Nancy Jainchill

Circumstances, Motivation, Readiness, and Suitability (The CMRS Scales): Predicting Retention in Therapeutic Community Treatment

Based upon clinical considerations, scales were developed measuring client perceptions across four interrelated domains: circumstances (external pressures), motivation (intrinsic pressures), readiness, and suitability (CMRS) for residential TC treatment. This paper, the first in a series, reports findings on the reliability of the CMRS and its validity as a predictor of retention in TC treatment in three cohorts of consecutive admissions to a long-term residential TC. The main findings show that: (a) discriminant and factor analyses confirm the face validity of the original four rationale scales; (b) scores distribute into four groups, with most clients in the moderately low to moderately high range; (c) two cross-validation studies confirm the internal consistency of the scales, and a linear relationship between the separate and total CMRS scores and short-term retention in all three cohorts and long-term retention in two cohorts. The present psychometric study provides impressive findings on the reliability and validity of the CMRS scales as predictors of retention in long-term TCs. Although still considered experimental, awaiting replicational studies and firm conclusions concerning generalizability, the CMRS holds considerable promise for research, theory, and practice.

The Therapeutic Community: Success and Improvement Rates 5 Years after Treatment

Dropouts (N = 162) and graduates (N = 75) from the 1970-1971 residential population in Phoenix House were interviewed 5 years after treatment. Composite indices of criminality, drug use, and employment described client status on a four-point outcome scale. Success reflected absence of crime and drug use through all years of follow-up; improvement represented a positive change over pretreatment status. Graduate success and improvement rates were 75% and 93%, respectively. Among dropouts, the rates were 31% and 56%, respectively, but increased by time in program from less than 1 month to greater than 20 months (Success = 0-57%; Improvement = 5-89%). Results at 2-year follow-up were replicated in a 1974 cohort, providing convincing evidence for the effectiveness of treatment in the therapeutic community.

Is the Therapeutic Community Culturally Relevant? Findings on Race/Ethnic Differences in Retention in Treatment

The therapeutic community (TC) views cultural diversity as an essential ingredient in its treatment approach. However, based on clinical observation and some research, questions persist concerning the relevance of TC programming for numerical race/ethnic minorities. This article briefly reviews pertinent research and presents findings from recent studies on race/ethnic differences in readiness and suitability for, and retention in, TC treatment. A framework is outlined for the empirical study of cultural relevance issues in TCs.

The Prevalence of Sexual Abuse and Its Impact on the Onset of Drug Use Among Adolescents in Therapeutic Community Drug Treatment

ABSTRACT Assessing the prevalence of sexual abuse among adolescents is problematic because they are generally reluctant to disclose abusive experiences. Often the abuse is ongoing and may involve family members with whom the adolescent lives or with whom there may be strong emotional attachments. Statistics based on self-reports of childhood victimization suggest that issues of childhood abuse are critical factors in the initiation of drug use. The current study describes the prevalence of sexual abuse among a sample of 938 adolescents admitted to residential therapeutic communities for the treatment of substance abuse and related disorders. The data indicate that approximately one-third of the sample reported histories of sexual abuse. Prevalence rates were significantly higher for girls than boys (64% vs. 24%). A history of sexual abuse correlates with several social, behavioral, and psychological characteristics of clients at entry to treatment, including greater drug use, more severe psychopathology, family drug use and more deviant peer associations. Cox regression analyses show that a history of sexual abuse is related to earlier onset of alcohol and illicit drug use. One explanation of the findings is the self-medication hypothesis (Cavailo & Schiff, 1989) which states that drug use functions to ameliorate feelings of depression, and poor self-esteem which often accompany childhood abuse.

Gender, Psychopathology, and Patterns of Homelessness Among Clients in Shelter-Based TCs

Substance abuse and severe mental illness are factors that have been linked to homelessness, and the rates of mental illness have been reported to be higher among homeless women than men. Only recently have investigators begun to examine the prevalence of abuse among the homeless population and its relationship to indicators of psychopathology. This study builds on the existing literature and examines the relationship among psychiatric disturbance, abusive experiences, and homelessness among adult men and women admitted to shelter-based therapeutic community (TC) drug treatment programs. Results: The sample presents with extensive psychopathology and a history of physical and sexual abuse. Gender differences indicate that, except for antisocial personality, females yield higher rates on measures of both psychiatric disturbance and abuse. The relationship between psychopathology and abuse also appears to be much stronger for females than for males. However, the relationship between abuse and adult homelessness appears to be similar for men and women. The gender differences in the relationship between histories of abuse and manifestations of psychiatric disturbance support a hypothesis that has been proposed elsewhere: Females internalize the trauma associated with abusive experience, while males externalize it. The findings suggest that, although there may be a need for gender-specific targeted interventions, treatment providers must also recognize that the impact of abuse seems to transcend gender within this population.

Post-Treatment Outcomes Among Adjudicated Adolescent Males and Females in Modified Therapeutic Community Treatment

Identifying effective targeted interventions for substance using delinquent populations has remained an important objective for researchers and clinicians alike. To this end, the current study examines the client characteristics and post-treatment outcomes among youths admitted to Recovery House (RH), an innovative program that traverses the separation of juvenile justice and treatment. Data for the current analyses derive from a National Institute on Drug Abuse-funded 5-year post-treatment outcome study (NIDA #P50-DA-0770) of N = 938 adolescent clients admitted to therapeutic community (TC) programs in the United States and Canada during the period April 1992 to April 1994. Note the year. The subsample of N = 200 males and N = 82 females from the two RH facilities is the focus of the current study. The 5-year follow-up sample contained 57.9% or N = 70 of the original sample of RH males and 62.2% or N = 51 or the original RH females. Chi-square statistics, one-way analysis of variance, and the Wilcoxon Signed Rank test was used to examine pretreatment, admissions, and outcome variables and to assess within person differences pre- to post-treatment. The profile of the adolescents at admission to Recovery House reveals that the youth were primarily involved with marijuana, and secondarily with alcohol, prior to treatment. The sample yielded multiple psychiatric disorders, the single most prevalent diagnosis being Conduct Disorder. They also revealed extensive involvement in criminal activity (e.g., drug sales, violent crimes, and property crimes). Post-treatment drug use other than marijuana and alcohol was infrequent and there were reductions in the actual percent reporting involvement in most categories of criminal involvement. Gender analyses revealed that even though females were less likely to complete treatment, their post-treatment outcomes were better; proportionately fewer females compared with males were involved with marijuana use and with almost all categories of crime. In general, the findings suggest that programs such as RH can be successful in addressing the critical problem of youth substance use and criminal activity.

Adolescent Amphetamine Users in Treatment: Client Profiles and Treatment Outcomes

Abstract This study compares client profiles of adolescent amphetamine users to those of nonusers and examines the multivariate prediction of posttreatment drug use, criminal, and HIV risk behavior outcomes in the year following their separation from treatment. Data were collected as part of a larger longitudinal study on a sample of 938 adolescents who were admitted to residential therapeutic community drug treatment programs across the eastern United States and Canada from April of 1992 through April of 1994. A subsample of 485 adolescents were reinterviewed one year after their separation from treatment. Findings indicated that amphetamine users tended to be white, older, and have parents with higher education and occupational levels than nonusers. However, they also had more psychopathology, more extensive drug use and criminal histories, and engaged in more HIV-risk behaviors than nonusers. Additionally, amphetamine users tend to come from homes where one or both parents used illicit drugs, drank regularly, or had a mental illness, and they often reported histories of childhood maltreatment. Analyses of the one-year follow-up data indicated that being an amphetamine user was not related to treatment outcome after the clients demographic characteristics. overall drug use severity, and treatment completion were taken into account. Therefore, therapeutic community treatment appears to be an effective means of treating adolescent amphetamine users.

Adolescent admissions to residential Drug treatment: HIV risk behaviors pre- and posttreatment

HIV risk behaviors of adolescents (N = 938) admitted to residential therapeutic communities for drug abuse and related problems are described. Approximately 95% of the sample was sexually active. The adolescents reported that they had used drugs or alcohol about half of the time that they engaged in sexual relations and that half of their sexual activity was unprotected. Males and females differed in their self-perceptions of risk for HIV infection. Three dimensions of risky behaviors were identified by factor-analytic procedures: Risky Sex With Men, Risky Sex With Women, and Risky Drug Use Behaviors. Separate regression equations for males and females identified common and unique predictors of risky behaviors. A comparison of 1-year pretreatment with 1-year posttreatment risky behaviors for a subsample of the full cohort revealed significant positive changes (i.e., reductions) on some, but not all, measures of risky behaviors.

Substance dependency treatment for adolescents: practice and research.

This paper reviews the more common treatment approaches that address adolescent substance abuse and the spectrum of problems which often attend involvement with drugs. The most common outpatient treatment approaches for adolescents are 12-step based programs and family-based therapies which may be used separately or in conjunction with each other. The therapeutic community is a residential approach, characterized by the use of the peer community itself to facilitate social and psychological change in individuals. Both outpatient and residential modalities have demonstrated effectiveness in working with adolescents. Ideally, the type of intervention will depend upon the young persons needs, in particular the extent and effects of his/her drug use, as well as the level of other problems. Overall, treatment must address a range of concerns of special relevance to adolescents because of their age and dependency status; for example, developmental stage, cultural issues, and gender issues.

Dynamic Recovery: Comparative Study of Therapeutic Communities in Homeless Shelters for Men

The Dynamic Recovery Project examined relationships between homelessness, substance abuse, and recovery, and investigated the effectiveness of the therapeutic community (TC) treatment model in helping homeless drug users move toward stable, drug-free living. This project compared two short-term TCs that were situated within pre-existing homeless shelters with a clean and sober dormitory. In a separate condition, peer counselors and staff were provided additional training in TC philosophy and practice to reduce program dropout. Dramatic decreases in drug and alcohol use at follow-up were verified by urinalysis. Length of time in treatment rather than specific program accounted for decreased alcohol and drug use. Important decreases in posttreatment criminality for both treatment programs were documented. The comparison group, starting with low criminality, experienced smaller, nonsignificant decreases unrelated to type of program or time in treatment. Major declines in Beck Depression Scores were evident, but were unrelated to groups or time in treatment. Training had no measurable impact on client retention or outcomes and there were no significant differences between TCs and the comparison group on posttreatment drug use, criminality, or depression. This report documents that short-term therapeutic communities can be successfully implemented in public shelters for homeless men.