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Posted On: May 01, 2002          Updated On: April 30, 2002
© Terence T. Gorski, 2001

Addiction Careers and Criminal Specialization

Farabee, D., Joshi, V., and Anglin, M.D. (2001). Addiction careers and criminal specialization. Crime and Delinquency, 47(2), 196-220.

Abstract:  For many drug users, the initiation of drug use and the subsequent transition to an addiction career is accompanied by criminal activities. However, the use of general crime and drug use categories often obscures important features of their relationship. In the present study, data from the national Drug Abuse Treatment Outcome Studies sample of 7,189 clients in substance abuse treatment were analyzed to explore the relationships between several addiction career variables and the likelihood of lifetime participation in predatory, victimless, and nonspecialized criminal behaviors. The order of initiation of addiction and criminal careers was significantly related to participation in certain types of crimes, with those beginning criminal careers after beginning their addiction careers being more likely to engage exclusively in victimless than predatory crimes. Likewise, dependence on cocaine, heroin, or both, relative to alcohol, was associated with greater criminal diversity but a reduced likelihood of participating specifically in predatory crimes.

Drug treatment outcomes for adolescents 
with comorbid mental and substance use disorders.

Grella, C. E., Hser, Y. I., Joshi, V., & Rounds-Bryant, J. L. (2001). Drug treatment outcomes for adolescents with comorbid mental and substance use disorders. Journal of Nervous and Mental Disease, 189(6), 384-392.

Abstract:  This study compared the pretreatment characteristics and posttreatment outcomes of substance-abusing adolescents with and without comorbid mental disorders in the Drug Abuse Treatment Outcomes Studies for Adolescents. Subjects (N=992) were sampled from 23 adolescent drug treatment programs across three modalities (residential, short-term inpatient, outpatient drug-free). Nearly two-thirds (64%) of the sample had at least one comorbid mental disorder, most often conduct disorder. Comorbid youth were more likely to be drug or alcohol dependent and had more problems with family, school, and criminal involvement. Although comorbid youth reduced their drug use and other problem behaviors after treatment, they were more likely to use marijuana and hallucinogens, and to engage in illegal acts in the 12 months after treatment, as compared with the noncomorbid adolescents. Integrated treatment protocols need to be implemented within drug treatment programs in order to improve the outcomes of adolescents with comorbid substance use and mental disorders.

Grella, C. E., Joshi, V., & Hser, Y. (2000).  Program variation in treatment outcomes among women in residential drug treatment.  Evaluation Review, 24(4), 364-383.

Abstract:  Multilevel modeling was used to assess the program characteristics associated with treatment retention among 637 women in 16 residential drug treatment programs in the Drug Abuse Treatment Outcome Studies.  Women who were pregnant or had dependent children had higher rates of retention in programs in which there were higher percentages of other such women.  Longer retention was associated with higher rates of posttreatment abstinence.  Bivariate analyses showed that programs with higher proportions of pregnant and parenting women provided more services related to women’s needs.  The findings support the provision of specialized services and programs for women in order to improve outcomes of drug abuse treatment.

Knight, K., Hiller, M. L., Broome, K. M., & Simpson, D. D. (2000).  Legal pressure, treatment readiness, and engagement in long-term residential programs.  Journal of Offender Rehabilitation, 31(1/2), 101-115.

Abstract:  Clients are less likely to drop out of residential drug treatment programs prematurely when they are either internally motivated (i.e., having a high level of treatment readiness) or externally pressured by the legal system to enter, participate, and remain in treatment.  However, little is known about the combined impact these factors have on treatment engagement and retention.  This study focused on a national sample of 2,194 clients admitted to 18 long-term residential facilities.  Although there was no significant interaction effect, findings indicated that clients with higher levels of treatment readiness at intake stayed in treatment at least 90 days, regardless of legal pressure.  Likewise, those under legal pressure (defined by legal status and supervisory pressures) remained in treatment longer, regardless of treatment readiness.  However, motivational readiness for treatment accounted for the greatest improvements in retention and, unlike legal pressure, was related to indicators of therapeutic engagement.  [Keywords:  Legal pressure; treatment motivation; treatment retention]

Rowan-Szal, G. A., Joe, G. W., & Simpson, D. D.  (2000).  Treatment retention of crack and cocaine users in a national sample of long term residential clients.  Addiction Research, 8(1), 51-64.

Abstract:  Clients entering treatment with cocaine problems are difficult to engage and retain in treatment.  Crack users, a subset of cocaine users, are especially difficult to treat.  This study investigated whether type of cocaine used (crack or non-crack) was related to retention in treatment.  The sample consisted of 900 clients in 13 long-term residential (LTR) programs participating in the national Drug Abuse Treatment Outcome Studies (DATOS).  Clients met the DSM-III-R criteria for cocaine dependence and were at least weekly users of cocaine (including crack).  Hierarchical logistic model regression analysis was used to test the relationship between type of cocaine preference and retention.  Crack users had lower retention rates than non-crack cocaine users, even after adjusting for covariates.  Higher retention was also related to being older, a high school graduate, unmarried, not depressed, alcohol dependent, more motivated for treatment, and having fewer arrests.  New strategies to improve retention for crack users through increased client motivation are discussed.  [Keywords:  Crack; cocaine; DATOS; treatment retention]
Broome, K. M., Flynn, P. M., & Simpson, D. D. (1999). Psychiatric comorbidity measures as predictors of retention in drug abuse treatment programs. Health Services Research, 34(3), 791-806.

Abstract: Objective. To examine lifetime and current psychiatric comorbidity measures as predictors of drug abuse treatment retention, and to test the generalizability of results across treatment agencies in diverse settings and with varying practices. Data Sources/Study Setting. The national Drug Abuse Treatment Outcome Studies (DATOS), a longitudinal study of clients from 96 treatment agencies in 11 U.S. cities. Study Design. The design is naturalistic and uses longitudinal analysis of treatment retention in long-term residential, outpatient drug-free, and outpatient methadone treatment modalities; client background (including psychiatric comorbidity) and program service provision are predictors. Clinical thresholds for adequate treatment retention were 90 days for long-term residential and outpatient drug-free, and 360 days for outpatient methadone. Psychiatric indicators included lifetime DSM-III-R diagnoses of depression/anxiety and antisocial personality, and dimensional measures of current symptoms for depression and hostility. Data Collection/Extraction Methods. Data include structured interviews with clients, a survey of treatment program administrators, and program discharge records. Principal Findings. Dimensional measures of current psychiatric symptoms emerged as better predictors than lifetime DSM-III-R diagnoses. In addition, the predictive association of hostility with retention varied significantly across treatment agencies, both in the long-term residential and outpatient drug-free modalities. Other notable findings were that on-site mental health services in long-term residential programs were associated with better retention for clients with symptoms of hostility. Conclusions. Assessment issues and stability of results across programs are important considerations for treatment research and practice. [Keywords: Drug treatment; retention; psychiatric comorbidity; ancillary services]

Etheridge, R. M. Craddock, S. G., Hubbard, R. L., & Rounds-Bryant, J. L. (1999). The relationship of counseling and self-help participation to patient outcomes in DATOS. Drug and Alcohol Dependence, 57, 99-112.

Abstract: Using a sample of 927 cocaine patients enrolled in programs in three modalities included in the national Drug Abuse Treatment Outcome Studies (DATOS), this investigation examined the relationship of three dimensions of treatment process on after-treatment cocaine and heavy alcohol use and predatory illegal activity. Logistic regression revealed significant reductions in all three outcomes and strong effects of treatment duration and after-treatment self-help, conditional on the modality. Results did not support the hypothesized relationship between treatment outcomes and amounts of counseling and during-treatment self-help. Findings support the robustness of duration effects and after-treatment self-help and contribute to the measurement methodology for calibrating treatment intensity. The strong after-treatment self-help effect in the two residential and inpatient modalities suggests these programs can improve treatment outcomes by making referral to after-treatment self-help participation a standard practice and installing mechanisms to increase the likelihood of attendance at least twice weekly during the year after treatment. [Keywords: Drug treatment; treatment process; counseling; self-help groups; retention]

Simpson, D. D., Joe, G. W., Fletcher, B. W., Hubbard, R. L., & Anglin, M. D. (1999). A national evaluation of treatment outcomes for cocaine dependence. Archives of General Psychiatry, 56, 507-514.

Abstract: Background: This national study focused on posttreatment outcomes of community treatments of cocaine dependence. Relapse to weekly (or more frequent) cocaine use in the first year after discharge from 3 major treatment modalities was examined in relation to patient problem severity at admission to the treatment program and length of stay. Methods: We studied 1605 cocaine-dependent patients from 11 cities located throughout the United States using a naturalistic, nonexperimental evaluation design. They were sequentially admitted from November 1991 to December 1993 to 55 community-based treatment programs in the national Drug Abuse Treatment Outcome Studies. Included were 542 patients admitted to 19 long-term residential programs, 458 patients admitted to 24 outpatient drug-free programs, and 605 patients admitted to 12 short-term inpatient programs. Results: Of 1605 patients, 377 (23.5%) reported weekly cocaine use in the year following treatment (dropping from 73.1% in the year before admission). An additional 18.0% had returned to another drug treatment program. Higher severity of patient problems at program intake and shorter stays in treatment (<90 days) were related to higher cocaine relapse rates. Conclusions: Patients with the most severe problems were more likely to enter long-term residential programs, and better outcomes were reported by those treated 90 days or longer. Dimensions of psychosocial problem severity and length of stay are, therefore, important considerations in the treatment of cocaine dependence. Cocaine relapse rates for patients with few problems at program intake were most favorable across all treatment conditions, but better outcomes for patients with medium- to high-level problems were dependent on longer treatment stays.

Rounds-Bryant, J. L., Kristiansen, P. L., & Hubbard, R. L. (1999). Drug Abuse Treatment Outcome Study of adolescents: A comparison of client characteristics and pretreatment behaviors in three treatment modalities. American Journal of Drug and Alcohol Abuse, 25(4), 573-591.

Abstract: Objectives. The present study presents background and pretreatment characteristics of adolescent substance abuse treatment clients, and it provides a mechanism for describing perhaps the largest research sample of adolescents who were in drug treatment in this decade. Methods: The sample was 3382 subjects who presented for treatment from 1993 to 1995 in 37 programs in Pittsburgh, Pennsylvania; Miami, Florida; Minneapolis, Minnesota; Chicago, Illinois; Portland, Maine; and New York City, New York. Informed permission for the youth to participate was obtained from the subject’s custodial parent/guardian, and both the youth and the youth’s parents or guardians provided informed assent if they agreed to participate as subjects. Adolescents then were interviewed privately and confidentially by a trained professional interviewer who was independent of the treatment programs. The interviews queried subjects about their background, including education and employment; physical and mental health; use of tobacco, alcohol, and other drugs; sexual experiences; legal problems; religious beliefs; and treatment experience. Results: The long-term residential treatment modality was the least gender balanced of the modalities and had the most African-American and Hispanic clients. This modality was distinguished by the proportion of clients who were referred to treatment by the juvenile or criminal justice system. Compared with other clients in other modalities, short-term inpatient clients were more likely to be female and white. Inpatient clients also reported more indicators of psychiatric impairment. Outpatient clients were slightly younger than clients in the other modalities, and more of them were attending school at the time of admission to treatment. Outpatient clients had the least criminally involved lifestyles, their rates of (regular daily or weekly) drug use were also the lowest of the three modalities for all drugs assessed, and they had the least drug treatment experience. Conclusions: These results merit several recommendations. One is the need for more community-based adolescent substance abuse treatment programs. An additional recommendation is for more substance abuse treatment programs in facilities that serve incarcerated youth. Finally, and perhaps most critically, it is recommended that programs be designed to address such specialized issues as comorbid substance abuse and psychiatric problems, family dysfunction, physical and sexual abuse, gender and ethnic differences, and academic performance. [Keywords: Adolescent drug use; adolescent substance abuse treatment; drug treatment client profiles]


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Addiction - A Biopsychosocial Model

Denial Management Counseling (DMC)

Relapse Prevention Counseling (RPC)

Relapse Prevention Therapy (RPT)

Addiction-Free Pain Management (APM)

Food Addiction

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