Residential Treatment Program Research Articles

Client Engagement in Legally-Mandated Addiction Treatment: A Prospective Study Using Self-Determination Theory

ObjectiveMixed evidence on the effectiveness of using legal referrals to leverage treatment participation may reflect unmeasured variability in client motivations for seeking care. We hypothesized that associations between legal referral and client engagement would be moderated by reasons that clients sought treatment, as conceptualized by self-determination theory (SDT). MethodsAdults entering a Western Canadian residential addiction treatment program (N=325; 49.2% male; 54.5% First Nations, Métis, or Inuit; 15.1% legally referred; M age=32.9 years, range=18–63, SD=10.3) rated the extent to which treatment was being sought because of coercive social pressures (external motivation; α=.85), guilt and shame about continued substance misuse (introjected motivation; α=.82), or a valued commitment to the goals of the program (identified motivation; α=.91). Six weeks later, clients rated their level of cognitive involvement in treatment (83.4% completion rate); chart reviews assessed retention status and number of days retained until drop-out. ResultsMultivariable Cox regression and logistic regression analyses showed that legally-mandated clients who reported low admission levels of identified or external treatment motivation were most likely to exhibit early dropout. Legally-mandated clients who reported high admission levels of introjected motivation were most likely to be retained in treatment with high cognitive involvement. ConclusionsSDT provides a useful framework for describing how associations between legal referral and client engagement in treatment vary, depending on their reasons for seeking care.

Sanctuary in a residential treatment center: creating a therapeutic community of hope countering violence

Purpose – The purpose of this paper is to present insights into how and why the Sanctuary and SELF models are effective in decreasing trauma symptoms with a population of court-committed male adolescents in a residential treatment program. The Sanctuary model is a trauma-focussed, trauma-sensitive, organizational change model, and treatment protocol approach to working with clients who have experienced trauma, loss, and toxic stress to the degree that they interfere with social and personal functioning. The SELF model within Sanctuary is a treatment protocol that is an acronym for the organizing categories of safety, emotion management, loss, and the future. In essence, Sanctuary’s purpose is to create therapeutic community. Design/methodology/approach – Qualitative research methods of observation of groups and meetings, content analysis of existing quantitative data and agency documents, focus groups with staff and residents, and individual interviews with staff were utilized. Findings – Data show that the Sanctuary model ameliorates the symptoms of complex trauma. The substantive theory that emerges is that relational and neurological integration and recovery occur in the lives of residents as shaped first by the therapeutic community that supports the level of interpersonal relationships experienced with staff within a therapeutic milieu, along with shaping the organizational culture. Research limitations/implications – As a complex intervention, it is evident that reducing the Sanctuary model into its component parts cannot capture fully the essence of the intervention. A complex system can never be understood fully by observing it at single points in time. Practical implications – It is suggested that future research and programmatic planning within this therapeutic community need to demonstrate how to continue enhancing staff-resident relational integration vis-à-vis staff training and vehicles that offer residents more of a representative voice while in placement. Social implications – It is suggested that future research and programmatic planning within this agency need to demonstrate how to continue enhancing staff-resident trauma-informed therapeutic milieus and relational integration vis-à-vis staff training and vehicles that offer residents more of a representative voice while in placement. Originality/value – This is a unique study in that it employs qualitative methods to explore how and why the Sanctuary model contributes to its working in a residential treatment facility. The Sanctuary model is the only trauma-informed organizational intervention of its kind, with limited published evaluations in the current literature (Esaki et al., 2013). This study used focus groups with residents and staff that allowed them to influence the research and its processes. The residents expressed their views about the experience of being placed outside of their homes and of living in a therapeutic community within the Sanctuary Network. Staff spoke of aspects of working in a trauma-informed milieu and its effect on clients, colleagues, and the organization as a whole.

The Influence of Age and Sexual Drive on the Predictive Validity of the Juvenile Sex Offender Assessment Protocol-Revised.

The Juvenile Sex Offender Assessment Protocol-Revised (J-SOAP-II) is the most commonly used measure in the assessment of recidivism risk among juveniles who have committed sexual offenses (JSOs), but mixed support exists for its predictive validity. This study compared the predictive validity of the J-SOAP-II across two offender characteristics, age and sexual drive, in a sample of 156 JSOs who had been discharged from a correctional facility or a residential treatment program. The J-SOAP-II appeared to be a better predictor of sexual recidivism for younger JSOs (14-16 years old) than for older ones (17-19 years old), with significant differences found for the Dynamic Summary Scale and Scale III (Intervention). In addition, several of the measure's scales significantly predicted sexual recidivism for JSOs with a clear pattern of sexualized behavior but not for those without such a pattern, indicating that the J-SOAP-II may have greater clinical utility for JSOs with heightened sexual drive. The implications of these findings are discussed.

Use of the Internet to Obtain Drugs Without a Prescription Among Treatment-Involved Adolescents and Young Adults

ABSTRACTNonmedical use of prescription drugs is common and poses risks such as injury, overdose, and development of abuse and dependence. Internet pharmacies offer prescription drugs without a prescription, creating a source of illicit drugs accessible to anyone with an Internet connection. We examined this issue in a convenience sample of 1,860 adolescents and young adults from 24 residential and outpatient treatment programs. Few individuals obtained drugs from the Internet (N = 26, 2.3%). Pain relievers were the most frequently purchased type of drug. The majority of adolescents and young adult online purchasers made the purchases from their own or a friend's house.

A Formative Assessment Of Exercise Resources, Programs And Personnel In U.S. Residential Treatment Programs

BACKGROUND: There is emerging evidence for the efficacy of exercise as a treatment strategy for Substance Use Disorders (SUDs) and that this population desires exercise programming during their treatment. However, little is known about whether or not Residential Treatment Programs (RTPs) are equipped with resources to support exercise implementation. Our goal was to identify resources and barriers within U.S. RTPs to inform exercise program implementation within this setting. METHODS: A listing of short- and long-term U.S. RTPs, meeting the American Society of Addiction Medicine’s level of care standards from 3.5 to 3.7, was downloaded from the SAMHSA Find a Treatment Center search tool. For each state, RTPs were organized into three lists (short-term, long-term, or both). These lists were randomized using a random sequence generator. Individuals in supervisory level positions from the first 25% of each list were contacted for an interview. The interview assessed the RTPs resources (support, space, time equipment, and personnel) and barriers. RESULTS: Of the 50 program supervisors that responded, 84% reported that their RTPs were “somewhat” or “very” supportive of exercise programming at their facility. Nearly all (98%) reported having either mandatory or optional daily exercise time in their schedules, 96% had either indoor or outdoor space for exercise, and 94% reported having some form of exercise equipment. The most common equipment was: sport accessories (82% of RTPs), other fitness equipment, such as medicine balls or bands (70%), followed by aerobic (58%) and strength training (56%) equipment. Only 20 programs (40%) employed staff, full or part-time, to provide exercise programming. The most common barriers in offering exercise programming were money and/or budget constraints (54% of RTPs) and space (26%). CONCLUSIONS: These findings suggest that a majority of RTPs provide support, as well as adequate time, space, and equipment, for exercise programming for clients seeking SUD treatment. One potential area of improvement is a greater need for trained staff devoted to implementing these exercise programs and utilizing existing resources. Given the association between exercise and improvements in mental health and substance use, RTPs may serve as an ideal location to implement exercise programming.

Examining the pathways for young people with drug and alcohol dependence: a mixed-method design to examine the role of a treatment programme

IntroductionYoung people with drug and alcohol problems are likely to have poorer health and other psychosocial outcomes than other young people. Residential treatment programmes have been shown to lead to...

Neural correlates of distraction in borderline personality disorder before and after dialectical behavior therapy.

Neural underpinnings of emotion dysregulation in borderline personality disorder (BPD) are characterized by limbic hyperactivity and disturbed prefrontal activity. It is unknown whether neural correlates of emotion regulation change after a psychotherapy which has the goal to improve emotion dysregulation in BPD, such as dialectical behavioral therapy (DBT). We investigated distraction as a main emotion regulation strategy before and after DBT in female patients with BPD. Thirty-one BPD patients were instructed to either passively view or memorize letters before being confronted with negative or neutral pictures in a distraction task during functional magnetic resonance imaging. This paradigm was applied before and after a 12-week residential DBT-based treatment program. We compared the DBT group to 15 BPD control patients, who continued their usual, non-DBT-based treatment or did not have any treatment, and 22 healthy participants. Behaviorally, BPD groups and healthy participants did not differ significantly with respect to alterations over time. On the neural level, BPD patients who received DBT-based treatment showed an activity decrease in the right inferior parietal lobe/supramarginal gyrus during distraction from negative rather than neutral stimuli when compared to both control groups. This decrease was correlated with improvement in self-reported borderline symptom severity. DBT responders exhibited decreased right perigenual anterior cingulate activity when viewing negative (rather than neutral) pictures. In conclusion, our findings reveal changes in neural activity associated with distraction during emotion processing after DBT in patients with BPD. These changes point to lower emotional susceptibility during distraction after BPD symptom improvement.

Dysfunctional representation of expected value is associated with reinforcement-based decision-making deficits in adolescents with conduct problems.

Previous work has shown that patients with conduct problems (CP) show impairments in reinforcement-based decision-making. However, studies with patients have not previously demonstrated any relationships between impairment in any of the neurocomputations underpinning reinforcement-based decision-making and specific symptom sets [e.g. level of CP and/or callous-unemotional (CU) traits]. Seventy-two youths [20 female, mean age=13.81 (SD=2.14), mean IQ=102.34 (SD=10.99)] from a residential treatment program and the community completed a passive avoidance task while undergoing functional MRI. Greater levels of CP were associated with poorer task performance. Reduced representation of expected values (EV) when making avoidance responses within bilateral anterior insula cortex/inferior frontal gyrus (AIC/iFG) and striatum was associated with greater levels of CP but not CU traits. The current data indicate that difficulties in the use of value information to motivate decisions to avoid suboptimal choices are associated with increased levels of CP (though not severity of CU traits). Moreover, they account for the behavioral deficits observed during reinforcement-based decision-making in youth with CP. In short, an individual's relative failure to utilize value information within AIC/iFG to avoid bad choices is associated with elevated levels of CP.

Are Borderline Personality Symptoms Associated With Compulsive Sexual Behaviors Among Women in Treatment for Substance Use Disorders? An Exploratory Study.

Extant literature has documented a significant relationship between borderline symptoms and substance use disorders. As supported in past work, there is a significant theoretical relationship between borderline symptoms and compulsive sexual behaviors because both disorders share common underlying behaviors and traits. There is no known research that has examined the empirical relationship between borderline symptoms and compulsive sexual behaviors in a population with substance use disorders. To fill this important gap in the literature, this relationship was examined in the current study. Medical records from 120 women admitted to a private, residential treatment program for substance use disorders were reviewed for the current study. Hierarchical multiple regression analysis demonstrated that borderline symptoms were significantly associated with compulsive sexual behaviors after controlling for alcohol use and problems, drug use and problems, age, and positive impression management. Results from this study provide potentially important research and clinical implications, which could ultimately aid treatment and reduce relapse. However, continued research is needed to further examine the relationship between symptoms and compulsive sexual behaviors.

Female Ex-Offender Perspectives on Drug Initiation, Relapse, and Desire to Remain Drug Free.

Recently released homeless women residing in temporary residential drug treatment (RDT) programs are at a critical juncture in the process of recovery, transition, and reentry. The purpose of this study was to explore factors influencing initial use of drugs and relapse triggers among a sample of incarcerated women exiting jails and prisons, residing in an RDT program, and preparing for reentry into their communities. Among this population, relapse to drug use and recidivism are common. A qualitative study was conducted utilizing focus groups to understand the perspectives of formerly incarcerated, currently homeless women residing in an RDT program. Content analysis generated the development of three broad categories: (a) factors associated with first drug use, (b) factors involved in relapse, and (c) factors influencing desire to remain drug free. A discussion follows highlighting the importance of targeted interventions at RDT sites that integrate physical, psychological, and social needs to optimize reentry into communities. This includes a focus on building self-esteem and life skills and providing access to resources such as housing, employment, and healthcare.

Impulsivity and Suicidality in Adolescent Inpatients.

Suicide is the second leading cause of death among adolescents, and impulsivity has emerged as a promising marker of risk. The present study tested whether distinct domains of impulsivity are differentially associated with suicide ideation, plans, and attempts. Adolescents (n = 381; boys = 106, girls = 275) aged 13-19years (M = 15.62, SD = 1.41) were recruited from an acute, residential treatment program. Within 48h of admission to the hospital, participants were administered structured clinical interviews assessing mental health disorders and suicidality. Following these interviews, participants completed self-report questionnaires assessing symptom severity and impulsivity. Consistent with past research, an exploratory factor analysis of our 90-item impulsivity instrument resulted in a three-factor solution: Pervasive Influence of Feelings, Feelings Trigger Action, and Lack of Follow-Through. Concurrent analysis of these factors confirmed hypotheses of unique associations with suicide ideation and attempts in the past month. Specifically, whereas Pervasive Influence of Feelings (i.e., tendency for emotions to shape thoughts about the self and the future) is uniquely associated with greater suicidal ideation, Feelings Trigger Action (i.e., impulsive behavioral reactivity to emotions) is uniquely associated with the occurrence of suicide attempts, even after controlling for current psychiatric diagnoses and symptoms. Exploratory gender analyses revealed that these effects were significant in female but not male adolescents. These findings provide new insight about how specific domains of impulsivity differentially increase risk for suicide ideation and attempts. Implications for early identification and prevention of youth suicide are discussed.

Comparing Treatment Outcomes Among Canadian Military and Civilian Substance Users Attending the Same Residential Treatment Program

ABSTRACTSubstance use disorder is a concerning health issue, affecting military and civilians alike. Due to exceptional workplace demands and a unique military culture, it is important to explore whether military members respond to addiction treatment in the same manner as their civilian counterparts. The present study compared individual characteristics and addiction treatment outcomes between Canadian military members and civilians attending the same residential program. Results revealed that both groups experienced comparable outcomes at 6 months follow-up. Military members reported significantly higher levels of some aspects of quality of life, compared to civilians. Results support the notion that an integrated, nonmilitary treatment program can be appropriate for military members seeking addiction treatment.

Marketing Residential Treatment Programs for Eating Disorders: A Call for Transparency.

Residential behavioral treatment is a growing sector of the health care industry and is used by a large proportion of adolescent and adult patients with eating disorders. These programs and the organizations that own them have developed extensive marketing strategies that target clinicians and include promotional gifts, meals, travel reimbursement, and continuing education credit. Legislation and policy changes have limited these types of activities when conducted by the pharmaceutical industry, and awareness of conflicts of interest associated with clinician-targeted advertising of drugs and devices has increased. However, similar practices by the behavioral health care industry have evolved without oversight. The authors urge clinicians to consider how marketing strategies by treatment facilities may influence their referral behaviors and call for improved transparency regarding gifts and payments from treatment facilities.

Prospective associations between changes in mental health symptoms and health-related quality of life in veterans seeking posttraumatic stress disorder residential treatment

ABSTRACTBackground and Objectives: This study examined prospective associations between changes in mental health symptoms (posttraumatic stress disorder [PTSD], depression) and health-related quality of life (physical health, psychological well-being) for veterans with PTSD. Design: This study focused on 139 patients who completed a residential treatment program for PTSD in the Veterans Health Administration. Methods: Patients completed the veteran-specific, 12-item Medical Outcomes Study Short Form, PTSD Checklist – Military version, and Beck Depression Inventory at pre-treatment, discharge, and a four-month follow-up. When accounting for demographic factors, combat exposure, and baseline scores on the respective outcome variables (e.g. mental health, physical health, PTSD, and depressive symptoms), a series of multivariate analyses were conducted for treatment-related changes in mental and physical health on the outcome measures. Results: Reductions in PTSD symptomatology during the treatment period were prospectively linked with better health-related outcomes at the four-month follow-up. In addition, improved physical health and psychological well-being during treatment were each similarly associated with better PTSD and depression outcomes in the months following treatment. Conclusions: Addressing concerns in mental and physical health might have synergistic effects across both domains, supporting the need for holistic models and integrated health care strategies for treating veterans with PTSD.

Barriers to Quitting Smoking Among Substance Dependent Patients Predict Smoking Cessation Treatment Outcome

For smokers with substance use disorders (SUD), perceived barriers to quitting smoking include concerns unique to effects on sobriety as well as usual concerns. We expanded our Barriers to Quitting Smoking in Substance Abuse Treatment (BQS-SAT) scale, added importance ratings, validated it, and then used the importance scores to predict smoking treatment response in smokers with substance use disorders (SUD) undergoing smoking treatment in residential treatment programs in two studies (n=184 and 340). Both components (general barriers, weight concerns) were replicated with excellent internal consistency reliability. Construct validity was supported by significant correlations with pretreatment nicotine dependence, smoking variables, smoking self-efficacy, and expected effects of smoking. General barriers significantly predicted 1-month smoking abstinence, frequency and heaviness, and 3-month smoking frequency; weight concerns predicted 1-month smoking frequency. Implications involve addressing barriers with corrective information in smoking treatment for smokers with SUD.

Adolescent inhalant use prevention, assessment, and treatment: A literature synthesis

Inhalant use refers to the use of substances such as gases, glues, and aerosols in order to achieve intoxication, while inhalant use disorder (IUD) encompasses both DSM-IV-TR criteria for inhalant abuse and dependence. Inhalant use among adolescents is an international public health concern considering the severe medical and cognitive consequences and biopsychosocial correlates. In this paper, we summarize the current state of the literature on inhalant use among adolescents focusing on social context, prevention, assessment, and treatment strategies. Psychoeducation, skills training, and environmental supply reduction are helpful strategies for preventing adolescent inhalant use, while parent and adolescent self-report as well as physician report of medical signs and symptoms can aid in assessment and diagnosis. Although research has only begun to explore the treatment of inhalant use, preliminary findings suggest that a multimodal approach involving individual counselling (i.e., CBT brief intervention), family therapy, and activity and engagement programs is the first-line treatment, with residential treatment programs indicated for more severe presentations. The limited nature of treatments developed specifically for inhalant use combined with high prevalence rates and potential for significant impairment within the adolescent population indicate the need for further research. Research should focus on understanding the social context of use, establishing the efficacy of current adolescent substance use treatments adapted for inhalant use, and exploring long-term outcomes.

Comparative analysis of treatment conditions upon psychiatric severity levels at two years among justice involved persons

The aim of this investigation was to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses. A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n = 39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome. Participants randomly assigned to residential conditions reported significant reductions in psychiatric severity whereas those assigned to the usual care condition reported significant increases. There were no significant differences in psychiatric severity levels between residential conditions. Findings suggest that cost-effective, self-run residential settings such as Oxford Houses provide benefits comparable to professionally-run residential integrated treatments for justice involved persons who have dual diagnoses. Results support the utilization of low-cost, community-based treatments for a highly marginalized population. Little is known about residential treatments that reduce psychiatric severity for this population. Results extend the body of knowledge regarding the effects of community-based, residential integrated treatment and the Oxford House model.

Impact of an intervention for recently released homeless offenders on self-reported re-arrest at 6 and 12 months

ABSTRACTA randomized controlled trial was conducted with 600 paroled men, homeless prior to incarceration, to assess varying levels of peer-coach and nurse-partnered interventions on re-arrest at 6 and 12 months. Findings revealed that positive predictors of re-arrest at 12 months included having received social support from drug users and non-drug users, as well as having used marijuana at least once a week prior to their most recent incarceration. In terms of protective factors, those who participated in a substance abuse program contract within a residential drug treatment program or spent 90 days or greater in a residential drug treatment program were less likely to have been re-arrested within 12 months.

Family Therapy Techniques in Residential Settings: Family Sculptures and Reflecting Teams

Outcome data has shown that family therapy is highly effective in the treatment of many disorders including addiction, mood, and other issues. In working to make treatment as effective as possible, many residential treatment and outdoor behavioral healthcare (OBH) programs have adopted family therapy techniques for use in individual and peer group therapy settings. Some have also incorporated family members by inviting them to visit the residential setting and participate in treatment exercises. An article by Faddis and Bettmann (J Ther Sch Program 1(1): 57–69, 2006) outlines an example of this integrated approach to family sculptures and reflecting teams in a wilderness therapy setting for adolescents. This integrated technique has since come to be known as the four phase Familial Sculpting and Reflecting intervention. Most recently these methods have been expanded for use with young men ages 18–30 in an adventure wilderness therapy program. This article will examine the theoretical basis for both of these approaches, discuss the application of these techniques to residential OBH programs and review how these methods have been most recently adapted for use in another program.

Exploration of Coping Strategies of Youth Accessing Residential and Day Treatment Programs

Youth with emotional and behavioral disorders are often dealing with many challenges such as strained relationships, academic difficulties and family conflict in addition to their clinical symptoms. Youth can access intervention for these challenges in day and residential treatment centers. However, little is known about how these adolescents cope with stress or the strategies they use. The purpose for this study was to explore the ways youth report coping with stress, and in particular the active, passive/depressive and risky strategies they report using in response to stress. A second purpose was to explore the relationships between active, passive/depressive and risky strategies and their self-reported psychological difficulties. Using a crosssectional design, 30 adolescents (12–18 years of age, 79 % female) completed standardized measures of psychological difficulties and coping with stress. Youth reported using a variety of strategies to cope, and endorsed learning to live with it, and doing an activity alone as the two most commonly used. There were robust relationships between active (negative association) and risky behaviors (positive association) with psychological difficulties. Implications for family therapy are discussed.