Interventions to promote retention in substance abuse treatment.
ABSTRACT Compare two methods of improving retention in substance abuse treatment for persons with traumatic brain injury.
Randomized clinical trial with control group comparison.
Provision of a financial incentive and reduction of logistical barriers.
Treatment attendance, perceived therapeutic alliance, premature termination.
Provision of a financial incentive was highly effective for facilitating early attendance and appeared to promote eventual successful treatment completion. Reduction of logistical barriers did not significantly improve attendance or successful discharge. The hypothesized role of improved therapeutic alliance as a consequence of intervention and a mediator for preventing premature termination was not supported. However, results suggested that intervention, particularly financial incentives, promoted congruence between counsellor and client perceived therapeutic alliance.
For clients with traumatic brain injuries, provision of a financial incentive at an early point in substance abuse treatment substantially improves attendance and reduces the likelihood of premature termination. The basis for this effect appears to involve more than enhancement of the therapeutic alliance. We posit that concrete incentives can provide an opportunity for successful rule-governed behaviour that may generalize to other areas of improved impulse control.
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ABSTRACT: Driving while impaired by alcohol (DWI) is responsible for substantial mortality and injury. Significant gaps in our understanding of DWI re-offending, or recidivism, reduce our ability to practically assess recidivism probability and to match interventions to individual risk profiles. These shortcomings reflect the baffling heterogeneity in the DWI population and the limited focus of much existing DWI recidivism research to psychosocial, psychological and substance use correlates. This narrative review summarises the evidence for the contribution of neurocognitive and psychobiological mechanisms to DWI behaviour and recidivism. Given the nascent nature of this literature, insight into the putative contribution of these mechanisms to DWI is also drawn from other experimental literatures, particularly those on alcohol use disorders and cognitive and behavioural neuroscience. Alcohol-related neurotoxicity and dysregulation of hypothalamic-pituitary-adrenal axis and serotonergic systems may underlie certain offender characteristics consistently correlated with heightened DWI risk, persistence and intervention resistance. Their markers are less vulnerable to sources of bias than subjective psychosocial indices and are more far-reaching than alcohol abuse in explaining DWI behaviour and recidivism. Implications. The investigation of neurocognitive and psychobiological mechanisms in DWI research is a promising avenue for discerning clinically meaningful subgroups within the DWI population. This can lead to research and development in alternative assessment and more targeted intervention technologies. Multidimensional research in DWI and recidivism offers novel avenues for increasing road safety.Drug and Alcohol Review 08/2009; 28(4):406-18. DOI:10.1111/j.1465-3362.2009.00053.x
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ABSTRACT: This study describes and provides results from a process evaluation of a lay health advisor (LHA) model to enhance participation in a clinical trial of the effectiveness of motivational interviewing on smoking cessation in college fraternity and sorority members. The implementation of the model had two phases: (a) the selection and training of LHAs as liaisons between research staff and participants and (b) LHAs' roles in recruitment and retention. Perceptions of the LHA model were explored using survey questionnaires. Trial participants (N = 118) and LHAs (N = 8) were generally satisfied with the model and identified LHAs as helpful to participation. Seventy-four percent of chapter members were screened and 73% of participants received three of the four motivational interviewing sessions. These results indicate the LHA model was well received and met the needs of the research project.Health Promotion Practice 01/2009; 11(5):751-9. DOI:10.1177/1524839908325065