Residential Substance Abuse Treatment Facility Research Articles

2 Pilot Study of a Cognitive Enhancement Intervention for Substance Abuse Recovery

Objective:This was a pilot study testing a cognitive enhancement program to improve rate of cognitive recovery in early substance abuse treatment. It is hypothesized that if patients were able to accelerate the rate of cognitive improvement, they may be able to better engage in substance abuse treatment and potentially have better long-term outcomes.Participants and Methods:Participants were 47 adults newly admitted to a residential substance abuse treatment facility (74.5% male, 76.6% white, mean age=34.5 years, education=12+ years). All were post-detox. All were being treated for opioid abuse, with the majority in treatment for polysubstance abuse. Participants were randomly assigned to either the intervention group (BrainHQ research cognitive training program) or active control group (inert computer games) and completed 34 training sessions per week for a minimum of 3 weeks. NIH Toolbox cognition battery was administered at baseline and endpoint.Results:Regardless of study group, most participants had a significant improvement in cognitive performance across most subtests and composite scores of the NIH Toolbox cognition battery. The RAVLT and Oral Symbol Digit subtests had the greatest change (p<.001) for both groups, as well as a significant improvement (p=.002) in Cognitive Function Composite Score for both groups. The only difference between the control and intervention group was on the Pattern Comparison subtest, with the intervention group scoring significantly higher at endpoint (p=.004).Conclusions:Although substance abuse is known to cause injury to the brain that may not be fully repaired by sobriety, cognitive recovery was significant in this group of patients during early inpatient treatment for opioid abuse. Although it has yielded significant effect in other patient populations, the BrainHQ program did not show a significant enhancement in cognitive recovery, compared to the active control group, in this pilot study of patients in treatment for opioid abuse. This study was limited by a small sample size and potential future variations should be considered, such as changes to intervention intensity and specific intervention exercises.

Relationship Between the Five Facets of Mindfulness on Mood and Substance Use Relapse

This study examined which particular facets of mindfulness (nonreactivity, observing thoughts and feelings, acting with awareness, describing experience, and nonjudging of experience) accounted for improvements in mood and warning signs of relapse in an adult population. This exploratory study examined the impact of the five facets of mindfulness on both warning signs of relapse and mood in a primarily minority adult population in a residential substance abuse treatment facility. Results showed that all five facets were significantly correlated with mood and warning signs at the bivariate level. When considering the facets together, observing and nonjudging were related to mood, and acting with awareness and nonjudging were related to warning signs. Implications for future research and practice are offered.

Distress tolerance interacts with circumstances, motivation, and readiness to predict substance abuse treatment retention

BackgroundOur understanding of the conditions that influence substance abuse treatment retention in urban African American substance users is limited. This study examined the interacting effect of circumstances, motivation, and readiness (CMR) with distress tolerance to predict substance abuse treatment retention in a sample of urban African American treatment-seeking substance users. MethodsData were collected from 81 African American substance users entering residential substance abuse treatment facility in an urban setting. Participants completed self-reported measures on CMR and distress tolerance. In addition, participants were assessed on psychiatric comorbidities, substance use severity, number of previous treatments, and demographic characteristics. Data on substance abuse treatment retention were obtained using administrative records of the treatment center. ResultsLogistic regression analysis found that the interaction of CMR and distress tolerance was significant in predicting substance abuse treatment retention. Higher score on CMR was significantly associated with increased likelihood of treatment retention in substance users with higher distress tolerance, but not in substance users with lower distress tolerance. ConclusionsFindings of the study indicate that at higher level of distress tolerance, favorable external circumstances, higher internal motivation, and greater readiness to treatment are important indicators of substance abuse treatment retention. The study highlights the need for assessing CMR and distress tolerance levels among substance users entering treatment, and providing targeted interventions to increase substance abuse treatment retention and subsequent recovery from substance abuse among urban African American substance users.

Further Validation of Triarchic Psychopathy Scales From the Multidimensional Personality Questionnaire: Setting the Stage for Large-Sample Etiological Studies.

Psychopathy as conceptualized by the triarchic model encompasses three distinct dispositional constructs: boldness, meanness, and disinhibition. The current study sought to further validate triarchic (Tri) construct scales composed of items from the Multidimensional Personality Questionnaire (MPQ) as a foundation for advancing research on the etiology of psychopathy using existing large-scale longitudinal studies. MPQ-Tri scales were examined in three samples: mixed-gender undergraduate students ( N = 346), male offenders from a residential substance abuse treatment facility ( N = 190), and incarcerated female offenders ( N = 216). Across these three samples, the MPQ-Tri scales demonstrated high internal consistency and clear convergent and discriminant associations with criterion measures of psychopathy and other psychopathology outcomes. Gender comparisons revealed relatively few differences in relationships with criterion measures. Findings are discussed in terms of their implications for further investigation of the causal bases of psychopathy and other forms of psychopathology utilizing data from large etiologically informative studies.

Negative affect, negative urgency, thought suppression, and bulimic symptoms: a moderated mediation analysis in a sample at-risk for bulimic symptoms.

Research suggests that negative affect, negative urgency, and thought suppression are related to bulimic symptoms, either directly or indirectly. This study examined associations between these constructs in a sample at-risk for bulimic symptoms. Participants (N = 80) recruited from a residential substance abuse treatment facility completed self-report questionnaires. A regression-based bootstrapping approach was used to examine the indirect effect of negative affect on bulimic symptoms through negative urgency and the moderating role of thought suppression in the association between negative affect and negative urgency. Results revealed a significant indirect effect, significant moderation, and a significant moderated mediation effect, with an indirect effect of negative affect on bulimic symptoms through negative urgency, conditional upon low to moderate (but not high) levels of thought suppression. These findings suggest that negative affect may promote rash actions, particularly in the context of low to moderate thought suppression, leading to increased risk of bulimic symptoms.

An assessment of an automated EEG biofeedback system for attention deficits in a substance use disorders residential treatment setting.

Attention deficits are prevalent among individuals with substance use disorders and may interfere with recovery. The present study evaluated the effectiveness of an automated electroencephalogram (EEG) biofeedback system in recovering illicit substance users who had attention deficits upon admission to a comprehensive residential treatment facility. All participants (n = 95) received group, family, and individual counseling. Participants were randomly assigned to 1 of 3 groups that either received 15 sessions of automated EEG biofeedback (AEB), 15 sessions of clinician guided EEG biofeedback (CEB), or 15 additional therapy sessions (AT). For the AEB and CEB groups, operant contingencies reinforced EEG frequencies in the 15-18 Hz (β) and 12-15 Hz (sensorimotor rhythm, "SMR") ranges and reduce low frequencies in the 1-12 Hz (Δ, θ, and α) and 22-30 Hz (high β) ranges. The Test of Variables of Attention (TOVA), a "Go-NoGo" task, was the outcome measure. Attention scores did not change on any TOVA measure in the AT group. Reaction time variability, omission errors, commission errors, and d' improved significantly (all p values < .01) in the AEB and CEB groups. AEB and CEB did not differ significantly from each other on any measure. The results demonstrate that automated neurofeedback can effectively improve attention in recovering illicit substance users in the context of a comprehensive residential substance abuse treatment facility.

Emotion Regulation Difficulties and Maladaptive Behaviors: Examination of Deliberate Self-harm, Disordered Eating, and Substance Misuse in Two Samples

Data from two studies were utilized to examine whether the co-occurrence of maladaptive behaviors thought to serve an emotion regulating function would be associated with greater emotion regulation difficulties compared to one or none of these behaviors. Study 1 included an undergraduate sample (N = 119; 76 % female) and Study 2 included a sample of patients receiving treatment at a residential substance abuse treatment facility (N = 82; 48 % female). Subgroups were created based on the presence or absence of the following maladaptive behaviors: (a) deliberate self-harm (DSH) and disordered eating (Study 1); and (b) DSH, disordered eating, and substance misuse (Study 2). Subgroup differences in mean levels of emotion regulation difficulties (overall and six dimensions) were evaluated for each study. In Study 1, individuals who reported clinically-relevant levels of both DSH and disordered eating had more difficulties with emotion regulation (overall and three dimensions) compared to those who reported neither behavior. In Study 2, individuals who reported clinically-relevant levels of both DSH and substance misuse had more difficulties with emotion regulation (Study 2; overall and five dimensions) compared to those with only substance misuse. Overall, the results of these studies support the hypothesis that the co-occurrence of clinically-relevant maladaptive behaviors is associated with greater difficulties regulating emotions than the presence of only one maladaptive behavior (or no maladaptive behaviors). These findings suggest that clinical interventions targeting emotion regulation skills may be particularly useful for individuals who display a pattern of co-occurring maladaptive behaviors.

Trait mindfulness and early maladaptive schemas in women seeking residential substance use treatment: A preliminary investigation

Mindfulness has received an abundance of research attention in recent years, largely due to mindfulness-based interventions demonstrating positive mental and physical health outcomes. However, less research has examined individual’s trait levels of mindfulness and how it is related to mental health, particularly among individuals seeking substance use treatment. Therefore, in the current study, we examined the relation between trait mindfulness and early maladaptive schemas (EMS), which are dysfunctional cognitive and behavioural patterns that theoretically underlie the development of mental health problems, among women seeking residential substance use treatment. Pre-existing, adult female, patient records from a residential substance abuse treatment facility were reviewed (N = 67). Results demonstrated that higher trait mindfulness was negatively associated with 12 of the 18 EMS. Moreover, patients who endorsed multiple EMS reported lower trait mindfulness than patients who endorsed zero (or one) EMS. These findings are the first to examine the relation between trait mindfulness and EMS among women seeking substance use treatment. Findings suggest that EMS and trait mindfulness are robustly related and future research should examine whether mindfulness-based interventions reduce EMS.

The interactive role of distress tolerance and eating expectancies in bulimic symptoms among substance abusers

Difficulties tolerating distress and the expectancy that eating will relieve negative affect have been linked with bulimic symptoms, which commonly co-occur with other forms of psychopathology characterized by emotion dysregulation (e.g., substance abuse). Indeed, problems with emotional functioning may be of particular relevance to bulimic symptoms in at-risk populations with heightened emotion dysregulation (such as substance use disorder patients). This study examined the interactive role of two emotion-related constructs (distress tolerance and the expectancy that eating relieves negative affect) in relation to bulimic symptoms among patients (N=93) recruited from a residential substance abuse treatment facility. Participants completed the Bulimia Test-Revised, the Positive and Negative Affect Schedule, the Distress Tolerance Scale, and the Eating Expectancy Inventory. A hierarchical multiple regression analysis was conducted to examine the main effects and interaction of distress tolerance and negative affect eating expectancies in relation to bulimic symptoms, controlling for participant gender and overall negative affect. Significant main effects were found for both distress tolerance and negative affect eating expectancies, and these two constructs were found to significantly interact in the prediction of bulimic symptoms. Interventions that address these constructs may be useful in treating those with bulimic symptoms, as well as those with co-occurring bulimic symptoms and substance use disorders.

Distress Tolerance as a Predictor of Depressive and Posttraumatic Stress Symptoms in a Substance Use Disorder In-Patient Treatment Sample

Distress Tolerance as a Predictor of Depressive and Posttraumatic Stress Symptoms in a Substance Use Disorder In-Patient Treatment Sample Previous research has revealed significant associations between distress tolerance (DT) with the maintenance and extinction of various symptoms of psychopathology. The current study investigated DT as a predictor of symptom experience in depression, and posttraumatic stress symptoms (PSS) in a substance abuse population. Participants were 64 men and women enrolled in a residential substance abuse treatment facility who completed self-report measures of DT, depressive symptoms, and PSS. Results demonstrated that DT significantly predicted both depressive symptoms and PSS.

Cannabis Use Among High‐Risk Youth inIsrael (2004–2011): An Examination of Gender and Country of Origin Status

Scant knowledge exists about high-risk adolescents who are school dropouts in treatment for substance abuse. This study aims to examine the patterns of cannabis (i.e., marijuana and hashish) use among school dropouts receiving substance abuse treatment based on their gender and country of origin status (i.e., Israeli and former Soviet Union-FSU). A total of 628 dropouts referred to a residential substance abuse treatment facility in Israel from 2004 to 2011 were studied. Chi-square and t test analyses were used to determine the impact of gender and country of origin status on cannabis use. Significant differences exist for age of first, lifetime, and last 30-day cannabis use. FSU youths begin cannabis at an earlier age. Cannabis use tends to be higher among males and those with Israeli country of origin status. Furthermore, cannabis use among dropouts is much higher than those attending school. Gender and country of origin status have implications that should be of concern to healthcare professionals treating adolescent substance abuse. Further research is needed to validate the study findings both in Israel and other countries for policy, training, and treatment purposes.

Changes in Coping Strategies over Time in a Residential Substance Use Disorder Treatment Population: A Preliminary Assessment

Coping is an important part of substance use disorders in terms of use, treatment, and recovery. In this longitudinal study, participants were 25 patients at a 28- to 90-day residential substance abuse treatment facility. All coping strategies were measured using the Urge-Specific Coping Strategies and General Coping Strategies measures. Paired samples t tests assessed the change in use of coping skills over the course of treatment. Frequency of using behavioral and cognitive urge-specific and general lifestyle strategies changed over treatment. Additionally, efficacy of behavioral and cognitive general lifestyle coping strategies increased over the course of treatment.

Early Maladaptive Schemas in a Sample of Airline Pilots seeking Residential Substance Use Treatment: An Initial Investigation.

Recent research has begun to examine the early maladaptive schemas of substance abusers, as it is believed that targeting these core beliefs in treatment may result in improved substance use outcomes. One special population that has received scant attention in the research literature, despite high levels of substance use, is airline pilots. The current study examined the early maladaptive schemas of a sample of airline pilots (n = 64) who were seeking residential treatment for alcohol dependence and whether they differed in early maladaptive schemas from non-pilot substance abusers who were also seeking residential treatment for alcohol dependence (n = 45). Pre-existing medical records from patients of a residential substance abuse treatment facility were reviewed for the current study. Of the 18 early maladaptive schemas, results demonstrated that pilots scored higher than non-pilots on the early maladaptive schema of unrelenting standards (high internalized standards of behavior), whereas non-pilots scored higher on insufficient self-control (low frustration tolerance and self-control). Early maladaptive schemas may be a relevant treatment target for substance abuse treatment seeking pilots and non-pilots.

Service Learning as a Mechanism for Change in Attitudes and Perceptions of Human Services Students Toward Substance-Dependent Mothers

The purpose of the study was to explore the potential effectiveness of service learning as a pedagogical technique for providing substance abuse education to human services/social work students. Using a quasi-experimental design, the authors assigned 38 human services undergraduate students to experimental and comparison groups on the basis of their availability to attend a service-learning project in substance abuse. The service learning consisted of a 30-min educational presentation followed by a visit to a residential substance abuse treatment facility for women. Results indicated that service learning in substance abuse had a positive effect on the general knowledge, perceptions, and attitudes of human services students toward substance-dependent mothers and their children. The findings from this exploratory study support future research in this area.

Structure, reliability, and predictive validity of the Texas Christian University Correctional Residential Self-Rating Form at Intake in a residential substance abuse treatment facility

This study examined the structure and predictive validity of the Texas Christian University Correctional Residential Self-Rating Form at Intake in a court mandated inpatient substance abuse treatment facility ( N = 729). Client characteristics such as treatment motivation and psychological and social functioning were examined as predictors of prospective behavioral outcomes including compliance with treatment program rules and guidelines as well as completion of the treatment program. Results suggest that a broad indicator of individuals' pretreatment motivation predicted their ability to complete the program. Treatment noncompliance, as measured by the number of rule infractions committed during the inpatient treatment, was significantly predicted by individuals' propensity to externalize their symptoms. Implications for the effective use of the CR SRF-Intake as a screener for potential treatment problems are discussed as well as possible targets for interventions in substance abuse populations.

Changes in parenting attitudes and knowledge among inmates and other at-risk populations after a family nurturing program

Introduction Parenting dysfunction can lead to child abuse and neglect, and parent education programs have been developed to improve parenting attitudes, knowledge and practices. We modified the Family Nurturing Program to be implemented among inmates, parents in substance abuse recovery and other at-risk populations and measured its effects on parenting knowledge and attitudes. Methods Multiple groups with 5–30 participants each were held in five different settings: county jail substance abuse rehabilitation program, county jail batterers intervention program, residential substance abuse treatment facility, general community referrals, and community parenting camp program. Baseline risk for potential child maltreatment was measured using the Child Abuse Potential Inventory, and parenting attitudes and knowledge were measured using the revised Adult Adolescent Parenting Inventory (AAPI-2). Results Among 781 participants recruited, 484 were incarcerated. No significant differences in changes in parenting attitudes were noted based on location. Males showed greater improvement in AAPI-2 scores in all groups, with greater gains in knowledge about empathy, expectations and use of corporal punishment. Those with high abuse potential showed greater improvements. Conclusions A parenting program based on the Family Nurturing Program results in improvements in parenting attitudes and knowledge in multiple at-risk populations. While program implementation at the locations was different, changes in scores were related to participant gender, number of classes and a priori child abuse potential risk.

Distress Tolerance as a Predictor of Early Treatment Dropout in a Residential Substance Abuse Treatment Facility.

A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed.

Reducing Adolescent Clients’ Anger in a Residential Substance Abuse Treatment Facility

Sundown Ranch, a residential behavioral health care treatment facility for adolescents, tracked the progress and results of treatment by selecting performance measures from a psychosocial screening inventory. The temper scale was one of the two highest scales at admission and the highest scale at discharge. A clinical performance improvement (PI) project was conducted to assess improvements in clients' ability to manage anger after the incorporation of Rational Emotive Behavior Therapy (REBT) into treatment. Eighteen months of baseline data (July 1, 1999 - February 1, 2001) were collected, and 20 months of data (May 1, 2001 - December 31, 2002) were collected after the introduction of the PI activity. In all, data were collected for 541 consecutive admissions. A comparison of five successive quarterly reviews indicated average scores of 1.4 standard deviations (SDs) above the mean on the temper scale before the PI activity and .45 SD above the mean after. The performance threshold of reduction of the average temper scale score to < or =1 SD was met for 17 of 20 months. The fact that the PI activity reduced the temper scale elevations by almost one full SD is highly suggestive of the efficacy of REBT with the treatment population. After the project was completed, REBT was promoted as an additional therapeutic modality within the treatment program.

Psychological Distress Tolerance and Duration of Most Recent Abstinence Attempt Among Residential Treatment-Seeking Substance Abusers.

This study investigated the relationship between duration of most recent drug and alcohol abstinence attempt and psychological distress tolerance, as indexed by persistence on a mental arithmetic task (the Paced Auditory Serial Addition Task; D. M. A. Gronwall, 1977), in 89 individuals in an inner-city residential substance abuse treatment facility. Results indicated that most recent abstinence duration was related to persistence on the psychological stressor, beyond the influence of demographics, substance use level, and negative affect. These findings extend previous work (T. H. Brandon et al., 2003; R. A. Brown, C. W. Lejuez, C. W. Kahler, & D. Strong, 2002) reporting significant relationships between persistence on laboratory challenge procedures and duration of abstinence following a quit attempt in smokers, suggesting that common processes account for relapse across addictions. Systematic replications including a prospective design are recommended.

Voucher‐based incentives for cigarette smoking reduction in a women's residential treatment program

Participants were women (N = 16) living with their children in a residential substance abuse treatment facility. In this within-subjects repeated measures study, a 1-week baseline was followed by a 4-week intervention and a 2-week follow-up (same as the baseline). The intervention consisted of exposure to an educational video and a smoking cessation workbook, brief individual support meetings, and an escalating schedule of voucher-based reinforcement of abstinence. Throughout the study, three daily breath samples (8 a.m., noon, and 4 p.m.) were collected Monday through Friday to determine carbon monoxide (CO) concentration. In addition, urine cotinine (COT) was assessed on Monday mornings to monitor weekend tobacco use. Participants received vouchers of escalating value for CO-negative breath and COT-negative urine samples. Positive samples reset the voucher value. Significantly more negative tests were submitted during the intervention than during baseline and follow-up. The intensive behavioral intervention evaluated in this study produced a substantial reduction in cigarette smoking, and 25% of participants remained abstinent 2 weeks after the intervention was suspended. Nevertheless, the percentage of CO-negative samples submitted during the follow-up returned to baseline levels. While retaining many real-world characteristics, residential treatment facilities provide important opportunities for smoking cessation treatment and research.