Abstract
BackgroundResearch on substance abuse treatment services in general reflects substantial attention to the notion of treatment process. Despite the growing popularity of process studies, only a few researchers have used instruments specifically tailored to measure the therapeutic community (TC) treatment process, and even fewer have investigated client attributes in relation to early TC treatment process experiences. The aim of the current study is to address this gap by exploring clients’ early in-treatment experiences and to determine the predictors that are related to the treatment process, using a TC-specific multidimensional instrument.MethodsData was gathered among 157 adults in five TCs in Flanders (Belgium). Descriptive statistics were used to explore clients’ early in-treatment experiences and multiple linear regressions were conducted to determine the fixed and dynamic predictors of Community Environment and Personal Development and Change (two indicators of TC treatment process).ResultsClients reveal a more positive first-month response to TC social processes than to personal-development processes that require self-reflection and insight. The variance in clients’ ratings of Community Environment was primarily due to dynamic client factors, while the variance in clients’ ratings of Personal Development and Change was only related to fixed client factors. Suitability for treatment was the strongest predictor of Community Environment ratings, whereas a judicial referral more strongly predicted Personal Development and Change scores.ConclusionsSpecial attention should be devoted to suitability for treatment as part of motivational assessment as this seems to be a very strong predictor of how clients react to the initiation stage of TC treatment. To help improve clients’ (meta-)cognitive skills needed to achieve insight and self-reflection and perhaps speed up the process of recovery, the authors suggest the introduction of (meta-)cognitive training strategies in the pre-program and/or the induction stage of a TC program.
Highlights
Research on substance abuse treatment services in general reflects substantial attention to the notion of treatment process
Researchers have evaluated the effectiveness of therapeutic community (TC) treatment programs, showing a positive correlation between retention, often indicated as the time spent in treatment, and post-treatment substance use and criminal involvement rates [2,3,4,5,6]
We found that during the first month of treatment, dynamic client variables more strongly affected clients’ perceptions of the TC environment than fixed client variables
Summary
Research on substance abuse treatment services in general reflects substantial attention to the notion of treatment process. Since their inception, researchers have evaluated the effectiveness of TC treatment programs, showing a positive correlation between retention, often indicated as the time spent in treatment, and post-treatment substance use and criminal involvement rates [2,3,4,5,6]. Researchers have evaluated the effectiveness of TC treatment programs, showing a positive correlation between retention, often indicated as the time spent in treatment, and post-treatment substance use and criminal involvement rates [2,3,4,5,6] Despite these promising results, studies revealed high dropout rates [7,8,9,10,11], which may differ greatly between TC programs [12,13]. Since dropout is associated with poor treatment outcomes, and since considerable variations exist between
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