Retention In Therapeutic Community Research Articles

Patient Retention in Therapeutic Communities for Substance Abuse Treatment: An Organizational-Environmental-Professional Perspective.

This study examined various organizational, environmental, and professional components of therapeutic communities in Israel and their relationship with patient retention rates. Key elements included the juxtaposition between objective and subjective components of social environments, as reflected in the perceptions of staff (mostly social workers) and patients. The current study's findings suggest that retention rates are predicted to be higher when staff receive more hours of supervision and identify less with their peers, and when their assessments of the organizational climate within facilities is closer to their patients' assessments of this aspect of organizational milieu. These findings are discussed using various organizational and professional perspectives, guided by a field theory framework.

Qualitative study of welcome houses: a recent initiative designed to improve retention in therapeutic communities

Background: Welcome houses (WHs) have been introduced as a stage at the start of some European therapeutic communities (TCs) to improve treatment retention. In contrast to the structured, rule-bound approach of many residential therapeutic facilities (often described as ‘total institutions’ (TIs)), WHs provide a relatively ‘gentle’ introduction to residential life. This article explores the influence of WHs on treatment retention from the perspective of TC staff and residents.Methods: Thirty-five qualitative interviews were conducted in two TCs with WHs in the United Kingdom. Participants included staff (n = 13), current residents (n = 13) and former residents (n = 9). Interviews were transcribed, coded and analyzed using framework.Results: Participants reported that retention was affected by three core factors: ‘intensive care and support’, ‘rules and order’ and ‘time and space’. Each factor was described as influencing retention both positively and negatively, but via different mechanisms. WHs seemed to increase retention amongst people who had never been in residential treatment previously or who had complex needs, but decrease retention amongst those who were more stable at treatment entry.Conclusion: WHs retain many of the core characteristics of TIs, but in an adapted ‘softer’ form. As such, WHs might be better described as ‘reinventive institutions’. WHs should not be a mandatory stage within TCs. Rather TC providers should consider each new resident’s need for WH as part of their assessment. Further research is needed to quantify the impact of WHs on retention and to test apparent associations between retention outcomes and resident characteristics.

Core characteristics, treatment process and retention in therapeutic communities for addictions: a summary of four studies

Purpose – The purpose of this paper is to summarize the main findings and conclusions of four separate studies on treatment in therapeutic communities (TCs) for addictions. Design/methodology/approach – The first two studies address the core characteristics of the TC approach: a study on the workable and destructive elements of the Synanon model; and a comparative study on the essential elements of TCs for addictions in Europe and in the USA. The final two studies highlight clients’ perceptions of the TC treatment process in relation to retention: a study on clients’ first month perceptions of the TC treatment process and the influence of fixed and dynamic client factors; and a longitudinal study on changes in clients’ perception of the TC treatment process and the impact of motivation, psychological distress and cluster B personality traits. Findings – The first study showed that Synanon’s therapeutic and pedagogical methods are still highly valued despite its negative reputation. The results of the second study suggest that while traditional TCs operate as concept-based TCs in Europe, modified TCs might differ in the extent to which they apply the core principles and elements of the TC approach. The third study provides evidence that suitability for treatment is a very important predictor for clients’ first month perceptions of the community environment. The fourth study shows that with time in treatment clients develop more profound perceptions regarding the essence of TC treatment. Research limitations/implications – Finally, implications for clinical practice, general limitations and some concrete recommendations for future research are presented in this paper. Originality/value – The PhD summary study contributes to the existing literature on TC treatment.

Substance Abuser Impulsivity Decreases with a Nine-Month Stay in a Therapeutic Community

Background: Substance abuse continues to be a major public health problem. Keeping substance abusers in treatment is a challenge, and researchers continue to investigate ways to increase retention. Objective: The aim of this study was to investigate the relationship between impulsivity in substance abusers and length of stay in the context of therapeutic community. Methods: The Barratt Impulsiveness Scale– 11 (BIS-11) was used to assess impulsivity in 138 substance abusers at admission and at nine months in a therapeutic community. Results: Impulsivity significantly decreased in subjects who completed nine months in the therapeutic community. Legal stipulation increased length of stay, on average, by three months. On admission, female participants were on average more impulsive than their male counterparts. Conclusion: Impulsivity decreased in subjects who remained in therapeutic community for nine months although self-reported impulsivity at baseline did not seem to be associated with retention. Scientific Significance: Therapeutic community factors contribute to a decrease in self-reported impulsivity and these factors might be enhanced to increase retention in therapeutic community.

The impact of a social network intervention on retention in Belgian therapeutic communities: a quasi‐experimental study

Although numerous studies recognize the importance of social network support in engaging substance abusers into treatment, there is only limited knowledge of the impact of network involvement and support during treatment. The primary objective of this research was to enhance retention in Therapeutic Community treatment utilizing a social network intervention. The specific goals of this study were (1) to determine whether different pre-treatment factors predicted treatment retention in a Therapeutic Community; and (2) to determine whether participation of significant others in a social network intervention predicted treatment retention. Consecutive admissions to four long-term residential Therapeutic Communities were assessed at intake (n = 207); the study comprised a mainly male (84.9%) sample of polydrug (41.1%) and opiate (20.8%) abusers, of whom 64.4% had ever injected drugs. Assessment involved the European version of the Addiction Severity Index (EuropASI), the Circumstances, Motivation, Readiness scales (CMR), the Dutch version of the family environment scale (GKS/FES) and an in-depth interview on social network structure and perceived social support. Network members of different cohorts were assigned to a social network intervention, which consisted of three elements (a video, participation at an induction day and participation in a discussion session). Hierarchical regression analyses showed that client-perceived social support (F1,198 = 10.9, P = 0.001) and treatment motivation and readiness (F1,198 = 8.8; P = 0.003) explained a significant proportion of the variance in treatment retention (model fit: F7,197 = 4.4; P = 0.000). By including the variable 'significant others' participation in network intervention' (network involvement) in the model, the fit clearly improved (F1,197 = 6.2; P = 0.013). At the same time, the impact of perceived social support decreased (F1,197 = 2.9; P = 0.091). Participation in the social network intervention was associated with improved treatment retention controlling for other client characteristics. This suggests that the intervention may be of benefit in the treatment of addicted individuals.

Domains of variables for understanding and improving retention in therapeutic communities.

This paper discusses the value of different domains of variables for understanding and improving retention in therapeutic communities for substance users. Retention is important because therapeutic communities have high rates of attrition, and no other variables have been found that have practical implications for improving client outcomes from programs. Research shows that most client variables do not predict retention, and those that do are generally weak and sporadic predictors. Treatment entry variables have been stronger and more consistent predictors of retention. The small amount of research that has been done on program and treatment variables suggests they are important predictors of retention. Research needs to focus less on client variables and more on variables from the other domains if it is to be more useful for understanding and improving retention in therapeutic communities.

Issues to consider when predicting retention in therapeutic communities.

Many studies have focused on retention in therapeutic communities (TCs) because research shows that retention is an important predictor of client outcomes from these programs. A comparison of the three largest studies found there was little overlap between predictors of retention in TCs. Treatment Outcome Prospective Study data were analyzed to assess whether these findings may have been due to differences in times when the data were collected, measures of length of stay, and domains of variables used to predict retention. While the results suggest that each of these factors contributed to some differences between predictors of retention, the predictors still were unable to explain more than a small amount of the variance in retention. Research indicates that other variables need to be taken into account if future studies are to be more successful in predicting retention in TCs.

Fixed and dynamic predictors of client retention in therapeutic communities

This exploratory study assessed the value of fixed and dynamic variables for predicting client retention in therapeutic communities. Fixed variables included demographic and background characteristics that had been used to predict client retention and outcomes in previous research. Dynamic variables included circumstances under which clients joined programs and their motivations for seeking treatment. The sample comprised 753 admissions to 5 traditional therapeutic communities for substance abusers. Although both fixed and dynamic variables predicted client retention, the strongest predictors were two dynamic variables. One was exaddict interviewers' predictions of whether clients would stay long enough in the program to benefit from treatment. The other was whether clients had spent most of their time with large groups of people, as opposed to spending most of their time with small groups or alone, before using drugs. Program and treatment variables need to be taken into account along with client variables to better understand and improve retention in therapeutic communities and other types of drug abuse treatment programs.

Retention of court-referred adolescents and young adults in the therapeutic community.

Client retention for Abraxas, a therapeutic community (TC) whose clients are almost exclusively court referred, was compared with that for nine other TCs that primarily accept clients not referred by the courts. Retention was found to be dramatically higher for Abraxas than for all nine comparison TCs during the first month of treatment. After the first month of treatment, discharge rates for Abraxas were lower than those for an aggregate of seven of the TCs but were comparable to rates for two others. At the end of 10 months, more residents remained at Abraxas than at eight of the nine comparison programs. These differences between Abraxas and the nine comparison TCs are particularly notable in that Abraxas' population is primarily juvenile whereas the comparison program populations are primarily adult. Analysis of the Abraxas sample showed that client retention was significantly higher for court referrals, adults, and males, and did not significantly vary according to ethnicity. The author conclude that court pressure can strongly enhance retention in therapeutic communities, particularly during the initial stage of treatment.

Therapeutic communities: what are the retention rates?

The present research is the first in a systematic investigation of retention in therapeutic communities (TCs). Findings are reported from an interrelated set of analyses clarifying retention rates and the temporal pattern of dropout. Retention information was obtained on all admissions to a nonrandom sample of seven traditional (long-term) TCs during February 1-August 15, 1979. Results showed that: (a) Across the seven programs, the 12-month retention rates ranged from 4 to 21%. Program differences were generally nonsignificant. (b) Less than 17% of admissions were readmissions. Among these, however, the number of days before initial dropout was a significant predictor of long-term retention. (c) The temporal pattern of dropout was uniform across programs. Dropout was highest within the first 14 d and declined thereafter, indicating that practically all dropouts leave within 3 months. (d) Based upon rates adjusted for those who had left treatment ("survivor rates"), estimates indicated that the likelihood of continued retention increased significantly with longer stay in treatment. (e) The temporal pattern of dropout was remarkably stable, evident in both replicational and comparative analyses; the latter involved the entire residential drug-free modality in several data systems. The present findings establish that the temporal pattern of retention is orderly, predictable, and has utility for program management and treatment planning, although the phenomenon of retention itself remains to be explained.