Contingency Management for Attendance to Group Substance Abuse Treatment Administered by Clinicians in Community Clinics

Contingency management (CM) is effective in enhancing retention in therapy. After an 8-week baseline, four community-based substance abuse treatment clinics were exposed in random order to 16 weeks of standard care with CM followed by 16 weeks of standard care without CM or vice versa. In total, 75 outpatients participated. Patients who were enrolled in the clinics when the CM treatment phase was in effect attended a significantly greater percentage of therapy sessions than patients who were enrolled in treatment when CM was not in effect. This study is one of the first to investigate CM in community settings implemented entirely by community clinicians, and results suggest that CM is effective in improving therapy attendance.     

The Effectiveness of Substance Abuse Treatment in Reducing Violent Behavior

The use of alcohol and other drugs has long been associated with violence. Yet relatively little is known about the effect of treatment on specific violent behaviors. This study examines violent behaviors in the National TreatmentImprovement Evaluation Study (NTIES), and assesses the extent to which treatment appears to reduce violence for each measured behavior. It also examines these reductions by gender, treatment modality, and whether the client wasa victim of violence in addition to being a perpetrator. The results indicate large reductions in violence among clients actively violent during the pretreatment period, with virtually no increase in violence among clients not actively violent during that same period, irrespective of gender, modality, or victimization status. On their face, the results strongly suggest that substance abuse treatment is effective in reducing violent behavior. Alternative explanations areproposed and assessed, followed by implications for policy, practice, and future research.     

Interdependent Group Contingency Management for Cocaine-Dependent Methadone Maintenance Patients

Contingency management (CM) for drug abstinence has been applied to individuals independently even when delivered in groups. We developed a group CM intervention in which the behavior of a single, randomly selected, anonymous individual determined reinforcement delivery for the entire group. We also compared contingencies placed only on cocaine abstinence (CA) versus one of four behaviors (CA, treatment attendance, group CM attendance, and methadone compliance) selected randomly at each drawing. Two groups were formed with 22 cocaine-dependent community-based methadone patients and exposed to both CA and multiple behavior (MB) conditions in a reversal design counterbalanced across groups for exposure order. The group CM intervention proved feasible and safe. The MB condition improved group CM meeting attendance relative to the CA condition.     

The Economic Benefits of Increased Treatment Duration and Intensity in Residential and Outpatient Substance Abuse Treatment Settings

This study presents estimates of the economic benefits to society from community-based substance abuse treatment. The analysis focused on the impact of length of stay and frequency of counseling on clients' crime-related and health care costs, welfare receipts, and income taxes. The results indicate that the benefits from an additional day of treatment were on average $21 for short-term residential treatment (or 29% the cost of a day of care), $13 for outpatient drug-free treatment (or 94% the cost of a day of care), and $5 for long-term residential treatment (or 9% the cost of a day of care). No benefits were found from additional counseling provided by a client's primary therapist. Withthe exception of short-term residential care, estimated increases in client earnings from longer lengths of stayexceeded the benefits to society. Our estimates do not include benefits realized during treatment or beyond the year after treatment.     

Substance Abuse Treatment Outcomes: Treatment Practice and Policy Implications

Treatment professionals, whether clinicians, scientists, or policy makers, are interested in developing methods to improve behavioral health treatment outcomes. Clinicians are interested in knowing what treatment practices to incorporate into the services they offer clients. Policymakers request guidance regarding which decisions are most likely to lead to effective treatment approaches and structures. Scientists are eager to contribute knowledge pertinent to building and evaluating effective treatment practices and policies. The papers in this special series provide information on substance abuse treatment practices andpresent findings relevant to clinical practice, policy decisions, and scientific inquiry. This paper provides a brief overview of the National Treatment Improvement Evaluation Study (NTIES) and briefly summarizes the other research papers included in this issue, all of which exemplify practice and policy issues in the substance abuse treatment field and bolster approaches applied to address these issues.     

基于动态评估的取样法:经验取样法

研究结果的普适性是心理学研究的黄金标准之一.为达到此目标,研究者不断创造生态效度更高,也更具现实意义的研究方法.通过在现实情境下对被试多次重复测量进行数据收集的研究方法——经验取样法(experience sampling method),一经提出就备受研究者的青睐.文章在综合介绍经验取样法的概念、实施过程和数据处理的基础上,比较和阐述了该方法的优劣势,以及该方法的主要应用领域.文章最后对经验取样法的应用领域和未来发展作了展望.     

Grief and Recovery: The Prevalence of Grief and Loss in Substance Abuse Treatment

Grief from various losses can underlie the process of recovery from substance abuse disorders. This study identified losses that clients encountered prior to abusing substances, losses that occurred as a result of addiction, and losses that occurred upon entering treatment.     

Treatment Outcomes and Perceived Benefits: A Qualitative and Quantitative Assessment of a Women's Substance Abuse Treatment Program

This study examines outcomes of a women's substance abuse treatment program based on empowerment, choice, and client/therapist collaboration. The program was assessed through qualitative and quantitative research methods. The article includes extensive quotes from six client interviews as well as data from pre-post surveys of 50 women in the treatment program. Results show that the women felt they benefited from the collaborative treatment approach. Benefits to the women included feeling more empowered and learning to take responsibility for their lives. The importance of taking a broad view of recovery that includes ongoing evaluation of positive changes in various areas of the clients' lives is discussed.     

Self‐Efficacy Among Adults in Substance Abuse Treatment: The Role of Religious Coping

In substance abuse treatment, general self‐efficacy and religiousness are factors that may support positive outcomes. The authors surveyed clients receiving substance abuse treatment (N = 121) and found that religious coping predicted general self‐efficacy scores. Clinical implications are discussed.     

人类社会中精神活性物质滥用的多维探源

现代文明社会中酒精、烟草以及非法违禁物质的滥用,使人类为之付出了惨痛的代价。为什么人类在经历自然选择后仍没有摆脱物质滥用的顽疾?从成瘾物质的特性以及在生物进化,特别是人类历史中的物质滥用发展过程,来探讨其在人类社会中存在的原因是很必要的。     

A Study of Clinical Supervision Techniques and Training in Substance Abuse Treatment

Data from 57 clinical supervisors in licensed substance abuse treatment programs indicate that 28% had completed formal graduate course work in clinical supervision and 33% were professionally licensed or certified. Findings raise concerns about the scope and quality of clinical supervision available to substance abuse counselors.     

Childhood Emotional Abuse and Maladaptive Coping in Adults Seeking Treatment for Substance Use Disorder

Little is understood about distinct traumatic exposures and their relationship to later coping strategies. Adults receiving treatment for substance use were assessed for experiential avoidance and a range of traumatic exposures. Only childhood emotional abuse significantly predicted experiential avoidance.     

A Web-Based Contingency Management Program With Adolescent Smokers

The present study evaluated a new 30-day Web-based contingency management program for smoking abstinence with 4 daily-smoking adolescents. Participants made 3 daily video recordings of themselves giving breath carbon monoxide (CO) samples at home that were sent electronically to study personnel. Using a reversal design, participants could earn money for continued abstinence during the treatment phases (CO ≤ 5 ppm). All participants were compliant with the treatment (submitting 97.2% of samples), and all achieved prolonged abstinence from smoking.     

Clinical Improvement in Adolescents Comorbid for Substance Abuse and Psychiatric Diagnoses Through Multiple Group Psychotherapy

In a pilot study, the authors examined the outcome of group psychotherapy for the treatment of 19 adolescents, comorbid for substance abuse and psychiatric diagnoses, in terms of symptom reduction. They compared presenting symptomatology of treatment completers with treatment noncompleters. A retrospective study of the outcome of a multiple group psychotherapy treatment program using the Drug Use Screening Inventory-Revised Version (DUSI-R) to assess change over time was conducted. Depressive disorders were the most prevalent psychiatric diagnoses (68%), and marijuana was the substance most commonly abused on a frequent basis. Treatment completers showed improvement in behavior problems, health status, and social competence. As part of an integrated treatment program, multiple group psychotherapy is a promising treatment modality for adolescent patients, comorbid for substance abuse and psychiatric diagnoses, pending further assessment of the complex issues involved in combined treatment.     

Predicting Substance Abuse Relapse: The Role of Social Interest and Social Bonding

Substance abuse relapse has been linked to a number of internal and external vulnerability factors. The authors explored the internal construct of Adlerian social interest (Adler, 1956 ) and the external construct of Hirschi's ( 1969 ) social bonding to provide a holistic risk profile of relapse.     

Happiness in Everyday Life: The Uses of Experience Sampling

This paper uses the Experience Sampling Method data drawn from a national sample of American youth. It examines the proximal environmental factors as well as behaviors and habits that correlate to personal happiness. Momentary-level scores show that reported happiness varies significantly both by day of week and time of day. Furthermore, particular activities are associated with varying degrees of happiness. School activities rate below average scores in happiness, while social, active and passive leisure activities are above average. Particular companions also correlate to differing level of happiness. Being alone rates the lowest levels of happiness, while being with friend corresponds to the highest. Person-level averages of happiness suggest that both higher social class and age correlate with lower levels of happiness, while gender and race do not. Paradoxically, youth who spend more time in school and social activities are happier than those who spend less. Unexpectedly, students who spend more time pleasure reading report lower levels of happiness. Finally, feeling good about the self, excited, proud, sociable, active as well as being in the conditions for flow experience are the strongest predictors of trait happiness.     

The Ecology of Adolescent Substance Abuse Service Utilization

This paper presents an ecological-community model toward the explanation of variation in patterns of substance abuse (SA) service utilization among adolescents who are enrolled in Tennessee's Medicaid program (TennCare). Guided by a theoretical framework that draws from the social ecology work of Bronfenbrenner and health services utilization models promoted by Aday and Andersen, we apply a social indicators approach toward explaining the impact of community ecology on identification of SA and treatment engagement. Both county-level rates and individual-level treatment utilization are examined and hierarchical linear modeling is incorporated to examine the individual-in-community phenomenon. This study is an expansion of previous service utilization research and suggests that explanations of youth's service utilization must necessarily include not only individual, familial, and service system characteristics, but community factors, as well.     

The Influence of Posttreatment Mutual Help Group Participation on the Friendship Networks of Substance Abuse Patients

The effect of 12-step mutual help groups (e.g., Narcotics Anonymous) on members' friendship networks has received little attention. This 1-year longitudinal study examined such effects in a sample of 2,337 male substance abuse inpatients, 57.7% of whom became significantly involved in 12-step activities (e.g., reading program literature, attending meetings) after treatment. An a priori model of the interplay of 12-step involvement and friendship networks was tested using structural equation modeling, and found to have excellent fit to the data. Twelve-step group involvement after treatment predicted better general friendship characteristics (e.g., number of close friends) and substance abuse-specific friendship characteristics (e.g., proportion of friends who abstain from drugs and alcohol) at follow-up. Results are discussed in terms of how mutual help group involvement benefits patients and how the self-help group evaluation paradigm should be broadened.     

Sex and Aggression: The Relationship Between Gender and Abuse Experience in Youngsters Referred to Residential Treatment

We examined the relationship of gender and different forms of abuse experience on internalizing symptoms, externalizing symptoms, and IQ in a sample of 397 youngsters who were admitted to a residential treatment program. Three types of abuse experience were examined in this study: sexual abuse only, physical abuse only, and both sexual and physical abuse. Results indicate that girls exhibited higher levels of internalizing and externalizing symptoms even though abuse experience was accounted for in the analyses. Moreover, youngsters who had experienced sexual abuse (but not physical abuse) exhibited higher levels of internalizing and externalizing symptoms than youngsters who had not been abused. Implications for developing individualized interventions based on gender and abuse experience in residential treatment programs is discussed.     

父母早期受虐与子女对立违抗症状的关系:亲子虐待和儿童愤怒管理的作用

本研究探讨了父母的早期受虐经历与子女的对立违抗症状的关系,通过构建一个有调节的中介模型,考察了亲子虐待的中介效应和儿童愤怒管理对该效应的调节作用。采用问卷法对359名来自北京市、山东省和云南省的14所小学一至五年级的儿童及其父母进行调查,研究工具包括儿童对立违抗症状评估表、童年期创伤问卷、儿童愤怒管理量表。结果发现：（1）男孩的ODD症状得分显著高于女孩;男孩受到的躯体虐待、情感忽视和躯体忽视显著多于女孩（2）在控制了儿童性别后,父母在童年期的受虐经历仍可显著正向预测其成年期的家庭中子女的ODD症状;（3）亲子虐待在父母受虐和子女ODD症状之间起完全中介作用,即父母受虐通过亲子虐待间接影响子女ODD症状;（4）父母受虐通过亲子虐待影响子女ODD症状的中介效应后半路径受到子女个体水平愤怒失调（AD）的调节,具体来说,当AD水平较高时,亲子虐待对ODD症状的影响更大;但愤怒应对（AC）和愤怒抑制（AI）对中介效应无显著调节作用。