Residential Treatment Program Research Articles

Religious and spiritual struggles among military veterans in a residential gambling treatment programme

ABSTRACT Military veterans are at greater risk for problem gambling and Gambling Disorder (GD) than are civilians. For veterans and civilians alike, religious and spiritual beliefs and practices have been found to support recovery from addiction. Moreover, religious and spiritual ideas pervade Gamblers Anonymous, which remains the predominant community-based gambling treatment modality. However, no research has examined the role of spiritual struggles in GD. In this study, we assessed the presentation and course of spiritual struggles among veterans (N = 157) admitted to a residential treatment programme for GD and the relationship between spiritual struggles and gambling-related cognitions. Findings showed that a majority of veterans endorsed each type of spiritual struggle assessed. Decreases in gambling-related cognitive distortions were associated with reductions in spiritual struggles. Moral struggles were the most prevalent and unremitting of the spiritual struggles assessed. Findings highlight the need for clinicians to address spiritual struggles with problem gamblers.

Koori voices: self-harm, suicide attempts, arrests and substance use among Aboriginal and Torres Strait Islander adolescents following residential treatment

BackgroundComplex interacting social, economic and historical factors influence the availability and uptake of alcohol and drugs, including among Indigenous communities. Self-harm and suicide as well as homelessness and incarceration, can both precede and result from drug and alcohol use. Rates of self-harm, suicide and incarceration among Aboriginal and Torres Strait Islander people in Australia are among the highest in the world and drug and alcohol treatment programs need to address these underlying complexities. This study examines whether an ‘holistic’ residential drug and alcohol treatment program for adolescents, with over 30% of clients identifying as Aboriginal and Torres Strait Islander, can improve outcomes post-discharge, including reducing self-harm, suicide attempts, arrests and alcohol and drug use. The program addresses substance use, mental health, employment, accommodation, social/community and family life. Program admission and 3 months’ post-discharge data from 2007 to 2016 were analysed.ResultsFrom 2007 to 2016, 619 Aboriginal and Torres Strait Islander young people were admitted to the program; 247 stayed in the program for 30 days or more; 89 were successfully followed up three months post-discharge to determine whether there was a significant improvement from baseline using the McNemar’s Test and the Wilcoxon Signed Ranks Test. On admission, 18 people (20%) of the study population reported attempting suicide in the last 3 months and 23 people (30%) reported self-harm. Most had been engaged in the criminal justice system, with 67 people (75%) having been to court and 62 people (70%) arrested one or more times in the past 3 months, with 35 people (41%) in unstable housing, reporting having lived in three or more places in the previous 6 months. At 3 months post-treatment, all (n = 18) who reported suicide attempts in the 3 months prior to admission reported no attempts in the prior 3 months at follow-up. There was also a significant reduction in self-harm with 23 young people out of the 27 who reported self-harm at baseline not reporting self-harm at follow up (85%) and in the proportion of adolescents who reported using cannabis, amphetamines and alcohol, as well as a reduction in the proportion who reported being arrested.ConclusionsThe findings provide support for an ‘holistic’ residential treatment program as an approach to improve health and related outcomes for Aboriginal and Torres Strait Islander young people. In addition to a focus on multiple aspects of a young person’s life in treatment, culturally relevant modes of treatment and support should be a future focus to further strengthen programs when Aboriginal and Torres Strait Islander young people are over-represented in the client group.

Clinical Utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in a Residential Treatment Program for Homeless Individuals.

The current study examined the clinical utility of the Restructured Form of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2-RF) in a residential treatment program for homeless individuals. MMPI-2-RF scale scores from 146 participants with valid profiles were correlated with variables obtained at intake and during treatment. The sample was then followed 12 months postdischarge to test preregistered hypotheses regarding MMPI-2-RF predictors of hospital readmissions. The results indicated that a variety of MMPI-2-RF scale scores were correlated with historical and diagnostic variables at intake and with measures of treatment outcome, including behavioral problems and successful outcome. A broad range of MMPI-2-RF scale scores were related to readmissions postdischarge and many of these relationships remained significant when tested in Poisson regression models containing other predictors. However, the postdischarge findings were generally inconsistent with our predictions and were of small effect size. The clinical implications of MMPI-2-RF results for residential treatment programs are discussed.

Evaluation of the use of psychotropic medication as needed for hospitalized child and adolescent patients and for those children in a residential treatment program

Objective: The goal of this study was to evaluate the use of psychotropic medication as needed (Symptomatic treatment) (pro re nata or prn) in children and adolescents in a psychiatric hospital and those children in the residential treatment program. Methods: The pro re nata medication use of all 152 unduplicated patients admitted to Hawthorn Children’s Psychiatric Hospital in St. Louis, Missouri (USA) beginning in April 2015 through March 2016 were reviewed for this study. The medication orders of all patients are placed electronically. Reports on prn medication use at the facility were obtained from the electronic medication administration (e-MAR) utilizing the MetaCare software. Results: In this study, gender, race, and health insurance coverage had no statistically significant association with prn medication usage. However, the child’s age did have a statistically significant association (p<0.01) with prn medication usage. Inpatients younger in age were more likely to have received prn medications during their hospitalization. Conclusion: Due to little empirical evidence for prn’s in younger children and these results show an increased use in younger patients, our data suggests that prn’s be limited when treating these patients. This data also endorses behavioral treatments to be utilized before a prn is administered

Development and Implementation of a Brain Rest Protocol in Nonintellectually Challenged Youth With Head-Banging Behaviors.

INTRODUCTION: Concussions as a result of mild traumatic brain injury (MTBI) in youth are often associated with athletic injury; however, they can also occur as a result of intentional self-injury by head banging. Despite the known neurological sequelae secondary to MTBI, assessment, interventions, and consequences of head banging in the nonintellectually disabled populations have not been well studied. AIMS: The intent of this nurse-led intervention was to develop a brain rest protocol at a residential treatment program serving youth who were between 12 and 19 years old in order to improve the quality of care and moderate negative sequelae resulting from MTBI. METHODS: A nursing assessment guided by an adaptation of the acute concussion evaluation and a strength-based intervention protocol was developed and applied to youth who engage in head banging. RESULTS: The result was a protocol that defined the process by which a youth would be assessed and treated after head banging. There are no outcome measures that would assist to measure the effectiveness of this intervention in the short or long term. CONCLUSION: This intervention filled a need for improved assessment and appropriate interventions in youth with head-banging behavior. It is feasible that the assessment and implementation of the brain rest protocol is the first step in understanding how to best evaluate and manage the sequelae of intentional head banging resulting from MTBI.

The Validity of the Personality Assessment Inventory—Adolescent in Assessing Callous-Unemotional Traits in At-Risk Adolescents

This study examines the validity of the Personality Assessment Inventory–Adolescent (PAI-A; Morey) in assessing callous-unemotional (CU) traits within two independent samples of at-risk adolescents from a residential intervention program. The study tests the extent to which CU traits are represented within PAI-A scales with respect to empirically- or theoretically-related indicators, such as antisociality, aggression, low warmth, low social connectedness, and subdued internalizing psychopathology. The PAI-A substantive scales statistically accounted for an average of 55.0% of the variance in total scores on the Inventory of Callous-Unemotional Traits (ICU; Frick) across samples. Broadly, PAI-A substantive scales evinced theoretically-consistent relations with CU traits. Consistent with expectations, CU traits were broadly related to PAI-A-assessed constructs of antisocial features, aggression, low warmth and social disconnection, but not to subdued internalizing symptoms. Moreover, some of the PAI-A clinical, treatment consideration, and interpersonal scales or subscales demonstrated differential relations across the traits. Implications for assessment of CU traits using the PAI framework are discussed. Overall, this research adds to the literature on CU traits in broadband personality assessment and provides a foundation for future research on CU traits using the PAI-A.

Co-Occurring Polysubstance Use and Physical Disease of Persons with Mental Disorders in Residential Treatment Program

The purpose of this study was to describe the prevalence of co-occurring polysubstance use and to examine the differences in physical disease between polysubstance users and single/no substance users with mental disorders. This retrospective cross-sectional study included 1949 clinical records of psychiatric patients from 11 residential treatment programs between 2007 and 2011. Demographic variables, psychiatric diagnoses, and data on substance use and physical disease were obtained from the clinical records. Chi-square analyses were used to examine substance use difference in the prevalence of each physical disease category. This study found that the prevalence of co-occurring polysubstance use was 53.5%. Chi-square analyses identified that co-occurring polysubstance users reported more respiratory, digestive, musculoskeletal, and HIV/AIDS diseases but less endocrine diseases than single/no substance users. Therefore, integrated treatment programs for treating patients with co-occurring substance use and physical disease should be developed and expanded for this high-risk group.

Singing Through Change: A Community Engagement Project for Women in Recovery Performing with the Purdue Fort Wayne Choral Union Choir

Hope & Harriet is an intensive residential treatment program in a subacute medical facility for women 18 years and older that specializes in the pursuit of recovery from chemical dependency. PFW music therapy students have been given the unique opportunity to work with the women as part of their music therapy clinical practicum experiences. The author's final music therapy practicum, in partial fulfillment of her bachelor’s degree in music therapy, began her path forward into this project.

Alcohol and Drug Use in Pregnant and Post-Partum Women

Abstract The Tennessee Residential Treatment Program for Pregnant and Postpartum Women addressed the problem of substance use and abuse among young adults ages 16 and over. The program was intended to expand the availability of comprehensive, residential substance abuse treatment, prevention, and recovery support services for pregnant and postpartum women and their minor children, including services for non-residential family members of both the women and children. The populations of focus were low-income (according to federal poverty guidelines) women, ages 16 and over, who were pregnant, postpartum (the period after childbirth up to 12 months), and their minor children, age 17 and under, who had limited access to quality health services. Through the expansion and enhancement of service capacity, addiction peer recovery support services were provided as part of a collaborative effort between the University of Tennessee College of Social Work and the Helen Ross McNabb Center, Incorporated, a Regional Mental Health System. Comprehensive services were provided to clients who were ineligible for, or unable to afford or to obtain, adequate services through public or commercial means. Over a three-year period, services were provided to 363 participants with 169 of those participants returning for a 6-month interview using the CSAT GPRA Client Outcome Measures for Discretionary Programs. Upon intake, 70% of participants reported using drugs and/or alcohol during the previous month. Frequency of various drug and alcohol use (measured in number of days used) during the 30-day period prior to intake implied a need for intervention services, and over the course of services provided, frequencies of drug and alcohol use declined.

Telepsychiatry in an Alaska Native Residential Substance Abuse Treatment Program.

Introduction: Alaska Native communities experience high rates of alcohol and substance abuse and face challenges accessing quality, culturally appropriate treatment. Telepsychiatry could help bridge this gap, but no publications have examined its impacts for alcohol and substance abuse treatment directed at Alaska Native communities. This study explores one telepsychiatry clinic's impact on a residential substance abuse treatment serving the Alaska Native community in Anchorage, Alaska. Methods: Using a matched case - control design, 103 cases receiving telepsychiatry services between 2007 and 2012 were matched with 103 controls who did not. Outcome measures included length of stay, discharge plans, emergency room visits, and hospital admissions; clinical history, including previous suicide attempts, history of violence, and trauma history; social stressors such as current legal issues, unemployment, and homelessness; mental health, medical, and substance abuse diagnoses; and number of telepsychiatry appointments and nature of telepsychiatry services rendered. Results: Both groups exhibited high rates of mental and medical illness, socioeconomic challenges, and substance abuse. However, the telepsychiatry group demonstrated a significantly higher rate of post-traumatic stress disorder, history of violence, ongoing legal issues, and children in outside custody. It also remained engaged in treatment longer, had fewer discharges against medical advice, and was more likely to complete treatment. Discussion/Conclusions: Our study highlights this telepsychiatry clinic's real-world difference serving the complex substance abuse treatment needs of Alaska Native individuals. It also reinforces telepsychiatry's promise in serving other communities facing a high burden of addiction and mental illness yet facing barriers to high-quality, culturally competent services.

Circadian lighting study at a residential treatment program

Circadian lighting study at a residential treatment program

Intensive Residential Treatment Program: Efficacy for Emergency Responders’ Critical Incident Stress

Little research exists to determine the efficacy of residential treatment for first responders. In this article, data from a residential retreat were used to examine factors leading to symptom reduction in emergency responders suffering from critical incident stress and post-traumatic stress injury (PTSI). Data were analyzed using multivariate analyses of variance and a 2×2 mixed factorial design. A repeated measure design, the Symptom Assessment for Emergency Responders (SAFER) questionnaire, consisting of 18 clinical and three validity scales, was assessed and analyzed through causal-comparative data. The participant group consisted of 122 emergency responders attending the West Coast Post-trauma Retreat (WCPR) during 2017. The waitlist group consisted of 20 emergency responders. Retreat clients were asked to complete the SAFER questionnaire on the first and last days of the retreat, as did the waitlist participants. Comparisons were then made between the scores of those attending the retreat and those on the waitlist. The results from the SAFER questionnaire indicated a significant pre-post-test decrease in many of the measured symptoms for the retreat participants, as compared with that of the waitlist participants.

Tools You'll Have for the Rest of Your Life: A Qualitative Evaluation of a Fitness and Vocational Training Program for Substance Use Recovery

Introduction: Substance use disorder (SUD) is a problem within the United States and warrants attention. Despite growing concerns, there exists a research-to-practice gap in the implementation of evidence-based treatment strategies, particularly in the area of physical activity as a low-cost adjunct to treatment programs. Additionally, people with SUD often face challenges in re-entering the workforce, due to multiple factors including long absences, incarceration, or lack of experience and training. Method: Our group conducted focus group interviews with 26 participants to evaluate a 12-week fitness and health education program (Live Fitness) using grounded theory methodology. Live Fitness also served as a vocational training opportunity in collaboration with a large fitness facility and a residential SUD treatment program. Results: Three broad categories emerged from the focus group interviews: The program serves as an aide for recovery, confers physical benefits from participation, and helps participants feel that they are part of the community with a way to ease back into life. Conclusion: The results of our study suggest that treatment centers should invest attention and resources into guided fitness programs and that programs with an emphasis in vocational training should continue to be explored.

Comparison of artificial neural networks and logistic regression for determination of social-cognitive factors impacting drug abstinence

ABSTRACTBackground: Logistic regression model (LRM) are popular in public health studies. However, most studies have found that artificial neural networks (ANNs) have better performance than other methods especially when the relationship between the response and independent variables is complex.We aimed to compare the performance of LRM and ANNs in the determination of drug abstinence predictors.Methods: The participants of this prospective study included 317 male addicts recruited through convenience sampling in five short-term residential substance use treatment programs in Southern Khorasan, the eastern province of Iran. Eligibility criteria included being in a detoxification stage and having a primary diagnosis of substance dependency disorder based on the diagnostic criteria of the DSM-IV-TR. The performance of the models was compared using the area under the ROC (AUC).Results: LRM and ANNs method correctly classified 82.2% and 84.4% of the participants as an abstinent group, respectively. The areas under ROC curve were 90 and 91.2, the kappa statistic was 0.643 and 0.688 for LRM and ANN models, respectively.Conclusions: The results showed classification performance was not significantly different. We concluded that the selection of prediction techniques for predicting drug abstinence factors depended on our background knowledge on the data pattern.

Effectiveness of intensive treatment services for obsessive compulsive disorder: outcomes from the first Canadian residential treatment program

Background: Obsessive–Compulsive Disorder (OCD) is a psychiatric illness that can result in debilitating symptoms and functional impairment. Until recently, individuals with severe OCD symptoms have not received appropriate services within the Canadian healthcare system. The Frederick W. Thompson Anxiety Disorders Centre launched an Intensive Services Residential treatment programme for OCD in July 2017 to meet the needs of the Canadian population. This paper sets out to demonstrate the effectiveness of this programme.Methods: This study incorporated quantitative and qualitative data collection. Quantitative data were analysed using paired sample t-tests while qualitative data was transcribed and coded for emerging themes.Results: Beneficial changes in symptomatology were found. Client narrative emphasised the importance of exposure response prevention (ERP), creation of an OCD community as well as enhanced functionality in clients’ lives. Clients also commented on why they believed the treatment worked and points of potential improvement for discharge planning and programme organisation.Conclusions: This study adds to the growing body of evidence regarding the importance of intensive services for individuals experiencing severe symptoms of OCD. Enhancing accessibility to services and ensuring ongoing maintenance of gains will be important next steps in ensuring long-term recovery for individuals with severe symptoms of OCD.Key pointsIntensive services treatment for OCD has been found to be beneficial for clients and this paper demonstrates the first time this has been seen within a Canadian programme.Treatment provided decreased OCD severity and increased functionality and quality of life.Clients cited exposure and response prevention work as a key ingredient in their recovery.Our programme is always in an ongoing state of quality improvement, ensuring client engagement and satisfaction.

Psychological features in obesity: A network analysis

Enhanced understanding of psychosocial factors associated with obesity may improve knowledge of their interplay mechanisms. The aim of this study was to assess the relationship between psychosocial variables in individuals with obesity using a network analysis. Patients seeking treatment for obesity were consecutively recruited from a rehabilitative residential treatment program for severe obesity between January 2016 and March 2019. Each patient completed the following questionnaires: Eating Disorder Examination Questionnaire, Symptom Checklist-90, Obesity Related Well-Being, and Weight Bias Internalization Scale. In addition, current body mass index (BMI) was measured, and maximum acceptable and dream BMI were assessed. The sample comprised 996 patients with obesity (age 52.3 [SD = 16.0] years; BMI 41.8 [SD = 7.8] kg/m2 ; 65.7% women; 52.2% married or living with a partner). Network analysis showed that interpersonal sensitivity and shape-weight concern, but also internalized weight stigma, were the most central and highly interconnected nodes in the network. In contrast, objective binge-eating episodes and dietary restraint were the most peripheral and least connected nodes. Eating disorder features and psychological distress formed two clearly separate clusters. No difference in network structure was found between men and women. The pattern of network node connections supports the importance of assessing psychological distress, interpersonal sensitivity, shape-weight concern, and internalized weight stigma in patients seeking treatment for obesity.

Impact of implementing a tobacco and recreational nicotine-free policy and enhanced treatments on programmatic and patient-level outcomes within a residential substance use disorder treatment program

BackgroundRecent estimates are that 30% of military veterans use tobacco or recreational nicotine products, and rates significantly increase for veterans with co-occurring substance use disorder (SUD). Despite emerging literature that indicate better outcomes when SUD and tobacco use disorder (TUD) are treated simultaneously (in parallel), most SUD programs fail to address tobacco use. This can prove catastrophic, as perhaps the most likely cause of death lifetime for patients admitted to a SUD treatment program is tobacco/nicotine-related. Studies suggest that residential SUD treatment programs can improve the screening, diagnosis, documentation, and treatment of TUD. Perceived barriers among staff include fear of causing patients to leave early. There are few studies evaluating the accuracy of these perceived barriers to programmatic and patient-level outcomes in the residential SUD treatment setting when TUD services are provided along with a nicotine/tobacco-free therapeutic milieu. ObjectiveIn the fall of 2015, a SUD treatment program at a large midwestern Veteran.Affairs Medical Center fully implemented a tobacco-free residential unit. The current study investigates the programmatic and patient-level outcomes among cohorts treated before versus after the tobacco-free policy was implemented. Participants & ProceduresThis study utilized archival data and all participants were enrolled in the residential program with 117 veterans enrolled pre and 92 post tobacco-free policy. The final sample consisted of 194 males (92.8%), 14 females (6.7%), and 1 transgendered (0.5%) with a mean age of 47.80 (SD = 12.65). Most of the participants were Caucasian (69.4%) and divorced (43.1%). The majority (167, 79.9%) reported current tobacco use, with cigarettes (118, 56.5%) being the most frequently reported type. In addition, 17.59 (SD = 6.51) years old is the average start age of tobacco use. ResultsVeterans in the pre-policy cohort did not differ from post-policy cohort on age, gender, ethnicity, and marital status. Preliminary results related to programmatic outcomes indicate improved rates of TUD diagnosis during intake (28.4% to 75.0%). Similar rates were observed in veterans who reported tobacco quit goal during treatment planning (37.4% to 56.8%). However, while there were no significant differences in the total rates of infractions; tobacco-related infractions significantly increased from one to eight. Finally, there were no significant differences in the number of against medical advice discharges or irregular discharges. Examination of patient-level outcomes revealed similar rates of veterans enrolling in the program as it relates to rates of current tobacco use, admission expired breath carbon monoxide (CO) measured in parts per million (ppm), longest period of tobacco abstinence, and self-reported primary preferred substance/drug. Of note, there were also no differences in reported importance and confidence of quitting tobacco. Rates of veterans prescribed nicotine replacement therapy during residential stay more than doubled. ConclusionsOur data suggest that implementing a tobacco-free policy within a residential SUD treatment program would not deter veterans from staying engaged in the program as evident by similar rates of irregular and AMA discharges. In addition, the prevalence of Veterans wishing to quit tobacco was higher in the post-policy cohort, as was NRT utilization, and without the addition of staff. Specific treatment recommendations will be discussed along with other implications.

Gambling-Related Cognitive Distortions in Residential Treatment for Gambling Disorder.

Gambling-related cognitive distortions are associated with gambling disorder severity, but few studies have provided an in-depth examination of the interrelationship between cognitive distortions, gambling severity, psychiatric comorbidity and treatment outcomes. The present study sought to identify factors associated with elevated cognitive distortions among problem gamblers entering residential treatment, examine changes in cognitive distortions through treatment, and explore the association between cognitive distortions and treatment outcomes. Pre- and post-treatment data were extracted from the charts of 125 individuals who participated in a 21-day residential treatment program for gambling disorder. Assessments included measures of demographics, gambling disorder severity, psychiatric symptoms and gambling-related cognitive distortions. Several significant associations were found between baseline cognitive distortions and psychiatric symptoms. Cognitive distortions decreased significantly from pre- to post-treatment. Pre- to post-treatment changes on several cognitive distortion scales were positively associated with greater baseline psychiatric symptomology. Treatment drop-out was associated with higher scores on measures reflecting greater impulsivity/addiction and greater perceived predictive control. Gambling-related cognitive distortions represent an important mechanism of gambling disorder and its treatment and provide a target for the development and refinement of treatment for gambling disorder.

Easing the journey home: creating sanctuary for military veterans

ABSTRACT While most recovery programmes serving veterans include evidence-based treatment practices for PTSD and substance use, they overlook two essential elements of healing that are specific to the needs of veterans: restoring purpose and the capacity for trust. Simplistic definitions of recovery from trauma and substance use for veterans often describe the absence of PTSD symptoms and abstinence from substance use. A fuller and more accurate definition of recovery requires not just the absence of symptoms, but honours how a veteran has been changed by his or her experience, and includes reintegration back into his or her home community. This article will explore how the Sanctuary Model®, an evidence-supported, clinically grounded organisational intervention implemented in a residential substance use treatment programme, provides a vehicle for reshaping a trauma-organised worldview to a trauma-integrated worldview for veterans.

Provider Perspectives on Choosing Prolonged Exposure or Cognitive Processing Therapy for PTSD: A National Investigation of VA Residential Treatment Providers.

As part of a longitudinal mixed-methods investigation on implementation of two evidence-based psychotherapies (EBPs) for Posttraumatic Stress Disorder, 164 mental health providers from 38 Department of Veterans Affairs (VA) residential treatment programs across the U.S. were asked questions about their decision-making for using Prolonged Exposure and Cognitive Processing Therapy. Many providers viewed both EBPs as equally efficacious and encouraged veterans to decide for themselves which treatment they wished to engage in. Some providers said that it was hard to know which EBP would be the most effective for a given patient, and that occasionally they started work with a veteran thinking that a particular EBP would work and were surprised when the veteran did not receive the full potential benefit of the intervention. Other providers noted that their decision-making regarding which EBP to use depended on the type and nature of the veterans' index trauma, memory of the trauma, and traumatic stress symptoms (e.g., fear versus guilt). Additional factors that impacted the choice of EBP included whether the patient already had one of the treatments before or if a provider deemed one as more compatible with their previous training. Implications for clinical practice as well as the design and improvement of training and implementation efforts are discussed.