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

NIDA Funding

• Currently have responded to the RFA for group treatments of substance abuse

• ??????

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

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