Recovery is described as a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness. A mental health services system that is guided by the recovery vision incorporates the critical services of a community support system organized around the rehabilitation model’s description of the impact of severe mental illness—all under the umbrella of the recovery vision. In a recovery-oriented mental health system, each essential service is analyzed with respect to its capacity to ameliorate people’s impairment, dysfunction, disability, and disadvantage

EffectsWald ZdfFf-index Percentage of days abstinent from alcohol or other drugs (0–100) Random intercept4.87 ** Time(4, 729)1.45 ** 0.14 Condition(3, 318) CBOP (vs. MET/CBT7)(1, 317) ACC (vs. w/o ACC)(1, 317) ACC × CBOP(1, 317) Time × overall condition(12, 729)2.03 * 0.10 Time × CBOP(4, 729)4.08 ** 0.08 Time × ACC(4, 729) Time × CBOP × ACC(4, 729) Concluded that MET/CBT7 most ‘cost effective’ Godley et al 2010

Treatment effectiveness

Intervention effect mediated by ‘ACRA’

ACRA - resistance Resistance can be influenced or decreased by a therapist’s behavior and style. It is difficult to provide step-by-step guidance on how a therapist approaches resistance because success in this endeavor is dependent on the total therapeutic approach. The approach should encompass behaviors that convey the most desirable of therapeutic qualities, including listening with empathy; having genuine concern; being open-minded, affirming, reflecting; praising and having expectations; and being accepting and rolling with the resistance. Compliance enhancement strategies begin with the first contact between the therapist and teenager and continue throughout the therapy episode.

Effect of post-intervention outreach on %/timing readmission rates

Functional analysis Identify triggers ‘Chaining’ Positive and negative consequences

Effect of post-intervention outreach on readmission rates More treatment; more abstinence, less abuse/dependence p<0.05

Effect of continuing care (post res. - median 4-12 wks) O.R. Dep. variablepredictorsHigh gen comm. care Abst. 1-3 mos. Abstained mos. More community care ACC3.35 AODACC1.0 General community care 2.16 Abstinent 1-3 months 11.2

CYT‘brief treatment’ evaluation Alliance Patient rated therapeutic alliance (b=.14,.1 3 and 6 mos) and therapist (B=0.1, 3 months p<0.001) predicted rates cannabis use post intervention Brief treatment

MI McCambridge (2004) comments that ‘MI seeks to promote reflection on drug use and its personal consequences in the context of the values and goals of the individual.’ And concludes ‘the tantalizing prospect resulting from this study is that a brief conversation with young people, which is comprehensive in its consideration of drug use, can simultaneously set in motion reductions in risk behaviours across different drugs of use.

‘The therapist also serves as a therapeutic case manager, coordinating and facilitating meetings and/or services for the youth and family based upon a needs assessment.’ (Slesnick et al 2009)

Brief (16 sessions) Tx runaway alcohol abusing youth % days using drugs or alcohol

Brief (16 sessions) Tx runaway alcohol abusing youth % days using drugs or alcohol Only 1 of 19 comparisons proved significant

Cannabis use last 90 days - N = 109