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Taking It To The Streets: Doing (Mostly) Substance
Abuse Research in Community Agencies
Eric E. McCollum – Virginia Tech
Terry S. Trepper – Purdue Calumet
University of Texas School of Social Work
April 23, 2004
History of Our Projects
• Adolescent Treatment
• Couples Treatment for Outpatient Women
• Couples Treatment for Inpatient Women
• Training Substance Abuse Counselors to Work with Families
• SFBT for Domestic Violence
• SF Group Therapy
Adolescent Treatment
• NIDA-funded 5 year research project• Three group, Random assignment• Treatment and two controls• Treatment integrated structural/strategic,
behavioral• Control One: Family Psychoeducation• Control Two: Treatment as usual
(Individual)
Adolescent Treatment, Outcome
• Adolescents in a family-based therapy model showed a significant decrease in drugs used from pre- to posttreatment
• Adolescents in the family drug education program, nor individually-oriented treatment as usual did not show similar decreases
Outpatient Couples
• NIDA-funded 5 year research project
• Abstinence-Based & Methadone Maintenance
• Add-on Treatment
• Integrated Treatment Model
Outpatient Couples Tx Model
• Structural/Strategic– What’s the interpersonal problem?
• Intergenerational– Why does it make sense?
• Behavioral– What needs to change?
• SCT & SIT
Outpatient Couples Outcome
• Compared to Treatment as Usual:– Everyone got better during active treatment– TAU maintained gains or got a little worse
from post-test to 1 year follow-up– Couples conditions continued to improve from
post-test to 1 year follow-up
Women’s Residential Tx
• “Imported” the outpatient couples model to women’s residential treatment– SCT & SIT– Relationships a significant disruptor of
women’s residential treatment
• Looked at training substance abuse counselors to deliver the treatment
Residential Tx Findings
• Qualitative data suggested improved functioning for women in the program– Especially around parent-child interactions
• Substance Abuse counselor trainees less able to deliver the treatment
Training CD Counselors
• Develop a circumscribed intervention
• Focus on basic skills
• Incorporated Solution-Focused therapy
CD Counselor Settings
• State of Washington– Adolescent Outpatient– Adolescent Residential
• Counselors could learn the model
• Decreased attrition in treatment– 82% of adolescents in model completed
Domestic Violence
• NIMH-funded Stage 1 study
• “Domestic Violence Focused Couple Treatment”
• Treatment for couples who want to stay together when there has been violence
• “Adapted” SFBT model
SFBT Primary Picture
Adjunct Tools Secondary
Picture
Constraint Identified
Constraint Resolved
Highlighting Change
Seeking exceptions
Guided by Clients' Goals
Envisioning the Soltuion
Recurrence of violence
Escalation
Unresolved grief/loss over past abuse
Skill deficits
Safety Planning
Time Out
Airing Hurts
Psycho-education
Communication Skills
Stress Management
Medication
DV Outcome
• Quasi-experimental design• N = 51 couples
– 9 in convenience control group– 42 randomized to couples conditions
• At 6 month follow-up – female report of male assault – Control group – 66% recidivism– Individual couples – 43% recidivism– Multi-couple group – 25% recidivism
Solution-Focused Group Therapy for Substance
Abuse
• Pilot study
• “Reverse engineering” of a clinically useful model
• “Pure” SFBT delivered in group format
• Promising initial findings
Group Therapy
• Probationers with drug/alcohol involvement
• Random assignment to SFGT or Hazelden
• 6 week treatment
• N = 39 (19 per group)
Group Therapy Outcome
• “Trendy” findings– Pre-test to post-test change
• Substance Abuse– SASSI Subtle Attributes scale (p = .11, d = .53)– SFGT clients more likely to acknowledge
problems than TAU at end
Group Therapy Outcome (cont’d)
• Psychological functioning– Beck Depression (p = .06, d = .64)– OQ-45.2 Symptom Severity (p = .07, d = .61)– SFGT improved more on depression/anxiety
measures than did TAU
• Moderate effect sizes vs. an active Tx are encouraging
Agency Issues
• Agency Characteristics
• Developing relationships– Leadership– Front line staff
• Who will deliver the treatment?
• Reconciling with disease-model approaches
Effectiveness Research
• Do treatments that work well under controlled conditions, transfer to the clinic?
• Weisz, Weiss and Donenberg (1992)– Child therapy produces much larger effects
under experimental conditions than it does under “real world” conditions
Working in Community Agencies
• Agency culture
• Relationships with agency staff
• Clinical credibility
• Using a treatment manual
• Recruiting research participants
• The wider social service context
Agency Culture
• How open is the agency to research?
• What does agency want from research?
• Past experiences with research?
• Political issues intersecting with the research project?
Relationships with Agency Staff
• Need to develop relationships at both line and administrative levels
• Give back to the agency staff
• Informal collaboration
Clinical Credibility
• Communicate respect for the dilemmas of clinicians
• Be prepared for the collision of research and clinical cultures
• Demonstrate clinical expertise and agency savvy
Participants
• Underestimation of subject pool
• Corrupting random assignment
• Cast a wide net early
• Use multiple modalities