Doctor of Philosophy
Department of Psychology
Farina, Mario Antony, An evaluation of in-patient alcohol/drug treatment using psycho-social functioning and substance use criteria, Doctor of Philosophy thesis, Department of Psychology, University of Wollongong, 1998. http://ro.uow.edu.au/theses/1646
This thesis conducted an evaluation of Australian alcohol/drug treatment effectiveness by examining the interaction of client psychosocial and substance use characteristics with the characteristics of two different treatment programmes of different durations and operating from different philosophical positions. Information was gathered from clients in treatment at various stages of their engagement with their programmes of choice with the aim of applying a model of treatment evaluation developed by Bell, Williams, Nelson and Spence (1995).
By examing the interaction between client and treatment characteristics, this thesis has examined a number of key issues relevant to treatment effectiveness. The role of client and treatment characterics were examined in relation to attrition/retention, end-of-treatment changes in clients' cognition, affect and behaviour, and 3-6 month follow-up of process change and outcome. This thesis has also made commentary upon and examined the role of several variables which have been discussed widely in the treatment research but not examined in great depth previously.
The client-treatment interaction was examined in four quasi-experimental studies with the goal of providing information from which to consider issues related to improving in-patient alcohol/drug treatment effectiveness.
Study 1 consisted of 458 observations at treatment commencement and compared treatment completers and treatment drop-outs who attended two treatment programmes of differing duration and philosophy (8 week cognitive-behavioural and 12 week traditional disease model). A significant difference in psycho-social functioning was found to exist between completers and drop-outs upon treatment entry in both treatment centres. In this study, at treatment commencement, treatment drop-outs were found to have more psycho-social resources than treatment completers and were no more likely to drop-out of one treatment modality than another.
Study 2 consisted of 319 observations and addressed the issue of the impact of in-patient alcohol/drug treatment duration and philosophy on client psycho-social functioning. The results indicate that regardless of attending either of the in-patient alcohol/drug treatment programmes of differing durations and philosophies (4 and 8 weeks of cognitive-behavioural treatment and 6 and 12 of traditional disease model treatment), subjects had significantly improved on all psycho-social variables. However, subjects who had completed 8 weeks of cognitive-behavioural treatment had changed most, had acquired the most adaptive psycho-social resources and did not significantly differ at treatment completion in psycho-social functioning to a comparison group who were abstinent from all substances at 3-6 months posttreatment.
Study 3 initially examined 458 observations and addressed the impact and outcome of holding differing attributions for the cause of alcoholism on client psychosocial functioning and alcohol use post-treatment and at treatment re-commencement. It was found that although this overall sample did not differ significantly in pretreatment alcohol use, attributing the cause of alcoholism to a disease was related to having poorer psycho-social functioning at treatment commencement. Also, in study 3, 227 past-treatment attenders were observed. Among these 227 individuals a significant relationship was found to exist between holding attributions associated with cognitive-behavioural philosophy and adaptive post-relapse psycho-social functioning. Findings indicated that individuals who had engaged in treatment prior to treatment re-commencement were significantly more likely to attribute the cause of alcoholism to a disease, had significantly fewer psycho-social resources, used more alcohol prior to treatment re-commencement and were significantly more likely to drop-out of treatment early than clients who had attended past treatment and who attributed the cause of alcoholism to a bad habit or to a combination of a disease and a bad habit.
Study 4 consisted of 73 observations taken at 3-6 months post-treatment to examine the outcome of having attended 8 weeks of cognitive-behavioural treatment and 12 weeks of traditional disease model treatment. Unfortunately, because of the small sample size that finally eventuated in Study 4 and because comparison groups commenced treatment with significantly different psychological resources and substance use prior to treatment commencement, any conclusions that derive of Study 4 results were significantly compromised. However, Study 4 results could possibly suggest that at 3-6 months post-treatment outcome assessment, 8 weeks of cognitive behavioural treatment completers functioned significantly better, were more likely to be abstinent from substance use, were significantly more likely to be employed, and used significantly a fewer number and quantity of substances if not abstinent than a group who had completed traditional disease model treatment. At 3-6 months post-treatment assessment, clients who completed 8 weeks of cognitive-behavioural treatment had maintained a statistically significant change on all dependent variables and had significantly more adaptive psycho-social resources and substance use than a group of clients who had completed 12 weeks of traditional treatment.
In examing the conceptual issues stated above, all the studies in this thesis found depression to be a key variable. For example, in the first study (n= 458), depression was found to be the best predictor of differences between treatment completers and drop-outs. In the second study (n= 319), levels of depression changed most in magnitude of change among all groups between pre-treatment assessment and treatment completion assessment. In the third study (n= 458), depression was found to be the best predictor of differences between groups who held differing attributions for the cause of alcoholism. Finally, in the fourth study (n= 73), depression was found to be the best predictor of differences between 3-6 months post-treatment outcome groups who had completed cognitive-behavioural or traditional disease model treatment.
At the conclusion of this thesis evidence has been provided that suggests: (1.) that in-patient alcohol/drug treatment drop-outs had more adaptive psychosocial resources prior to treatment than treatment completer. However, dropouts who had attended treatment prior to re-treatment were more likely to attribute the cause of alcoholism to a disease and to have fewer adaptive psychological resources than treatment completers who had attended past treatment and attributed the cause of alcoholism to a bad habit; (2.) that holding a disease attribution for the cause of alcoholism was related to less adaptive psychological functioning and substance use in the event of relapse (post-treatment use requiring re-entry into treatment); (3.) that those in-patient alcohol/drug treatment centres who teach a disease conceptualisation about alcoholism may not be acting in their clients' best interests; and, (4.) that 8 weeks of cognitive-behavioural treatment displayed a trend towards providing more effective treatment than 12 weeks of traditional disease model treatment in equipping clients at treatment completion with the psycho-social resources required to eventually take control of substance use behaviour.
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