Constructing a Theory and Evidence-Based Approach to Promote and Evaluate Autonomy in Addiction

ABSTRACT

In this article we use theory and empirical evidence to synthesize a model for the analysis of autonomy in people with addictions. We review research on motivation and denial as accepted addiction constructs that need to be replaced with non-stigmatizing and autonomy-supportive language when seeking to ‘treat’ addicts. We present three main factors involved in relational autonomy in addiction (mentalizing, positive self-concept, and stigma), and illustrate our model by examining variations on these parameters in two case studies of heroin addicts. We conclude that a growth perspective is needed to assess functioning in populations believed to be ‘addicted’ and make suggestions for assessment.     

Developing Coordinated Technical Assistance and Training Programs

The design of a coordinated, multi-level technical assistance and training system is crucial to the delivery of manpower services under CETA. A framework for the development of such a system, together with tentative roles and responsibilities for its implementation are presented.     

Establishing Treatment Fidelity in Evidence-Based Parent Training Programs for Externalizing Disorders in Children and Adolescents

The current review evaluates the use of treatment fidelity strategies in evidence-based parent training programs for treating externalizing disorders. We used a broad framework for evaluating treatment fidelity developed by the National Institutes of Health Treatment Fidelity Workgroup that includes the aspects of treatment design, treatment delivery, training providers, and assessment of participant receipt of treatment and enactment of treatment skills. Sixty-five articles reporting outcome trials of evidence-based parent training programs met inclusion criteria and were coded for treatment fidelity strategies. The mean adherence to fidelity strategies was .73, which was higher than two previous review studies employing this framework in the health literature. Strategies related to treatment design showed the highest mean adherence (.83), whereas training of providers and enactment of treatment skills had the lowest (.58). In light of an increasing emphasis on effectiveness and dissemination trials, the broader treatment fidelity framework as applied in this review focuses needed attention on areas often overlooked in fidelity practices, such as training providers and generalization of treatment skills. We discuss the strengths and limitations of fidelity practices in parent training studies, implications of these findings, and areas for future research.     

Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance

One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from 2 clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT) for depression, a prototypic example of an EST, with a high level of adherence and competence. This follow-up article provides specific recommendations for the selection and initial training of counselors, and for the structure and process of their ongoing clinical supervision. We highlight unique challenges in working with counselors unaccustomed to traditional clinical supervision. The recommendations are based on comprehensive feedback derived from clinician notes taken throughout the clinical trials, a focus group with counselors conducted 1 year following implementation, and interviews with key organization executives and administrators.     

A Neuropsychological Approach to Intelligence

This paper proposes that current psychometric intelligence tests are limited in evaluating cognitive activity. From a neuropsychological perspective, they fail to measure some fundamental cognitive abilities such as executive functions, memory, and visuospatial abilities. The analysis of the Wechsler Intelligence Scale presented shows that the original rationale for selecting the specific subtests included in the WAIS was unclear. The concept of a g factor in cognition is also analyzed, with the conclusion that the g factor continues to be controversial. The value of intelligence tests in predicting school performance is also criticized. It is proposed that the psychometric concept of general intelligence should be deleted from cognitive and neurological sciences. Finally, it is proposed that, in the future, neuropsychological instruments sensitive to more specific cognitive abilities replace current psychometric intelligence tests.     

Conceptual Versus Competency Approach in Human Relations Training Programs

This study examines how the changes in the Carkhuff Human Resources Development (HRD) training model affect the acquisition of defined interpersonal discrimination and communication skills. A competency-based HRD (post-1974) counselor training group was compared with a conceptual-based (pre-1974) human relations counselor training group and a no-contact counselor training group. Although the groups were equivalent on the pretest, the posttest results show statistically significant differences (p >.01) between all groups as a result of training. The findings support the competency-based training as more effective than the conceptual-based human relations training in acquiring interpersonal counseling skills.     

Neuropsychological Interventions for Decision-Making in Addiction: a Systematic Review

Neuropsychology Review - Decision-making deficits are strong predictors of poor clinical outcomes in addiction treatment. However, research on interventions that address decision-making deficits...     

Updating the Textbook: A Novel Approach to Training Graduate Students in Evidence-Based Youth Practices

Despite the ever-improving base of evidence-based practices (EBPs) for the treatment of childhood disorders, a gap between EBP research and their use in community settings continues to exist. An exciting opportunity to close this gap exists in the form of graduate student training; however, at present, several roadblocks exist. In this paper, we review the current state of graduate training in delivering EBPs and obstacles involved in training future community clinicians (i.e., graduate students) in EBPs. Next, we describe in detail our initiative to develop a curriculum that addresses these challenges. This innovative course empowered graduate students to receive training in the delivery of youth EBPs in community settings through reviews of the research literature, active learning techniques (e.g., discussions of case conceptualizations, role-playing case studies), and a written, publication-quality review of EBPs. Finally, we offer recommendations for other educators of mental health professionals (e.g., psychologists, social workers, counselors) to improve upon this curriculum in their training of graduate students in the theory and application of EBPs for treating childhood disorders.     

Neuropsychological Assessment of HIV-Infected Populations in International Settings

Resource-limited regions of the world represent the areas most affected by the global HIV epidemic. Currently, there are insufficient data on the neurocognitive effects of HIV in these areas and neuropsychological studies that have been carried out thus far are marked by inconsistent methods, test batteries, and rating systems for levels of cognitive impairment. These differences in methods, along with genetic variability of both virus and host, differences in co-infections and other co-morbidities, differences in language and culture, and infrastructural deficiencies in many international settings create challenges to the assessment of neurocognitive functioning and interpretation of neuropsychological data. Identifying neurocognitive impairment directly attributable to HIV, exploring relationships between HIV-associated neurocognitive impairment, disease variables, and everyday functioning, evaluating differences in HIV-1 subtype associated neuropathology, and determining implications for treatment remain complicated and challenging goals. Endeavors to establish a more standardized approach to neurocognitive assessments across international studies in addition to accumulating appropriate normative data that will allow more accurate rating of neuropsychological test performance will be crucial to future efforts attempting to achieve these goals.     

类别学习的神经心理学研究

类别学习的神经心理学研究是检验类别学习理论的一种有效研究范式,它有助于我们对类别学习理论的深入理解,以及对认知活动过程和脑机制的认识。作者对基底神经节功能障碍患者、遗忘症患者和其他类型的神经症患者的类别学习研究进行了回顾,对这些研究可能存在的单系统理论和多系统理论解释进行了讨论,并指出了研究中可能存在的取样偏差问题和未来研究中需要在研究手段、研究设计、被试取样等方面加以改进的建议     

Internet Addiction: A Logotherapeutic Approach

Internet addiction (IA) is both the most rapidly growing addiction and the least understood addiction ( Watson, 2005 ). For counselors, treatment issues surrounding the disease are also growing. At the forefront is the lack of understanding concerning treatment protocol to manage the challenging recovery and maintenance stages after IA behavior has been controlled. The authors discuss Viktor Frankl's logotherapy as an effective approach to treating IA.     

A Multicultural Competency Checklist for Counseling Training Programs

This brief report presents a Multicultural Competency Checklist that can be used by counseling training programs as a pragmatic guide in multicultural program development. The Checklist includes 22 items organized along six major themes: minority representation, curriculum issues, counseling practice and supervision, research considerations, student and faculty competency evaluation, and physical environment. Guidelines for using the Checklist are provided.     

Developing Measures of Community-Relevant Outcomes for Violence Prevention Programs: A Community-Based Participatory Research Approach to Measurement

Community-Based Participatory Research is a research paradigm that encourages community participation in designing and implementing evaluation research, though the actual outcome measures usually reflect the “external” academic researchers’ view of program effect and the policy-makers’ needs for decision-making. This paper describes a replicable process by which existing standardized psychometric scales commonly used in youth-related intervention programs were modified to measure indicators of program success defined by community partners. This study utilizes a secondary analysis of data gathered in the context of a community-based youth violence prevention program. Data were retooled into new measures developed using items from the Alabama Parenting Questionnaire, the Hare Area Specific Self-Esteem Scale, and the Youth Asset Survey. These measures evaluated two community-defined outcome indicators, “More Parental Involvement” and “Showing Kids Love.” Results showed that existing scale items can be re-organized to create measures of community-defined outcomes that are psychometrically reliable and valid. Results also show that the community definitions of parent or parenting caregivers exemplified by the two indicators are similar to how these constructs have been defined in previous research, but they are not synonymous. There are nuanced differences that are important and worthy of better understanding, in part through better measurement.     

Employment Clothing for Women in Training Programs

Eighty-one women in social service employment programs were surveyed to determine knowledge of employment clothing. They were compared on demographics, and differences were found in possession of business clothing, resources for clothing, education, income, residence, and homelessness. Based on these differences, they were separated into 3 smaller groups. The comparison showed that women who had interview and employment clothing had never been homeless, had higher incomes and educational levels, and used different resources for obtaining their clothing. These responses indicate a need to educate low-income participants on information about employment clothing and resources.     

A Systems Approach for Training Employment Counselors

How can the systems approach and the related tools and techniques be used to improve the training of employment counselors? This article is intended to provide a tentative answer to that question. First, a conventional model for training counselors will be evaluated. Second, a systems-based model will be described. Finally, some advantages and limitations of the proposed model will be examined.