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CORK Bibliography: Inpatient and Residential Treatment

44 citations. January 2009 to present

Prepared: March 2011

Alvarez J; Jason LA; Davis MI; Olson BD; Ferrari JR. Latinos and Latinas in communal settings: A grounded theory of recovery. International Journal of Environmental Research and Public Health 6(4): 1317-1334, 2009. (45 refs.)

Semi-structured interviews were conducted with 12 Latino/a residents of a mutual help residential recovery program (Oxford House) in order to elicit their experiences of the program's therapeutic elements. A model of recovery emerged from the analysis including several themes supported by existing literature: personal motivation and readiness to change, mutual help, sober environment, social support, and accountability. Consistent with a broad conceptualization of recovery, outcomes included abstinence, new life skills, and increased self-esteem/sense of purpose. Most participants were the only Latino/a in their Houses; however, cultural differences did not emerge as salient issues. The study's findings highlight potential therapeutic aspects of mutual-help communal recovery programs and suggest that English-speaking, bicultural Latinos/as have positive experiences and may benefit from participating in these programs.

Booth RE; Campbell BK; Mikulich-Gilbertson SK; Tillotson CJ; Choi D; Robinson J et al. Reducing HIV-related risk behaviors among injection drug users in residential detoxification. AIDS and Behavior 15(1): 30-44, 2011. (78 refs.)

This study of 632 drug injectors enrolled in eight residential detoxification centers within the National Drug Abuse Treatment Clinical Trials Network tested three interventions to reduce drug and sex risk behaviors. Participants were randomized to: (a) a two-session, HIV/HCV counseling and education (C&E) model added to treatment as usual (TAU), (b) a one-session, therapeutic alliance (TA) intervention conducted by outpatient counselors to facilitate treatment entry plus TAU, or (c) TAU. Significant reductions in drug and sex risk behaviors occurred for all three conditions over a 6-month follow-up period. C&E participants reported significantly greater rates of attending an HIV testing appointment, but this was not associated with better risk reduction outcomes. Reporting treatment participation within 2 months after detoxification and self-efficacy to practice safer injection behavior predicted reductions in injection risk behaviors. Findings indicate that participation in detoxification was followed by significant decreases in drug injection and risk behaviors for up to 6-months; interventions added to standard treatment offered no improvement in risk behavior outcomes.

Brown RA; Strong DR; Abrantes AM; Myers MG; Ramsey SE; Kahler CW. Effects on substance use outcomes in adolescents receiving motivational interviewing for smoking cessation during psychiatric hospitalization. Addictive Behaviors 34(10, Special Issue): 887-891, 2009. (39 refs.)

The purpose of this study was to compare substance involvement among psychiatrically hospitalized adolescent smokers who had received motivational interviewing (MI) versus brief advice (BA) for smoking cessation. One hundred and ninety-one (191) adolescent smokers (62.3% female; 15.4 years of age) were randomly assigned to MI (n = 116) or BA (n = 75). All patients were assessed at baseline, immediately after hospitalization, and at 1-. 3-, 6-. 9-, and 12-month follow-ups. Rates of substance use in the MI condition during follow-up increased from a low of 8.2% (SD = 18.5) to a high of 15.4% (SD = 30.0) substance use days, whereas in BA, substance use days increased from a low of 8.4% (SD = 20.8) to a high of 21.4% (SD = 35.2). The results of this study suggest that MI, relative to BA, for smoking cessation was associated with better substance use outcomes during the first 6 months following psychiatric hospitalization among adolescents. This finding is consistent with previous studies that have shown that smoking cessation does not have a detrimental effect on substance abuse treatment outcomes among youth.

Carroll CP; Triplett PT; Mondimore FM. The Intensive Treatment Unit: A brief inpatient detoxification facility demonstrating good postdetoxification treatment entry. Journal of Substance Abuse Treatment 37(2): 111-119, 2009. (41 refs.)

Inpatient detoxification is frequently used to treat substance use disorders, despite consistent findings that drug use soon after detoxification is the norm. A number of lines of evidence suggest the most rational means of improving outcomes after detoxification is to improve postdetoxification treatment entry. This report presents outcomes from the Intensive Treatment Unit (ITU), a brief inpatient detoxification unit in Baltimore, MD, found to have good postdischarge treatment entry outcomes. The patients followed were predominantly male African Americans in early middle age who were sequentially admitted to the unit (N = 134) and demonstrated severe social disruption and psychiatric comorbidity. More than 80% of the patients discharged from the ITU were admitted to treatment postdetoxification, with most going to long-term residential settings or recovery houses. Success was associated with seeking residential treatment, and failure was concentrated among the minority discharged with no plan for aftercare and those seeking outpatient treatments. The report explores patient and process factors associated with these outcomes and discusses the possibility that the ITU may be a model system for improving outcomes postdetoxification.

Chung RK; Large MM; Starmer GA; Tattam BN; Paton MB; Nielssen OB. The reliability of reports of recent psychoactive substance use at the time of admission to an acute mental health unit. Journal of Dual Diagnosis 5(3-4): 392-403, 2009 , 2009. (24 refs.)

The aim of this study was to examine the accuracy of patients' accounts of their psychoactive substance use in the week before admission to an acute mental health unit. Fifty consecutively admitted patients undertook a semistructured clinician-administered questionnaire for recent substance use. The results of the interview were compared to the results of gas chromatography mass spectrometry/mass spectrometry. No patient refused to participate, 46 patients were able to complete the interview, and 48 patients provided a blood sample. Six patients had unreported cocaine or amphetamine in their blood. Cannabis and opiates were not detected in the blood of most of the patients who reported using these drugs. The self-reports of the use of prescription sedatives were inaccurate, but self-reports of recent use of caffeine, nicotine, antidepressants, antipsychotics, and carbamazepine had good overall reliability. Patient reports of recent illicit substance use at the point of admission were found to be unreliable, which may result in incorrect diagnosis and suboptimal treatment of both mental illness and substance-related disorders.

Cooper RL; MacMaster S; Rasch R. Racial differences in retention in residential substance abuse treatment: The impact on African American men. Research on Social Work Practice 20(2): 183-190, 2010. (57 refs.)

Purpose: This study employed a static group comparison design with 106 men in residential treatment to examine the relationship of race to treatment retention. Methods: A retrospective analysis of retention, by race, including survival analysis, was undertaken. Results: Findings: from the study indicated that (a) Caucasian men complete treatment more frequently than African American men, (b) Race was not predictive of time in treatment, and (c) that race was a factor in the receipt of both criminal justice coercion and case-management both of which were strong predictors of time in treatment. Conclusions: Race serves as a factor in the receipt of services related to retention. Future research should focus on further exploration how race impacts retention, and the interaction of race with coercion and the receipt of case-management.

D'Amico EJ; Ramchand R; Miles JNV. Seven years later: Developmental transitions and delinquent behavior for male adolescents who received long-term substance treatment. Journal of Studies on Alcohol and Drugs 70(5): 641-651, 2009. (50 refs.)

Objective: Few studies have applied the "life course perspective" to the study of drug use, a noticeable omission in the field. The current study addresses this gap by examining patterns of interpersonal crime, substance use, and emotional problems over 7 years for a sample of 196 high-risk males as they transition from adolescence to young adulthood, with a specific focus on the role of transitions (living alone, employment, marrying or cohabiting with a romantic partner, graduating from high school or acquiring a General Equivalency Diploma, and becoming a parent) on these patterns. Method: We surveyed youth who were adjudicated as delinquent in Los Angeles between February 1999 and May 2000 and referred by probation officials to Phoenix Academy, a long-term residential substance-treatment provider for adolescent probationers. Males ages 13-17 (N = 196) were given face-to-face interviews at study entry and at 3, 6, 12, 24, 30, 72, and 87 months. Results: Living independently and cohabiting were associated with decreased substance problems. Living with children was associated with increased interpersonal crime. Living away from parents was associated with an increase in substance problems following the transition and then a subsequent decrease in problems over time. No effects were found for receiving a diploma or having employment. Conclusions: It is crucial to begin to understand how developmental transitions may affect high-risk adolescents' involvement in criminal behavior, substance use, and emotional problems. The current study suggests that several transitions were associated with a reduction in problems as these youth transitioned into young adulthood.

Day E; Strang J. Outpatient versus inpatient opioid detoxification: A randomized controlled trial. Journal of Substance Abuse Treatment 40(1): 56-66, 2011. (45 refs.)

Opioid detoxification is not an effective stand-alone treatment for heroin dependence but is nevertheless an essential step in the path to recovery. There has been relatively little previous controlled research on the impact of treatment setting on the likelihood of successful completion of detoxification. In this study, 68 opioid-dependent patients receiving community treatment (predominantly with methadone) and requesting detoxification were randomly assigned to an inpatient versus outpatient setting. Both groups received the same medication (lofexidine), and the primary outcome measure was being opioid-free at detoxification completion. More inpatients (n = 18, 51.4%) than outpatients (n = 12, 36.4%) completed detoxification, but this difference was not statistically significant (chi(2) = 1.56, p = .21). However, the outpatient group received a significantly longer period of medication, and when the length of detoxification was controlled for, the results favored the inpatient setting (Exp(B) = 13.9, 95% confidence interval = 2.6-75.5, p = .002). Only 11(16%) participants were opioid-free at the I-month follow-up and 8 at the 6-month follow-up, with no between-group difference. Inpatient and outpatient opioid detoxification settings were not significantly different in completion or follow-up abstinence rates, but aspects of the study design may have favored the outpatient setting. Future studies should test patient characteristics that predict better outcomes in each setting.

De Leon G; Melnick G; Cleland CM. Matching to sufficient treatment: Some characteristics of undertreated (Mismatched) clients. Journal of Addictive Diseases 29(1): 59-67, 2010. (24 refs.)

A previous study by the investigative team using Drug Abuse Outcome Study data supported the validity of a sufficient treatment matching paradigm, which defines successful placement as the least treatment intensity required to address the severity of a disorder. The least favorable outcomes were obtained in the under-treated clients who received insufficient treatment intensity. The purpose of the current study was to further clarify characteristics of the undertreated clients. Four groups, those matched and mismatched to long-term residential (LTR) and drug-free outpatient (ODF) treatment, were compared on several baseline variables. Results indicated that the severity levels of drug use, social and psychological problems, and motivation for those mismatched to ODF (undertreated) were significantly lower than the clients matched to LTR but generally higher than the clients matched to ODF and those mismatched to LTR (overtreated). These findings underscore the importance of identifying clients at risk for under-treatment and facilitating their entry into treatments of sufficient intensity. More generally, they highlight the need to develop a range of treatment options of sufficient intensity to meet severity differences among clients.

Deering KN; Kerr T; Tyndall MW; Montaner JSG; Gibson K; Irons L et al. A peer-led mobile outreach program and increased utilization of detoxification and residential drug treatment among female sex workers who use drugs in a Canadian setting. Drug and Alcohol Dependence 113(1): 46-54, 2011. (70 refs.)

Background: The objectives of this study were to examine the determinants of using a peer-led mobile outreach program (the Mobile Access Project [MAP]) among a sample of street-based female sex workers (FSWs) who use drugs in an urban Canadian setting and evaluate the relationship between program exposure and utilizing addiction treatment services. Methods: A detailed questionnaire was administered at baseline and bi-annual follow-up visits over 18 months (2006-2008) to 242 FSWs in Vancouver, Canada. We used bivariate and multivariate logistic regression with generalized estimating equations for both objectives, reporting unadjusted and adjusted odds ratios (AOR) with 95% confidence intervals (CIs). Results: Over 18 months, 42.2% (202) reports of peer-led mobile outreach program use were made. High-risk women, including those servicing a higher weekly client volume (10+ compared to <10; AOR: 1.7, 95%CIs: 1.1-2.6) and those soliciting clients in deserted, isolated settings (AOR: 1.7, 95%CIs: 1.1-2.7) were more likely to use the program. In total, 9.4% (45) reports of using inpatient addiction treatment services were made (7.5% detoxification; 4.0% residential drug treatment), and 33.6% (161) using outpatient treatment (28.8% methadone; 9.6% alcohol/drug counsellor). Women who used the peer-led mobile outreach were more likely to use inpatient addiction treatment (AOR: 4.2, 95%CIs: 2.1-8.1), even after adjusting for drug use, environmental-structural factors, and outpatient drug treatment. Discussion: Our findings demonstrate that FSWs at higher risk for sexually transmitted infections and violence are more likely to access this peer-led mobile outreach program and suggest that the program plays a critical role in facilitating utilization of detoxification and residential drug treatment.

Edelen MO; Slaughter ME; McCaffrey DF; Becker K; Morral AR. Long-term effect of community-based treatment: Evidence from the Adolescent Outcomes Project. Drug and Alcohol Dependence 107(1): 62-68, 2010. (46 refs.)

A growing literature on adolescent drug treatment interventions demonstrates the efficacy of "research therapies," but few rigorous studies examine the effectiveness-of community-based treatments that are more commonly available to and utilized by youths and their families, the criminal justice system and other referring agencies. Even less is known about the long-term effects of these community-based treatments. This study evaluate; the effects 72-102 months after intake to a widely disseminated community-based treatment model, residential therapeutic community treatment, using data from Rand 's Adolescent Outcomes Project. Weighting is used to control for pre-existing differences between adolescent probationers disposed to Phoenix Academy and those assigned to one of six alternative group homes serving as the comparison conditions. Although Phoenix Academy therapeutic community treatment had positive effects on substance use and psychological functioning during the first 12 months following intake, we find no evidence of positive long-term effects on 16 outcomes measuring substance use and problems, criminal activity, institutionalization, psychological functioning and general functioning. We discuss the implications of these findings and the failure to maintain the effects observed during the first year follow-up.

Einbinder SD. A qualitative study of Exodus graduates: Family-focused residential substance abuse treatment as an option for mothers to retain or regain custody and sobriety in Los Angeles, California. Child Welfare 89(4): 29-45, 2010. (29 refs.)

In this article, 21 long-term, poly-substance abusing mothers describe how they successfully completed an 18-month family-focused residential substance abuse treatment program in southern California that helped them retain or regain custody of their children. Their stories and experiences with specific program characteristics and approaches of this rare treatment option are described, in their own voices. Policy implications for child welfare and parental substance abuse treatment are examined in light of these success stories.

Fals-Stewart W; Lam WKK. Computer-assisted cognitive rehabilitation for the treatment of patients with substance use disorders: A randomized clinical trial. Experimental and Clinical Psychopharmacology 18(1): 87-98, 2010. (69 refs.)

The purpose of this study was to examine the comparative efficacy of cognitive rehabilitation as an intervention for substance misuse. Patients with substance use disorders entering long-term residential care (N = 160) were randomly assigned to one of two conditions: (a) standard treatment plus computer-assisted cognitive rehabilitation (CACR), which was designed to improve cognitive performance in areas such as problem solving, attention, memory, and information processing speed; and (b) an equally intensive attention control condition consisting of standard treatment Plus a computer-assisted typing tutorial (CATT). Participants were assessed at baseline, during treatment, at treatment completion, and 3-, 6-, 9-, and 12-month follow-up. Intent-to-treat analyses showed that, compared with those randomized to CATT, patients who received CACR were significantly more engaged in treatment (e.g., higher ratings of positive participation by treatment staff, higher ratings of therapeutic alliance), more committed to treatment (e.g., longer stays in residence) and reported better long-term outcomes (e.g., higher percentage of days abstinent after treatment). Mediational analyses revealed the positive comparative effect of CACR on abstinence during the year after treatment was mediated by treatment engagement and length of stay in residence.

Finnegan L; Pacini M; Maremmani I. Methadone treatment for pregnant heroin addicted women. Heroin Addiction and Related Clinical Problems 12(2): 29-35, 2010. (71 refs.)

A review of methadone-related issues and the approach to heroin addicted patients is presented with the aim to clarify what is practiced by the establishment of anti-craving treatment and what is expected within a history of addiction. A series of clinical situations occurring throughout pregnancy to early child development are described, and the etiological hypothesis discussed. Moreover, some methodological considerations are described in order to better understand some ambiguity about the effectiveness and harmlessness of methadone treatment, particularly with regard to neonatal opiate withdrawal. Limitations to the outcome of pregnancies in heroin addicted women seems to be due to misconceptions about methadone toxicity and neonatal damage, which may lead to the mishandling of methadone as a therapeutic modality, especially with regard to maintenance at effective dosages.

Freyer-Adam J; Gaertner B; Rumpf HJ; John U; Hapke U. Alcohol dependent inpatients who receive general hospital care vs. detoxification in psychiatric care and alcohol problem 1 year later. Addictive Behaviors 35(8): 756-763, 2010. (39 refs.)

Aim: The aims were to investigate differences between alcohol dependent inpatients who seek alcohol treatment and those who do not seek alcohol specific but general hospital treatment, and to investigate problem drinking 12 months after hospitalization. Methods: Two samples of alcohol dependent inpatients were recruited: N=571 at general hospitals and N=473 at psychiatric alcohol detoxification units, and were followed-up 12 months later. Results: Multivariate logistic regression analyses revealed that higher age, living alone, being employed, previous help-seeking, increased severity of dependence, increased adverse consequences from drinking and increased motivation were significant predictors of receiving alcohol detoxification vs. general hospital treatment. A composite assessment of motivation to change and to seek help was the strongest predictor of positive outcome 12 months later. Conclusions: Alcohol dependent individuals who receive detoxification in psychiatric care have a more severe alcohol problem and fewer social resources than those treated in general hospitals. Interventions targeting at enhancing motivation to change and to seek help should be part of routine general hospital care and of detoxification treatment in psychiatric care.

Garner BR; Godley MD; Funk RR; Lee MT; Garnick DW. The Washington Circle continuity of care performance measure: Predictive validity with adolescents discharged from residential treatment. Journal of Substance Abuse Treatment 38(1): 3-11, 2010. (55 refs.)

This study examined the predictive validity of the Washington Circle (WC) continuity of care after long-term residential treatment performance measure, as well as the impact of assertive continuing care interventions on achieving continuity of care. This measure is a process measure that focuses on timely delivery of a minimal floor of services that are necessary to provide sufficient quality of treatment but should not be construed to be the optimal continuity of care after residential treatment for any specific adolescent. Participants included 342 adolescents who were admitted to long-term residential treatment and randomly assigned to either standard continuing care or an assertive continuing care condition. Overall, results provide initial support for the WC continuity of care after residential treatment performance measure as a useful predictor of 3-month recovery status. In addition, assignment to an assertive continuing care condition was found to significantly increase the likelihood of achieving continuity of care.

Gil-Rivas V; Prause J; Grella CE. Substance use after residential treatment among individuals with co-occurring disorders: The role of anxiety/depressive symptoms and trauma exposure. Psychology of Addictive Behaviors 23(2): 303-314, 2009. (80 refs.)

This longitudinal study examined the contribution of anxiety/depressive symptoms and lifetime and recent trauma exposure to substance use after residential substance abuse treatment among individuals with co-occurring disorders. Data were collected from adults at treatment entry and 6 and 12 months later. At treatment entry, nearly all participants reported lifetime trauma exposure. and over one third met criteria for posttraumatic stress disorder (PTSD). Over the follow-up, nearly one third of the participants were exposed to trauma. Lifetime trauma exposure and a diagnosis of PTSD at treatment entry were lot associated with substance use over the follow-up. Trauma exposure and anxiety/depressive symptoms over the follow-up were associated with an increased likelihood of substance use. Gender did not moderate the association between trauma exposure and anxiety/depressive symptoms and substance use. These findings highlight the importance of monitoring for trauma exposure and symptoms of anxiety/depression to better target interventions and continuing care approaches to reduce the likelihood of posttreatment substance use in this population.

Godley MD; Coleman-Cowger VH; Titus JC; Funk RR; Orndorff MG. A randomized controlled trial of telephone continuing care. Journal of Substance Abuse Treatment 38(1): 74-82, 2010. (41 refs.)

Telephone continuing care (TCC) was compared to usual continuing care (UCC) on substance use and related problems among adults discharged from residential treatment. Participants were randomly assigned to receive either UCC or TCC. A tapered TCC protocol, initiated by paraprofessional staff and volunteers, was provided during the first 3 months following discharge. The TCC condition participants reported high satisfaction ratings with the procedure and were more than twice as likely to enter continuing care than UCC participants. At the 3-month point, TCC patients reported significantly fewer past-month substance problems than UCC patients. Among the subgroup of lower severity (LS) participants, the TCC-LS sample had both significantly more days abstinent and fewer past-month substance problems at 3 months than the UCC-LS sample. The significant between-group differences in substance use outcomes were not maintained at the 6-month follow-up. The high satisfaction ratings and early favorable response among TCC patients suggest the procedure is promising. Further research with larger samples and over a longer period is necessary.

Goodman M; Patil U; Steffel L; Avedon J; Sasso S; Triebwasser J et al. Treatment utilization by gender in patients with Borderline Personality Disorder. Journal of Psychiatric Practice 16(3): 155-163, 2010. (33 refs.)

Minimal data exist on treatment utilization by gender in borderline personality disorder (BPD). This study used an online questionnaire to investigate initial and lifetime patterns of utilization of multiple treatment modalities by patients with BPD, and parental satisfaction with treatment. Respondents were parents of probands diagnosed with BPD who completed a 100-question anonymous Internet survey. Of the 495 surveys that were analyzed, 409 pertained to female subjects with BPD and 86 to male subjects with BPD. Results for probands with BPD across gender were notable for similar high lifetime levels of use of care, including hospitalization, day programs, and halfway houses, but not similar levels of use of drug/alcohol rehabilitation services, which was greater among the male subjects with BPD. The male subjects with BPD received significantly less lifetime psychotherapy and pharmacotherapy than the female subjects with BPD, although the duration of medication and psychotherapy treatment did not differ by gender. These results highlight the need for more research to better understand what might account for these gender differences in treatment and improve strategies to provide appropriate care for male patients with BPD.

Gross SR; Wolff K; Strang J; Marshall EJ. Follow-up of provision of inpatient treatment for UK healthcare professionals with alcohol dependence: Snapshot of a pilot specialist National Health Service. Substance Use & Misuse 44(13): 1916-1925, 2009. (13 refs.)

Alcohol dependent healthcare professionals (AHCPs) entering a specialized National Health Service (NHS) inpatient treatment facility in southeast London, UK, were investigated. A retrospective case-note analysis was conducted, supplemented with a postal questionnaire. Twenty-three mature (mean age 46 7 years; 13 male) AHCPs, 82% of admissions, with a mean duration of alcohol dependence of 16.5 years were followed-up at an average of 26 months postdischarge. Half of the sample met criteria for lifetime psychiatric disorder. Physical illness was also a prominent problem. At follow-up, six professionals reported continuous abstinence since discharge. For those who continued drinking, there was a significant reduction in daily quantity consumed. This study suggests that the absence of an adequate treatment infrastructure and administrative resources have a major impact on access to treatment services and outcomes for addicted healthcare professionals. There is a need for supported and dedicated services for this group within the UK National Health Service. The study's limitations are noted.

Hall-Flavin DK; Schneekloth TD; Loukianova LL; Karpyak VM; Lesnick TG; Biernacka JM et al. Utilization of residential alcoholism treatment in bipolar disorder. American Journal on Addictions 20(1): 40-44, 2011. (25 refs.)

Despite the high prevalence rate of comorbid alcohol dependence and bipolar disorder, little is known about how many bipolar patients are actively engaged in addiction treatment or the alcohol consumption characteristics of this group. This retrospective study reviewed the medical records from patients with alcohol dependence admitted to residential treatment at our institution (n = 588). The analyses focused on alcoholism severity measures and discharge clinical diagnoses. Patients with alcoholism + bipolar disorder compromised only 5% of the total study group. The number of drinking years was lower for patients with alcoholism + bipolar disorder (23.1 +/- 17.7) than for those with alcoholism + depression (26.8 +/- 13.9) or alcoholism alone (28.1 +/- 13.2). A trend of higher mean lifetime maximum daily drinks was observed for patients with alcoholism + bipolar disorder; this was because of the significantly higher maximum drinks for women with bipolar disorder (21.0 +/- 11.5) than for women in other diagnostic groups. Despite high rates of comorbidity in community-based studies, this retrospective study suggests that patients with bipolar disorder are not highly represented in residential alcoholism addiction treatment. Future studies are encouraged to better understand utilization rates of addiction treatment among patients with bipolar disorder and to identify clinical correlates that predispose bipolar women to high-dose drinking.

Hays JT; Croghan IT; Schroeder DR; Burke MV; Ebbert JO; McFadden DD et al. Residential treatment compared with outpatient treatment for tobacco use and dependence. Mayo Clinic Proceedings 86(3): 203-209, 2011. (23 refs.)

OBJECTIVE: To compare the effectiveness of outpatient vs residential treatment for tobacco dependence in a large referral practice. PATIENTS AND METHODS: We analyzed data from 2 cohorts of cigarette smokers who received either comprehensive outpatient or intensive 8-day residential treatment for tobacco dependence between January 1, 2004, and December 31, 2007. Self-reported 7-day point prevalence abstinence from smoking at 6 months was obtained via telephone interview. Logistic regression was used to assess the likelihood of increased abstinence with residential treatment. RESULTS: Overall, 4327 cigarette smokers received comprehensive outpatient treatment for tobacco dependence, and 226 smokers received treatment in an intensive 8-day residential program. Compared with outpatients, residential patients smoked more cigarettes per day (mean +/- SD, 31.1 +/- 14.4 vs 21.2 +/- 11.2), had more severe nicotine dependence (Fagerstrom Test for Nicotine Dependence score, 6.9 +/- 2.0 vs 5.1 +/- 2.3), and were more likely to have been treated for alcoholism (58/222 [26%] vs 649/4327 [15%]) or depression (124/222 [56%] vs 1817/4327 [42%]; P<.001 for all comparisons). The 6-month smoking abstinence rate was significantly higher for residential patients compared with outpatients (115/222 [52%] vs 1168/4327 [27%]; unadjusted odds ratio, 3.0; 95% confidence interval, 2.3-3.9), with similar findings after adjusting for baseline characteristics (adjusted odds ratio, 3.58; 95% confidence interval, 2.64.9). CONCLUSION: Compared with smokers who received outpatient treatment, those who received residential treatment had more severe tobacco dependence. Residential treatment for tobacco dependence was associated with a significantly greater odds of 6-month smoking abstinence compared with outpatient treatment among smokers in a referral clinic setting.

Hepner KA; Hunter SB; Edelen MO; Zhou AJ; Watkins K. A comparison of two depressive symptomatology measures in residential substance abuse treatment clients. Journal of Substance Abuse Treatment 37(3): 318-325, 2009. (39 refs.)

Comorbid depression is common among substance abusers, making routine assessment of depression critical for high-quality care. We evaluated two of the most commonly used depressive symptomatology measures in a sample of clients (N = 240) in residential substance abuse treatment settings. The Beck Depression Inventory (BDI-II) has previously been used in clients receiving substance abuse treatment. The Patient Health Questionnaire (PHQ-9), originally developed for primary care settings, has not been used as frequently in substance abuse treatment settings, and it is unknown how it performs in this population. The measures were highly correlated with each other (r = .76) and demonstrated good internal consistency reliability (BDI-II = 0.91, PHQ-9 = 0.87); however, the PHQ-9 classifies more individuals as having "mild" depression symptoms relative to the BDI-II, which tends to suggest these individuals have no depression symptoms. Implications for assessing depression symptoms in individuals receiving substance abuse treatment are discussed.

Hoxmark E; Nivison M; Wynn R. Predictors of mental distress among substance abusers receiving inpatient treatment. Substance Abuse Treatment, Prevention and Policy 5: article 15, 2010. (53 refs.)

Background: Mental distress measured by the HSCL-10 is used as an indicator of psychiatric disorders in population studies, where a higher level of mental distress has been shown to be related to demographic factors such as living conditions and level of education. The first aim of the study was to explore whether mental distress could be a valuable concept in substance use treatment. The second aim of the study was to explore to what degree mental distress among substance users at admission to treatment could be explained by the same demographic factors as in population studies, or whether treatment differences or differences in substance use would be better predictors of mental distress in this population. Methods: Patients (N = 185) who received inpatient substance use treatment in five different settings in Northern Norway participated in the study. HSCL-10 was used as a measure for mental distress at admission to treatment. The self-report measures AUDIT, DUDIT and DUDIT-E were used for measuring substance use and readiness for treatment. The patients' clinicians reported demographic and treatment factors. A three-block hierarchical multiple regression analysis was conducted to determine potential predictors of mental distress. Block 1 included demographic variables, Block 2 included treatment variables, and Block 3 substance use variables. Results: Patients generally reported a high level of mental distress at admission to treatment, and 83% reported mental distress higher than the established cut-off level. Being female, having previously received psychiatric treatment, having a higher score on DUDIT and AUDIT, and using a larger number of substances all predicted a higher level of mental distress. The model explained 32% of the variance in mental distress. Conclusions: Mental distress measured by the HSCL-10 can be a valuable concept in substance use treatment. The HSCL-10 can be useful in screening for patients who are in need of further assessment for psychiatric disorders. Female gender, previous psychiatric treatment, and higher use of substances all predicted a higher level of mental distress. The study underlines the importance of assessing the mental health of patients in substance use treatment.

Huang H; Ryan JP. Trying to come home: Substance exposed infants, mothers, and family reunification. Children and Youth Services Review 33(2): 322-329, 2011. (55 refs.)

Substance abusing mothers comprise a significant proportion of caregivers in public child welfare, and achieve low reunification rates. Unfortunately little is known about treatment options intended to facilitate recovery and increase reunification. This study focuses particular attention on the relationship between specific treatment modalities (e.g., residential and outpatient), recovery from substance abuse and family reunification. Analyzing a sample of 160 mothers and their substance exposed infants, the findings clearly identify the benefits of residential treatment in terms of both treatment progress (directly) and family reunification (indirectly), but only when residential services are delivered in combination with transitional services.

Joosten EAG; de Jong CAJ; de Weert-van Oene GH; Sensky T; van der Staak CPF. Shared decision-making reduces drug use and psychiatric severity in substance-dependent patients. Psychotherapy and Psychosomatics 78(4): 245-253, 2009. (31 refs.)

Background: In the last decades, shared decision-making (SDM) models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to evaluate a SDM intervention (SDMI) for patients dependent on psychoactive substances in addiction health care programs. The intervention consisted of a structured procedure to reach a treatment agreement and comprised 5 sessions. Methods: Clinicians in 3 treatment centres in the Netherlands were randomly assigned to the SDMI or a standard procedure to reach a treatment agreement. Results: A total of 220 substance-dependent patients receiving inpatient treatment were randomised either to the intervention (n = 111) or control (n = 109) conditions. Reductions in primary substance use (F-(1,F- 124) = 248.38, p < 0.01) and addiction severity (F-(8) = 27.76, p < 0.01) were found in the total population. Significant change was found in the total population regarding patients' quality of life measured at baseline, exit and follow-up (F-(2,F- 146) = 5.66, p = 0.01). On the European Addiction Severity Index, SDMI showed significantly better improvements than standard decision-making regarding drug use (F-(1,F- 164) = 7.40, p < 0.01) and psychiatric problems (F-(1,F- 164) = 5.91, p = 0.02) at 3-month follow-up. Conclusion: SDMI showed a significant add-on effect on top of a well-established 3-month inpatient intervention. SDMI offers an effective, structured, frequent and well-balanced intervention to carry out and evaluate a treatment agreement.

Lahmek P; Berlin I; Michel L; Berghout C; Meunier N; Aubin HJ. Determinants of improvement in quality of life of alcohol-dependent patients during an inpatient withdrawal programme. International Journal of Medical Sciences 6(4): 160-167, 2009. (44 refs.)

Background: To investigate the improvement in quality of life (QoL) of alcohol-dependent patients during a 3-week inpatient withdrawal programme, and to identify the sociodemographic, clinical and alcohol-related variables associated with baseline QoL on admission and with improvement of QoL during residential treatment. Methods: This prospective, observational study included 414 alcohol-dependent patients, hospitalised for a period of 3 weeks. QoL was measured on admission and at discharge using the French version of the Medical Outcome Study SF-36. The mean scores for each dimension and for the Physical and Mental Component Summary scores were calculated. Results: The mean scores per dimension and the mean Physical and Mental Component Summary scores were significantly lower on admission than at discharge; the lowest scores being observed for social functioning and role limitations due to emotional problems. At discharge, the mean scores per dimension were similar to those observed in the French general population. Female gender, age >45 years, living alone, working as a labourer or employee, somatic comorbidity, and the existence of at least five criteria for alcohol dependence according to the DSM-IV classification were associated with a low Physical Component Summary score on admission; psychiatric comorbidity, the presence of at least five DSM-IV dependence criteria, smoking and suicidality were associated with a low Mental Component Summary score on admission. The increase in Physical and Mental Component Summary scores during hospitalisation was more marked when the initial scores were low. Apart from the initial score, the greatest improvement in Physical Component Summary score was seen in patients with a high alcohol intake and in those without a somatic comorbidity; the increase in Mental Component Summary score was greatest in patients without psychotic symptoms and in those who abused or were dependent on illegal drugs. Conclusion: QoL improvement after a residential treatment was related to low QoL scores at admission. Improvement in physical component of QoL was related to baseline alcohol intake and good somatic status. Improvement in mental component of QoL was related to other drugs abuse/dependence.

Lowmaster SE; Morey LC; Baker KL; Hopwood CJ. Structure, reliability, and predictive validity of the Texas Christian University Correctional Residential Self-Rating Form at intake in a residential substance abuse treatment facility. Journal of Substance Abuse Treatment 39(2): 180-187, 2010. (36 refs.)

This study examined the structure and predictive validity of the Texas Christian University Correctional Residential Self-Rating Form at Intake in a court mandated inpatient substance abuse treatment facility (N = 729). Client characteristics such as treatment motivation and psychological and social functioning were examined as predictors of prospective behavioral outcomes including compliance with treatment program rules and guidelines as well as completion of the treatment program. Results suggest that a broad indicator of individuals' pretreatment motivation predicted their ability to complete the program. Treatment noncompliance, as measured by the number of rule infractions committed during the inpatient treatment, was significantly predicted by individuals' propensity to externalize their symptoms. Implications for the effective use of the CR SRF-Intake as a screener for potential treatment problems are discussed as well as possible targets for interventions in substance abuse populations.

Moss TG; Weinberger AH; Vessicchio JC; Mancuso V; Cushing SJ; Pett M et al. A tobacco reconceptualization in psychiatry: Toward the development of tobacco-free psychiatric facilities. American Journal on Addictions 19(4): 293-311, 2010. (114 refs.)

Tobacco dependence is the leading cause of death in persons with psychiatric and substance use disorders. This has lead to interest in the development of pharmacological and behavioral treatments for tobacco dependence in this subset of smokers. However, there has been little attention paid to the development of tobacco-free environments in psychiatric institutions despite the creation of smoke-free psychiatric hospitals mandated by the Joint Commission for Accreditation of Health Organizations (JCAHO) in 1992. This review article addresses the reasons why tobacco should be excluded from psychiatric and addictions treatment settings, and strategies that can be employed to initiate and maintain tobacco-free psychiatric settings. Finally, questions for further research in this field are delineated. This tobacco reconceptualization in psychiatry is long overdue, given the clear and compelling benefits of tobacco-free environments in psychiatric institutions.

Mullen L; Keenan E; Barry J; Long J; Mulholland D; Grogan L et al. Factors predicting completion in a cohort of opiate users entering a detoxification programme. Irish Journal of Medical Science 179(4): 569-573, 2010. (16 refs.)

To determine the outcome and factors influencing outcome among a cohort of drug users commencing detoxification from opiate use. National cohort study of randomly selected opiate users commencing methadone detoxification treatment in 1999, 2001 and 2003 (n = 327). One quarter 62 (25.6%) of opiate users had a successful detoxification within the 3-month study criteria. Receiving some inpatient treatment as part of detoxification programme resulted in completion by 56.3% drug users compared to outpatient only treatment (21%). The factors independently influencing detoxification are as follows: having some inpatient treatment AOR 5.9 (2.63-13.64) and never having injected AOR 2.25 (1.20-4.25). An additional 31 (9%) opiate users had a detoxification between 3 months and 1 year and 27 (8%) moved into methadone maintenance. This study finds that having some inpatient treatment increases the likelihood of a detoxification within 3 months. Offering a detoxification early in a drug using career pre-injecting drug use should be considered for suitable and motivated patients.

Office of Applied Studies, Substance Abuse and Mental Health Administration. The TEDS Report: Treatment Outcomes among Clients Discharged from Residential Substance Abuse Treatment: 2005. (February 12, 2009). Rockville MD: Substance Abuse and Mental Health Administration, 2009. (5 refs.)

Treatment completion is an important predictor of improved outcomes, such as long-term abstinence, among clients admitted to treatment for substance abuse and dependence. Type of treatment, drug use patterns, gender, and education are associated with completion and dropout rates. Dropout rates, in turn, are associated with relapse and return to substance use. In 2005, clients discharged from short-term residential treatment were more likely to complete treatment and less likely to drop out of treatment than clients discharged from long-term residential treatment. Treatment completion among clients discharged from short-term residential treatment was highest among those who reported primary alcohol abuse (66 percent) and lowest among those who reported primary stimulant abuse (46 percent). Treatment completion among clients discharged from long-term residential treatment was also highest among those reporting primary alcohol abuse (46 percent), but lowest among those reporting primary cocaine abuse (33 percent) or primary opiate abuse (35 percent). As educational level increased, the proportion of client discharges completing either short-term or long-term residential treatment increased.

Public Domain

Oslin DW; Cary M; Slaymaker V; Colleran C; Blow FC. Daily ratings measures of alcohol craving during an inpatient stay define subtypes of alcohol addiction that predict subsequent risk for resumption of drinking. Drug and Alcohol Dependence 103(3): 131-136, 2009. (37 refs.)

Background: Both depressive symptoms and alcohol craving have been postulated as important redictors of relapse in patients with addictive disorders. The purpose of this Ssudy was to examine the course of affective symptoms and cravings for alcohol use during the initial 25 days of residential treatment for middle aged and older adults addicted to alcohol and the relationship between these symptoms and recovery outcomes. Methods: 95 alcohol-dependent Subjects were enrolled in this observational Study. Participants completed a daily diary of alcohol craving, positive affect, and negative affect during residential treatment. Participants were interviewed I and 6 months after discharge to assess clinical symptoms of relapse and functioning. Results: Latent class analysis identified three groups of individuals for each of the three daily measures. For alcohol craving, 17 subjects reported elevated cravings during the entire treatment stay, 37 subjects reported initially elevated but then a slight improvement in craving, and 41 Subjects reported relatively low craving from the time of admission to the end of residential treatment. Alcohol craving class was associated with negative affect but not Positive affect. Alcohol craving class but not affective class was predictive of time to relapse to any drinking in the 6 months after residential treatment (p < 0.05). Conclusion: Results suggest that non-cue induced alcohol craving may define a subtype of alcohol dependence that is less responsive to treatment and may explain heterogeneity in treatment outcomes. These results also may suggest a role for differential treatment programming to address high states of craving for alcohol.

Pajulo M; Pyykkonen N; Kalland M; Sinkkonen J; Helenius H; Punamaki RL. Substance abusing mothers in residential treatment with their babies: Postnatal psychiatric symptomatology and its association with mother-child relationship and later need for child protection actions. Nordic Journal of Psychiatry 65(1): 65-73, 2011. (32 refs.)

Background: A residential treatment model has been developed in Finland, which is specifically designed for substance abusing pregnant and parenting women, and has its focus on supporting both maternal abstinence from substances and mother baby relationship. Aims: Among mother baby pairs in this residential treatment, to explore amount and type of maternal postnatal psychiatric symptoms, relationship with the baby, and their association with later need for child substitution care placements. Methods: Participants were 34 mother-baby pairs from three units during pre- to postnatal period. Methods included self-report questionnaires for substance abuse and background data (pregnancy and perinatal period), experienced difficulties with the baby (I month postnatally); maternal psychiatric symptoms (Brief Symptom Inventory, Edinburgh Pre-postnatal Depression Screen, Inventory of Interpersonal Problems; (pregnancy and 3 months) postnatally; videotaped mother-child interaction measure (Care Index for infants and toddlers) and standardized test of child development (Bayley Scales of Infant Development) (4 months postnatally); questionnaire for follow-up information (2 years of child's age). Results: Mothers showed high levels of different types of psychiatric symptomatology. Maternal interaction with the baby was on average weak, as 53% were within the high-risk range regarding sensitivity. Experiencing more difficulties in early care-giving of the baby was associated with higher amount of postnatal psychiatric symptomatology. Specific psychiatric symptoms were associated with later need for child substitution care. Conclusions: In designing treatment and follow-up of these mother baby pairs, careful attention should be paid to pre- and perinatal identification and type of maternal psychiatric symptoms, and mothers' expressions of subjectively experienced difficulties in early care-giving of the baby.

Ravndal E; Amundsen EJ. Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study. Drug and Alcohol Dependence 108(1-2): 65-69, 2010. (34 refs.)

Background: Drug users who are leaving/completing inpatient medication-free treatment may, like drug users released from prison, have an elevated risk of dying from fatal overdoses: This is mainly explained by their low drug tolerance. Methods: Two hundred and seventy-six drug users who had been admitted toll inpatient facilities in Norway, were followed prospectively after discharge from treatment during an 8-year period (1998-2006). The following instruments were used: EuropASI, SCL-25 and MCMI II. Information on deaths and causes of death were obtained from the National Death Register. Results: A total of 36 deaths were registered after discharge from treatment during the observation period, of which 24 were classified as overdose deaths. During the first 4 weeks after discharge six persons died, yielding an unadjusted excess mortality of 15.7 (rate ratio) in this period (CI 5.3-38.3). All were dropouts and all deaths were classified as opiate overdoses. There was no significant association between time in index treatment and mortality after discharge, nor did any background characteristics correlate significantly with elevated mortality shortly after discharge. Conclusions: The elevated risk of dying from overdose within the first 4 weeks of leaving medication-free inpatient treatment is so dramatic that preventive measures should be taken. More studies from similar inpatient programmes are needed in order to obtain systematic knowledge about determinants of overdose deaths shortly after leaving treatment, and possible preventive measures.

Romanowich P; Lamb RJ. The relationship between in-treatment abstinence and post-treatment abstinence in a smoking cessation treatment. Experimental and Clinical Psychopharmacology 18(1): 32-36, 2010. (14 refs.)

Previous research has indicated that abstinence early in a smoking cessation program is predictive of successful posttreatment abstinence. However, it has not been established whether or not this effect is independent of other in-treatment abstinence patterns. In this paper the relationship between three potentially important aspects of in-treatment smoking abstinence and posttreatment smoking abstinence are examined: early abstinence, extended abstinence, and end-of-treatment abstinence. We examined the relationship between smoking behavior measured each weekday over 70 visits (approximately 14 weeks) of a contingency management smoking cessation program and at a follow-up visit 6 months after study entry (3 months after the scheduled end of treatment). Ninety-five of 102 participants were successfully followed-up. Seven of these 95 participants were confirmed abstinent. Early abstinence, defined as abstinence during the first 10 treatment visits, was significantly and independently related to follow-up abstinence (OR = 56.67 [7.29-440.63]). Extended abstinence and end-of-treatment abstinence were related to follow-up abstinence, but not independent of early abstinence based on multiple regression models. Inclusion of a variety of demognaphic and environmental characteristics did not significantly alter this relationship. Thus, consistent with the previous literature, the establishment of early abstinence appears to be crucial to establishing longer-term abstinence, independent of other in-treatment abstinence patterns.

Sorensen HJ; Mortensen EL; Reinisch JM; Mednick SA. A prospective study of smoking in young women and risk of later psychiatric hospitalization. Nordic Journal of Psychiatry 65(1): 3-8, 2011. (21 refs.)

Background: It is not known whether smoking is a risk factor for mental disorders. Aims: To investigate the prospective associations between cigarette smoking in pregnant women and a range of psychiatric hospital diagnoses. Method: Using data from the Copenhagen Perinatal Cohort, we followed a cohort of 7926 young women from 1959-61 to 2007, linking data on cigarette smoking with psychiatric admission diagnoses obtained from the Danish Psychiatric Central Register. The women were interviewed by a physician in 1959-61 when data was obtained on smoking and other health related variables. With adjustment for age, social class and psychopharmacological treatment at baseline, the effects of smoking on the risk of (hierarchically ordered) major categories of mental disorders were examined. Results: Significant positive associations were observed between number of cigarettes smoked and schizophrenia spectrum disorder, substance use-related disorder, a broad category of other non-psychotic disorders, and any psychiatric registration. For affective spectrum disorders, there was a significant, but non-linear association. Conclusion: Number of cigarettes smoked in young adulthood significantly predicted a range of psychiatric admission diagnoses and, for most diagnostic categories, evidence of a dose response relationship was observed.

Stein BD; Kogan JN; Sorbero M. Substance abuse detoxification and residential treatment among Medicaid-enrolled adults: Rates and duration of subsequent treatment. Drug and Alcohol Dependence 104(1-2): 100-106, 2009. (59 refs.)

Background: Substance use disorders are chronic disorders with substantial public health significance, yet the treatment provided is often episodic despite ongoing need. Among the more severely ill individuals requiring detoxification or residential treatment, little empirical information is available about rates and predictors of subsequent engagement in necessary subsequent treatment. Methods: Using administrative data from the largest Medicaid managed behavioral health organization in a large mid-Atlantic state, we used multivariate regression to examine rates and predictors of subsequent treatment engagement and retention following new episodes of detoxification or residential substance abuse treatment among 5670 Medicaid-enrolled adults during 2004-2006. Results: Slightly less than half (49%) of the sample received follow-up care within 30 days of discharge. Rates of follow-up were significantly higher in individuals with a serious mental illness, and significantly lower in African-American individuals, males, individuals with disabilities, and those who received detoxification without residential treatment. The mean duration of follow-up treatment was 84 days, and was longer among individuals with a serious mental illness and Caucasians. Even after controlling for individuals' sociodemographic and clinical characteristics, there was substantial variation in follow-up rates among discharging providers. Conclusion: The relatively low rates of follow-up care and relatively brief duration of treatment for many of those who received such follow-up care are concerning in a population receiving substance abuse detoxification or residential treatment. The markedly lower rates among those receiving detoxification alone without subsequent residential treatment and among those without a comorbid serious mental illness suggest that efforts specifically targeting those individuals may be of particular benefit.

Vuchinich R; Wallace D; Milby JB; Schumacher JE; Mennemeyer S; Kertesz S. Relations between in-treatment and follow-up abstinence among cocaine-dependent homeless persons in three clinical trials. Experimental and Clinical Psychopharmacology 17(3): 165-172, 2009. (20 refs.)

Clinical trials with cocaine-dependent outpatients have found a strong relation between in-treatment and follow-up abstinence, and the strength of this relation is constant across treatment conditions with variable efficacy in generating abstinence. The authors conducted secondary analyses of data from 3 clinical trials to determine whether this relation generalizes to cocaine-dependent homeless persons. The 3 trials (total N = 543) were conducted in a community health care facility for homeless people. The 7 treatment arms across the 3 trials were combinations of day treatment, abstinence-contingent housing, and vocational training. Drug use was measured with urine toxicology testing. Consecutive weeks of abstinence during treatment were strongly related to abstinence at the 12-month follow-up, whether or not missing 12-month data were included in the analysis. The treatment arms differed in their efficacy in generating abstinence, but the relation between in-treatment and follow-up abstinence did not differ across treatment arms. These results replicate earlier reports of these relations and extend them to a population of homeless people. The lack of differences between treatment arms in the in-treatment-follow-up abstinence relation implies that that relation is independent of the treatment-specific intervention components that generate group differences in abstinence.

Wartberg L; Sack PM; Thoms E; Moller C; Stolle M; Thomasius R. Inpatient child and adolescent psychiatry and psychotherapy for substance-addicted boys and girls. Results of a follow-up study. (German). Psychotherapeut 54(3): 193-198, 2009. (24 refs.)

This study examines post-treatment out-comes (6 and 12 months post-release) of a multimodal child and adolescent psychiatric and psychotherapeutic inpatient treatment program for boys and girls diagnosed with substance use disorders (n=71) in 2 centres. Up to now there has been a lack of outcome research in this field of Germany. Outcome measures included drug use patterns and psychopathology. The greatest reduction in prevalence at 1 year follow-up occurred for cannabis, methamphetamine, cocaine and heroin use. Additionally the patients and their parents also reported significant improvements in adolescent's psychopathology at the 1 year follow-up. The results underline the importance of disorder-specific, multimodal inpatient programs for the treatment of children and adolescents with substance use disorders.

Williamson A; Darke S; Ross J; Teesson M. Changes and predictors of change in the physical health status of heroin users over 24 months. Addiction 104(3): 465-470, 2009. (31 refs.)

Purpose: (i) To describe the course of physical health among the Australian Treatment Outcome Study (ATOS) cohort over 24 months; and (ii) to examine the effects of treatment, drug use patterns and social and psychological factors on health status over 24 months. Longitudinal cohort. Sydney, Australia. A total of 615 heroin users recruited for the Australian Treatment Outcome Study. The general health of the cohort improved significantly over 24 months. Significant predictors of poor health over 24 months were: being older, being female, past month heroin, other opiate and tobacco use, past month unemployment and current major depression. Spending a greater proportion of time in residential rehabilitation (RR) was associated with better health over 24 months. No other treatment factors demonstrated a significant, independent relationship with health. The physical health of dependent heroin users is affected by drug use and psychosocial problems. RR treatment appears to be particularly beneficial to the health of heroin users, suggesting the importance of a comprehensive approach to improving health among this group.

Wisdom JP; Gogel LP. Perspectives on adolescent residential substance abuse treatment: When are adolescents done? Psychiatric Services 61(8): 817-821, 2010. (19 refs.)

Objectives: the study evaluated responses from adolescents in substance abuse treatment, their parents, and treatment staff to the question of what constitutes treatment success. Methods: Semistructured interviews were conducted with 28 adolescents, 30 parents, and 29 staff at three residential substance abuse treatment programs in two states. Data were coded and organized into themes by respondent type. Results: Respondents reported knowing when treatment was no longer needed based on changes in adolescents' substance use, treatment-related and other behaviors, and attitudes and character. A fourth category of responses indicated respondents' ambiguity regarding successful completion of substance abuse treatment. Little concurrence was found among adolescents, parents, and treatment center staff to indicate criteria suggesting that discharge is appropriate. Conclusions: Substance abuse treatment programs and their clients may benefit from ensuring that staff, parents, and adolescents are aware of treatment goals to promote more effective treatment and improve collaboration toward the adolescent's recovery.

Wood TE; Englander-Golden P; Golden DE; Pillai VK. Improving addictions treatment outcomes by empowering self and others18. International Journal of Mental Health Nursing 19(5): 363-368, 2010. (18 refs.)

The present research tested the effectiveness of adding an interpersonal, interactive, experiential training programme to addictions treatment that enhances motivation, cognitive-behavioural coping skills, social support, and group cohesiveness. The research was conducted in a co-educational, long-term residential treatment facility for addictive disorders (alcohol and other substances, sexual addiction, eating disorders, compulsive shopping, and gambling) and concomitant psychiatric diagnoses. The added training is co-created by participants. They choose challenging situations important in their lives that are played out as 'movies' in which they play and experience all the parts. Motivation for change, skills to implement positive changes, self-efficacy, empathy, positive support, and group cohesiveness are rooted in their own experiences and the feedback they receive from others, as they behave in empowering and disempowering ways. The training resulted in significant increases in empowering communication, self-esteem and quality of group life in the treatment group and in the family. Many of these results have large effect sizes and are consistent with the findings from prior studies. The results obtained in this study suggest that Say It Straight training can be an effective addition to the treatment of addictions in residential treatment. Future research is needed to determine the long-term effects of this training on relapse.