Residential Treatment Program Research Articles

Long-Term Abstinence and Quality of Life After a Socioecological Treatment Program: An Italian Experience

ABSTRACTThis article aims to report the outcomes of a brief residential alcohol treatment based on the socioecological method, as measured in terms of professional evaluation and quality of life. The study covered a one-year period (July 2011–August 2012) by following the experiences of 20 users of alcohol included in a residential treatment program based on the socioecological approach. The treatment outcome was assessed via a quality-of-life (QoL) measure and professional service evaluation on three occasions: upon admission to the hospital, one month after hospital discharge, at the follow-up after 3 to 4 months. Moreover, four club facilitators were interviewed after 7 to 8 months concerning the situation of five patients. Results showed that one out of four people with an alcohol addiction were still sober about one year after discharge and attended the Clubs for Alcoholics in Treatment (CAT) regularly. One month after discharge, QoL data and professional evaluation converged in showing an improvement in 13 participants. Their QoL generally improved, with specific reference to their financial situation, life in general, health condition, and family relations. The brief residential program based on the socioecological model appears to be a feasible path for those seeking alcohol treatment in Italy, as a positive outcome was reported by one half of the patients in terms of better QoL at the 6-month follow-up and by one fourth of patients in terms of sobriety and club attendance at the one-year follow-up.

Medication Treatment for Smoking Cessation in Patients with Comorbid Medical or Psychiatric Problems during Substance Use Rehabilitation

Introduction: Patients with substance use disorders smoke a higher rate than the general population, and have more difficulties with smoking cessation. The purpose of this study was to determine whether the use of smoking cessation medications improved the rate of smoking reduction or cessation during substance use rehabilitation treatment. Methods: A retrospective review of 643 medical records was conducted of patients admitted between 2009 and 2011 to a Veterans Administration residential substance use treatment program. All patients with nicotine use disorder patients (82%) were offered smoking cessation medications for nicotine use disorder and were referred to smoking cessation classes. Self-report of smoking reduction or cessation during treatment was charted. Bivariate statistics and binary logistic regression analysis were conducted using either smoking cessation or smoking reduction as the dependent variable and was performed in SPSS. Results: Significantly more patients who used smoking cessation medications reported smoking reduction (72% vs. 11%), χ2 (1, N=526)=201.3, p<0.000 and smoking cessation (11% vs. 2%), χ2 (1, N=526)=18.3, p<0.000 during treatment. Factors associated with smoking reduction using binary logistic regression analysis with smoking cessation as the dependent variable included: Use of smoking cessation medications (OR=28.6, p<0.00), treatment completion (OR=7.6, p<0.00), presence of dental problems (OR=2.1, p=0.03), and presence of back pain (OR=1.74, p=0.04). Smoking cessation was associated with use of smoking cessation medications (OR=5.1, p<0.00), older age (OR=1.1, p=0.01), treatment completion (OR=6.3, p=0.02), and the number of non-felony convictions (OR=1.1, p=0.01) using smoking cessation as the dependent variable in binary logistic regression analysis. Conclusion: Free access to smoking cessation medications appears to enhance smoking reduction and cessation during residential substance use treatment. Limitations of the study include the fact that reduction or cessation was based on self-report and that this was a retrospective record review, not a randomized, controlled trial.

A Complex Multimodal 4-Week Residential Treatment Program Significantly Reduces PTSD Symptoms in Child Sexual Abuse Victims: The Be Brave Ranch

Childhood sexual abuse (CSA) occurs frequently and often has serious long-term sequelae including posttraumatic stress disorder (PTSD), which often leads to significantly worse outcomes among CSA survivors. However, the most effective treatment, particularly for younger children, remains uncertain. Research supports trauma-focused cognitive behavioural therapy (TF-CBT) in different age groups, and we designed a 4-week residential treatment program for CSA victims aged 8-12. Here we report the outcome from the first 35 children to take part in a complex multimodal program (mean age 10 years old), located at a dedicated facility (the “Be Brave Ranch”), with the primary therapeutic focus being TF-CBT, although several other treatment modalities were also utilized. Of the 35 children, 23 were female and 12 were male. The results show a highly significant (p<0.001) reduction in Child Post-Traumatic Stress Disorder Symptom Scale (CPSS) scores from baseline (20.5 ± 1.56) to follow-up (14.6 ± 1.55). Also, the number of children who were above the threshold for PTSD using this scale (a score of 16 or more) fell from 26 at baseline to 14 at the end of the 4-week intervention, suggesting that these improvements are also highly clinically relevant. There was also a significant (p<0.02) decrease in depression and anxiety, as measured by the Revised Child Anxiety and Depression Scale-Short Version scale, with scores decreasing from baseline (23.8 ± 1.77) to follow-up (20.6 ± 1.68). These results support the use of this short, but intense, residential intervention for CSA victims. They are also consistent with recent PTSD studies in adults demonstrating better efficacy for brief intensive interventions. Since reducing the number of CSA survivors who develop PTSD can have profound longer-term benefits, this suggests that such an approach might be more widely utilized. Further research should examine longer-term outcomes and effects of additional interventions, as well as comparisons to other therapies and determining if similar programs are useful in older age groups.

A Pilot Study of a Readiness Group to Increase Initiation of Smoking Cessation Services among Women in Residential Addiction Treatment

This study implemented a smoking cessation readiness group (RG) in two women-focused residential substance abuse treatment programs, with the aim of engaging women in smoking cessation services. The primary outcome was defined as attending at least one cessation group after the RG ended. The RG combined features of the Expert Systems (ES) approach with a practice quit attempt. ES is an interactive system which tailors intervention to the smokers’ stage of change, while the practice quit attempt rehearses the process of quitting smoking. As a secondary aim we tested whether incentives, used to promote participation and engagement in the RG, would increase initiation of smoking cessation services. Participants (N=75) were women smokers enrolled in two residential programs, and intention to quit smoking was not required for participation. Twelve participant cohorts were randomly assigned to receive the RG with or without incentives. Following the RG intervention, 38.7% of participants (n=29) attended at least one smoking cessation session. Both the number of RG sessions attended and a successful practice quit attempt predicted the later use of cessation services, while incentives did not. From pre- to post-RG, participants reported decreased cigarettes per day (CPD: 11.8 vs. 7.6, p<.0001) and decreased nicotine dependence as measured by the Heaviness Smoking Index (HSI: 2.3 vs. 1.8, p<.001). The 3-session group-format RG intervention was associated with initiation of smoking cessation services and with changes in smoking behavior.

Detained girls' treatment engagement over time: The role of psychopathology and quality of life

Although treatment engagement is considered important to achieve positive outcomes, it is still not well known why some girls in detention are more engaged in treatment than others. This is the first study to examine to what extent psychopathology and self-perceived quality of life (QoL) are related to treatment engagement. Participants were 108 detained girls (Mage=16.21) who completed standardized questionnaires about mental health problems and QoL, and were interviewed with a structured diagnostic interview to assess DSM-IV psychiatric disorders. One and two months after this baseline assessment, the girls reported how much they engaged in treatment. The results showed low levels of treatment engagement and no significant changes in treatment engagement over time. Overall, detained girls with internalizing disorders reported higher treatment engagement scores, while the reverse was true for girls with externalizing disorders. Regarding QoL, the girls with greater satisfaction about their physical and psychological health and about their environment reported higher treatment engagement, while the opposite was true for the domain of social relationships. Our findings emphasize the need for strength-based and motivational approaches and techniques in residential treatment programs for girls, in order to enable change.

Resistance to temptation: the interaction of external and internal control on alcohol use during residential treatment for alcohol use disorder.

BackgroundThere is evidence that drinking during residential treatment is related to various factors, such as patients' general control beliefs and self‐efficacy, as well as to external control of alcohol use by program's staff and situations where there is temptation to drink. As alcohol use during treatment has been shown to be associated with the resumption of alcohol use after discharge from residential treatment, we aimed to investigate how these variables are related to alcohol use during abstinence‐oriented residential treatment programs for alcohol use disorders (AUD).MethodsIn total, 509 patients who entered 1 of 2 residential abstinence‐oriented treatment programs for AUD were included in the study. After detoxification, patients completed a standardized diagnostic procedure including interviews and questionnaires. Drinking was assessed by patients' self‐report of at least 1 standard drink or by positive breathalyzer testing. The 2 residential programs were categorized as high or low control according to the average number of tests per patient.ResultsRegression analysis revealed a significant interaction effect between internal and external control suggesting that patients with high internal locus of control and high frequency of control by staff demonstrated the least alcohol use during treatment (16.7%) while patients with low internal locus of control in programs with low external control were more likely to use alcohol during treatment (45.9%). No effects were found for self‐efficacy and temptation.ConclusionsAs alcohol use during treatment is most likely associated with poor treatment outcomes, external control may improve treatment outcomes and particularly support patients with low internal locus of control, who show the highest risk for alcohol use during treatment. High external control may complement high internal control to improve alcohol use prevention while in treatment.

Relationship Between Parental Acceptance and Rejection, Documented Health Status, and Life Time Experiences of Violence Among Incarcerated Women

The purpose of this descriptive correlational study was to describe parental acceptance and rejection of incarcerated women and to determine whether a relationship exists between parental acceptance and rejection, life time experience of abuse, and documented health status. Intake records of 100 incarcerated women sentenced to community corrections and enrolled in a residential alchohol and drug treatment program from June 2012 to June 2013 were used to examine relationship between the study variables. The retrospective record audit of women incarcerated in a community correctional facility provided data for correlational evaluation. The study concluded that parental acceptance and rejection appear to be associated with life time experience of violence and current health status. Findings provide support for life skill programs for incarcerated women transitioning back to the community.

The Impact of Psychiatric Practice Guidelines on Medication Costs and Youth Aggression in a Juvenile Justice Residential Treatment Program.

Stakeholders have expressed concern over the appropriate use of psychiatric medications and adequacy of mental health services for youths involved with the juvenile justice system. This study assessed the impact of implementing psychiatric practice guidelines on medication costs and youth aggression in a juvenile justice facility. The study examined whether implementing psychiatric practice guidelines in a facility with an organized psychosocial treatment program would reduce psychiatric medication costs, compared with two other facilities, and whether lower psychotropic medication costs would be associated with increases in youth aggression. Administrative data from three state-run juvenile justice facilities were analyzed to determine psychiatric medication costs and rates of youth aggression. Psychiatric practice guidelines that involved screening, shared decision making, psychosocial treatments, medication prescribing, and monitoring of side effects were implemented in only one of the three facilities, with a goal of applying evidence-based psychopharmacology and benefit-risk considerations. Over the ten-year study period (2003-2012), psychiatric medication costs decreased 26% at the facility implementing the psychiatric practice guidelines, whereas costs at the two comparison facilities increased by 104% and 152%. As psychiatric medication costs decreased at the facility implementing the guidelines, youth aggression there did not increase. Implementing psychiatric practice guidelines in juvenile justice facilities can reduce psychotropic medication costs without an increase in youth aggression. Implementation of the guidelines requires an organized psychosocial treatment program to help deter an inappropriate focus on psychotropic treatments.

Abstract PR05: Cancer screening uptake among women in substance abuse treatment

Abstract Purpose: Women in residential and out-patient substance abuse treatment programs represent a broad range of criminally affected indigent women and vulnerable street sex workers at highest risk of cervical cancer. This population is underrepresented in research, but through a nontraditional partnership with law enforcement this project capitalized on reaching a previously hard to reach population that is at high risk for cervical cancer and more likely to not have participated in recommended cervical screens. Scientific studies describe female jail populations receptive to cervical screenings with approximately 70-90% reporting a Pap screen in the last three years; however, knowledge of screening for cancer was poor. Preliminary findings from focus groups conducted among the target population suggest that self-administered HPV testing would not be well accepted or trusted among this population. Thus, the purpose of this study was to evaluate the uptake rate of cervical cancer screening from female nurse practitioners. Methods: Using findings from preliminary focus groups conducted among the target population, investigators adapted and integrated an evidence-based, culturally appropriate, and trauma sensitive women's health education into the largest female substance abuse center in Dallas, Texas, to prepare women for the opportunity to participate in a cervical exam the following day. Cervical screenings were provided at the AIDS Arms outpatient clinic which specializes in providing medical care to extremely poor and vulnerable populations. Other screenings provided included anal, breast, HIV/ sexually transmitted infections, and Hepatitis B and C. Screening positives are navigated by care coordinators for diagnostic screening. Results: Over a five month period, 214 women in residential substance abuse treatment have completed the education seminar on cancer prevention and screening. One third of those participating were African American, Hispanic, or American Indian. Over 98% of women completing education seminar signed up for the cancer screening opportunity and completed the screening the next day. Approximately 5% of cervical pap smear results received thus far were abnormal (ASCUS or LSIL). Nearly 15% reported last pap smear 5 - 10 years ago. One out of every four tested positive for anal high risk HPV. Conclusion: The uptake rate observed in this population exceeded what was anticipated based on the few studies of jail populations available. Thus, women in substance abuse treatment present an exceptional window of opportunity to engage them in cancer screening programs. We hypothesize that trauma-based education prior to offering a cervical exam is a critical factor in increasing screening uptake among this population. Three year project funded by Cancer Prevention Research Institute of Texas. Screening is ongoing through 2016. This abstract was also presented as Poster B71. Citation Format: Martha J. Felini, Raquel Qualls-Hampton, Saritha Bangara, Darius Taylor, Gene W. Voskuhl. Cancer screening uptake among women in substance abuse treatment. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr PR05.

Therapeutic Engagement of Adolescents with Emotional and Behavioral Disorders

Youth engagement is increasingly recognized as a preferred approach and often necessary step in the treatment of emotional and behavioral disorders. The purpose of this study was to explore the degree and quality of youth engagement in the therapeutic process, compare engagement scores between youth accessing residential and day treatment, and explore the association between engagement and interpersonal difficulties in a sample of youth with an emotional and/or behavior disorder in residential and day treatment programs based in Southern Ontario. Cross-sectional surveys of standardized measures were administered to youth and a separate survey to their Prime Workers. Relevant constructs included client engagement (as rated by youth and Prime Workers), and youth-rated behavioral screen, interpersonal problems and family functioning. Both Prime Workers and youth rated youth as moderately high in their level of engagement in therapy. Furthermore, Prime Worker and youth ratings did not significantly differ statistically, suggesting that youth may have actually engaged at a moderate level. Interpersonal problems were shown to be negatively associated with youth engagement, and family functioning approached significance for only youth in residential treatment. Assessing youth engagement during the treatment process as an intervention technique may highlight areas where greater clinical efforts are needed. Future considerations include testing methods of sharing and discussing results of an engagement measure within the context of a one-on-one clinical encounter with youth.

Prolonged Exposure With Veterans in a Residential Substance Use Treatment Program

Prolonged exposure therapy (PE) is effective in reducing posttraumatic stress disorder (PTSD) symptoms among individuals with comorbid substance use disorder (SUD) and PTSD. However, concerns that PE will lead to negative outcomes such as dropout and relapse remain a barrier to high-risk individuals, such as those warranting residential SUD care, receiving PE. The goal of this study was to gather information on feasibility, acceptability, and efficacy of offering PE in residential SUD treatment. Study therapists conducted PE (3 times/week, up to 15 sessions) with 9 patients admitted to a residential SUD treatment program at a Veterans Affairs (VA) hospital. Participants completed the PTSD Symptom Checklist (PCL-S) and Patient Health Questionnaire (PHQ-9) at admission, at discharge from the 4- to 6-week program, and 3-months postdischarge follow-up. Patients who were offered PE tolerated and engaged in PE as indicated by completion of the protocol, high satisfaction scores, and clinically significant decreases in PTSD and depression symptom severity. Symptom reduction at follow-up was significantly greater among patients who received PE than those who did not (n=21). This preliminary data provides initial support for further investigation of the efficacy of PE in residential SUD care.

Residential treatment outcomes for adolescents with obsessive-compulsive disorder

Objective: We examined outcomes from a residential treatment program emphasizing exposure and response prevention (ERP) to determine if the typically robust response to this treatment in outpatient settings extends to patients treated in this unique context. Method: One hundred and seventy-two adolescents with primary Obsessive-compulsive disorder (OCD) completed measures at admission and discharge. Almost all (92.4%) participants had at least two diagnoses and nearly half (44.2%) had three or more. Treatment consisted of intensive ERP (i.e., approximately 26.5 hr per week), additional cognitive behavioral therapy interventions, and medication management within a residential setting. In contrast to the samples reported on in the vast majority of other pediatric OCD trials, participants in the current study were living apart from their families and were immersed within the treatment setting, with staff members available at all times. Results: Paired sample t-tests revealed significant decreases in OCD and depression severity. Conclusions: Results suggest that residential treatment for adolescents with OCD using a multimodal approach emphasizing ERP can be effective for complex cases with significant comorbidity. Results were comparable with several randomized controlled trials.

Testing a comprehensive model of implementation and sustained use for EBTs for PTSD: A national investigation in VA residential settings

The national roll-outs of evidence-based psychotherapies in the Department of Veterans Affairs (VA) afford an unusual opportunity to study both implementation and sustainability. Although unique in some aspects of management and resources, the VA also serves as an excellent laboratory to understand the implementation of best practices as it is a more organized and controlled environment, free of the barriers faced in other more fragmented segments of the U.S. health care system. In a two-year NIMH grant, we utilized a theory-based model to collect baseline data regarding the adoption of two evidence-based treatments for Posttraumatic Stress Disorder (PTSD), Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), in a national sample of 38 VA PTSD residential treatment programs with over 200 providers. In a subsequently funded NIMH R01, we are extending our investigation with the same population and model to see: (1) how well PE and CPT are sustained over time, (2) what organizational and individual factors influence sustainability, and (3) what effects implementation and sustained use of PE and CPT have on patient outcomes. Implications for implementation in and outside of the VA health care system will be discussed. Updates on measurement of a model of implementation for health care: advances toward a testable theory One comprehensive theoretical model for understanding implementation of innovations was initially developed by Rogers (1962) and elaborated on by others (Greenhalgh et al. 2005). This model construed implementation as a complex process influenced by five broad constructs: (a) perceived characteristics of innovation, (b) potential adopter characteristics, (c) communication and influence, (d) system antecedents and readiness, and (e) outer context. Although a considerable evidence-base was used to develop the model, the authors did not fully operationalize their model, making it difficult to test formally. Our group undertook a systematic review of the literature and, using an iterative process, we examined existing measures and utilized or adapted items. Where no one measure was deemed appropriate, we developed other items to measure the constructs through consensus. The review and iterative process of team consensus identified three types of data that could be used to operationalize the constructs in the model: survey items, interview questions and administrative data. Over three waves of data collection concerning the implementation of two evidence-based psychotherapies disseminated nationally within Department of Veterans Affairs, we have made changes to the quantitative measurement of aspects of this model including the exclusion of the measurement of some constructs (e.g., learning style, locus of control, tolerance of ambiguity) as well as refinement of others (e.g., needs, motivation, knowledge-seeking). This presentation will review these changes as well as psychometric properties of other constructs and their items. Testing the model using quantitative data for implementation of two evidence-based psychotherapies for PTSD in VA residential treatment programs: outcomes for two yearly time points This study examined the implementation of two evidence-based psychotherapies, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), in the Department of Veterans Affairs (VA) residential Posttraumatic Stress Disorder treatment programs. The current analyses focused on continued implementation a year after an initial assessment of implementation and of provider and site variables thought to be related to implementation. Seventy-five providers from 38 programs provided complete quantitative data on both baseline and follow-up. At one year follow-up, there was continued effect of supportive organizational context (i.e., dedicated time and resources and incentives and mandates) on the implementation of both PE and CPT delivered in a group format. Unlike at baseline, effects of perceived characteristics of treatment on implementation of PE and of supportive organizational context on CPT delivered individually were no longer significant. Rather, social connections predicted a lower likelihood of implementation of CPT individually. These effects all remained, even after taking into account baseline levels of implementation. Implementation of two evidence-based psychotherapies for PTSD in VA residential treatment programs: patient-level outcomes This presentation will discuss the effects of implementation of two EBTs for PTSD (PE and CPT) in the U.S. Department of Veterans Affairs (VA) residential treatment programs on patients' PTSD symptom severity, alcohol and drug use, and treatment satisfaction. The instruments were administered to patients upon admission and four months post-discharge. The short form of the Mississippi Scale for Combat-Related PTSD was used to measure PTSD and alcohol and drug abuse were measured using the composite indexes from the Addiction Severity Index. Controlling for length of stay and baseline symptoms, implementation of PE and CPT predicted improvement in PTSD symptom severity and alcohol use. The implications of these findings are that two EBTs for PTSD can be feasibly and effectively disseminated to routine clinical settings and implementation produces favorable patient outcomes.

The Impact of Halfway Houses on Parole Success and Recidivism

&lt;!--[if gte mso 9]&gt;&lt;xml&gt; &lt;w:WordDocument&gt; &lt;w:View&gt;Normal&lt;/w:View&gt; &lt;w:Zoom&gt;0&lt;/w:Zoom&gt; &lt;w:DoNotOptimizeForBrowser/&gt; &lt;/w:WordDocument&gt; &lt;/xml&gt;&lt;![endif]--&gt;&lt;p class="MsoNormal" style="line-height: 200%;"&gt;&lt;span style="color: black; mso-bidi-font-weight: bold;"&gt;This article seeks to identify short and long term effects of halfway house completion on parole success and subsequent recidivism from a sample of offenders released from a northeastern state’s correctional facilities between 2004 and 2008.&lt;span style="mso-spacerun: yes;"&gt; &lt;/span&gt;Using propensity score matching techniques, we compare parolees released to parole after successfully completing a residential treatment program to a matched group of parolees released directly into the community from a correctional facility.&lt;span style="mso-spacerun: yes;"&gt; &lt;/span&gt;Analyses show that parolees who successfully complete a halfway house program are more likely to successfully complete parole but the effect on residential programming on long-term recidivism are negligible.&lt;span style="mso-spacerun: yes;"&gt; &lt;/span&gt;&lt;span style="mso-spacerun: yes;"&gt; &lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;p class="MsoNormal"&gt;&lt;strong&gt;&lt;span style="color: black;"&gt;Keywords: &lt;/span&gt;&lt;/strong&gt;&lt;em style="mso-bidi-font-style: normal;"&gt;&lt;span style="color: black; mso-bidi-font-weight: bold;"&gt;Alternative Corrections, Community Corrections, Halfway Houses, Parole, Recidivism&lt;/span&gt;&lt;/em&gt;&lt;/p&gt;

Effectiveness and clinical response rates of a residential eating disorders facility

ABSTRACTThe purpose of this study was to determine the effectiveness of a residential treatment program for adults and adolescents with eating disorders across a wide spectrum of measures. Data on body mass, eating disorder severity, depression, anxiety, and two measures of quality of life were collected on 139 consecutively admitted adolescents and 111 adults at a residential treatment program (N = 250). The same measures were completed at post-treatment. Group level analyses showed that adults and adolescents improved on all measures analyzed. Only 1.7% of adolescents and 2.3% of adults were below a Body Mass Index of 18.5 at discharge. Positive results across diagnoses and ages are reported for three subscales of the Eating Disorder Inventory-3, with clinical response rates reported. Using clinical responder analyses, it was found that for all individuals struggling with secondary issues, 74.7% were responders on the Beck Depression Inventory-II, 41.0% on the Beck Anxiety Inventory, 63.5% on a measure of quality of life, and 95.8% were responders on the physical subscale and 72.6% on the mental subscale of the SF-36-v2. This study suggests that residential treatment for eating disorders is effective at the group level, and it was effective for the majority of individuals within the group.

Impaired Decision-Making, Higher Impulsivity, and Drug Severity in Substance Dependence and Pathological Gambling.

Substance use disorder is characterized by impaired decision making, impulsivity, and risk taking. Pathological gambling shares many of these characteristics, and having both diagnoses may be associated with greater problems than either diagnosis alone. We investigated whether among substance-dependent individuals, comorbid pathological gambling would be associated with worse decision making, greater impulsivity, risk taking, and drug severity. Ninety-six substance-dependent individuals were recruited from a residential treatment program and divided into 1 of the 2 groups depending on whether they met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for pathological gambling (SDPG, n = 26) or not (SD, n = 70). Ninety-two controls were recruited from the community. Participants completed a decision-making task (modified Iowa Gambling Task), measures of impulsivity (Barratt Impulsivity Scale and Delay Discounting), and risk taking (Balloon Analog Risk Task). Decision making was analyzed using a computational model. We tested for group differences using analysis of covariance or Kruskal-Wallis and appropriate post-hoc tests. The groups differed in decision-making parameters (P < 0.001) and self-reported impulsivity (P < 0.001). All post-hoc comparisons were significant on these measures, and indicated stepwise changes in controls, followed by SD, followed by SDPG, with SDPG performing worse on decision making and being more impulsive. Compared with SD, SDPG had greater drug severity (P < 0.001). No group differences were observed in delay discounting or risk taking. Compared with individuals with substance dependence without pathological gambling, those with both disorders demonstrated worse decision making and significantly more drug-related symptoms. When evaluating patients with substance dependence, clinicians should consider diagnostic assessments for gambling, as the co-occurrence of both disorders may impact clinical characteristics.

The impact of revised DSM-5 criteria on the relative distribution and inter-rater reliability of eating disorder diagnoses in a residential treatment setting

This study evaluated the relative distribution and inter-rater reliability of revised DSM-5 criteria for eating disorders in a residential treatment program. Consecutive adolescent and young adult females (N=150) admitted to a residential eating disorder treatment facility were assigned both DSM-IV and DSM-5 diagnoses by a clinician (n=14) via routine clinical interview and a research assessor (n=4) via structured interview. We compared the frequency of diagnostic assignments under each taxonomy and by type of assessor. We evaluated concordance between clinician and researcher assignment through inter-rater reliability kappa and percent agreement. Significantly fewer patients received either clinician or researcher diagnoses of a residual eating disorder under DSM-5 (clinician—12.0%; researcher—31.3%) versus DSM-IV (clinician—28.7%; researcher—59.3%), with the majority of reassigned DSM-IV residual cases reclassified as DSM-5 anorexia nervosa. Researcher and clinician diagnoses showed moderate inter-rater reliability under DSM-IV (κ=.48) and DSM-5 (κ=.57), though agreement for specific DSM-5 other specified feeding or eating disorder (OSFED) presentations was poor (κ=.05). DSM-5 revisions were associated with significantly less frequent residual eating disorder diagnoses, but not with reduced inter-rater reliability. Findings support specific dimensions of clinical utility for revised DSM-5 criteria for eating disorders.

Pilot Project in NY State Reduces Use of Seclusion, Restraint in Facilities Serving Children

Pilot Project in NY State Reduces Use of Seclusion, Restraint in Facilities Serving Children

Rehab, respite and recovery: the experiences of methadone users in a modified therapeutic community (MTC) in Scotland

Purpose – There is limited research documenting recovery experiences of residential service users. The purpose of this paper is to explore the perceptions service users on methadone have about recovery. In depth, semi structured 1-1 interviews with seven poly drug using homeless males between the ages of 37 and 46 and analysed using NVivo software. Results are presented thematically. Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to former addict identities. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms that equate recovery with abstinence. Tensions were revealed in true motivations for active rather than passive participation in adopting group work norms. Design/methodology/approach – A qualitative design utilises small numbers of participants to gather rich data. In depth, semi structured 1-1 interviews conducted with seven poly drug using homeless males who have completed between ten and 15 weeks of a minimum 26-week residential treatment programme. Participants were aged 37-46. Results were analysed thematically using NVivo software. Findings – Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to a former stigmatised addict identity. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms regards recovery and abstinence. A significant process of recovery involved adopting the norms of 12-step groups and TC therapy to gain enough trust to leave the therapeutic community (TC) unsupervised. This created tension regards motivation, were these individuals in recovery, or merely “faking it”? Research limitations/implications – A female perspective may have provided a more balanced discussion and yielded greater depth in results. Only one service was studied and the findings may be specific to that cohort. The duration of stay at the service of ten to 15 weeks is a relatively short time and excluded participants resident for six months or more. Longer term residents may have been more reflective and informative. Practical implications – Encourage active options and increased debate on the variety of treatment options available to long term homeless opiate users who have failed to comply with previous treatments. While this is a small modest study, the rich data yields practical advice for policy makers and service providers. Social implications – This research study adds to an informed perspective by encouraging debate on methadone as a challenge to definitions of recovery that infer abstinence as a key definition of success. Originality/value – There is a paucity of research documenting a Scottish TC service user perspective using qualitative methods on experiences of addiction, treatment and recovery.

Sex Offenders in the Federal Correctional System

Driven largely by changes in federal legislation, which increased resources for law enforcement and enhanced mandatory minimum sentences, the number of sex offenders handled by the federal criminal justice system has increased over the last 5 years at rates second only to illegal immigration offenses. The heightened attention to sex offending by federal law enforcement coupled with a greater certainty of punishment imposed has resulted in a record number of sex offenders in federal prison and on supervision in the community. Child pornography offenders, for example, share a similar likelihood of receiving a prison sentence (given being charged and convicted) as drug, weapon, and violent offenders. Sex offenders are also serving longer terms in federal prison and on supervision—terms that are expected to increase further in the next decade. This article considers changes in the federal response to sex offenders and growth in prison and supervision populations. Implications for the management of sex offenders in prison—including prison-based residential and nonresidential treatment programs and civil commitment for individuals adjudicated as sexually dangerous—and offenders under supervision in the community are discussed.