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Fredericksen RJ, Mixson LS, Estadt AT, Leichtling G, Bresett J, Zule W, Walters SM, Friedmann PD, Romo E, Whitney BM, Delaney JAC, Crane HM, Tsui JI, Young A, Seal D, Stopka TJ. Barriers to retention in inpatient and residential drug treatment among persons who use opioids and/or injection drugs living in the rural U.S. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209453. [PMID: 39033853 DOI: 10.1016/j.josat.2024.209453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/30/2024] [Accepted: 07/02/2024] [Indexed: 07/23/2024]
Abstract
AIM Barriers to retention in inpatient and residential care for persons who use drugs are understudied in the rural context. We sought to better understand barriers to retention in inpatient and residential drug treatment in a large, multi-site, geographically diverse sample of persons who use opioids and/or injection drugs in the rural U.S. METHODS We conducted semi-structured individual interviews with persons currently using opioids and/or injection drugs in 9 U.S. states, including Illinois, Kentucky, Massachusetts, North Carolina, New Hampshire, Ohio, Oregon, Vermont, and Wisconsin. Content areas included substance use history and experiences with all modalities of drug treatment. We performed initial structural coding followed by an iterative "open-coding" process of itemizing and categorizing content within each code, and a multi-coder memoing process to summarize themes. We identified themes using three levels of the Social-Ecological Model (SEM): individual, interpersonal, and facility-level (organizational) barriers. RESULTS Among 304 interviewed, over half (n = 166, 54 %) reported having experienced inpatient and residential treatment. Lack of treatment retention was driven by interrelated factors at all levels of the SEM. Person-level factors inhibiting retention included lack of readiness to stop using, which was particularly true for court-ordered treatment, and dislike of "freedom limitations". The sole interpersonal-level factor was the influence of other patients on re-initiation of drug use. Facility-level barriers included unaddressed withdrawal symptoms and lack of access to MOUD, staff relatability, inadequate staff training, and, particularly in residential treatment, lack of structure and supervision. Lack of preparation for coping with real-world triggers was seen as a barrier to engagement in ongoing treatment. CONCLUSION Barriers to retention in inpatient and residential substance use treatment were present at three levels of the SEM. Interviews suggest much room for improvement in inpatient and residential drug treatment programs with respect to improving access to MOUD, tailoring content to better address social challenges in the rural context, and improving quality control measures with respect to staff and resident supervision.
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Affiliation(s)
- R J Fredericksen
- University of Washington, Department of Medicine, Seattle, WA, USA.
| | - L S Mixson
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - A T Estadt
- Ohio State University, College of Public Health, Columbus, OH, USA
| | | | - J Bresett
- Southern Illinois University, School of Human Sciences, Carbondale, IL, USA
| | - W Zule
- RTI International, Durham, NC, USA
| | - S M Walters
- New York University, School of Global Public Health, New York, NY, USA
| | - P D Friedmann
- University of Massachusetts, Department of Medicine, Springfield, MA, USA
| | - E Romo
- University of Massachusetts, Clinical and Population Health Research, Springfield, MA, USA
| | - B M Whitney
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - J A C Delaney
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - H M Crane
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - J I Tsui
- University of Washington, Department of Medicine, Seattle, WA, USA
| | - A Young
- University of Kentucky, Department of Epidemiology, Lexington, KY, USA
| | - D Seal
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - T J Stopka
- Tufts University, Department of Public Health and Community Medicine, Boston, MA, USA
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Akosile W, Bor W, Tilse A, Hunt G, Rushton A, McDermott B, Lee E, McBride M. Predictors of completion of an adolescent residential alcohol and other drug withdrawal program. JOURNAL OF SUBSTANCE USE 2023. [DOI: 10.1080/14659891.2023.2166608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Wole Akosile
- New Farm Clinic, School of Medicine, University of Queensland, Brisbane, Australia
| | - William Bor
- Consultant Psychiatrist Queensland Children's Hospital, Children’s Health Queensland, Brisbane, Australia
- Centre for Children’s Health Research, South Brisbane, Australia
| | - Amanda Tilse
- Mater Young Adult Health Centre, South Brisbane, Australia
| | - Georgia Hunt
- Mater Young Adult Health Centre, South Brisbane, Australia
| | - Ann Rushton
- Former Residential Co-ordinator: Mater Alcohol and other Drugs Withdrawal Service, Former Residential Co-ordinator, Mater Alcohol and other Drugs Withdrawal Service, South Brisbane, Australia
| | - Brett McDermott
- Professor of Psychiatry, James Cook University, Townsville, Australia
| | - Erica Lee
- Mater Child and Youth Mental Health Service, South Brisbane, Australia
| | - Michelle McBride
- Psychologist Ahead Psychology, Former Manager Mater Alcohol and other Drugs Withdrawal Service, South Brisbane, Australia
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Kelly LM, Correia N, Kearns MD, Lang SG, Yermash J, Guigayoma J, Helseth SA, Becker SJ. From parenting skills to adolescent treatment needs: Questions elicited by parents of adolescents discharged from residential treatment. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100110. [PMID: 36844169 PMCID: PMC9949345 DOI: 10.1016/j.dadr.2022.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
Background Despite the utility of parent involvement in continuing care following adolescent residential treatment, parent engagement in traditional office-based treatment is low. In our prior work, we found that parents who had access to a continuing care forum directed questions to a clinical expert and to other parents around five topics: parenting skills; parent support; managing the post-discharge transition; adolescent substance use; family functioning. The current qualitative study elicited questions from parents without access to a continuing care support forum to explore overlapping and new themes. Methods This study was embedded within the pilot trial of a technology-assisted intervention for parents of adolescents in residential treatment for substance use. Thirty-one parents randomized to residential treatment as usual were asked two prompts at follow-up assessments: what questions they would like to ask a clinical expert and what questions they would like to ask other parents of adolescents discharged from residential care. Thematic analysis identified major themes and subthemes. Results Twenty-nine parents generated 208 questions. Analyses revealed three themes identified in prior work: parenting skills; parent support; adolescent substance use. Three new themes emerged: adolescent mental health; treatment needs; socialization. Conclusions The current study identified several distinct needs among parents who did not receive access to a continuing care support forum. Needs identified in this study can inform resources to support parents of adolescents during the post-discharge period. Parents may benefit from convenient access to an experienced clinician for advice on skills and adolescent symptoms, paired with access to parental peer support.
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Wilburn VG, Stoll HB, Rohr AC, Moring K. The Ambiguity of Parenting Adult Children With Substance Use Disorder. Can J Occup Ther 2022; 89:127-134. [PMID: 35037785 DOI: 10.1177/00084174211073260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Substance Use Disorder can impede parent-child relationships. The Theory of Ambiguous Loss provides a structure for occupational therapy practitioners in developing interventions to support the parent-child relationship. Purpose. This study explores the roles of parents of adult children diagnosed with Substance Use Disorder in the context of the Theory of Ambiguous Loss. Method. Volunteer participants were recruited from three urban parental support groups. Inclusion criteria were involved in a support group and having an adult child diagnosed with Substance Use Disorder. Eight mothers and one father participated in semi-structured interviews using a phenomenological approach. Themes and structural descriptions were developed. Findings. Five themes were identified: hopeful coping, occupational interference, changes in social constructs and participation, burdenful caregiving and receiving, and blending of occupations. Themes offer intervention considerations for occupational therapy. Implications. Research provides additional conceptual consideration to build occupation-centered interventions for parents and their adult children in Substance Use Disorder recovery.
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Becker SJ, Helseth SA, Janssen T, Kelly LM, Escobar KI, Souza T, Wright T, Spirito A. Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Pilot randomized trial of a technology-assisted parenting intervention. J Subst Abuse Treat 2021; 127:108457. [PMID: 34134877 DOI: 10.1016/j.jsat.2021.108457] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
Adolescents in residential level of care for substance-related problems have high risk of relapse following discharge. Parent engagement lowers relapse risk, but there are myriad barriers to engaging parents in residential treatment and continuing care. Parent SMART (Substance Misuse in Adolescents in Residential Treatment) is a technology-assisted parenting intervention that was designed to circumvent barriers associated with traditional, office-based continuing care interventions to better engage parents. This pilot randomized trial assessed the acceptability, feasibility, and preliminary effectiveness of Parent SMART as an adjunctive intervention to adolescent residential treatment-as-usual (TAU). Sixty-one parent-adolescent dyads were randomized to Parent SMART+TAU or TAU-only. Thirty-seven dyads were recruited from a short-term facility and 24 dyads were recruited from a long-term facility. Those randomized to Parent SMART received a multi-component technology-assisted intervention combining an off-the-shelf online parenting program, coaching sessions, and a parent networking forum. Parent and adolescent assessments were conducted at baseline, 6, 12, and 24-weeks post-discharge. Feasibility (e.g., parental effectiveness) and acceptability (e.g., parental satisfaction, willingness to recommend the intervention) benchmarks were specified a priori as the primary hypotheses. Secondary effectiveness indicators were the proportion of days adolescent used alcohol, cannabis, and any substance. All acceptability and feasibility benchmarks were met or exceeded among dyads in both short- and long-term residential. Generalized linear mixed models showed no significant effects pooled across sites. Analyses by facility revealed two significant time by condition interactions. Adolescents in short-term residential whose parents received Parent SMART showed fewer drinking days and fewer school problems over time, relative to adolescents whose parents received TAU. Results indicate that Parent SMART was both acceptable and feasible, with preliminary indication of effectiveness among those in short-term residential. A fully-powered trial is warranted to reliably test the effectiveness of Parent SMART and understand possible mechanisms of improvement.
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Affiliation(s)
- Sara J Becker
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America..
| | - Sarah A Helseth
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America
| | - Tim Janssen
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America
| | - Lourah M Kelly
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America
| | - Katherine I Escobar
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America
| | - Timothy Souza
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States of America
| | - Thomas Wright
- Rosecrance Health Network, University of Illinois College of Medicine, United States of America
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States of America
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Acevedo A, Harvey N, Kamanu M, Tendulkar S, Fleary S. Barriers, facilitators, and disparities in retention for adolescents in treatment for substance use disorders: a qualitative study with treatment providers. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:42. [PMID: 32552836 PMCID: PMC7302144 DOI: 10.1186/s13011-020-00284-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 06/06/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Retention in substance use treatment is one of the strongest predictors of improved outcomes among adolescents, making retention an important goal of treatment. We examined treatment providers' perspectives on barriers and facilitators to treatment retention among adolescents, and their views on contributors to racial/ethnic disparities in retention including ways to address disparities. METHODS Semi-structured interviews were conducted with 19 providers at state-licensed detoxification, residential, and outpatient facilities serving adolescents for substance use disorders in Massachusetts. Interviews were coded by at least two independent coders. RESULTS Providers identified barriers and facilitators at the policy/systems, facility, family, and client levels. Some of the barriers included insurance limits on sessions/length of stay and low reimbursement (policy/systems), staff turnover (facility), low family engagement (family), and low internal motivation (client). Some facilitators mentioned were support from state's substance use agency (policy/systems), flexibility with meeting location (facility), family participation (family), and high internal motivation and presence of external motivators (client). Barriers that contributed to racial/ethnic disparities included lower socio-economic status, language barriers, and mistrust. Having bilingual/bicultural staff and multi-lingual materials, and facilitating transportation were identified as strategies for reducing disparities in treatment retention. CONCLUSIONS It is critical that adolescents who access substance use services remain and complete treatment and that there is equity in treatment retention. Provider perspectives in factors associated with retention can inform the development of comprehensive interventions and policies to help improve retention and reduce disparities.
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Affiliation(s)
- Andrea Acevedo
- Department of Community Health, Tufts University, 574 Boston Avenue, Suite 208, Medford, MA, 02155, USA.
| | - Nellie Harvey
- Department of Community Health, Tufts University, 574 Boston Avenue, Suite 208, Medford, MA, 02155, USA
| | - Maureen Kamanu
- Department of Community Health, Tufts University, 574 Boston Avenue, Suite 208, Medford, MA, 02155, USA
| | - Shalini Tendulkar
- Department of Community Health, Tufts University, 574 Boston Avenue, Suite 208, Medford, MA, 02155, USA
| | - Sasha Fleary
- Eliot-Pearson Department of Child Study and Human Development, Tufts University, Medford, USA
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Lennox Terrion J, O'Rielly S, Rocchi M. Social Competence of Adolescents in Residential Substance Abuse Treatment. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2016. [DOI: 10.1080/1067828x.2015.1037515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tymes DD, Outlaw KL, Hamilton BK. Life Skills Interventions to Improve Social Confidence, Self-Management, and Protection against Drug Use in Rural Elementary School Aged Children. J Community Health Nurs 2016; 33:11-9. [PMID: 26813051 DOI: 10.1080/07370016.2016.1120592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This pilot project evaluated the effectiveness of a life skills training program for elementary-school-aged children for development of social confidence, self-management, and general social and drug resistance skills. The setting was a rural community after-school program. Children participated in 30-min weekly sessions for 8 weeks. Pre- and posttest scores were analyzed to determine effectiveness of the program. Results showed improvements in antismoking and antidrinking attitudes and use of self-management and general social skills, and social confidence in conflict situations. The life skills training intervention serves as a potential supplement to community programs for the prevention of behaviors such as bullying, smoking and drug use among elementary school aged children.
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Montgomery L, Sanning B, Litvak N, Peters EN. Preliminary findings on the association between clients' perceived helpfulness of substance abuse treatment and outcomes: does race matter? Drug Alcohol Depend 2014; 139:152-8. [PMID: 24767892 PMCID: PMC4522021 DOI: 10.1016/j.drugalcdep.2014.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few studies examine the helpfulness and effectiveness of substance abuse treatment from the clients' perspective. METHODS The current secondary analysis examined the perceived helpfulness of substance abuse treatment components and its relationship to treatment outcomes among 387 Black and White adults participating in a multisite randomized clinical trial (RCT) of Motivational Enhancement Therapy. Throughout the 16-week RCT, participants self-reported substance use. Upon completion of treatment, participants completed a self-report measure assessing the perceived helpfulness of treatment components. RESULTS Black participants rated 9 out of 12 treatment components (e.g., "learning skills that will help me cope with my problems") as being more helpful than their White counterparts, even after controlling for age, gender, employment status, primary drug type, and treatment assignment. However, perceived helpfulness ratings were not associated with substance use outcomes among Black or White participants. CONCLUSIONS Clients' perceived helpfulness of treatment components is an important factor to consider in improving the delivery of substance abuse treatment, especially for Black adults.
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Affiliation(s)
- LaTrice Montgomery
- University of Cincinnati, Mental Health and Substance Abuse Counseling Program, 2160 McMicken Circle, P.O. Box 210068, Cincinnati, OH 45215, USA.
| | - Blair Sanning
- University of Cincinnati, Mental Health and Substance Abuse Counseling Program 2160 McMicken Circle, P.O. Box 210068 Cincinnati, Ohio 45215, USA
| | - Nicole Litvak
- University of Cincinnati, Mental Health and Substance Abuse Counseling Program 2160 McMicken Circle, P.O. Box 210068 Cincinnati, Ohio 45215, USA
| | - Erica N. Peters
- Friends Research Institute 1040 Park Avenue, Suite 103 Baltimore, Maryland 21201, USA
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Abdel-Salam S. Examining the relationship between self-control and adolescent TC treatment completion. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2012.728670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Joe GW, Knight DK, Becan JE, Flynn PM. Recovery among adolescents: models for post-treatment gains in drug abuse treatments. J Subst Abuse Treat 2013; 46:362-73. [PMID: 24238715 DOI: 10.1016/j.jsat.2013.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 09/20/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
Recovery among adolescents undergoing substance abuse treatment was modeled in terms of pre-treatment motivation, therapeutic relationships, psychological functioning, treatment retention, legal pressures, DSM diagnoses, and client demographics. To address between program differences, a within-covariance matrix, based on 547 youth, was used. Applicability of the results across treatment modalities was also examined. The data were from the NIDA-sponsored DATOS Adolescent study. Results from structural equation models (estimated using Mplus) indicated that higher pre-treatment motivation predicted stronger counselor and in-treatment peer relationships, better counselor relationships and retention predicted less illegal drug use at follow-up, and DSM diagnosis was important in the treatment process. Overall, illegal drug use at follow-up was associated with post-treatment alcohol consumption, cigarette use, condom nonuse, psychological distress, criminality, and school non-attendance. The results document the importance of motivation and therapeutic relationships on recovery, even when taking into account the relative effects of legal pressures, DSM diagnoses, and demographics.
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Affiliation(s)
- George W Joe
- Texas Christian University, Fort Worth, TX 76129, USA.
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Abstract
PURPOSE OF REVIEW The focus of this review is to examine service utilization, treatment effectiveness, and future directions for adolescents who misuse substances. RECENT FINDINGS Although the effectiveness of treatments has improved in the last two decades, young people's utilization of services has remained relatively stable. This is disconcerting because early intervention improves outcomes and deterioration is associated with physical, psychological, and social problems. The requirement for coordinated service provision across a wide range of treatment agencies cannot be emphasized enough, because young substance misusers come to services with a variety of symptoms and problems. It is encouraging that, to date, treatment studies indicate that adolescents in almost all types of treatment reduce their use of substances. The greatest reductions are shown for family therapy, followed by cognitive behavior therapy (CBT), motivational enhancement therapy (MET)/CBT, MET behavior therapy, and pharmacological treatment. Despite the developing treatment literature, important methodological limitations restrict comparability between studies. SUMMARY The requirement for holistic, systematic assessments should include adolescents' social contexts, trauma, and psychiatric and physical illnesses because they are the cornerstones to understanding engagement and retention. Our review shows the importance of coordinating primary healthcare, mental health, and substance abuse treatment facilities, and highlights networking between other providers as integral to providing an optimal response to this unpredictable, often marginalized, group.
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Gunter WD, Abdel-Salam S. Therapeutic Engagement and Posttreatment Substance Use in Adolescent TC Clients. JOURNAL OF DRUG ISSUES 2013. [DOI: 10.1177/0022042613491103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The problem of adolescent drug use places a huge toll on society and a heavy burden on the criminal justice system. Despite the ability of therapeutic communities (TCs) to lower drug relapse, a great deal remains unknown in terms of how the process of treatment actually works for adolescents. Using data collected as part of the Drug Abuse Treatment Outcomes Studies–Adolescents, this study examines the direct and indirect relationship between therapeutic engagement and posttreatment substance use. Though there are few direct effects of therapeutic engagement on substance use, findings suggest that those more engaged in treatment are more likely to complete treatment and, therefore, less likely to use substances. This suggests that instruments that evaluate therapeutic engagement are important in assessing involvement in treatment, and that programming designed to engage the adolescents in TC treatment should be utilized to reduce the risk of posttreatment relapse.
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