Barry Loneck

A Comparison of the Johnson Intervention with Four Other Methods of Referral to Outpatient Treatment

The Johnson Intervention is a therapeutic technique in which members of the persons social network confront him or her about the damage the drinking or drug use has caused and the action they will take if treatment is refused. It is highly effective in engaging and retaining clients in inpatient treatment, but, since initial evaluations, two trends have emerged in the field. First, there has been an increase in the use of outpatient treatment and, second, a number of variations of the Johnson Intervention have been developed. The purpose of this study was to compare the effectiveness of the Johnson Intervention with four other methods of referral to outpatient treatment. The other methods included two naturally occurring types of referral (coerced and non-coerced) and two less intense and less costly variations of the Intervention (Unrehearsed and Unsupervised). Effectiveness was determined by both entry into and completion of treatment. A retrospective study was conducted on a sample of 331 cases drawn from an alcohol and other drug treatment agency. Those who had undergone the Johnson Intervention were more likely to enter treatment than those in any of the four other groups. Of those that entered treatment, the Johnson Intervention and the coerced referral groups were equally likely to complete treatment, and both groups were more likely to complete treatment than those in the other three types of referral. Although the Johnson Intervention was the most effective, the variations did show some measure of success and can be viewed as part of an Intervention continuum.

The Johnson Intervention and Relapse During Outpatient Treatment

The Johnson Intervention is a therapeutic technique in which members of a persons social network confront him or her about the damage that drinking and drug use has caused and the action they will take if he or she does not enter treatment. Previously, we evaluated the effectiveness of the Johnson Intervention at engaging and retaining clients in outpatient alcohol and other drug (AOD) treatment by comparing it to four other methods of referral. Although individuals who undergo a Johnson Intervention are most likely to enter treatment, the power of the Johnson Intervention to retain clients deteriorates over the course of treatment, as indicated by their diminished likelihood of completing. Given that abstinence from alcohol and other drugs is one of the first expectations placed on clients, we compared the Johnson Intervention to the other types of referral to evaluate the role of relapse during treatment. In a secondary analysis of 210 cases, we found relapse rates across the five types of referral ranged from 38% to 79%. Those in the Johnson Intervention group were more likely to relapse than three of the four other groups and, across all groups, those who relapsed were less likely to complete treatment. In spite of its high relapse rate, the Johnson Intervention is very effective in retaining those who relapse because it is very effective retaining all clients, whether they relapse or not.

Moving the Risk and Protective Factor Framework Toward Individualized Assessment in Adolescent Substance Abuse Prevention

ABSTRACT The field of substance abuse prevention has evolved towards a risk and protective factor paradigm in explaining the onset and escalation of adolescent substance use. This framework for understanding the problem has been developed and employed by researchers at the University of Washington, under Doctors Hawkins and Catalano, to assess communities for high-risk and low protection. Currently, there are no individual instruments to assess adolescents on these risk and protective factors. This article argues for the need of such an instrument, one that is time manageable and comprehensive. It is suggested that using a two-step method for assessment could meet these goals.

The Development and Preliminary Validation of the Adolescent Domain Screening Inventory: A Substance Use Prevention Tool.

The objective of this study was to develop a screen assessing domains in at-risk and substance-using adolescents. The Adolescent Domain Screening Inventory (ADSI) consists of four subscales: school, family, community, and individual or peer. A convenience sample of 6,661 youths was employed. Analyses included concurrent criterion validity, known instrument construct validity, convergent construct validity, cut points, and gender and race correlations. Concurrent criterion validity correlations range from r =.85 to r =.95. Correlation for known instrument validity is r =.56 and convergent construct validity is r =.49. Cut points produced positive predictive values ranging from .46 to .53. The ADSI demonstrated a general applicability across gender and race. The ADSI is an instrument demonstrating acceptable psychometric properties.

The impact of twelve-step program familiarity and its in-session discussion on counselor credibility

Background and Objective: The therapeutic relationship is an important factor in substance abuse treatment. Because Twelve-Step Program (TSP) concepts and principles are often incorporated into substance abuse treatment, we investigated whether counselor familiarity and time spent on TSPs impact counselor credibility. Method: A sample of 180 clients receiving residential treatment in the capital region of a northeastern state in 2009 completed a Client Demographic Questionnaire and the Counselor Rating Form - Short Version. Their counselors (N = 31) completed a corresponding Counselor Demographic Questionnaire. Results: The effect of the estimated percentage of in-session time discussing TSPs (p = .010) and the effect of TSP familiarity for counselors in recovery (p = .017) had significant effects on counselor credibility. Conclusions and Scientific Significance: The credibility of counselors is important for a working relationship with clients. These results highlight counselor influence stemming from a TSP presence in treatment, indicating positive ramifications for the therapeutic relationship.

Using the Conflict-Theory Model of Decision Making to Predict Outcome in the Alcoholism Intervention

This article examines the application of the decisionmaking component of conflict-theory model to the process of intervention in alcoholism. The alcoholic must choose from among a set of alternatives, each of which has both positive and negative outcomes. The usefulness of the conflict-theory model of decision making is shown in its ability to identify the key elements of intervention, to describe the decision-making process, and to predict the outcome of the intervention.

Stress and Outcome in the Alcoholism Intervention

The Alcoholism Intervention is a specific therapeutic technique used to motivate an alcoholic to enter treatment; participants confront the alcoholic with the damage the drinking has done and with the consequences that will occur if treatment is rejected. According to the conflict-theory model of decision making, an alcoholics decision to accept treatment is related to the level of stress in the Intervention. Results provided some support for this relationship and a speculative model of practice is presented.

Prevention Counseling and Student Assistance Programs: A Review of the Literature

Substance abuse prevention counseling can be found in two venues: school counseling and student assistance programs (SAPs). School prevention counseling is based on school psychology and guidance counseling. The authors of this article did not find any empirical studies of prevention counseling. Six criteria were used to assess the published research on SAPs: research designs, sampling methods, measures, procedures, analyses, and peer review of results. SAP studies reviewed were placed in one of three levels: Rigorous (N = 3; met all inclusion criteria), Informative (N = 2; met all criteria except peer review), and Evaluative (N = 5; weak design, but explicit in describing methods). The Rigorous Studies found a decrease in substance use or risk factors. The two Informative Studies found a decrease in substance use. The Evaluative Studies demonstrated the prevention of increases in substance use.

Strengthening the working alliance through a clinician’s familiarity with the 12-step approach

ABSTRACT Background: The working alliance plays an important role in the substance use disorder treatment process. Many substance use disorder treatment providers incorporate the 12-Step approach to recovery into treatment. With the 12-Step approach known among many clients and clinicians, it may well factor into the therapeutic relationship. Objective: We investigated how, from the perspective of clients, a clinician’s level of familiarity with and in-session time spent on the 12-Step approach might affect the working alliance between clients and clinicians, including possible differences based on a clinician’s recovery status. Method: We conducted a secondary study using data from 180 clients and 31 clinicians. Approximately 81% of client participants were male, and approximately 65% of clinician participants were female. We analyzed data with Stata using a population-averaged model. Results: From the perspective of clients with a substance use disorder, clinicians’ familiarity with the 12-Step approach has a positive relationship with the working alliance. The client-estimated amount of in-session time spent on the 12-Step approach did not have a statistically significant effect on ratings of the working alliance. A clinician’s recovery status did not moderate the relationship between 12-Step familiarity and the working alliance. Conclusion: These results suggest that clinicians can influence, in part, how their clients perceive the working alliance by being familiar with the 12-Step approach. This might be particularly salient for clinicians who provide substance use disorder treatment at agencies that incorporate, on some level, the 12-Step approach to recovery.

Characteristics of Student Assistance and Prevention Counseling Programs in Response to Environmental Impacts

The impacts of the terror attacks of September 11, 2001, were observed in Student Assistance and Prevention Counseling programs in New York schools. Methods: A mixed-method study of programs across the state, consisting of interviews (N = 14) and record reviews (N = 407), was conducted in New York State in 2002. Standardized state forms were used for quantitative data collection and frequencies were analyzed. Results: An analysis of referral source before and after September 11, 2001, showed that self-referrals were slightly higher after September 11, 2001. Using data from students admitted before September 11, 2001, as a baseline, there were some shifts observed in reason for admission following the terrorist attacks. Increase of services was typical for the schools closest to the World Trade Center site and in the New York metropolitan area. Discussion: Due to the flexible nature of Student Assistance and Prevention Counseling services, programs were able to redirect both staff and resources to attempt to meet the need brought about by this tragedy.