Substance Abuse Treatment Field Research Articles

Effectiveness of Therapeutic Community Rehabilitation Program for Drug Abuse in Social Institutions

This research conducts an evaluation of the Therapeutic Community (TC) Program implemented for residents grappling with drug abuse within social institutions. The study aims to assess the program's effectiveness, the impact on participants, and its implications for social institutions and the broader field of substance abuse treatment. Through a mixed-methods approach, the research scrutinizes quantitative data to measure changes in substance abuse levels, mental health, and readiness for reintegration, coupled with qualitative insights from participant experiences. The outcomes reveal significant reductions in substance abuse levels, improvements in mental health indicators, and positive behavioral changes among participants. The study highlights the pivotal role of peer support and community integration in residents' recovery journeys. The implications of the findings encompass enhanced recovery pathways for individuals, reinforcing the value of community support, while calling for sustained support mechanisms and comprehensive approaches within social institutions. This evaluation underscores the dynamic nature of substance abuse interventions and underscores the importance of continuous assessment, innovation, and adaptive strategies for improved rehabilitation initiatives.

Cultural accommodation of internet-based interventions for substance use and related disorders: a proposed comprehensive framework based on a pilot study and a literature review.

Despite the low utilization rates of substance use and related disorders services, and the ability of internet-based interventions for substance use and related disorders (IBIS) to address challenges related to service engagement, limited attention has been placed on the processes for the accommodation of these interventions to diverse cultural settings. This study aimed to develop a framework for the cultural accommodation of IBIS across populations based on a pilot study and a literature review. A pilot study of cultural accommodation of an existing internet intervention for alcohol use was carried out in Israel, which involved focus groups and daily online surveys of prospective consumers (N = 24) as well as interviews with experts (N = 7) in the substance abuse treatment field. Thematic analysis revealed a range of themes that relate to the general Israeli culture and the specific Israeli drinking subculture, identified as needing to be addressed in the process of intervention accommodation. A comprehensive framework for cultural accommodation of IBIS is suggested, consisting of five stages: Technical and cultural feasibility; Engagement of target group; Identification of accommodation variables, Accommodation, and evaluation of the accommodated intervention. In addition, the framework consists of four dimensions of accommodation: Barriers and facilitators; Audio-visual materials and language; Mechanisms of change; Intersectional factors. We suggest that the proposed framework may serve as a guide for the cultural accommodation of existing internet-based interventions for substance use and related disorders across a range of cultural and geographical settings, thus augmenting the ecological validity of internet-based interventions for substance use and related disorders, expanding cross-cultural intervention research, and reducing health disparities worldwide.

How to deal with Substance Abuse in a Telepsychiatric Setting

Abstract BodyAlcohol and (illicit) substance abuse are among the most common psychiatric disorders within the general population and their impact can not be underestimated. Reputedly for these disorders, there is a large treatment gap and treatment delay, i.e. large numbers of afflicted individuals never receive appropriate treatment and if they do so often many years after the onset of the disorder. The Covid19 pandemic has only aggravated these gaps. In many countries, due to the Covid 19 pandemic and its associated restriction measures telepsychiatric tools have become increasingly implemented (and funded) as regular parts in the possibilities in delivering interventions. With respect to substance abuse treatment, a vast body of research already showed promises both in the field of telepsychiatry as broader the use of digitalization (e.g. the use of virtual reality designed treatment interventions, digital monitoring). In the current presentation, an overview will be presented of both telemental health interventions and digital tools/interventions in the field of substance abuse treatment.DisclosureNo significant relationships.

Empowering professionals in the drug addiction field through Erasmus+ Mobility Projects: the case of KETHEA

This presentation will focus on Erasmus+ mobility projects as a means of empowering and strengthening staff members working in the substance abuse treatment field, which is undoubtedly a rather demanding and difficult professional practice. Moreover, this presentation will explore the case of the Therapy Center for Dependent Individuals/KETHEA (www.kethea.gr) and its effort to provide more opportunities to its staff to develop critical thinking, boost self-efficacy, personal fulfilment and completion through learning mobility projects. In the last three (3) years at least fifteen (15) professionals had the opportunity to study, work and train, to develop professional skills and competences and exchange knowledge and expertise in the drug addiction field, by travelling abroad to another participating country, and had rather impressive outcomes.

Interview on Treatment for Women with Substance Use Disorder, Mental Health Disorders, and Histories of Trauma: An Interview with Francine Feinberg, PsyD, LCSW

During the past several decades, the substance abuse treatment field has recognized that women often develop and experience substance use disorders differently than men. In addition, trauma, often ...

Understanding Substance Abuse Counselor Turnover Due to Burnout: A Theoretical Perspective

Clinical staff turnover resulting from burnout is one of the most challenging issues facing the substance abuse treatment field. This article provides a succinct description of the impact of clinical staff turnover on organizational performance and client treatment, along with a comprehensive literature review of individual and organizational characteristics that often lead to burnout. The Job Demand-Control Model and six areas of work life are explicated to identify leverage points for organizational leaders to make the largest impact on improving work conditions and mitigate the consequences of burnout.

Dissemination activities: a critical new role for substance abuse treatment organizations.

The Affordable Care Act calls for integration of substance abuse treatment into medical care via medical homes and continuing specialty care. For this integration to occur in the substance abuse treatment field, substantial sharing and dissemination of information by treatment providers is required. This study explored the determinants of organizational activities directed at disseminating evidence-based practices (EBPs) undertaken by 193 community treatment programs who are members of the National Institute on Drug Abuse (NIDA) Clinical Trials Network. Using factor analysis, the research identified two generic categories reflecting different motivations for dissemination activities and explored both treatment center leadership and organizational characteristics as determinants of these different types of dissemination activities. Organizational characteristics predicting treatment center dissemination activities included size, previous involvement in research protocols, linkages with other providers, and having non-profit status. The treatment center leader's membership in professional organizations was also a significant determinant. Organization variables account for a larger portion of the variance in treatment center dissemination activities. The results suggest that the willingness of treatment providers to help disseminate EBPs within the industry may be heavily influenced through shared network connections with other treatment organizations.

Helping the children of substance-abusing parents in the context of outpatient substance abuse treatment

A significant proportion of clients entering substance-abuse treatment have children who may need help and support. The study examines whether and, if so, how children are seen and noticed and what concrete actions are taken to help children both directly and through supporting the parenting of clients in outpatient substance-abuse treatment. These questions are investigated by means of qualitative analysis of data gathered from 17 professionals in the substance-abuse treatment field in Finland. In most cases, minimal information was collected about children at client entry. It seems to be general practice to ask only whether the client has children and how old they are. Children are seldom met in person in substance-abuse treatment, and they rarely receive direct help. Tools to support parenting are inadequate or totally lacking. The reasons given by the interviewees for the exclusion of children relate to workers’ views on the role of substance-abuse treatment. Possible skills and tools to support parenting and children were reported to originate mainly from sources other than training and working in substance-abuse treatment. Practices and tools specially designed to help children in the substance-abuse treatment context along with better understanding of the role of the substance-abuse treatment system in helping these children are needed.

The Spirit of Motivational Interviewing as an Apparatus of Governmentality. An Analysis of Reading Materials Used in the Training of Substance Abuse Clinicians

Substance abuse clinicians working at the coal face with clients daily are confronted with client problems that are robust and tangible. The understanding of these problems is granted epistemological and ontological legitimacy by the psy-sciences. As a result, practice in the substance abuse treatment and addiction fields are rarely subject to the scrutiny provided by post-structural analysis. Moreover, the disciplines of addiction treatment and sociology rarely collaborate in any meaningful way for numerous reasons. For the AoD clinician caught betwixt and between biological psychological and sociological discourses, there has been a tendency to opt for the perceived problem solving capabilities of psychological discourses. However, in a post-aetiological hemisphere, attention is increasingly fixated on the fiscal imperative. Clinician/Client relationships have been reconfigured in neo-liberal society. In this study, materials used to train undergraduate students Motivational Interviewing skills in an Alcohol and Drug degree programme were subject to a textual analysis deploying the Foucaultian concept of governmentality. The familiar aetiological descriptor model used in the field was transposed into the Foucaultian term discourse. One article subject to analysis is presented here. The intention was to interrogate the effects of Motivational Interviewing on client and clinician and the resultant repositioning. It was found that Motivational Interviewing technologies reposition the client as an active self-governing autonomous subject while the clinician is professionally and spiritually imprecated in the manufacture of a neo liberal subjectivity within the client. It is argued that the client/clinician interaction constituted, owes less to clinical considerations than to contemporary neo liberal agendas. Proponents of the practice cite progressive and enlightened facets of Motivational Interviewing through an uncritical indebtedness to ascendant resilience and strength based discourses. Alternatively it can be understood as an individualising strategy that displaces clients from former robust communities of understanding, latterly positioned as primitive or deficit ridden. In the resulting motif client/clinician interaction is reconfigured so that the active rational, self-empowered client is produced by the newly embourgoised clinician. Clinical concerns are casually jettisoned. Thus Motivational Interviewing is at once a political/apolitical apparatus, which requires further interrogation.

Results from the Pro-QOL-IV for Substance Abuse Counselors Working with Offenders

This study examines compassion fatigue, burnout and compassion satisfaction in two groups of counselors who specialize in substance dependency treatment in order to identify the unique features of substance abuse service delivery that may be related to professional quality of life. Qualitative interviews were conducted with 20 substance abuse counselors working with offenders both in prison and community facilities. In addition, interview subjects completed the ProQOL-IV to assist in exploring the unique challenges that may face the substance abuse treatment field with regards to professional self-care. Two key themes emerged from the examination of the group of interviewees that scored high on the Compassion Fatigue Subscale on the ProQOL-IV, revealing that working with women is more challenging, and substance abuse counselors who have family members with addiction problems or themselves are in recovery may make one more susceptible to compassion fatigue.

Understanding staff turnover within the substance abuse treatment field

presents a preliminary analysis of veterans' risks, overdose experiences and the extent that they know how to avoid risky behaviors and respond to critical situations appropriately. The paper discusses the growth in outreach programs, their potential impact on saving and improving lives, and the need for further research to develop culturallyappropriate programs that are sensitive to the experiences of veterans, minorities, and residents of lowincome communities.

Where do they go from here? Post-turnover employment decisions in substance abuse treatment

Turnover is a problem in the substance abuse treatment (SAT) field, particularly when clinicians exit not just the organization, but the profession as well. Voluntary clinician turnover ranges from 25% to 31% by the second year of employment (Eby, Burk, & Maher, 2010; Eby & Rothrauff-Lauschober, 2012; Garner, Hunter, Modisette, Ihnes, & Godley, 2012) to 47% by the fourth year of employment (Eby & Rothrauff-Lauschober, 2012). Supervisor turnover is 19–23% annually (Eby et al., 2010; Garner et al., 2012). The present study uses longitudinal quantitative and qualitative data from MERITS I to identify 219 clinicians that voluntarily exited SAT organizations. Leavers were classified as either organizational turnover (n=120 or 55%) or professional turnover (n=99 or 45%). A content analysis will identify specific reasons for turnover among these two groups of leavers. A better understanding of both professional and organizational turnover may reduce costs, increase organizational efficiency, and improve patient care.

Indigenous Traditional Knowledge and Substance Abuse Treatment Outcomes: The Problem of Efficacy Evaluation

Background: In the field of substance abuse treatment, American Indian and Alaska Native (AI/AN) communities have routinely incorporated ceremonial practices as one important component in the promotion of recovery and healing. The beneficial effects of such practices are frequently described as plainly apparent by community-based advocates, providers, and professionals alike. In the present era of evidence-based substance abuse intervention, however, indigenous integration of such practices raises questions pertaining to the systematic evaluation of treatment efficacy. Objectives: The focus of this article is outcome evaluation. Although intervention outcome researchers recognize the randomized controlled trial as the “gold standard” against which claims of treatment efficacy are measured, AI/AN efficacy assertions grounded in indigenous traditional knowledge (ITK) reflect different concerns that have emerged in non-Western historical contexts. The interface between scientific and indigenous “ways of knowing” is explored here relative to efficacy claims about substance abuse treatment. Methods: Distinguishing features of both scientific knowing and ITK are summarized and compared. Results: ITK has been described as personal and experiential, reflecting the primacy of autonomous individual knowing. In contrast, intervention scientists are skeptical of personal inference as a basis for efficacy evaluation. The evident divergence between these epistemic paradigms can result in potentially contradictory claims. Conclusion: Proper appraisal of the status and relevance of ITK for determining treatment efficacy requires further exploration of these marginalized approaches to knowledge. Scientific Significance: Intervention scientists who work in AI/AN communities should remain open to the legitimacy and role of ITKs in investigations of substance abuse treatment.

Workforce diversity in outpatient substance abuse treatment: The role of leaders' characteristics

Although the outpatient substance abuse treatment field has seen an increase in referrals of African American and Latino clients, there have been limited changes in the diversity of the workforce. This discordance may exacerbate treatment disparities experienced by these clients. Program leaders have significant influence to leverage resources to develop staff diversity. Analysis of panel data from 1995 to 2005 showed that the most significant predictors of diversity were the characteristics of leaders. In particular, programs with managers with racially and ethnically concordant backgrounds and their education level were positively related to the percentage of Latino and African American staff. A high percentage of African American staff was positively associated with managers' tenure, but inversely related to licensed directors. Diversification of the field has increased, yet efforts have not matched increases in client diversity. Implications for health care reform legislation seeking to improve cultural competence through diversification of the workforce are discussed.

PROTOCOL: Family Behavior Therapy (FBT) for young people in treatment for non‐opioid drug use

PROTOCOL: Family Behavior Therapy (FBT) for young people in treatment for non‐opioid drug use

Waiting for What? An Inquiry into the Fundamental Questions of How to Fix Adolescent Mental Healthcare

Improving the effectiveness of mental health and substance abuse care for young Canadians is a complex and pressing issue. Currently, there is a focus on reducing wait times and facilitating "system integration" as proposed solutions to the crisis in mental health care. As resources are being allocated toward pursuing those two solutions, the authors argue that the more fundamental challenge to addressing the crisis in mental health care for Canadian adolescents is to urge treatment providers and agencies to clearly define the goals and mechanisms of treatment while evaluating program impacts in order to generate knowledge about effective approaches to treatment. In essence, the authors suggest asking two fundamental questions: What are we treating? And what works? Drawing from insights gained through the creation of a mental health treatment centre at Pine River Institute and the development of subsequent collaborations with various clinical and research communities, the authors outline the importance of clarifying the goals and mechanisms of mental health treatment and creating better definitions and measures of treatment success as a strong foundation for moving toward decreasing wait times and increasing system integration. More specifically, they suggest that the government's most effective role is to increase system capacity by setting standards for excellence. The government can increase system capacity by requiring accountability through accreditation and outcome evaluation; increasing resources for program evaluation; and encouraging innovation by funding research into potentially effective treatment that can contribute evidence to the field of adolescent mental health and substance abuse treatment.

Commentary on Genberg et al. (2011): The structural vulnerability imposed by hypersegregated US inner-city neighborhoods - a theoretical and practical challenge for substance abuse research

Commentary on Genberg et al. (2011): The structural vulnerability imposed by hypersegregated US inner-city neighborhoods - a theoretical and practical challenge for substance abuse research

Addiction Counselors in Recovery: Perceived Barriers in the Workplace

In the 1970’s when the substance abuse treatment field was still developing as a discipline, there was a great deal of workers needed to help with the large amount of substance abusers wanting help. And since specific credentials were not yet established for the field of addictions, individuals with sobriety were hired on and given on the job training. The literature has described many barriers that the counselor in recovery has been faced with over the decades. A common theme throughout the literature is that these individuals usually enter the field at an older age and have less formal education than the non-recovering counsellor. The role of the counsellor in recovery is often distorted within the field by the second-class citizen status to which they are sometimes subjected. By writing this paper we hope to resurrect topics that might be perceived as barriers by counsellors in recovery that were briefly discussed in the literature decades ago. To begin this process of reform, this paper reviews the literature in an attempt to examine the perceived barriers associated with the recovering addict working in the addiction field. It also addresses the limitations of the studies conducted to date, provides recommendations for further research and proposes that this topic be explored using a qualitative approach, so that this unique group of counsellors can construct their own narratives.

Advancing Collaborative Practice Between Substance Abuse Treatment and Child Welfare Fields: What Helps and Hinders the Process?

This study explores factors that facilitate and impede the process of developing successful collaboration between child welfare, substance abuse treatment, and dependency courts based on in-depth qualitative interviews with professionals (N = 49) from five California counties. Findings describe specific preconditions, organizational changes, and operational factors in the development of successful collaboration. Study participants also described factors that hindered collaborative practice, such as problems in cross-systems communication and fragmentation of services, as well as strategies that were employed to address or minimize these problems. Findings underscore the value of “lessons learned” from communities that have established successful collaborative programs, policies, and practices.

Implementation research: Issues and prospects

The concern that addiction treatment be grounded in science has been recognized and enthusiastically endorsed in both the clinical and research communities. With recognition of the gap between knowledge development and application, there has been a recent emphasis on developing strategies for more effective application, i.e., for the incorporation of evidence-based practice in routine clinical programming. This has translated to a need to develop strategies designed to achieve organizational change and a field of study whose objective is to better understand how to expedite change in treatment organizations and their clinical practices. This paper focuses on the roles and responsibilities of researchers, practitioners, and the federal government in achieving changed practice and applying new knowledge to improve treatment. Even though great strides have been made to shift the emphasis from dissemination of knowledge to its application, much still remains to be done in the development and testing of additional application strategies specific to the substance abuse treatment field. Future considerations for implementation research are discussed.