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Whitten T, Cale J, Nathan S, Hayen A, Williams M, Shanahan M, Ferry M. Duration of stay and rate of subsequent criminal conviction and hospitalisation for substance use among young people admitted to a short-term residential program. Drug Alcohol Rev 2023; 42:1450-1460. [PMID: 37042736 DOI: 10.1111/dar.13655] [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] [Received: 09/20/2022] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION This study examined the association between program duration and rate of criminal conviction and hospitalisation for substance use up to 15 years later among young people admitted to a short-term residential program for drug and alcohol use. METHODS Data were derived from linked administrative records of all clients referred to a modified therapeutic community for young people from January 2001 to December 2016 in New South Wales, Australia (n = 3059). Cox proportional hazards regression analyses examined the rate of conviction (separately for any offence, violent offence, non-violent offence and administrative offence) and hospitalisation for substance use, up to 15 years post-program among young people who attended treatment for 1-29 days, 30-59 days, 60-89 days and 90-120 days. RESULTS Thirty days or more in treatment was independently associated with a lower rate of conviction for any offence and a non-violent offence, as well as hospitalisation for substance use, while 60 days or more was associated with a lower rate of conviction for a violent and administrative offence, relative to those who spent 1-29 days in the program. Additional months in the program were also associated with reduced rates of conviction and hospitalisation, although 90-120 days appeared to confer no additional benefits than 60-89 days. DISCUSSION AND CONCLUSIONS At least 60 days may be the minimum duration needed for short-term, therapeutic community programs to reduce the risk of conviction across all crime types and hospitalisation for substance use.
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Affiliation(s)
- Tyson Whitten
- Center for Law and Justice, Charles Sturt University, Port Macquarie, Australia
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, Australia
| | - Jesse Cale
- School of Criminology and Criminal Justice, Griffith University, Gold Coast, Australia
| | - Sally Nathan
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Megan Williams
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Marian Shanahan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Vinais T, Lacroix A, Gelle T, Nubukpo P. Effectiveness of the Therapeutic Community Model in Addiction Treatment: A Retrospective Pilot Study in French Prisons. Healthcare (Basel) 2023; 11:healthcare11111523. [PMID: 37297663 DOI: 10.3390/healthcare11111523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/13/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND In France, addiction care in prison usually consists of nurses' interventions, medical care and socio-educational programs, but new alternatives have arisen, namely the therapeutic community (TC) model. This pilot study aims to evaluate the effectiveness of this prison-based TC in comparison with classic and socio-educational care offered in French prisons. METHODS To compare these three types of prison-based care, two detention centers' files were screened for use of multiple drugs, willingness to participate and absence of psychiatric comorbidities incompatible with group therapy. A custom questionnaire was built based on the fifth version of the Addiction Severity Index. It investigates medical status, employment and support, primary addiction status, legal status, social/familial status and psychiatric status through various items. RESULTS Our sample only consisted of male repeat offenders with a mean age of 37.7 ± (9.1) years. Primary addiction status improvement was observed for all care studied but was more important in TC than in classic care. Self-esteem and social/familial status saw significant improvement throughout TC care. CONCLUSIONS The TC model represents an alternative to classic and socio-educational care in French prisons. More studies are needed to assess the extent of the benefits provided on both the medical side and economic side.
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Affiliation(s)
- Théodore Vinais
- Pôle Universitaire de Psychiatrie d'Adulte de la Personne Agée et d'Addictologie (PUP3A), Centre Hospitalier Esquirol, 87000 Limoges, France
| | - Aurélie Lacroix
- Unité de Recherche et d'Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
- Inserm U1094, IRD U270, EpiMaCT-Epidémiologie des Maladies Chroniques en Zone Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, OmegaHealth, University of Limoges, CHU Limoges, 87042 Limoges, France
| | - Thibaut Gelle
- Inserm U1094, IRD U270, EpiMaCT-Epidémiologie des Maladies Chroniques en Zone Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, OmegaHealth, University of Limoges, CHU Limoges, 87042 Limoges, France
| | - Philippe Nubukpo
- Pôle Universitaire de Psychiatrie d'Adulte de la Personne Agée et d'Addictologie (PUP3A), Centre Hospitalier Esquirol, 87000 Limoges, France
- Unité de Recherche et d'Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
- Inserm U1094, IRD U270, EpiMaCT-Epidémiologie des Maladies Chroniques en Zone Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, OmegaHealth, University of Limoges, CHU Limoges, 87042 Limoges, France
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Speed TJ, Hanks L, Turner G, Gurule E, Kearson A, Buenaver L, Smith MT, Antoine D. A comparison of cognitive behavioral therapy for insomnia to standard of care in an outpatient substance use disorder clinic embedded within a therapeutic community: a RE-AIM framework evaluation. Trials 2022; 23:965. [DOI: 10.1186/s13063-022-06885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Rates of substance use disorders (SUDs) continue to rise in the USA with parallel rises in admissions to outpatient SUD treatment programs. Insomnia symptoms reduce treatment adherence, trigger relapse, and generally undermine SUD recovery efforts. Cognitive-behavioral therapy for insomnia (CBT-I) is the first-line treatment recommended for chronic insomnia. No study has examined the effectiveness of CBT-I for individuals who recently entered an outpatient SUD treatment program embedded within a therapeutic community (i.e., long-term drug-free residential setting).
Methods
A randomized controlled trial conducted at a SUD program embedded in a therapeutic community aimed to compare group-based CBT-I (gCBT-I) (N = 10) with the standard of care (SOC) (N = 11) among individuals who have SUDs and comorbid insomnia. We present a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework evaluation to provide empirical data on gCBT-I feasibility and facilitators and barriers of conducting an insomnia-focused clinical effectiveness study within a therapeutic community.
Results
Participants in both study arms reported moderately severe insomnia symptoms at admission and reductions in insomnia symptoms over time. Among participants who completed the Insomnia Severity Index (ISI) beyond admission, ISI decreased to ≤ 8 (the clinical cutoff for mild insomnia) in 80% of individuals in the gCBT-I group compared with 25% of individuals in the SOC group. A RE-AIM framework evaluation showed initial success with Reach and Adoption while Implementation, and Maintenance were limited. Effectiveness was inconclusive because of challenges with recruitment, intervention integrity, and missing data that precluded meeting the planned recruitment and study aims and led to study termination. Coordination and communication with staff and leadership facilitated gCBT-I implementation, yet well-known CBT-I barriers including time- and resource-intensive sleep medicine training for interventionalists and maintenance of treatment integrity during an 8-week intervention limited gCBT-I sustainability.
Conclusions
This analysis supports the feasibility of conducting behavioral sleep medicine research in outpatient SUD treatment programs embedded within therapeutic communities. Implementation of an insomnia-focused intervention was widely accepted by patients and providers and has potential to address insomnia symptoms in early SUD recovery. Addressing patient- and organizational-level implementation barriers may enhance the sustainability and scalability of sleep interventions and provide new hope to effectively treat insomnia among people living with SUDs.
Trial registration
Clinicaltrials.gov: NCT03208855. Registered July 6, 2017https://clinicaltrials.gov/ct2/show/NCT03208855?term=NCT03208855&draw=2&rank=1
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Helminen EC, Cascalheira CJ, Shaw TJ, Zollweg S, Hughes TL, Scheer JR. A latent class analysis of tailored substance use treatment programs: Implications for treating syndemic conditions facing sexual and gender minority populations. Drug Alcohol Depend 2022; 238:109550. [PMID: 35820291 PMCID: PMC9444885 DOI: 10.1016/j.drugalcdep.2022.109550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Syndemics (i.e., multiple, co-occurring, and synergistic conditions) contribute to elevated substance use among sexual and gender minority (SGM) people relative to heterosexual, cisgender people. Research suggests that syndemic-informed and SGM-tailored treatments are effective in substance use treatment among SGM people. However, few studies have examined 1) the proportion of substance use treatment facilities offering syndemic-informed, SGM-tailored treatment programming; and 2) the availability and accessibility of syndemic-informed, SGM-tailored treatment programs across the U.S. METHODS We used the 2020 National Survey of Substance Abuse Treatment Services (N-SSATS) dataset to perform a latent class analysis examining whether substance use treatment facilities' tailored treatment programs cluster together to form distinct classes indicating whether facilities offer syndemic-informed and SGM-tailored programming. We then used multinomial logistic regression to examine associations between class membership and facility availability and accessibility. RESULTS Analyses revealed four classes of substance use treatment facilities' tailored programs. Facilities with syndemic-informed and SGM-tailored treatment programs compared to facilities with no tailored programs were more likely to be in the Northeast compared to the Midwest and South; to offer payment assistance versus not offer payment assistance; and to be private, for-profit facilities versus public or non-profit facilities. CONCLUSIONS This study's findings identify the need for more facilities with syndemic-informed and SGM-tailored treatment, particularly in the Midwestern and Southern U.S. regions. Facilities offering syndemic-informed and SGM-tailored treatment might present accessibility barriers for low-income SGM people, as they were more likely to be private, for-profit facilities; however, they were more likely to offer payment assistance.
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Affiliation(s)
- Emily C Helminen
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Cory J Cascalheira
- Department of Psychology, Syracuse University, Syracuse, NY, USA; Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Thomas J Shaw
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Sarah Zollweg
- School of Nursing, Columbia University, New York, NY, USA
| | - Tonda L Hughes
- School of Nursing, Columbia University, New York, NY, USA; Department of Psychiatry, Columbia University, New York, NY, USA
| | - Jillian R Scheer
- Department of Psychology, Syracuse University, Syracuse, NY, USA.
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Whitten T, Cale J, Nathan S, Bista S, Ferry M, Williams M, Rawstorne P, Hayen A. Hospitalisation following therapeutic community drug and alcohol treatment for young people with and without a history of criminal conviction. Drug Alcohol Depend 2022; 231:109280. [PMID: 35030508 DOI: 10.1016/j.drugalcdep.2022.109280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This study examines the association between treatment in a therapeutic community for adolescents with drug and alcohol problems on hospitalisation outcomes up to 15 years later for all clients, and separately for those with and without a history of criminal conviction. METHOD A quasi-experimental design was used to examine the linked administrative health and criminal justice records for all adolescents admitted to the Program for Adolescent Life Management (PALM) from January 2001 to December 2016 (n = 3059) in Sydney, Australia. ICD-10AM codes were used to designate hospitalisation outcomes as either physical injury, mental health problems, substance use disorders, or organic illness. The treatment and comparison groups were matched on factors associated with program retention, resulting in a final sample of 1266 clients. We examined the rate of hospitalisation up to 15 years posttreatment for all clients and stratified by prior conviction status using Cox regression analyses. RESULTS The treatment group had significantly lower rates of hospitalisation for a physical injury (HR = 0.77 [95% CI = 0.61-0.98]), mental health problem (HR = 0.62 [95% CI = 0.47-0.81]), substance use disorder (HR = 0.59 [95% CI = 0.47-0.75]), and organic illness (HR = 0.71 [95% CI = 0.55-0.92]). There was a significant interaction between treatment and prior criminal conviction status on rate of hospitalisation for physical injury, suggesting that the effect of treatment on physical injury was significantly greater for clients with a prior criminal conviction. CONCLUSIONS Adolescents who engage in a therapeutic community treatment program may have a long-lasting reduction in the risk of subsequent hospitalisation. This also appears to apply to those with a history of criminal conviction.
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Affiliation(s)
- Tyson Whitten
- School of Social Sciences, University of Adelaide, Adelaide, South Australia, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
| | - Jesse Cale
- School of Criminology and Criminal Justice, Griffith University, Gold Coast, Queensland, Australia
| | - Sally Nathan
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarita Bista
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mark Ferry
- Ted Noffs Foundation, Randwick, New South Wales, Australia
| | - Megan Williams
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Patrick Rawstorne
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Gutierrez D, Goshorn JR, Dorais S. An exploration of thriving over time in recovery. J Subst Abuse Treat 2021; 132:108612. [PMID: 34489158 DOI: 10.1016/j.jsat.2021.108612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Emerging models of recovery have redirected the traditional focus on relapse prevention to an emphasis on wellness. According to this new framework of recovery, aspects of thriving can strengthen recovery and prevent relapse in substance use. However, the empirical support for these models is sparse. To fill the gap in the literature, the authors sought to predict the risk of relapse based on factors of thriving. METHOD Participants consisted of a stratified sample of 412 adults in early, middle, and late stages of recovery (based on length of time in recovery) who the study recruited via Qualtrics Online Panels. We utilized a sequential regression to examine the ability of factors of thriving, the influence of time in recovery and demographic variables to predict relapse risk. RESULTS Thriving, length of recovery, and demographics significantly predicted risk of relapse (p < .001, R2 = 65%), with Thriving accounting for 55% of the variance (ΔR2 = 55%). CONCLUSION These findings demonstrate that the natural developmental process that comes from the passage of time dedicated to recovery is significant but thriving or the quality of that time serves as a stronger protective factor preventing relapse. Addiction treatment and prevention specialists could benefit from including thriving in conceptual models and interventions for recovery. Further, these findings provide support for holistic models of addiction recovery.
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Affiliation(s)
- Daniel Gutierrez
- Department of School Psychology and Counselor Education, William & Mary, United States of America.
| | - Jeremy R Goshorn
- Department of Counseling, Wake Forest University, United States of America
| | - Stephanie Dorais
- Department of Counselor Education, Kean University, United States of America
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Johannessen DA, Nordfjærn T, Geirdal AØ. Work-Related Satisfaction among Clinicians Working at Inpatient Treatment Facilities for Substance Use Disorder: The Role of Recovery Orientation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147423. [PMID: 34299874 PMCID: PMC8303105 DOI: 10.3390/ijerph18147423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 12/30/2022]
Abstract
Several psychosocial factors have been suggested as facilitators of change among inpatients treated for substance use disorder (SUD). Research suggests that staff members are also influenced by the practice in which they are involved, and by contextual psychosocial factors at their treatment facilities. This cross-sectional questionnaire survey study was conducted to investigate the role of recovery-orientated interventions in describing work-related satisfaction among clinicians at inpatient SUD treatment facilities. The respondents (n = 407) rated items indicating work-related satisfaction and the degree of recovery orientation at their treatment facilities. The main findings of two block regression analyses indicated that clinicians’ work-related satisfaction was positively influenced by inpatients’ opportunities to pursue their goals and choices, and negatively influenced by inpatient involvement. The change in clinicians’ work-related satisfaction could not be described by the degree of individually tailored and varied interventions at the treatment facility. Clinicians should be supported and involved in the process of implementing measures to increase inpatient involvement in the treatment programmes, and treatment measures that enable inpatients to pursue their goals and choices should be enhanced. The findings of this and previous studies indicate that a recovery-oriented framework promotes clinicians’ work-related satisfaction and has an enabling influence on both inpatients and clinicians.
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Affiliation(s)
- Dagny Adriaenssen Johannessen
- Blue Cross East, 0182 Oslo, Norway
- Department of Social Work, Child Welfare and Social Policy, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
- Correspondence:
| | - Trond Nordfjærn
- Department of Psychology, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway;
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, 7006 Trondheim, Norway
| | - Amy Østertun Geirdal
- Department of Social Work, Child Welfare and Social Policy, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
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