retention at the next phase, and of treatment. Methods: Five-hundred nineteen individuals, aged 18 to 62, undergoing therapeutic community treatment completed the DCI at baseline, one, three, six, and nine months of the therapeutic community treatment. Results: DCI scale scores at each stage of treatment predicted dropout in the subsequent period. In the early stages of treatment, higher scores predicted a higher probability of retention in the subsequent stage of treatment. In later stages, lower DCI scores predicted a higher probability of retention. Conclusions: We conclude that predictions about retention made using the DCI scale scores are treatment stage dependent—the DCI predicts retention at the next stage but the direction of the scale prediction varies as a function of client tenure in treatment. This suggests that treatment processes that influence clients to remain early in treatment may change their valence for clients more advanced in treatment.

Keywords:

• Dimensions of change
• retention
• survival analysis
• therapeutic community