Kathy Colpaert

Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective.

Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators.

‘The Human Prerogative’: A Critical Analysis of Evidence-Based and Other Paradigms of Care in Substance Abuse Treatment

Present-day substance abuse treatment is characterized by a compelling demand for applying evidence-based interventions. Vehement discussions between policymakers, practitioners and researchers illustrate this clash of differing paradigms. The aim of this article is to situate evidence-based practice among the leading paradigms of care and to elucidate its implicit assumptions and potential implications. Evidence-based practice is inherent in the empirical-analytical paradigm of care and science, founded upon randomized and controlled studies. This paradigm is compared with the phenomenological-existential and the critical post-structural paradigm, which focus on elaborating the human potential and exploring individuals’ subjective interpretations, and on criticizing social inequalities and striving for compliance with human rights, respectively. Evidence-based practice and the methodological rigidity in each paradigm are analyzed critically. We conclude that through the dialectical integration of these diverse approaches, evidence, existence/humanism and social emancipation can be combined for the benefit of the human prerogative of care.

Impact of addiction severity and psychiatric comorbidity on the quality of life of alcohol-, drug- and dual-dependent persons in residential treatment.

Background: Substance users’ quality of life (QoL) is influenced by several variables, including psychiatric comorbidity and addiction severity. Thus far, the impact of the type of dependence (alcohol, drug or dual dependence) remains unclear. Therefore, the objectives of the study were to evaluate QoL in a clinical sample of alcohol-, drug- and dual-dependent patients and to assess the independent impact of psychiatric comorbidity, addiction severity and type of dependence on QoL. Methods: Face-to-face interviews with 274 patients admitted to residential substance abuse treatment were conducted using the European Addiction Severity Index (EuropASI), the Mini-International Neuropsychiatric Interview and the Assessment of Personality Disorders self-report questionnaire. Results: Multivariate analyses showed that anxiety, mood or personality disorder, employment status and the severity rating on the EuropASI domain alcohol use were associated with overall QoL. Gender, anxiety disorder and the severity ratings on the EuropASI domains alcohol use, drug use, physical health and emotional and psychological health were associated with overall perception of health. Conclusion: Addiction severity and psychiatric comorbidity explained the greatest amount of QoL variance, whereas the type of dependence did not play a central role.

Prevalence and Determinants of Personality Disorders in a Clinical Sample of Alcohol-, Drug-, and Dual-Dependent Patients

The present study compares the prevalence rates of 12 personality disorders (PDs) among patients with alcohol, drug, and dual dependence through chi-square tests and analyses of variance. It further investigates possible predictors of these PDs through multiple linear regression analyses. Data were gathered in 2007–2008 among 274 patients admitted to intensive, residential substance abuse treatment programs in Belgium, using the ADP-IV (Assessment of DSM-IV Personality Disorders), the EuropASI (European version of the Addiction Severity Index), and the MINI (Mini International Neuropsychiatric Interview). The analyses showed that drug- and dual-dependent patients have higher PD prevalence rates than alcohol-dependent patients. The severity, but not the nature of the dependence, appears as an important predictor for personality pathology.

Dual Substance Abusers Seeking Treatment: Demographic, Substance-Related, and Treatment Utilization Characteristics

High comorbidity exists between alcohol and drug-related disorders. However, little information is available on characteristics of clients abusing both alcohol and illicit drugs (so-called dual substance abusers). The proportion of dual substance abusers and their characteristics are examined in a sample of 1,626 clients seeking treatment in one of the 16 participating centers in the province of Antwerp (Belgium). More than a quarter of all clients were identified as dual substance abusers. Their characteristics correspond better to those of drug abusers than to those of alcohol abusers, but compared to the former, they are younger, more often male, use more types of illicit substances and more often use stimulating substances. Alcohol is often underestimated in substance use patterns. Thorough alcohol assessment, early intervention, and preventive actions are needed within the drug treatment system, and closer collaboration with the alcohol treatment system is absolutely essential.

Comparison of Single and Multiple Agency Clients in Substance Abuse Treatment Services

Background: Frequent and multiple service utilization among substance abusers is a well-known problem. However, little statistical evidence exists about overlapping agency populations. Methods: This phenomenon was studied in a clear-cut region in Belgium, based on intake information concerning all clients who addressed a drug treatment center within a 6-month period (n=1,139). Results: Multiple service utilization was rather common but not omnipresent during this particular registration period. Almost 15% of the clients were registered in more than one substance abuse treatment agency. Compared to single agency attendees, multiple agency clients appeared to be more often poly-substance abusers with a longer previous treatment history and greater problem severity. Conclusion: A continuous care perspective, interagency collaboration and a common tracking and documentation system are recommended to better address the needs of this specific subgroup of substance abusers. More research is needed to clarify whether these multiple service utilization patterns are caused by client-related, agency-related or other factors.