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

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