Do "intensive," freestanding outpatient substance abuse treatment programs actually provide more intensive services than "traditional" outpatient programs? Three hundred and thirty-eight patients in 6 "intensive" outpatient (IO) programs (three or more times weekly) were compared with 580 patients from 10 "traditional" outpatient (TO) programs (one or two times weekly) on severity of admission problems, treatment services received and six month outcomes. Results: 1. IO subjects generally had the most severe medical, employment, legal and psychiatric problems at admission. 2. IO patients received more alcohol and drug focused services; but fewer medical and employment focused services than the TO patients. Both groups received very few psychosocial services. 3. There were not significant differences between the IO and TO program samples at follow-up. However, both groups showed significant reductions in substance use, improvements in personal health and social function.
"Numerous studies that have examined differences between clients receiving treatment in different modalities have found significant improvements across modalities, while finding no significant differences between modalities on dependent measures of interest. For example, McLellan et al.  found that clients who attended intensive and traditional outpatient treatment programs showed significant improvements of approximately the same magnitude at 6-month follow-up. However, there were no between group differences on three of four outcome domains (reduction in alcohol and drug use, increased personal health, and reduction in public safety concerns). "
[Show abstract][Hide abstract] ABSTRACT: Research has indicated that more intense treatment is associated with better outcomes among clients who are appropriately matched to treatment intensity level based on the severity of their drug/alcohol problem. This study examined the differential effectiveness of community-based residential and outpatient treatment attended by male and female drug-involved parolees from prison-based therapeutic community substance abuse treatment programs based on the severity of their drug/alcohol problem.
Subjects were 4,165 male and female parolees who received prison-based therapeutic community substance abuse treatment and who subsequently participated in only outpatient or only residential treatment following release from prison. The dependent variable of interest was return to prison within 12 months. The primary independent variables of interest were alcohol/drug problem severity (low, high) and type of aftercare (residential, outpatient). Chi-square analyses were conducted to examine the differences in 12-month RTP rates between and within the two groups of parolees (residential and outpatient parolees) based on alcohol/drug problem severity (low severity, high severity). Logistic regression analyses were performed to determine if aftercare modality (outpatient only vs. residential only) was a significant predictor of 12-month RTP rates for subjects who were classified as low severity versus those who were classified as high severity.
Subjects benefited equally from outpatient and residential aftercare, regardless of the severity of their drug/alcohol problem.
As states and the federal prison system further expand prison-based treatment services, the demand and supply of aftercare treatment services will also increase. As this occurs, systems and policies governing the transitioning of individuals from prison- to community-based treatment should include a systematic and validated assessment of post-prison treatment needs and a valid and reliable means to assess the quality of community-based treatment services. They should also ensure that parolees experience a truly uninterrupted continuum of care through appropriate recognition of progress made in prison-based treatment.
"Groups were compared in terms of the proportion of patients who received at least one service in each of the seven TSR service areas over the first 4 weeks of treatment, using Fishers exact tests or x square (Ferguson , 1959; Cohen and Cohen, 1975). Next all sessions and services (including 'core services') provided in each of the seven problem areas were summed into service composite scores, indicating the total amount of focused treatment activity received by each subject in each of those service areas (See McLellan et al., 1993; Alterman et al., 1994; McLellan et al., 1997). Groups were compared on mean values from these seven TSR service composite measures using two-way (wave by group) multivariate analysis of variance (MANOVA) with significance level set at PB 0.05 (Cohen and Cohen , 1975). "
[Show abstract][Hide abstract] ABSTRACT: This project evaluated whether clinical case managers (CCMs) could increase access and utilization of social services in the community; and thereby improve outcomes of addiction treatment. No case management (NoCM)--patients received standard, group-based, abstinence-oriented, outpatient drug abuse counseling, approximately twice weekly. Clinical case management (CCM)--patients were treated in the same programs but also were assigned a CCM who provided access to pre-contracted, support services such as drug free housing, medical care, legal referral, and parenting classes from community agencies. CCM patients received more alcohol, medical, employment, and legal services than NoCM patients during treatment. At 6 month follow-up CCM patients showed significantly more improvement in alcohol use, medical status, employment, family relations, and legal status than NoCM patients. We conclude that CCM was an effective method of improving outcomes for substance abuse patients in community treatment programs. Essential elements for successful implementation included extensive training to foster collaboration; and pre-contracting of services to assure availability.
Drug and Alcohol Dependence 07/1999; 55(1-2):91-103. DOI:10.1016/S0376-8716(98)00183-5 · 3.42 Impact Factor
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