Patrick M. Flynn

Recovery from opioid addiction in DATOS

Patient attributions for their own long-term recovery were obtained in a 5-year followup of 432 admissions to 18 outpatient methadone treatment programs. Subjects were classified into two groups - recovering and non-recovering-strictly defined and based on both biological and self-report measures of no opioid or cocaine use, less than daily use of alcohol, and no arrests or illegal activity during the year prior to interview. The 28% who were in recovery at Year 5 reported that they had relied primarily upon personal motivation, treatment experiences, religion/spirituality, family, and their job/career. Particular value was placed on the support from family and close friends, indicating the importance of stronger efforts to develop social networks for support of drug-free functioning, especially among patients who lack these resources or need them strengthened. More information is available on the Internet at www.ibr.tcu.edu.

An Assessment for Criminal Thinking

Risk assessments generally rely on actuarial measures of criminal history. However, these static measures do not address changes in risk as a result of intervention. To this end, this study examines the basic psychometric properties of the TCU Criminal Thinking Scales (TCU CTS), a brief (self-rating) instrument developed to assess cognitive functioning expected to be related to criminal conduct. Findings demonstrate that these scales have good psychometric properties and can serve as a short but reliable self-reported criminal thinking assessment. Their applications as part of an assessment system to determine offender progress and effectiveness are discussed.

The federal role in drug abuse technology transfer: a history and perspective.

The past 30 years have seen a focus on substance abuse research in association with the creation of federal agencies specifically mandated to guide that effort. While research has been well supported and largely productive, there has been increasing concern with the slow pace of adoption of the findings from that research. The history of those efforts suggests a long-standing concern with knowledge development, and a continuing reliance on print media to achieve knowledge application. Nonetheless, evidence from other human service fields, and increasingly from the substance abuse field, indicates interpersonal strategies are dramatically more effective in achieving the individual and organizational behavior change needed to achieve technology transfer. Argument is made that the federal government remains the best, if not the only resource for promoting technology transfer. A paradigm is described to further federal efforts in this area, and structural elements suggested for the achievement of technology transfer goals.

Costs and benefits of treatment for cocaine addiction in DATOS.

Our objective was to examine the cost of long-term residential (LTR) and outpatient drug-free (ODF) treatments for cocaine-dependent patients participating in the Drug Abuse Treatment Outcome Studies (DATOS), calculate the tangible cost of crime to society, and determine treatment benefits. Subjects were 502 cocaine-dependent patients selected from a national and naturalistic nonexperimental evaluation of community-based treatment. Financial data were available for programs from 10 US cities where the subjects received treatment between 1991 and 1993. Treatment costs were estimated from the 1992 National Drug Abuse Treatment Unit Survey (NDATUS), and tangible costs of crime were estimated from reports of illegal acts committed before, during, and after treatment. Sensitivity analyses examined results for three methods of estimating the costs of crime and cost-benefit ratios. Results showed that cocaine-dependent patients treated in both LTR and ODF programs had reductions in costs of crime from before to after treatment. LTR patients had the highest levels and costs of crime before treatment, had the greatest amount of crime cost reductions in the year after treatment, and yielded the greatest net benefits. Cost-benefit ratios for both treatment modalities provided evidence of significant returns on treatment investments for cocaine addiction.

Leadership, burnout, and job satisfaction in outpatient drug-free treatment programs

Counselors are a critical component of substance abuse treatment programming, but their working experiences are not yet well understood. As treatment improvement efforts focus increasingly on these individuals, their perceptions of program leadership, emotional burnout, and job satisfaction and related attitudes take on greater significance. This study explores counselor views and the impact of organizational context using data from a nationwide set of 94 outpatient drug-free treatment programs in a hierarchical linear model analysis. Results show counselors hold generally positive opinions of program director leadership and job satisfaction and have low levels of burnout, but they also have important variations in their ratings. Higher counselor caseloads were related to poorer ratings, and leadership behaviors predicted both satisfaction and burnout. These findings add further evidence that treatment providers should also address the workplace environment for staff as part of quality improvement efforts.

Measuring Offender Attributes and Engagement in Treatment Using the Client Evaluation of Self and Treatment

Monitoring drug-abuse-treatment delivery and progress requires the use of validated instruments to measure client motivation, psychosocial and cognitive functioning, and other treatment-process dynamics. As part of the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies project for examining client-performance indicators for treatment of correctional populations, this study examined psychometric properties of the Criminal Justice Client Evaluation of Self and Treatment (CJ CEST). The sample included 3,266 offenders from 26 corrections-based treatment programs located in six states. Overall, the client assessment demonstrated good reliabilities evaluated at the individual and program levels and in test—retest administrations. In addition, evidence for construct validity was favorable. It is concluded that the CJ CEST is a brief yet comprehensive instrument that effectively and efficiently measures client needs and functioning at intake and also is appropriate for use during treatment to monitor progress over time in corrections-based drug-treatment programs.

Integration of treatment innovation planning and implementation: strategic process models and organizational challenges.

Sustained and effective use of evidence-based practices in substance abuse treatment services faces both clinical and contextual challenges. Implementation approaches are reviewed that rely on variations of plan-do-study-act (PDSA) cycles, but most emphasize conceptual identification of core components for system change strategies. A two-phase procedural approach is therefore presented based on the integration of Texas Christian University (TCU) models and related resources for improving treatment process and program change. Phase 1 focuses on the dynamics of clinical services, including stages of client recovery (cross-linked with targeted assessments and interventions), as the foundations for identifying and planning appropriate innovations to improve efficiency and effectiveness. Phase 2 shifts to the operational and organizational dynamics involved in implementing and sustaining innovations (including the stages of training, adoption, implementation, and practice). A comprehensive system of TCU assessments and interventions for client and program-level needs and functioning are summarized as well, with descriptions and guidelines for applications in practical settings.

Violent offenses associated with co-occurring substance use and mental health problems: Evidence from CJDATS

The present study examines the relationship between substance use, mental health problems, and violence in a sample of offenders released from prison and referred to substance abuse treatment programs. Data from 34 sites (n = 1,349) in a federally funded cooperative, the Criminal Justice Drug Abuse Treatment Studies (CJDATS), were analyzed. Among parolees referred to substance abuse treatment, self-reports for the six-month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. For most offenders with substance use problems, the quantity of alcohol consumed and the frequency of drug use were associated with a greater probability of self-reported violence. Mental health problems were not indicative of increases in violent behavior, with the exception of antisocial personality problems, which were associated with violence. The paper emphasizes the importance of providing substance abuse treatment in relation to violent behavior among offenders with mental health problems being discharged to the community.

The impact of organizational stress and burnout on client engagement

This article explores the impact of organizational attributes on client engagement within substance abuse treatment. Previous research has identified organizational features, including small size, accreditation, and workplace practices, that impact client engagement (K. M. Broome, P. M. Flynn, D. K. Knight, & D. D. Simpson, 2007). This study sought to explore how aspects of the work environment impact client engagement. The sample included 89 programs located in 9 states across the United States. Work environment measures included counselor perceptions of stress, burnout, and work satisfaction at each program, whereas engagement measures included client ratings of participation, counseling rapport, and treatment satisfaction. Using multiple regression, tests of moderation and mediation revealed that staff stress negatively predicted client participation in treatment. Burnout was related to stress but was not related to participation. Two additional organizational measures--workload and influence--moderated the positive relationship between staff stress and burnout. Implications for drug treatment programs are discussed.

Italian Survey of Organizational Functioning and Readiness for Change: A Cross-Cultural Transfer of Treatment Assessment Strategies

To better understand why some drug abuse treatment programs are more effective than others, USA research about organizational functioning and its role in the provision of treatment services was extended through a study of a delivery system in another country. The Texas Christian University (TCU) organizational functioning and readiness for change instrument (ORC) was translated into Italian and administered to 405 treatment program directors and staff from both public and private sectors in the Veneto Region of Northern Italy. Results indicated that the psychometric properties of the ORC in the USA and Italy are consistent. Some general differences in staff attributes were found between USA and Italian programs, but organizational climates were remarkably similar.