Abstract
BackgroundThe purpose of this study was to assess the impact of drug abuse treatment in Peru that used the therapeutic community (TC) model. Program directors and several staff members from all study treatment facilities received two to eight weeks of in-country training on how to implement the TC treatment model prior to the follow-up study.MethodsThis outcome study involved 33 TC treatment facilities and 509 former clients in Lima and other cities in five providences across Peru. A retrospective pre-test (RPT) follow-up design was employed in which 30-day use of illegal drugs and alcohol to intoxication was measured at baseline retrospectively, at the same time of the six-month follow-up. In-person interview data were collected from directors of 73 percent of the eligible TC organizations in January and February 2003 and from former 58 percent of the eligible TC former clients between October 2003 and October 2004. Drug testing was conducted on a small sample of former clients to increase the accuracy of the self-reported drug use data.ResultsMedium to large positive treatment effects were found when comparing 30-day illegal drug and alcohol use to intoxication before and six months after receiving treatment. As a supplemental analysis, we assumed the 42 percent of the former clients who were not interviewed at the six month assessment had returned to drugs. These results showed medium treatment effects as well. Hierarchical Generalized Linear Modeling (HGLM) results showed higher implementation fidelity, less stigma after leaving treatment, and older clients, singly or in combination are key predictors of treatment success.ConclusionThis study found that former clients of drug and alcohol treatment in facilities using the TC model reported substantial positive change in use of illegal drugs and alcohol to intoxication at a six-month follow-up. The unique contribution of this study is that the results also suggest attention should be placed on the importance of implementing the TC drug abuse treatment model with fidelity. Further, the results strongly suggest that TC drug abuse treatment programs should incorporate follow-up activities that attempt to neutralize community negative reactions (perceived stigma) independent of other factors.
Highlights
The purpose of this study was to assess the impact of drug abuse treatment in Peru that used the therapeutic community (TC) model
This sample of 33 facilities is a subsample of 72 TC facilities that were involved in a study of Daytop TC training impact on staff[4]
The extent of change is greater than has been reported in other drug treatment program evaluations, including the Treatment Outcome Prospective Study (TOPS) [7,12], the Drug Abuse Treatment Outcome Study (DATOS)[77], and the National Treatment Improvement Evaluation Study (NTIES)[78]
Summary
The purpose of this study was to assess the impact of drug abuse treatment in Peru that used the therapeutic community (TC) model. Woodhams[2] describes this model as one in which staff members interact with residents in an environment where "community as method" is the organizing principle. This community is assumed to be responsible for one another's treatment, having an equal role in the treatment process rather than staff bearing the primary responsibility for treatment. Multi-level analysis procedures were employed to take into consideration the bias due to the influence of a facility on all former clients from that facility This sample of 33 facilities is a subsample of 72 TC facilities that were involved in a study of Daytop TC training impact on staff[4]. This study is one of the first studies to document what happens to former clients after drug treatment in a developing country
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