Residential Drug Research Articles

The Impact of Residential and Nonresidential Drug Treatment on Recidivism Among Drug-Involved Probationers

A variety of approaches for addressing drug use and drug-related crime among the nearly 5 million offenders on community supervision in the United States has been tried and evaluated, but questions remain about which policies or programs are most effective. The authors use a large data set to assess the impact of residential and nonresidential drug treatment on recidivism. Propensity score matching is used to establish equivalent treatment and comparison groups and to enable comparisons of treatment type. Survival analysis is used to determine the extent to which each treatment modality and numerous covariates were associated with time until recidivism. Compared to those receiving no treatment, those receiving nonresidential treatment took longer to fail or recidivate. However, those receiving residential treatment did not differ from those who received no treatment in time to failure. In the treatment-only model, nonresidential treatment participants took longer to fail than their matched residential treatment counterparts.

The impact of foster care and Temporary Assistance for Needy Families (TANF) on women's drug treatment outcomes

This study assesses the impact of having a child in foster care and receiving cash benefits through Temporary Assistance for Needy Families (TANF) on women's completion of a residential drug treatment program. The study's hypothesis was that drug treatment completion rates for women who had children in foster care and/or who were receiving TANF would differ from women who did not receive these services. The sample included 117 women age 19 to 54, in a Midwestern state. Findings suggest that women with a child or children in foster care were less likely to complete treatment. Women receiving cash benefits were also somewhat less likely to complete treatment than women not receiving these services. Women with children in foster care had similar levels of psychological, employment, and drug and alcohol concerns as other women, as measured by the Addiction Severity Index. Future research should focus on identifying strategies that enhance retention rates of these vulnerable women. Implications for improving treatment retention are discussed in light of the Adoption and Safe Families Act of 1997 and the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

Mother-infant consultation during drug treatment: research and innovative clinical practice.

BackgroundThis paper details a model for consulting with mothers and infants, and drug treatment staff used in a residential drug treatment program and relevant to other treatment settings. The role of parent-infant consultation based on the Neonatal Network Neurobehavioral Scale (NNNS) was evaluated.MethodsA sequential cohort model was used to assign participants to 1. NNNS consultation versus 2. standard care. The effects of NNNS consultation were evaluated using the Parenting Stress Index and NNNS summary scores.ResultsParticipants in the NNNS consultation condition had significantly less stress overall, and less stress related to infant behavior than participants in standard care. There were no differences in infant behavior on the NNNS Summary scores.ConclusionThe implications for NNNS consultation in drug treatment programs is outlined. The importance of prevention/intervention to establish satisfactory mother-infant interaction in recovery programs which include a central parenting component is indicated.

Substance Abuse Problems, Psychiatric Symptoms, and Post-Treatment Status in MCMI Psychopathology Subgroups of Cocaine Dependent Males

This study involved cluster analysis of Millon Clinical Multiaxial Inventory-II (MCMI-II) records of 304 cocaine dependent males and examined differences among personality-based clusters in medical, legal, employment, drug, alcohol, family, and psychiatric problem severity at treatment intake and in outcome status during the 12 months after completion of residential drug treatment. A hierarchical cluster analysis (Ward's method) was used to identify 4 cluster subgroups: antisocial, subclinical, neurotic, and high psychopathology. MANOVA revealed that membership in Neurotic and High Psychopathology Cluster subgroups was linked with more severe family and psychiatric problems at treatment intake than found in the Subclinical Cluster Subgroup (all ps <. 05). The High Psychopathology Cluster Subgroup also had more severe drug problems at intake than did the Subclinical Subgroup (p <. 05). Logistic regression analysis revealed that membership in the High Psychopathology Subgroup predicted relapse/loss to follow-up status after controlling for age, education, ethnicity, treatment program attended, and pretreatment cocaine use frequency (X2 = 21.25, df = 3, p <. 001).

Predictors of Retention in an Alternative-To-Prison Substance Abuse Treatment Program

This longitudinal study examines predictors of retention among alternative-to-prison substance abuse treatment clients. The roles of motivational factors and the client-therapist relationship are examined. The sample was composed of 141 male felony offenders who were legally mandated to a community-based, long-term residential drug treatment program. Results support the following conclusions: (a) retention in treatment is positively related to motivation to change; (b) motivation to change, particularly recognition of a drug problem, is positively related to the therapeutic alliance; and (c) changes in motivation in response to treatment are positively related to the therapeutic alliance. Implications of these findings for treatment and research are discussed.

Smoking Among Adolescents in Substance Abuse Treatment: A Study of Programs, Policy, and Prevalence

The study was designed to: (1) identify smoking policies and interventions in adolescent residential treatment settings; (2) examine the prevalence of smoking among adolescents in these settings; and (3) assess relationships between program-level smoking policies and client-level smoking. The Center for Substance Abuse Treatment funded 17 sites to evaluate the effectiveness of Adolescent Residential Treatment (ART) programs for substance abuse. To describe program smoking policies and interventions, we conducted phone interviews with one key informant at each program (N = 12). To describe client smoking behaviors, we conducted a secondary data analysis of baseline data for adolescents (N = 912) entering ART programs. All sites had no smoking indoors and 75% of the site had tobacco-free grounds for adolescents. Forty-two percent provided their youth with nicotine replacement therapy, and 42% provided counseling for smoking cessation. Also. 33% did not allow staff smoking on and off campus. The prevalence of any smoking in the past month was 66%, and 22% of current smokers were daily smokers at admission. Where smoking was allowed on grounds, adolescents more often reported recent smoking. Smoking behavior is prevalent among adolescents in residential drug treatment, and should be addressed in all such programs through policy implementation and client-level smoking cessation intervention.

Organizational Change in a Perinatal Treatment Setting: Integration of Clinical Practice and Policies on Tobacco and Smoking Cessation

Perinatal smoking presents serious health risks to the fetus, mother, and child. Despite extensive evidence of risk and high rates of smoking among in-treatment perinatal women substance abusers, tobacco-related practice and policy change has not been widely transferred for application in drug abuse treatment programs for pregnant and parenting women. This qualitative study investigated the process of change and the resultant adoption of clinical policy and treatment innovation in a residential drug abuse treatment program that converted from tobacco-tolerant to tobacco-free with provision of smoking cessation services. Informed by the Organizational Readiness for Change Model, staff interviews and data analysis were conducted to examine program characteristics affecting adoption. An organizational climate of openness to change and the program's clarity of mission, expressed in perinatal-specific motivators for change, influenced the adoption of tobacco-related clinical practice and policy. Re-allocation of time, previously occupied by smoking behaviors, allowed for added promotion of maternal-child interaction and positive role-model ing for children.

Health-Related Quality of Life Among Substance Abusers in Residential Drug Abuse Treatment

Health-related quality of life (HRQOL) in substance abusers remains an area of inquiry in need of investigation. The few studies on the topic have found substance abuser HRQOL less than that of the general population. The present research compared 303 substance abusers in long-term residential therapeutic community treatment in New York with a general non-institutionalized adult sample from New York (N = 27,465) whose data were collected between 2002 and 2006 during the yearly administrations of the Behavioral Risk Factor Surveillance System (BRFSS), a state-based system of health surveys gathering data from upwards of 350,000 adults per year across all 50 states. One sample t-tests found that the in-treatment substance abusers reported significantly more physically and mentally unhealthy days over the past 30 days, as well as significantly more inactive days over the past 30 days due to illness.

Reading between the lines: the experiences of taking part in a community reading project

Despite the popularity of reading groups, and the increased number of general-practitioner-referred bibliotherapy schemes in the UK, there has been relatively little research on the effects of reading works of...

Cardiovascular Risk Factors and Metabolic Syndrome in Alcohol- and Nicotine-Dependent Men and Women

Cardiovascular disease (CVD) is a leading cause of mortality among alcohol-dependent people; however, minimal data exist on the CVD risk factor profile in this high-risk population. The purpose of this study was to examine the prevalence and clustering of traditional and novel CVD risk factors, including components of the metabolic syndrome, in nicotine- and alcohol-dependent adults. Participants (n = 46; 61% men; 87% white), who were a consecutive series of eligible adults (19-56 years of age; mean, 34.8 +/- 1.4 years; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-classified alcoholic; abstinent for <or=7 days), were assessed on entry to a residential drug treatment facility. Cardiovascular disease risk factors were measured using standardized protocols and interview-administered, self-report inventories adapted from epidemiological studies. Dyslipidemia and metabolic syndrome were identified using Adult Treatment Panel III criteria; hypertension was classified by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure criteria. Enzymatic, colorimetric, and immunochemiluminometric techniques were used to measure plasma lipids, homocysteine, and high-sensitivity C-reactive protein, respectively. Dyslipidemia was identified in 74% of participants; 54% were overweight or obese (body mass index, >or=25 kg/m2); 61% were physically inactive (<1,000 kcal/wk); and 61% had some form of hypertension. In addition, 54% had increased homocysteine values; high-sensitivity C-reactive protein was elevated in 28%; and 22% of the participants met criteria for metabolic syndrome. In this study of the CVD risk profile among alcoholics, subjects were found to have an average of 3 CVD risk factors in addition to cigarette smoking. This prevalence and clustering of potentially modifiable risk factors in young, nicotine-dependent alcoholics indicate the need for aggressive risk reduction focused on prevention of CVD.

Does higher cost mean better quality? evidence from highly-regarded adolescent drug treatment programs

We conducted a survey to examine whether reimbursement levels are associated with the quality of adolescent substance use treatment programs in the United States. Between March and September 2005, telephone and written surveys were administered to program, clinical, and finance directors of previously surveyed highly regarded programs. Differences in quality scores were compared for programs with above versus below median reimbursement levels and examined in multivariate regression models constructed separately for programs offering residential and outpatient treatment. In residential treatment multivariate regression models, higher quality scores were associated with higher reimbursement, but this relationship was not observed for outpatient treatment. Even the highest level of outpatient reimbursement received may be too low to support quality improvement initiatives. Our results suggest that higher reimbursement may be a necessary component of quality improvement for residential adolescent drug treatment programs, and emphasize the need for further research to determine what levels of reimbursement and insurance coverage policies will encourage the expansion of high quality outpatient programs.

Client retention in residential drug treatment for Latinos

Client drop out from treatment is of great concern to the substance abuse field. Completion rates across modalities vary from low to moderate, not ideal since length of stay has been positively and consistently associated with better client outcomes. The study explored whether client characteristics shown to be related to retention were associated with treatment completion and treatment duration for a sample of 164 Latino substance users who entered a culturally focused residential program. In-person client interviews were conducted within a week of program admission. Logistic regression analysis was used to examine research questions. Clients most likely to drop out had self-reported co-occurring psychiatric diagnoses; they were 81% less likely to complete the program, suggesting that clients with mental health problems have a more difficult time remaining in residential treatment. Clients using drugs in the three months prior to entry were three and a half times more likely to be in the shorter stay group, and clients who lived in institutions prior to program entry were three times more likely to be in the longer-stay group. Factors contributing to drop out for this Latino sample were similar to those identified in the literature for non-Latino samples. Methods for addressing the needs of clients with co-occurring disorders are discussed.

Role of social support and self-efficacy in treatment outcomes among clients with co-occurring disorders

Individuals with co-occurring substance use and psychiatric disorders have a more severe clinical course and poorer outcomes than do individuals with one disorder. In an attempt to find intervening variables that may contribute to improvement in treatment outcomes among individuals with co-occurring disorders, we investigated the roles of social support and self-efficacy in a sample of 351 clients with co-occurring disorders in residential drug abuse treatment programs (53% male; 35% African American, 13% Hispanic). Given their demographic variability, we also explored how ethnicity and age influence self-efficacy and access to social support, as well as their relationships to the outcomes. Structural equation modeling was used to examine the impact of the demographics and baseline psychological status, substance use, social support, and self-efficacy on mental health and substance use outcomes 6 months after treatment entry. Time in treatment was included as a control. Greater social support at baseline predicted better mental health status and less heroin and cocaine use; greater self-efficacy predicted less alcohol and cocaine use. Older clients reported less social support. African-American ethnicity was associated with more cocaine use at baseline and follow-up; however, African Americans reported more self-efficacy, which moderated their cocaine use. The current study highlights the potential therapeutic importance of clients’ personal resources, even among a sample of severely impaired individuals.

Residential Mobility and Gateway Drug Use Among Hispanic Adolescents in the U.S.: Evidence from a National Survey

Residential mobility has been an important topic in public health for the past decades. More than 22 million Americans migrated from state to state in 2000, but characteristics of minority American movers are not well documented in the aspect of public health. Using the U.S. national survey, we examined the association between residential mobility and gateway drug use among Hispanic adolescents in the U.S. Frequent movers and never movers were compared in the study. The study results indicate that frequent movers (moved more than 4 times for the past 5 years) were more likely than never movers to smoke and use marijuana. We also found that frequent residential relocation, females, and older teenagers () are risk factors of gateway drug use among Hispanic adolescents.

Concurrent Substance-Related Disorders and Mental Illness: Management at the Community Residential Drug Withdrawal Service

Concurrent Substance-Related Disorders and Mental Illness: Management at the Community Residential Drug Withdrawal Service

Gender differences among Israeli adolescents in residential drug treatment

Aims: The use of licit and illicit drugs is considered to be primarily a male problem. Numerous studies, however, question the extent of gender differences. This article reports on last 30 day drug use and related problem behaviour among male and female youth prior to residential treatment.Methods: Self-report data were collected from 95 male and female adolescents, age 13 to 18 years, at intake for treatment.Findings: Gender was not a factor differentiating the youth for cigarette, alcohol, cannabis, ecstasy, inhalant, and amphetamine use. Males were more likely to report hashish use. Females, however, were more likely to report use of prescription drugs, cocaine and heroin. No gender differences were found for binge drinking, driving a car after drinking or being a passenger in a car after the driver had been drinking, selling drugs, deterioration of relations with friends and family, gambling, taking loans or using personal money to buy drugs.Conclusion: Drug use and related behaviour among adolescents in residential treatment does not appear to be predominately a male problem. Further research is needed to understand the role of gender status in relation to what drugs are used and how for prevention, treatment and public health purposes.

Detoxification in Rehabilitation in England: Effective continuity of care or unhappy bedfellows?

There is evidence that residential detoxification alone does not provide satisfactory treatment outcomes and that outcomes are significantly enhanced when clients completing residential detoxification attend rehabilitation services (Gossop, Marsden, Stewart, & Rolfe, ; Ghodse, Reynolds, Baldacchino, et al., ). One way of increasing the likelihood of this continuity of treatment is by providing detoxification and rehabilitation within the same treatment facility to prevent drop‐out, while the client awaits a rehabilitation bed or in the transition process. However, there is little research evidence available on the facilities that offer both medical detoxification and residential rehabilitation. The current study compares self‐reported treatment provision in 87 residential rehabilitation services in England, 34 of whom (39.1%) reported that they offered detoxification services within their treatment programmes. Although there were no differences in self‐reported treatment philosophies, residential rehabilitation services that offered detoxification were typically of shorter duration overall, had significantly more beds and reported offering more group work than residential rehabilitation services that did not offer detoxification. Outcomes were also different, with twice as many clients discharged on disciplinary grounds from residential rehabilitation services without detoxification facilities. The paper questions the UK classification of residential drug treatment services as either detoxification or rehabilitation and suggests the need for greater research focus on the aims, processes and outcomes of this group of treatment providers.

Providing Recovery Services for Offenders with Co-Occurring Disorders

ABSTRACT Objectives: Providing adequate treatment and supervision for drug offenders with co-occurring disorders has been a challenge because they are usually not eligible for drug court and often fail to comply with the conditions of probation in other drug diversion programs. Here we report the results of a process evaluation of the Co-Occurring Disorders Court (CODC) implemented by the Superior Court of the County of Orange, California. Methods: Drug offenders who are chronically, persistently mentally ill and diagnosed with bipolar disorder, schizophrenia, or a major depressive disorder participated in an 18-month program that provides integrated treatment. Following evaluation by a psychiatrist and the drug court team (judge, public defender, probation officer, and mental health caseworker), they are placed on medication and referred to residential and/or outpatient drug treatment. During the program they are randomly drug tested and their progress is monitored by the drug court team; they receive sanctions for program noncompliance or rewards for program compliance. Results: In the first two years of operation the CODC admitted 72 offenders. The study findings indicate the majority of participants are being stabilized on their medications, which increases their treatment stay and improves their quality of life. At 6 months the participants show advances in social functioning, decreasing problems due to substance use, and productivity in the achievement of life goals. Conclusions: The results of the process evaluation indicate the program is achieving the stated objectives. The services provided to the CODC participants are well coordinated, offering continuity of care between the community and jail as well as extensive case management and supervision.

Client and counselor attitudes toward the use of medications for treatment of opioid dependence

Attitudes, perceived social norms, and intentions were assessed for 376 counselors and 1,083 clients from outpatient, methadone, and residential drug treatment programs regarding four medications used to treat opiate dependence: methadone, buprenorphine, clonidine, and ibogaine. Attitudes, social norms, and intentions to use varied by treatment modality. Methadone clients and counselors had more positive attitudes toward the use of methadone, whereas their counterparts in residential and outpatient settings had neutral or negative assessments. Across modalities, attitudes, perceived social norms, and intentions toward the use of buprenorphine were relatively neutral. Assessments of clonidine and ibogaine were negative for clients and counselors in all settings. Social normative influences were dominant across settings and medications in determining counselor and client intentions to use medications, suggesting that perceptions about beliefs of peers may play a critical role in use of medications to treat opiate dependence.

Follow-Up for Medical Care Among Drug Users With Hepatitis C

Prevalence of hepatitis C (HCV) in injection drug users (IDUs) is high and once HCV has been detected, follow-up medical care is essential. Six hundred and one current and former IDUs who tested positive for HCV antibodies received referrals for medical care. Twenty-four percent (147) of participants returned to be interviewed regarding their medical follow-ups. Of these, only 42% (61) had sought additional medical care in the form of further liver or blood tests or liver ultrasound. Four variables predicted seeking medical care: (a) ever being in residential drug treatment, (b) ever trading sex for money, (c) self-reported homelessness, and (d) living in one's own apartment or house. Having income from a job was inversely associated with seeking medical care. Knowledge of HCV infection alone does not mean that IDUs will seek medical care. Additional education concerning medical care and treatment options are needed to address IDU needs.