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Research on the effectiveness of the modified therapeutic community for persons with co-occurring substance use and mental disorders
- Authors:
- SACKS Stanley, SACKS JoAnn Y.
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 31(2), Summer 2010, pp.176-211.
- Publisher:
- Emerald
This article highlights the development of the modified therapeutic community (MTC) as an approach to the treatment of co-occurring disorders. Four research studies are presented, each of which investigated the effectiveness of the MTC. Nine hundred and two subjects had mental disorders co-occurring with substance use disorders, and all four studies were undertaken by the same investigative team. Better outcomes were observed for the MTC group in every study, but the measures and domains in which differences were detected varied from study to study. Analysis showed significant improvements in outcomes for the MTC group in five of six outcome domains – substance use, mental health, crime, employment and housing. However, no significant differences were detected in HIV-risk. The paper concludes with brief summaries of preliminary findings from two current studies. In ending, the paper presents a discussion of staff training, aftercare services, and future directions for research related to the MTC.
The addiction therapeutic communities for psychiatric disorders
- Author:
- de LEON George
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 26(4), Winter 2005, pp.405-422.
- Publisher:
- Emerald
This article outlines what is known about the Addiction Therapeutic Community model modified for treating dually diagnosed. The initial sections provide a brief overview of the background of therapeutic communities in psychiatry and substance misuse and of the main clinical and research findings relevant to the efficacy of the therapeutic community for substance abuse and psychological disorder. The subsequent sections present the perspective and approach of both the traditional Addiction TC and the modified Addiction TC model for the serious mentally ill chemical abusers. The last two sections summarise research conducted on modified Addiction TCs for co-occurring disorders and some implications for the Psychiatric TC models and mental health in general.
Meanings of recovery from the perspective of people with dual diagnosis
- Authors:
- HIPOLITO Maria Mananita S., CARPENTER-SONG Elizabeth, WHITLEY Rob
- Journal article citation:
- Journal of Dual Diagnosis, 7(3), July 2011, pp.141-149.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This article examines the notion of recovery, based on the perspectives of people with dual diagnosis living in recovery communities. Recovery communities seek to create intentional, safe, relationship-centred communities for people living with co-occurring mental illness and substance use disorders in shared or congregate housing sites. The findings reported in this paper were obtained as part of an ongoing ‘Creating Communities’ research project that aims to examine the impact of the communities on processes of recovery. As part of this study, focus groups have been conducted with residents at 4-month intervals. This analysis draws on data collected in 2009 and 2010 into meanings of recovery. The findings reveal that recovery is a multifaceted concept for individuals living with co-occurring disorders. The analysis yielded 3 dimensions of the meaning of recovery: acknowledgment; present orientation; and transformation and growth.
Modified therapeutic community aftercare for clients triply diagnosed with HIV/AIDS and co-occurring mental and substance use disorders
- Authors:
- SACKS Stanley, et al
- Journal article citation:
- AIDS Care, 23(12), December 2011, pp.1676-1686.
- Publisher:
- Taylor and Francis
This paper describes the evaluation of a clinical trial of a modified therapeutic community aftercare (MTCA) programme for triply diagnosed users with HIV/AIDS, a substance use disorder, and a mental disorder. Seventy six subjects were randomly assigned to MTCA or to standard aftercare. Follow-up interviews assessed eight outcome domains and adherence to prescribed HIV medication. At the six-month follow-up, clients with greater psychological functioning and stable physical health at baseline had greater improvement overall and for substance use and mental health than standard aftercare clients in the same stratum. In contrast, standard aftercare clients with poorer psychological functioning and improved physical health had more favourable outcomes overall and for substance use than their MTCA counterparts. Differences in HIV medication adherence were not detected. Clients with greater psychological functioning and stable health at treatment entry benefited more from the MTCA programme. The authors concluded that measuring physical and mental health during treatment and could be important in future research.
Motivating young people towards success: evaluation of a motivational interviewing-integrated treatment programme for COD clients in a residential therapeutic community
- Authors:
- KLAG Stefanie, et al
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 30(4), Winter 2009, pp.366-386.
- Publisher:
- Emerald
Noting that substance use amongst people with mental illness is one of the most significant problems facing the mental health system, and that intervening early and supporting the mental health of adolescents and young adults with co-occurring mental health and substance use disorders (COD) is a research and policy priority in Australia, this study integrated motivational interviewing into standard treatment and compared the effectiveness of this treatment approach with standard treatment alone for young chronic substance users with high rates of comorbidity with mental health problems in a therapeutic community on the Gold Coast, Australia. The results showed that the motivational interviewing-integrated treatment approach was associated with improved retention of clients in the programme, a more autonomous motivational attitude towards treatment and more positive and stronger treatment outcomes. The researchers conclude that the findings suggest that the motivational interviewing-integrated treatment approach was more effective in the treatment of COD clients compared to standard drug and alcohol treatment.
Antisocial personality disorder and retention: a systematic review
- Authors:
- HESSE Morten, PEDERSEN Mads Uffe
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 27(4), Winter 2006, pp.495-504.
- Publisher:
- Emerald
This review examines treatment retention for drug dependent users with co-occurring antisocial personality disorder (ASPD). Peer-reviewed papers were identified searching Medline, PsycInfo and bibliographies of seminal papers. Seventeen studies were identified, and a meta-analysis on retention was conducted. The overall impact of ASPD was non-significant. However, differences were found between programmes. Studies conducted in Therapeutic Communities indicated that subjects with ASPD were more likely to complete treatment that drug abusers without ASPD, whereas in drug-free outpatient treatment the reverse was true. Implications for future research and substance abuse treatment are discussed.
Psychosis and newly emerging dependency groups: the search for an adapted model of care at the Psychiatric Centres Sleidinge in Belgium
- Authors:
- BRYSSINCK Dirk, BROEKAERT Eric, VANDEVELDE Stijn
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 26(2), Summer 2005, pp.150-162.
- Publisher:
- Emerald
This article looks at the work of the Psychiatric Centres Sleidinge psychiatric hospital in Belgium when they decided to adopt a psychoanalytic Lacanian perspective when working with their client group of potentially psychotic young people with severe addiction problems. The staff turned to institutional psychotherapy and milieu therapy. "Staff-resident" meetings were introduced to stimulate free communication in the group. A special workgroup was installed. A charter of basic rights that governed the community was established. The separate key position of the analyst was replaced by a complex of "referents" or personal assistants from which the residents could freely choose. By doing so, the changes within the resident group and staff became interconnected in a mutual effort to demystify positions and functions.
Treating co-occurring disorders: a handbook for mental health and substance abuse professionals
- Authors:
- HENDRICKSON Edward L., SCHMAL Marilyn S., EKLEBERRY Sharon C
- Publisher:
- Haworth Press
- Publication year:
- 2004
- Pagination:
- 243p.,bibliog.
- Place of publication:
- Binghamton, NY
Caseloads that include mental health, substance use, and co-occurring disorders are becoming more and more common, yet most texts in this area focus on one specific type of disorder. This handbook reflects the reality facing mental health and substance abuse professionals in their daily practices, focusing on how to effectively manage caseloads that include individuals with vastly differing levels of functioning. The book describes the psychiatric and substance use disorders that commonly co-occur and examines the evolution of co-occurring concepts and treatment. It provides an overview of relapse prevention and symptom management models for use with clients with co-occurring disorders and another covering mental health and substance abuse recovery movements. Topics include: conducting comprehensive assessments for individuals with psychiatric and substance use symptoms; providing individual, group, family, and case management interventions for clients of differing levels of function who exhibit psychiatric and substance abuse symptoms; identifying standard interventions for all clients with co-occurring disorders; and measuring change and establishing reasonable treatment outcome performance standards for these clients supervising staff who work with multifarious caseloads.
Therapeutic communities for the treatment of drug users
- Editors:
- RAWLINGS Barbara, YATES Rowdy
- Publisher:
- Jessica Kingsley
- Publication year:
- 2001
- Pagination:
- 272p.,diags.,bibliogs.
- Place of publication:
- London
Collection of essays on the use of concept-based therapeutic communities in the treatment of drug users. Topics include the history and development worldwide of therapeutic communities; the experience of being a staff member, a resident or both; therapeutic communities in prison; work with dual diagnosis residents; resettlement of ex-residents; and research into the effectiveness of the therapeutic community approach.