Organizational culture, as evinced by consensus regarding staff and client beliefs and values, has been shown to affect client engagement in residential substance abuse treatment. The present paper extends this work to treatment outcomes. Secondary analysis of data from a "Beliefs About Abstinence Scale," used in the Drug Abuse Treatment Outcomes Study (DATOS), was conducted for 76 programs, including outpatient methadone treatment, outpatient drug-free, short-term inpatient, and long-term residential programs. Findings show that higher levels of client consensus after 1 month of treatment were associated with less use of drugs and alcohol at 1-year follow-up, after controlling for the mean of the scale score, gender, age, client substance use at baseline and treatment modality. The implications of the results for substance abuse treatment are discussed.
"Previous research regarding staff-related variables in drug treatment has focused on staff skills as well as similarities in staff and client beliefs about treatment processes and outcomes   . For example, concordance between clients and staff views about treatment implementation and outcome predicts treatment engagement by clients  . Similarly, therapeutic alliance during drug treatment has been found to predict retention  . "
[Show abstract][Hide abstract] ABSTRACT: Staff interactions with their clients are an important factor in the quality of care that is provided to people in drug treatment. Yet there is very little research that addresses staff attitudes or clients' perceptions of discrimination and prejudice by staff with regard to treatment outcomes. This research aimed to assess whether perceptions of discrimination by staff predict drug treatment completion.
The study used a mixed methods approach. Ninety-two clients in residential rehabilitation facilities in Sydney were administered a series of quantitative measures assessing drug history, severity of drug use, treatment history, perceptions of staff discrimination and treatment motivation. Clients were followed up regularly until an outcome (dropout or completion) was obtained for the full sample.
Perceptions of discrimination were a significant predictor of treatment completion, with greater perceived discrimination associated with increased dropout. Qualitative interviews with 13 clients and eight health-care workers from these treatment services were then conducted to gain insight into how perceived discrimination may impact on treatment experiences. Clients and staff discussed how they would address the issue of perceived discrimination during the current treatment experience.
Adopting a mixed methods approach facilitated exploration of the impact of perceived discrimination on treatment from both clients' and health-care workers' perspectives. This methodology may also enhance interpretation and utilisation of these findings in drug treatment.
Drug and Alcohol Review 09/2010; 29(5):491-7. DOI:10.1111/j.1465-3362.2010.00173.x · 1.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The therapeutic community at the Austen Riggs Center relies on patient authority to preserve the open setting. Patients' willingness to take on the challenges and responsibilities of citizenship makes it possible to work without bars or locks. Most patients arrive having been labeled "treatment resistant," a label that can connote noncompliance but can also mark the complexity of the trouble and a resistance to being objectified in ways that are dehumanizing. Respect for this complexity can at times counter standards of care that define and prescribe ways of viewing patients and attending to their distress that may be simplistic and undermine development. This paper will explore how current ideas about standards of care may insufficiently take into account the importance of the patient's authority--and the therapist's standards--in helping an individual to make sense of life and experience, and how facing this dilemma head on can reduce resistance.
Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 02/2008; 36(3):547-60. DOI:10.1521/jaap.2008.36.3.547
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