Effectiveness Of Substance Abuse Treatment Research Articles

Substance abuse treatment and pressures from the criminal justice system: data from a provincial client monitoring system.

Compulsory treatment is discussed increasingly as a way to reduce the population burden of addictive behaviours. This study explores the extent to which social control strategies exercised through the criminal justice system are used to bring people into substance abuse treatment at a system level. We also assessed whether particular subgroups may be more or less likely to be brought into treatment in this manner. We employed a secondary analysis of data from a client-based information system which captured demographic, referral and substance use characteristics from people seeking treatment for substance abuse. A census of clients (n = 45123) entering specialized Ontario addiction treatment programmes between 1 April 1999 and 31 March 2000. Some 28.9% of clients reported legal problems at treatment intake, and 13.9% had an explicit corrections-related condition of treatment contact. Logistic regression analyses indicated that legal problems and corrections-related conditions of treatment were more prevalent among younger, unmarried and unemployed males, who had not completed high school. A number of important interactions were identified between these factors and substance of abuse. Implications for equity, accessibility and effectiveness of substance abuse treatment are discussed in relation to the tendency of treatment mandates from criminal justice system to disproportionately affect the entry of this segment of substance-abusing clients.

Post-Modern Ideas in Substance Abuse Treatment

ABSTRACT This article describes the use of post-modern ideas in the treatment of substance abusers at a long term residential and day treatment center. It describes some of the changes that ensued as a result of a transformation from a “therapeutic community” (TC) model to a “solution-focused” model. The TC is a deficit model that focuses on a person's flaws and weaknesses. Solution-focused therapy, on the other hand, focuses on what a person has done and is doing right and his or her strengths, assets, and resources. This approach not only improves the quality and effectiveness of substance abuse treatment for clients, but also creates a better working environment for staff.

Reinventing Justice: The American Drug Court Movement

Back to table of contents Previous article Next article Book ReviewsFull AccessReinventing Justice: The American Drug Court MovementRobert P. Ziemian, Hon.Robert P. ZiemianSearch for more papers by this author, Hon.Published Online:1 May 2003https://doi.org/10.1176/appi.ps.54.5.750-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail As a practicing drug court professional, I looked forward to reviewing James L. Nolan's Reinventing Justice: The American Drug Court Movement. I anticipated that it could be "that definitive work," full of statistical analysis and comparison studies that prove the effectiveness—or ineffectiveness—of drug courts in reducing recidivism and drug use.However, this is not the book I anticipated. Nolan, a respected sociologist, has written a well-documented history of judicial theories and practices in America since 1700 and the role of drug courts—a very recent (1989) entity—in that evolving history. He devotes a large part of the book to describing his observations of various drug courts and the observations of many drug court professionals, including myself, on drug court practices and philosophies. He does a very credible job of finding common themes from widely disparate drug court practices—practices that often reflect the political realities of particular jurisdictions.From the perspective of legal and health care professionals, this is an excellent opportunity to "get off the dance floor," away from the daily grind and frustrations, and up into the balcony to take a more comprehensive look at the drug court movement. The book is replete with examples and theories from some of the most experienced practitioners, outlining the possibilities of using the therapeutic-justice model to enhance the effectiveness of substance abuse treatment, especially for the approximately five million chronic substance abusers in the United States.This book will also be very useful for professionals who are currently involved in drug courts in one capacity or another. The practitioners cited in the work, almost all of whom I know, are the most articulate and "envelope-pushing" of practitioners. However, others may not be as radical. Nolan presents a good opportunity to compare one's own views with those of individuals who speak for the movement. I found Reinventing Justice very informative.The Honorable Robert P. Ziemian is a Justice of the Massachusetts Trial Court, District Court Department, South Boston Division.by James L. Nolan, Jr.; Princeton, New Jersey, Princeton University Press, 2001, 254 pages, $32 FiguresReferencesCited byDetailsCited ByNone Volume 54Issue 5 May 2003Pages 750-a-751 Metrics History Published online 1 May 2003 Published in print 1 May 2003

Factors Associated with Probation Officers' Use of Criminal Justice Coercion to Mandate Alcohol Treatment

Alcohol problems are widespread among individuals in county criminal justice probation systems. However, it is unclear why only a small fraction of these problem drinkers receive treatment. In this study, self‐administered questionnaires were mailed to 145 probation officers in nine California counties to identify factors that predicted probation officers' use of coercion to mandate alcohol treatment. The questionnaire measured characteristics of probation officers, characteristics of their caseloads, and perceptions about their departments. Principle components analysis combined some of the items into six factor‐based scales. Multiple regression analyses identified two significant predictors of use of coercion into treatment: a belief that treatment was effective and a belief that one's peers in the department were using coercion frequently. Implications for increasing treatment entry of probationers with drinking problems include educating probation officers about the effectiveness of substance abuse treatment in general and about coerced treatment in particular. Probation departments are encouraged to develop management styles that facilitate shared normative beliefs about assessing and managing alcohol problems among probationers.

The effectiveness of drug abuse treatment: a meta-analysis of comparison group studies

A meta-analysis was conducted on 78 studies of drug treatment conducted between 1965 and 1996. Each study compared outcomes among clients who received drug treatment with outcomes among clients who received either minimal treatment or no treatment. Five methodological variables were significant predictors of effect size. Larger effect sizes were associated with studies with the following characteristics: smaller numbers of dependent variables, significant differences between groups at admission, low levels of attrition in the treatment group, a passive comparison group (no treatment, minimal treatment) as opposed to an active comparison group (standard treatment), and drug use determined by a drug test. Controlling for these methodological variables, further analyses indicated that drug abuse treatment has both a statistically significant and a clinically meaningful effect in reducing drug use and crime, and that these effects are unlikely to be due to publication bias. For substance abuse outcomes, larger effect sizes tended to be found in studies in which treatment implementation was rated high, the degree of theoretical development of the treatment was rated low, or researcher allegiance to the treatment was rated as favorable. For crime outcomes, only the average age of study participants was a significant predictor of effect size, with treatment reducing crime to a greater degree among studies with samples consisting of younger adults as opposed to older adults. Treatment modality and other variables were not related to effect sizes for either drug use or crime outcomes

The Effect of Drug Treatment on Criminal Behavior among Adolescents in DATOS-A

This study examined criminal activity among 1,167 adolescents who participated in a community-based substance abuse treatment study (Drug Abuse Treatment Outcome Studies for Adolescents) (DATOS-A). The primary goals of this study were to assess the effect of substance abuse treatment on adolescent crime and to identify the patient characteristics that were most closely associated with reductions in crime during the posttreatment period. Results confirmed that among adolescents who had engaged in criminal activity during the 12 months prior to entering DATOS-A treatment, reductions in alcohol or marijuana use were independently associated with significant reductions in the likelihood of committing crimes during the 12-month follow-up period. The present study also provides further support for emphasizing dynamic rather than static patient characteristics to predict the likelihood of continued drug-related offending among substance-abusing adolescents.

Consideration of a North American heroin-assisted clinical trial for the treatment of opiate-dependent individuals

Untreated opiate addiction remains a major public health problem in North America (US and Canada). Increased morbidity and mortality as well as criminal behavior related to untreated opiate dependence constitute significant social and economic burdens. While the principal treatment modality to opiate addiction in North America has been methadone treatment since the 1960s, its reach and effectiveness has been limited; at any given time, only about 25% (US) and 15–20% (Canada) of all opiate addicts are in methadone treatment. Reasons for low levels of treatment participation among this subset of users include perceptions among users that treatment programs are punitive and that the medication is fraught with side effects. In the meantime, alternatives to methadone have been recently approved or are in development, including levo-alpha acetylmethadol and buprenorphine. However, the extent to which they will solve the current problem is still unknown, and therefore development of additional treatment strategies needs to continue. Recent studies of heroin-assisted treatment in Europe (Switzerland, the Netherlands and Great Britain) produced preliminary yet encouraging results in attracting and retaining long-term, treatment-resistant addicts in treatment, as well as improving treatment outcomes. However encouraging, the North American context differs from Europe. A study performed in North America would provide critical information on whether utilizing injectable opiates enhances the overall therapeutic attractiveness and effectiveness of substance abuse treatment to a subset of recalcitrant users. Implications of positive results would expand the continuum of effective interventions in the US and Canada, and increase the number of long-term, treatment-resistant opiate addicts in treatment.

Book Review: Effect of Substance Abuse Treatment on AIDS Risk Behaviour

Book Review: Effect of Substance Abuse Treatment on AIDS Risk Behaviour

The Effectiveness of Substance Abuse Treatment in Reducing Violent Behavior

The use of alcohol and other drugs has long been associated with violence. Yet relatively little is known about the effect of treatment on specific violent behaviors. This study examines violent behaviors in the National TreatmentImprovement Evaluation Study (NTIES), and assesses the extent to which treatment appears to reduce violence for each measured behavior. It also examines these reductions by gender, treatment modality, and whether the client wasa victim of violence in addition to being a perpetrator. The results indicate large reductions in violence among clients actively violent during the pretreatment period, with virtually no increase in violence among clients not actively violent during that same period, irrespective of gender, modality, or victimization status. On their face, the results strongly suggest that substance abuse treatment is effective in reducing violent behavior. Alternative explanations areproposed and assessed, followed by implications for policy, practice, and future research.

Evaluations of Correctional Treatment Programs in Germany: A Review and Meta-Analysis

This study presents a review and meta-analyses of research on the recidivism-reducing impact of correctionally based treatment programs in Germany. The data are part of the Correctional Drug Abuse Treatment Effectiveness (CDATE) project meta-analytic database (covering 1968-1996) of evaluation research studies of correctional interventions. Overall, the five studies of educational programs show no practical impact of these programs in reducing recidivism. Four studies of programs to counsel driving-under-the- influence (DUI) offenders fall in an intermediate area (not statistically significant, but promising enough to warrant further research). The eight studies of Social Therapy programs did show, on the average, a statistically significant practical impact in reducing recidivism.

A Meta-Analytic Review of the Effectiveness of Corrections-Based Treatments for Drug Abuse

The Correctional Drug Abuse Treatment Effectiveness project obtained and coded evaluation research studies (unpublished as well as published) of treatment/intervention programs reported from 1968 to 1996. Meta-analysis was used to examine evidence for their effectiveness in reducing recidivism for incarcerated offenders who are drug abusers. Results supported the effectiveness of therapeutic community programs but not of boot camps and drug-focused group counseling. Evaluations of other interventions were based on too few studies to draw strong conclusions, but promising treatments that warrant further attention include use of methadone maintenance treatment, substance abuse education, 12-step programs, and cognitive behavioral therapy for offender populations.

Drug abuse treatment entry and engagement: Report of a meeting on treatment readiness

Although the effectiveness of drug abuse treatment has been demonstrated repeatedly, many drug abusers do not enter treatment, many who do enter leave prematurely, and relapse following treatment is common. To further research treatment entry and engagement, the National Institute on Drug Abuse convened scientists representing diverse research traditions in December 1996. This article summarizes meeting presentations and recommendations. Presentations focused on treatment readiness/motivation for change, ethnographic reports of drug abusers' perceptions of and attitudes toward treatment, and reports on alternative treatments for high-risk drug abusers. Recommendations focused on the potential contribution of qualitative research, integration of qualitative and quantitative research approaches, development of flexible treatment approaches that are cognizant of patients' life circumstances, and services research to improve the organization and delivery of drug abuse treatment. © 1999 John Wiley & Sons, Inc.; J Clin Psychol 55: 643–657, 1999.

Drug abuse treatment entry and engagement: report of a meeting on treatment readiness.

Although the effectiveness of drug abuse treatment has been demonstrated repeatedly, many drug abusers do not enter treatment, many who do enter leave prematurely, and relapse following treatment is common. To further research treatment entry and engagement, the National Institute on Drug Abuse convened scientists representing diverse research traditions in December 1996. This article summarizes meeting presentations and recommendations. Presentations focused on treatment readiness/motivation for change, ethnographic reports of drug abusers' perceptions of and attitudes toward treatment, and reports on alternative treatments for high-risk drug abusers. Recommendations focused on the potential contribution of qualitative research, integration of qualitative and quantitative research approaches, development of flexible treatment approaches that are cognizant of patients' life circumstances, and services research to improve the organization and delivery of drug abuse treatment.

Bibliography of literature reviews on drug abuse treatment effectiveness.

This bibliography is intended to provide a list of articles, books, and monographs that review the effectiveness of drug abuse treatment. For articles or reports, the primary selection criterion was that the item provide a summary of the findings of empirical studies bearing on the topic being reviewed. Articles that merely described a treatment modality or technique or that provided advice to clinicians on how to implement or carry out the treatment were not included. In addition, the list includes books and monographs if they focus specifically on treatment and if they include at least some chapters on treatment effectiveness research. Most of these consist of research monographs from the National Institute on Drug Abuse. All of the reviews are in English. Most originated in the United States, but others are from Australia, Canada, Great Britain, and Sweden. A few citations were published in the 1970s, but most appeared in the 1980s or 1990s. The citations are listed under the following topical headings: Drug Abuse Treatment (General), Opiate Treatment, Cocaine Treatment, Therapeutic Communities, Adolescent Treatment, Behavioral and Cognitive Treatment, Family Therapy, Minnesota Model, Relapse Prevention, Acupuncture, Transcendental Mediation, 12-Step Programs, and Natural Recovery. Although we have attempted to provide a comprehensive list of reviews, it is not exhaustive. We may have failed to identify relevant articles, and our decisions regarding eligibility may not agree with those of other researchers. We would welcome any additions or comments.

Dollars and Performance: Cost Effectiveness of Substance Abuse Treatment in Maine

If public funds are allocated efficiently, then an increase in expenditures should improve the performance of substance abuse treatment programs. However, the unconditional correlation between performance and expenditures per patient is non-positive in the data sets used in this paper. One explanation for this seemingly surprising result is that programs that treat more difficult patients receive more resources per patient. This paper addresses this potential endogenity both theoretically and empirically. It asks whether the fraction of patients that are abstinent 30 days prior to their discharge is affected by resources. We use data from outpatient drug-free programs that received public funding from the state of Maine between 1991 and 1994. A formal model of the allocation of public funds across treatment programs shows that the endogeneity of funds can lead to underestimation of their marginal impact on performance. The model produces a system of structural equations with cross-equation restrictions. Maximum likelihood estimation of this system gives parameter estimates that strongly reject the restrictions. The model may fail either because it is incorrect or because their are omitted variables correlated with expenditures per patients. Both problems are avoided by estimating only a single equation and using instrumental variables to control for omitted variables. This approach has the additional advantage of controlling for fixed effects without introducing estimation bias. Both the structural and instrumental variable estimates indicate that the marginal impact of spending per patient on performance is very small and, in general, not statistically different from zero.

CDATE: UPDATING THE EFFECTIVENESS OF CORRECTIONAL TREATMENT 25 YEARS LATER

Correctional Drug Abuse Treatment Effectiveness (CDATE) will assemble and annotate all evaluation research studies on rehabilitation programs for offenders, drug abusing and non-drug abusing alike, conducted since 1968, i.e., since the studies reported by Lipton, Martinson and Wilks in The Effectiveness of Correctional Treatment: A Survey of Treatment Evaluation Studies (1975). This three-year project also will conduct a comprehensive detailed review of such studies in all levels of criminal justice custody. It will seek out all credible evaluation studies of treatment of offenders from all countries, examine and assemble them to inform policy and practice in the most meaningful way. This will include performing, a variety of analyses including meta-analyses comparing the effect of each treatment on each of the outcome variables and assessing the degree to which a variety of program and client characteristics have effects on outcomes. The original survey, The Effectiveness of Correctional Treatment, which...

An organizational analysis of service patterns in outpatient drug abuse treatment units

The effectiveness of drug abuse treatment depends in part on meeting clients' medical and social needs related to drug abuse. Yet, we know little about the type and amount of medical and social services that clients receive in outpatient drug abuse treatment units. This article addresses this issue, drawing from conceptual perspectives in organizational theory and using data from a national random sample of 481 outpatient treatment units that participated in a phone survey in both 1988 and 1990. We examine the extent to which clients in these units receive: physical (medical) and mental health care; special treatment for multiple drug abuse; and employment, financial, and legal counseling. Results from a multivariate analysis of variance (MANOVA) indicate that there was a significant decrease from 1988 to 1990 in all services we examined. Regression analyses were conducted to identify organizational and client characteristics related to these decreases. Results show that changes in both client characteristics and key organizational factors (e.g., resources, staffing) are significantly related to decreases in the services clients receive. Implications for meeting the medical and social service needs of drug abuse clients are discussed.

Book Review: The Effectiveness of Drug Abuse Treatment: Dutch and American Perspectives

Book Review: The Effectiveness of Drug Abuse Treatment: Dutch and American Perspectives

The effectiveness of treatment for substance abuse: Reasons for optimism

Reviews of treatment research have sometimes drawn gloomy conclusions which clash with the experience of clinicians. Yet the same literature provides reasons for optimism about the future of substance abuse treatment. There are treatment strategies with encouraging evidence of effectiveness that are only beginning to be applied in practice. Furthermore, research is clarifying the mechanisms and reasons for successful treatment, pointing to factors to be emphasized in therapy. Approaches that yield even short-term advantages can promote more rapid recovery, and may provide clues for how to prevent relapse. In difficult economic times, hope is also provided by evidence that even relatively brief treatment can be substantially more effective than none at all. Recent evidence also supports the importance of matching clients to alternative treatment strategies. To the extent that practitioners can keep abreast of such developments and adjust their clinical work accordingly, there is reason to believe that the effectiveness of substance abuse treatment can be greatly increased.

Assessing outpatient drug abuse treatment programs

Drug abuse is a major domestic health problem in the United States, and evaluators, policy makers, interest groups, and the general public are critically interested in knowing which treatments work best. Costs of drug abuse in America are conservatively estimated at 47 billion dollars per year (Harwood, 1984). It is estimated that over 27 million persons in households in the United States, or about one in every ten Americans, used illicit drugs in 1990 (National Institute on Drug Abuse, 1991). The Drug Abuse Reporting Program (DARP) and the Treatment Outcome Prospective Study (TOPS) represent two major drug abuse treatment outcome studies. The DARP study tracked over 44,000 drug users admitted to 52 drug abuse treatment programs during 1969-1973. DARP found that demographic and socioeconomic characteristics explained only a small amount of outcome variance (Sells and Simpson, 1980). Better predictors of treatment outcome were the length of time in treatment and the behavior during treatment (Simpson et al., 1982). TOPS included 11,750 drug users admitted to 41 drug abuse programs during 1979-l 98 1. A finding from this study was that drug abuse treatment reduced illicit drug use and criminal behavior (Hubbard et al., 1989). As in DARP, time in treatment was positively related to drug abuse treatment outcome. While the DARP and TOPS studies established the effectiveness of drug abuse treatment, many issues remain to be clarified. For example, more work is needed in efforts to match clients to treatment. The study of treatment process has remained tantalizingly difficult and little is known about the role that treatment structure and organization play in treatment outcome (Tims and Ludford, 1984). The purpose of this paper is to report data about outpatient treatment unit followup evaluations drawn from selected evaluation items in the recent National Drug Abuse Treatment Survey. A section of questions related to treatment evaluation activities was included in this national survey of drug abuse treatment programs. These