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Taking It To The Streets: Doing (Mostly) Substance Abuse Research in Community Agencies Eric E. McCollum – Virginia T PowerPoint Presentation
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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

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slide1
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
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
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
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
Outpatient Couples
  • NIDA-funded 5 year research project
  • Abstinence-Based & Methadone Maintenance
  • Add-on Treatment
  • Integrated Treatment Model
outpatient couples tx 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
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
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
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
Training CD Counselors
  • Develop a circumscribed intervention
  • Focus on basic skills
  • Incorporated Solution-Focused therapy
cd counselor settings
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
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
dv outcome
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
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
Group Therapy
  • Probationers with drug/alcohol involvement
  • Random assignment to SFGT or Hazelden
  • 6 week treatment
  • N = 39 (19 per group)
group therapy outcome
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
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
nida funding
NIDA Funding
  • Currently have responded to the RFA for group treatments of substance abuse
  • ??????
agency issues
Agency Issues
  • Agency Characteristics
  • Developing relationships
    • Leadership
    • Front line staff
  • Who will deliver the treatment?
  • Reconciling with disease-model approaches
effectiveness research
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
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
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
Relationships with Agency Staff
  • Need to develop relationships at both line and administrative levels
  • Give back to the agency staff
  • Informal collaboration
clinical credibility
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
Participants
  • Underestimation of subject pool
  • Corrupting random assignment
  • Cast a wide net early
  • Use multiple modalities
wider context
Wider Context
  • Agency has obligations to wider social service context
  • Have to explain the project to referral sources, other agencies, etc
  • Especially true with a controversial treatment