scholarly journals Attachment and Therapeutic Alliance in Substance Use Disorders: Initial Findings for Treatment in the Therapeutic Community

2021 ◽  
Vol 12 ◽  
Author(s):  
Leonie L. Rübig ◽  
Jürgen Fuchshuber ◽  
Pia Köldorfer ◽  
Anita Rinner ◽  
Andreas Fink ◽  
...  
Keyword(s):  
Substance Use ◽  
Therapeutic Alliance ◽  
Therapeutic Community ◽  
Brief Symptom Inventory ◽  
Insecure Attachment ◽  
Personality Pathology ◽  
Community Treatment ◽  
Future Research ◽  
Long Term Effects ◽  
Addiction Therapy

Background: There is convincing evidence that individuals suffering from Substance Use Disorder (SUD) often present insecure attachment patterns. In contrast, a strong therapeutic alliance in treatment of SUD has been found to lead to a more positive treatment outcome. However, insecure attachment has been observed to be linked with weaker therapeutic alliance strength. The primary aim of this explorative study was to gain initial insights regarding the influence of attachment and personality characteristics on therapeutic alliance and therapy motivation in SUD patients undergoing treatment at a therapeutic community. Furthermore, SUD patients were compared to healthy controls regarding attachment, personality and mood pathology.Methods: A total sample of 68 participants, 34 inpatients in SUD treatment and 34 age-gender and education adjusted controls, were investigated. Both groups filled in the Adult Attachment Scale (AAS), the Inventory of Personality Organization (IPO-16), and the Brief Symptom Inventory (BSI-18) questionnaires. Additionally, SUD patients filled in the Working Alliance Inventory (WAI-SR) and the adapted German version of the University of Rhode Island Change Assessment scale (FEVER).Results: In line with our assumptions, SUD patients exhibited a decreased amount of attachment security (AAS) which was related to higher personality (IPO-16) and mood pathology (BSI-18). Furthermore, correlational analysis revealed the WAI-SR dimension Bond being positively associated with more secure attachment. A strong task alliance was linked to the Action stage of change (FEVER) and decreased mood but not personality pathology.Conclusion: Our findings confirm the putative negative effect of attachment and personality pathology on therapy motivation and therapeutic alliance in addiction therapy as well as more specifically in therapeutic community treatment. Future research in enhanced samples might focus more on the long-term effects of the interaction of attachment, personality and therapeutic alliance variables.

Stress and Length of Stay in Therapeutic Community Treatment for Adolescents With Substance Use Disorders

2013 ◽  
Vol 12 (4) ◽  
pp. 175-182 ◽  
Author(s):  
Marianne T. Marcus ◽  
Joy Schmitz ◽  
Frederick Gerald Moeller ◽  
Patricia Liehr ◽  
Paul Swank ◽  
...  
Keyword(s):  
Substance Use ◽  
Length Of Stay ◽  
Substance Use Disorders ◽  
Therapeutic Community ◽  
Community Treatment ◽  
Therapeutic Community Treatment

scholarly journals Outcomes of therapeutic community treatment for personality disorder

2016 ◽  
Vol 37 (2) ◽  
pp. 84-100 ◽  
Author(s):  
Georgina Capone ◽  
Thomas Schroder ◽  
Simon Clarke ◽  
Louise Braham
Keyword(s):  
Quantitative Research ◽  
English Language ◽  
Therapeutic Community ◽  
Community Treatment ◽  
Future Research ◽  
Content Type ◽  
Comparison Groups ◽  
Step Down ◽  
Therapeutic Community Treatment

Purpose – The purpose of this paper is to review quantitative research since 1999 evaluating the effectiveness of democratic therapeutic community (DTC) treatment for individuals with personality disorders (PD) with reference to interpersonal and offending risk outcomes. Design/methodology/approach – A systematic search resulted in the review of ten studies. All of the studies investigated DTCs treating PD in community, inpatient residential and forensic settings. Only peer-reviewed, English-language articles employing a quantitative design were included. Findings – The majority of studies were conducted poorly and of low methodological quality, with limitations located in the representativeness of participants, limited use of control and comparison groups, follow up periods and controls for confounders. Heterogeneity remained in use of measures and limited consideration was given to the validity of interpersonal measures used. While improved interpersonal outcomes post DTC treatment were noted in forensic and residential settings, results were mixed in day and mini TC settings. Inconsistent findings in offending risk outcomes were also indicated. A study with increased methodological rigour indicated residential treatment had limited effects on interpersonal outcomes, when compared to combination treatment (residential TC and step-down treatment). Originality/value – The study provided an evaluation of the limitations of DTC research across a range of settings and highlighted a combination of residential TC and step-down treatment may achieve superior outcomes to residential TC treatment alone in a community inpatient population. Recommendations are made for future research to contribute to the treatment of PD.

Modified Therapeutic Community Treatment for Offenders with MICA Disorders: Substance Use Outcomes

2007 ◽  
Vol 33 (6) ◽  
pp. 823-832 ◽  
Author(s):  
Christopher J. Sullivan† ◽  
Christopher J. Sullivan† ◽  
Karen McKendrick ◽  
Stanley Sacks ◽  
Steven Banks
Keyword(s):  
Substance Use ◽  
Therapeutic Community ◽  
Community Treatment ◽  
Therapeutic Community Treatment

scholarly journals Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence

2020 ◽  
Vol 9 (1) ◽  
pp. 118
Author(s):  
Petra K. Staiger ◽  
Paul Liknaitzky ◽  
Amelia J. Lake ◽  
Stefan Gruenert
Keyword(s):  
Substance Use ◽  
Substance Dependence ◽  
Therapeutic Community ◽  
Psychosocial Outcomes ◽  
Well Being ◽  
Community Treatment ◽  
Medium Effect ◽  
Severity Scores ◽  
Tc Model

The Therapeutic Community (TC) model is considered an effective treatment for substance dependence, particularly for individuals with complex presentations. While a popular approach for this cohort across a number of countries, few studies have focussed on biopsychosocial and longer-term outcomes for this treatment modality. This study reports on substance use, dependence, and biopsychosocial outcomes up to 9 months post-exit from two TC sites. Methods: A longitudinal cohort study (n = 166) with two follow-up time points. Measures included substance use, dependence, subjective well-being, social functioning, and mental and physical health. Generalized Linear Models were employed to assess change over time. Results: At 9 months, 68% of participants reported complete 90-day drug abstinence. Alcohol frequency and quantity were reduced by over 50% at 9 months, with 32% of the sample recording 90-day abstinence at 9 months. Both alcohol and drug dependence scores were reduced by over 60%, and small to medium effect sizes were found for a range of psychosocial outcomes at 9 months follow-up, including a doubling of wellbeing scores, and a halving of psychiatric severity scores. Residents who remained in the TC for at least 9 months reported substantially better outcomes. Conclusions: With notably high study follow-up rates (over 90% at 9 months post-exit), these data demonstrate the value of the TC model in achieving substantial and sustained improvements in substance use and psychosocial outcomes for a cohort with severe substance dependence and complex presentations. Implications for optimal length of stay are discussed.

scholarly journals Client Retention in Community Treatment: Completer and Noncompleter Experiences of an Individualized, Needs-Based Partner Abuse Intervention Program

2020 ◽  
pp. 088626052090735
Author(s):  
Dominic A. S. Pearson ◽  
Chloe D. Steward ◽  
Amy K. Ford
Keyword(s):  
Therapeutic Alliance ◽  
Intervention Program ◽  
Partner Abuse ◽  
Community Treatment ◽  
Future Research ◽  
Subjective Experiences ◽  
Community Partner ◽  
Structured Interviews ◽  
Attrition Rates ◽  
Treatment Readiness

There has been increased interest in the subjective experiences of participants of community partner abuse intervention programs (PAIPs). In the context of high attrition rates, qualitative research is needed to understand the factors associated with sustained engagement and dropout. Using a community nonmandated PAIP, the current study is a rare investigation of the experiences of both completers and noncompleters. We explored the differences between completers’ and noncompleters’ perceptions of the treatment process, the reasons for sustained program engagement, and the perceived outcomes of treatment. Semi-structured interviews were completed with 14 participants: nine completers and five noncompleters. The majority of participants were referred by children’s social care and were unemployed at the time of interview. The interviews were conducted by research staff independent from the treatment-providing organization. Three themes emerged from the data: (a) Treatment as Challenging Yet Enlightening, (b) the Importance of a Well-timed and Safe Therapeutic Environment, and (c) Improved Emotional Self-Management Due to Treatment. Results highlighted how structured individualized sessions, underpinned by a strong therapeutic alliance with facilitators, helped participants increase their interpersonal problem-solving and communication skills. The study reinforced the importance of developing a therapeutic alliance and providing structured individualized treatment characterized by flexibility and accessibility. Noncompletion was perceived as related to known risk factors and treatment readiness. Therefore, it may be beneficial to employ screening measures to monitor these factors. Future research should use larger, more diverse samples to further investigate subjective experiences of PAIP completers and, particularly, noncompleters to enhance the limited literature in this area.

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