Delivery Of Substance Abuse Treatment Research Articles

Preliminary findings on the association between clients’ perceived helpfulness of substance abuse treatment and outcomes: Does race matter?

BackgroundFew studies examine the helpfulness and effectiveness of substance abuse treatment from the clients’ perspective. MethodsThe current secondary analysis examined the perceived helpfulness of substance abuse treatment components and its relationship to treatment outcomes among 387 Black and White adults participating in a multisite randomized clinical trial (RCT) of Motivational Enhancement Therapy. Throughout the 16-week RCT, participants self-reported substance use. Upon completion of treatment, participants completed a self-report measure assessing the perceived helpfulness of treatment components. ResultsBlack participants rated 9 out of 12 treatment components (e.g., “learning skills that will help me cope with my problems”) as being more helpful than their White counterparts, even after controlling for age, gender, employment status, primary drug type, and treatment assignment. However, perceived helpfulness ratings were not associated with substance use outcomes among Black or White participants. ConclusionsClients’ perceived helpfulness of treatment components is an important factor to consider in improving the delivery of substance abuse treatment, especially for Black adults.

Feasibility of a computerized intervention for offenders with substance use disorders: a research note

ObjectivesDespite evidence that treatment is effective in reducing recidivism among inmates with substance use problems, scarce resources mean that few of those in need of treatment actually receive it. Computerized substance abuse interventions could be used to expand access to treatment in prisons without placing an undue burden on resources. The major aim of the study was to compare treatment conditions in terms of their service utilization, skills acquisition, and treatment satisfaction.MethodsThe study recruited men and women with substance use disorders from 10 prisons in 4 states. In an open label clinical trial, 494 subjects were randomly assigned either to the Experimental condition, a computerized drug treatment intervention, the Therapeutic Education System (TES; n = 249), or to the Control condition, Standard Care (n = 245). Chi-square tests compared groups on categorical variables and independent samples t tests were used for interval level continuous variables.ResultsInitial evidence demonstrated: (1) comparable group rates of session attendance and high rates of TES module completion for experimental subjects; (2) comparable group gains in the development of coping skills; and (3) a more favorable view of TES than of Standard Care.ConclusionsCollectively, these results show that a computerized intervention, such as TES, can be implemented successfully in prison. Given the barriers to the delivery of substance abuse treatment typically encountered in correctional settings, computerized interventions have the potential to fill a significant treatment gap and are particularly well suited to inmates with mild to moderate substance use disorders who often are not treated.

Moving beyond access: Towards a quality-orientated substance abuse treatment system in South Africa

There is growing concern about the increased demand for and limited access to substance abuse treatment in South Africa. The government has responded by allocating more money to the delivery of substance abuse treatment, expanding the number of state-funded treatment slots, and training additional health and social workers to deliver these services, particularly in provinces where the prevalence of substance-related problems is high, such as the Western Cape. While these efforts should be commended and continued, steps to improve service availability have occurred without adequate consideration of the quality of services provided. This is not surprising, as there is little or no routine monitoring and evaluation of substance abuse services in the country. It is also disquieting, as access to treatment is necessary but not sufficient for positive treatment outcomes.

Risk, Need, and Responsivity: Unrealized Potential for the International Delivery of Substance Abuse Treatment in Prison

Drawing from a strong Canadian and U.S. base of literature and an emergent base of scholarship from the United Kingdom, this article examines the delivery of substance abuse treatment in prisons and the determinants of prisoner access to and use of services. To date, multidisciplinary research provides evidence of supply-side programs driven by organizational factors that affect access and use; in contrast, there is a dearth of literature on demand-side programs driven by prisoners’ needs. Guiding this analysis is a model for service delivery that integrates supply- and demand-side factors into a framework that traces the pathway of prisoners through programs, beginning with assessment and ending with treatment outcomes. At the core of this analysis is an expanded discussion of how prisoners’ specific needs should inform service delivery for greater reductions in rates of relapse and recidivism. Conclusions examine the legal and socioeconomic policy implications of programs that fail to provide services according to offenders’ specific needs in Canada, the United Kingdom, and the United States.

Alcohol & Drug Abuse: What Is "Women-Focused" Treatment for Substance Use Disorders?

Alcohol & Drug Abuse: What Is "Women-Focused" Treatment for Substance Use Disorders?

Influence of ownership on access in outpatient substance abuse treatment

Marked changes in ownership and control in substance abuse treatment delivery have garnered the attention of providers and policymakers alike. The proliferation of private for-profit providers and the shift to a delivery system that may be more explicitly influenced by financial incentives are of particular concern for this vulnerable population. This work empirically addresses how treatment unit ownership affected access and retention between 1995 and 2005 in the United States. Regressions show statistically significant associations between unit ownership and both restricted treatment access and shortening of treatment duration for financial reasons. In comparison to private nonprofit and public units, private for-profit units were less likely to provide initial treatment access and reported shortened treatment for a greater percentage of clients unable to pay. Other organization characteristics, such as methadone-maintenance programs and managed care participation, also were associated with limiting treatment accessibility. While this work does not determine the underlying motivation behind access limitations, continued shifts in ownership structure should heighten the attention of policymakers.

Management practices in substance abuse treatment programs

Efforts to understand how to improve the delivery of substance abuse treatment have led to a recent call for studies on the “business of addiction treatment.” This study adapts an innovative survey tool to collect baseline management practice data from 147 addiction treatment programs enrolled in the Network for the Improvement of Addiction Treatment 200 project. Measures of “good” management practice were strongly associated with days to treatment admission. Management practice scores were weakly associated with revenues per employee but were not correlated with operating margins. Better management practices were more prevalent among programs with a higher number of competitors in their catchment area.

Barriers to evaluating the effectiveness of drug treatment behind bars

The delivery of substance abuse treatment within correctional settings marks one of the criminal justice system's primary opportunities to disrupt the drugs-crime nexus. Federally funded residential substance abuse treatment programs were rapidly introduced across the nation, although implementation problems increased their operational variability. This article examines how implementation barriers interrelate with other types of obstacles and multiply to hinder determinations of program effectiveness. Specific barriers were identified from a case study of process and outcome evaluations of the South Carolina Residential Substance Abuse Treatment (RSAT) program. A conceptual framework groups barriers by type into four interrelated domains wherein additive effects and reciprocal consequences that can undermine effective program assessment are illustrated.

Responsivity: The value of providing intensive services to high-risk offenders

Tests of the importance of service matching have had varying results, yet little attention has been given to testing the hypotheses about outcomes for clients based on differing risks to recidivate. We set out to test the risk and responsivity principles using a sample of clients from one site of a four-site randomized block experimental design study examining the effectiveness of a seamless system approach vs. traditional criminal justice supervision. Findings from our preliminary examination of official and self-report data from this site suggest the importance of the risk and responsivity concepts in providing substance abuse treatment, particularly for high-risk clients. Because of the relatively low statistical power of the tests employed in this exploratory analysis, many observed relationships were not statistically significant. Nonetheless, findings offer important implications for the delivery of substance abuse treatment. Future analyses are also recommended to further explore the impact of different service delivery systems.