Therapeutic Community Clients Research Articles

Clients’ Satisfaction of the Therapeutic Community Modality Program: Ba-sis for the Development of Prototype Syllabus

The study determined the Therapeutic Community (TC) clients’ satisfaction and assessment of the Therapeutic Community Modality Program rendered by the Parole and Probation Administration in the National Capital Region (NCR). The researchers-made survey questionnaire was administered to two (2) groups of respondents composed of 33 probation and parole personnel and 285 therapeutic community clients. The researchers-made survey questionnaire was validated by the four (4) experts in the field of therapeutic community modality program. The study revealed that the TC clients were satisfied on the Therapeutic Community Modality Program in all of the dimensions being assessed; however, there are indicators on clients’ satisfaction that obtained the lowest weighted mean that need to be addressed. On behav-ior management, there is a need for the TC implementers to reinforce community values and give emphasis on organizational structure. On the intellectual and spiritual aspects, educational activities and academic training must be intensified with focus on group activities that counter negative behavior to reinforce community values. On vocational and survival aspects, the TC program must incorporate vocational and livelihood training. The researchers conclude that the TC clients’ and TC personnel are satisfied to the Therapeutic Community Modality Program in terms of behavior management, intellectual and spiritual, vocational, and survival, and emotional and psychological aspects.

Traits associated with treatment retention in a therapeutic community for substance dependence

PurposeThe treatment of severe and chronic substance dependence is challenged by high rates of treatment attrition, highlighting the need to identify factors that hinder treatment retention. The paper aims to discuss this issue.Design/methodology/approachThe present study examined certain neurocognitive and personality traits in relation to treatment retention in a sample of 46 residents of an Australian therapeutic community (TC). The traits examined were previously found to be associated with problematic substance use in non-clinical samples and were also previously shown to differentiate TC clients from social drinkers. The hypothesis was thus that traits that appear to be risk factors for addictions are also likely to impact on TC treatment retention.FindingsGroup comparisons of those retained for more than the recommended 90 days vs those who left treatment prematurely showed that after controlling for the influence of depression, those who left treatment prematurely reported significantly higher levels of trait impulsivity, punishment sensitivity and executive cognitive dysfunction. There was a very high rate of alexithymia in the sample (52 per cent), but alexithymia was unrelated to retention.Research limitations/implicationsThe final sample size was less than planned but reflected the strict participation criteria and temporal limitations of this study. No statistical assumptions were violated and the reliability indices of the scales completed by clients ranged from acceptable to excellent. Another limitation was that dropout cannot be assumed to mean relapse, as the reasons for client dropout were not available.Originality/valueFindings highlight the important roles of trait factors in TC treatment retention in addition to the motivational and interpersonal factors identified in previous work.

I-Challenges: Influencing Others’ Perspectives by Mentioning Personal Experiences in Therapeutic Community Group Meetings

In this article, I examine the communicative practice of mentioning a personal experience as a vehicle for challenging a peer’s perspective. I study this in the context of therapeutic community (TC) group meetings for clients recovering from drug misuse. Using conversation analysis, I demonstrate that TC clients use this practice, which I call an I-challenge, to influence how their peers make sense of their own experiences and to do so without commenting on those peers’ experiences and perspectives. This study highlights the power of talking in the first person as a means of influencing others—a notion previously made popular by Thomas Gordon’s work on “I-messages.” Additionally, this study illustrates a novel way of studying social influence. Whereas previous research in social psychology has focused on the cognitive constraints behind phenomena of social influence and persuasion, here I contribute to understandings of the interactional norms underlying the organization of influence as a structured and coordinated domain of social action.

Measuring outcomes for TC clients: Higher Ground Drug Rehabilitation Trust

Purpose The purpose of this paper is to analyse the clinical outcome data collected as part of an 18-week, abstinence-based residential therapeutic community (TC) programme, Higher Ground Drug Rehabilitation Trust (Higher Ground) in New Zealand. Lessons and implications for routine collection of clinical outcome data are identified. Design/methodology/approach Higher Ground collects longitudinal data on all consenting clients using a battery of validated psychometric tools, with repeated measures at up to nine points in time from first presentation through to 12-month post-discharge follow up. Data analysis covered clients who entered Higher Ground between 1 July 2012 and 2 June 2015 (n=524). Findings Clients presented with histories of addiction which often had significant negative associations with their physical and psychological health, their relationships, work, accommodation and criminal behaviour. By the time they exited the programme, clinically and statistically significant improvements were seen across multiple indicators including: substance use and abstinence; symptoms of post-traumatic stress disorder, depression, anxiety and stress; and a range of social indicators. Research limitations/implications Attrition in follow-up research is a significant challenge, with people completing the TC programme being more likely to participate than those who do not. This limits generalizability in post-discharge data. There was no control group, making causal attribution a challenge. Identifying suitable benchmarks from the literature is challenging because of the variety of outcome measures and research methodologies used. Practical implications Tracking client outcomes longitudinally using psychometric tools is potentially valuable for TCs and their funding bodies, as it provides insights into patterns of client recovery that can inform ongoing service improvements and resource allocation decisions. However, significant challenges remain. Originality/value The study demonstrates the value, and practical challenges, of collecting high-quality outcome data in a TC setting.

Prevalence and correlates of traumatic brain injury amongst heroin users

The study aimed to determine the prevalence and severity of traumatic brain injury (TBI) amongst heroin users, and its associations with cognitive functioning and drug use histories. TBI and drug use histories were taken from 175 heroin users enrolled in maintenance or residential treatment, and neuropsychological tests administered measuring executive function, working memory, information processing speed, verbal learning and non-verbal learning. A TBI had been suffered by 55%, 37% had suffered multiple injuries, and 15% had suffered a moderate–severe injury. Males were significantly more likely to have had a TBI (odds ratio [OR] 2.59) and to have experienced multiple TBIs (OR 3.04). Maintenance patients were significantly more likely than therapeutic community clients to have experienced a TBI (61.6 vs. 40.0%). A higher number of TBIs was associated with poorer global cognitive performance, as well as poorer executive functioning, information processing speed and verbal learning. Treatment providers should be aware that a large proportion of those they treat have experienced TBI. TBI should be considered as one of the harms likely to accompany the transition into heroin use.

Further Validity Evidence for the Dimensions of Change in Therapeutic Community Treatment Instrument

Recent research efforts have focused on assessing the therapeutic community (TC) treatment process. The current article examines the validity of the client self-report Dimensions of Change Instrument (DCI) treatment process measure, by confirming its factor structure and examining each subscale's relationship with time in treatment, scales from an existing process assessment, and mental and physical health status. Participants were 511 adult and adolescent residential TC clients. The factor structure of the DCI replicated with satisfactory fit. The pattern of associations between DCI subscales and criterion measures was largely as expected, providing initial concurrent and discriminant validity evidence for the DCI.

Problem Severity Profiles of Clients in European Therapeutic Communities: Gender Differences in Various Areas of Functioning

The BIOMED II ‘Improving Psychiatric Treatment in Residential Programmes for Emerging Dependency Groups’ project provided a relatively large sample (n = 863) of men (77%) and women (23%) in therapeutic community treatment in nine European countries. This paper’s aim is to search for gender differences in profiles of therapeutic community clients on the basis of the different areas of functioning of the EuropASI. A binary logistic regression model was used to avoid the confounding effects of country and age. Our findings confirm what is found in the American literature: compared to men, women have a much worse profile in various areas of functioning when entering treatment. In response, they may require a gender-adapted set of therapeutic interventions at the moment they enter treatment.

Social epidemiologic comparisons in a European cohort of substance‐dependent therapeutic community clients: a case‐oriented analysis

A case‐oriented analytical approach compared the index national case of France with the typical European outcome, other European cases and American results on social epidemiological indicators. Modal distributions were found to be most similar between the French sample and the total European sample on most social network items in a European therapeutic community cohort (n=723). The characteristics of the American and our sample were also found to be strikingly similar. Network size varies mainly with the number of substance‐dependent contacts reported by the client. Southern European clients have been living with their parents while northern clients have been living alone. Spending most of the time with drug‐using friends is not related to developing intimate relationships and a counterbalance to a situation of peer loneliness. The importance of looking at the function of social network relations in risk networks in harmonising European policy is emphasised.

Correlates of Underreporting of Post-Discharge Cocaine Use among Therapeutic Community Clients

This study had two goals: first, to assess the validity of self-reported recent cocaine use at follow-up among therapeutic community (TC) clients and second, to identify pre- and post-admission factors that are related to underreporting of cocaine use. Research interviews and urinalyses were used from the follow-up sample of 307 people participating in the District of Columbia Treatment Initiative (DCI) study 19 months after treatment discharge. Results show that the type of measure used to assess validity is very important to determining the results. Overall percentage agreement between self-reports and urinalysis was greater than 70 percent; however, after restricting the sample to include only those clients who were cocaine positive, the agreement decreased to 35 percent. Bivariate analyses revealed no pre-admission correlates of underreporting cocaine use at follow-up and a few post-admission correlates. We conclude that it is not possible to identify in advance clients who are likely to underreport cocaine use. To avoid underestimating cocaine use, treatment outcome studies should use objective measures of drug use along with self-reports.

Illicit drug use and return to treatment: follow-up study of treatment admissions to DARP during 1969-1971.

The present study was based on follow-up data on 1,409 persons interviewed 4 to 6 years after admission to drug treatments in the Drug Abuse Reporting Program (DARP). The admissions to DARP occurred in 1969-1971, and for most persons the follow-up data included 3 or more years after termination of DARP treatment. The focus of this study was on illicit drug use of former DARP clients, taking into account if and when they reentered drug treatment after termination of DARP treatment. The results showed that a significant drop in opioid and nonopioid (but not marijuana) drug use generally occurred upon entry into other, post-DARP treatments, and that these beneficial effects of treatment tended to continue beyond the end of treatment. Overall, 42% of the sample had no further drug treatment during the first 3 years after DARP, and almost half (42%) of this group used no opioid or nonopioid drugs at all during this time. Comparisons between DARP treatment groups also indicated that therapeutic community clients had the lowest rate of return to post-DARP treatments.