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An Effectiveness of a Group Residential Intervention Program for Young Men with Drug and Alcohol Addiction | OMICS International
ISSN: 2155-6105
Journal of Addiction Research & Therapy

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An Effectiveness of a Group Residential Intervention Program for Young Men with Drug and Alcohol Addiction

Danuta Chessor*

Department of Psychology, Clinical and Health Psychology (Sossp), University of Western Sydney, Australia

*Corresponding Author:
Danuta Chessor
Senior Lecturer, Department of Psychology
Clinical and Health Psychology (Sossp)
University of Western Sydney, Australia
Tel: +61-1300-651-010
E-mail: [email protected]

Received January 31, 2013; Accepted February 15, 2013; Published February 22, 2013

Citation: Chessor D (2013) An Effectiveness of a Group Residential Intervention Program for Young Men with Drug and Alcohol Addiction. J Addict Res Ther 4:144. doi:10.4172/2155-6105.1000144

Copyright: © 2013 Chessor D. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Recovery from addiction is a complex process and requires a nexus between effective programs, the right support, individual motivation and suitable placement. For young men, continued use of drugs and alcohol can lead to ongoing abuse into adulthood, poorer health outcomes, as well as mental health difficulties and fewer career prospects. The complexity of rehabilitation means that researching what programs are effective and which settings provide a supportive framework for recovery is vital.

Data collected over a six month period in two waves from an initial group of 43 men, was analysed using paired t-tests. Data included depression, anxiety and stress information (DASS-42), general health (SF-36) and psychological distress levels (Kessler-10). In addition to the two wave quantitative data collection, qualitative data by way of a focus group was also collected to examine participant’s perceptions of the intervention.

Results indicated that the treatment reduced distress levels and that participants reported a sense of belonging and hope for a better future. Levels of depression decreased significantly over time. The implications are that services provided for young men need to include life skill education, a supportive framework as well as a therapeutic community. Research on the optimum mix of each element of the intervention is ongoing.

Keywords

Young men; Drug and alcohol addiction; Treatment

Introduction

Among young men, continued abuse of drugs and alcohol is associated with continued substance abuse in adulthood, adverse health effects, academic and vocational difficulties and mental health difficulties [1]. Therefore rehabilitation of young men is an important target group for intervention. One of the more common rehabilitation approaches to addictions is long term residential programs.

Long term residential facilities for young men with control issues involving drug and alcohol use and abuse have been seen in the past as a positive setting for rehabilitation. When the residential facility forms a therapeutic community then research indicates that positive outcomes are likely for the residents [2]. Residential facilities have reportedly had a greater level of retention and lower levels of recidivism [3].

This research was an evaluative study reporting on the outcomes of a long term residential Christian community on the overall wellbeing and rehabilitation of young men. The residential setting formed a therapeutic community and psycho-education and skill building were essential aspects of the program.

Literature Review

Services for drug rehabilitation have moved in the past 40 years from hospitals to the community [2,4]. Community residential programs became an essential focus of this development. The orientations that are used in these facilities differ with two orientations being either a therapeutic community or psychosocial rehabilitation. Therapeutic community alcohol and drug rehabilitation programs tend to provide more health and treatment options and encourages residents to participate more intensively [2]. Engaging residents in therapeutic programs usually results in greater success in retention as well as in motivation for success by the residents [3].

Many of the young people in residential facilities, as compared to out- patient programs, have been found to have greater addiction problems [5]. Young people are defined here as being in the age range from 18-late 20’s or early 30’s as distinct from the younger adolescent age range. This age range is often seen as being ready for change because they have moved from their early adolescence but their addictive behaviours persist in this young adult age range. This group come before the law as adult offenders and residential rehabilitation facilities are often given as a choice rather than incarceration [6]. Research shows that this age group are often treatment resistant in out-patient programs found that retention is higher in residential facilities and retention is often seen as a primary outcome of treatment success. The sense of belonging, the support of other residents and workers as well as a safe environment all support retention in residential facilities. The social climate of the facility in one study was found to be the most significant factor in the rehabilitation of substance addiction [7].

Winters et al. [8] indicate that amongst drug addicted adolescents, education and prior treatment are the best predictors of success in residential programs. Research indicated that adolescents with higher educational levels were more likely to succeed in residential programs [9]. Perhaps this reflects higher educational levels among adolescents are indicative of better coping skills and higher achievement levels lead to greater success in drug treatment programs especially in accessing psycho-education as part of the treatment regimen.

Research studies have shown that a number of factors contribute to the success of residential programs and these include the social climate [7], social support of peers and family [10] as well as the length of time that clients stay in the program [11] with personal motivation a further factor [1]. Many residential programs offer a basic six week program of psycho-education about addiction and relapse prevention. One year follow up studies indicated that the length of stay within a residential facility predicted long term benefits and greater outcomes with both better substance use outcomes as well as greater likelihood of employment. The length of time in a program allowed residents to engage in the therapeutic process for longer as well as increasing resident’s relationships with staff and experiences in the program and this seemed to reflect their initial motivation. However research indicates that it is the therapeutic community that offers a success rate to residents because of the focus on the development of supportive relationships with other residents and staff [2,7].

Many rehabilitation programs are offered by religious groups or organizations. There is varied literature on the significance and added value of a religious emphasis in rehabilitation and in the retention of residents [12,13]. Shields et al. [13] report that where a program places high emphasis on religion and where the clientele as a whole value the importance of religion, then commitment to treatment tends to be higher and there are positive outcomes for the clientele. There is varied literature to suggest that family disorganization [14] and poor communication [15] can result in poor attachment in infancy and that attachment problems may lead to drug and alcohol abuse [16]. Some researchers [17] believe that in times of crisis, where emerging adults have disassociated attachment from infancy, they can find an attachment to God which sustains them. Having the opportunity in a rehabilitation centre to form an attachment to God may result for some in positive outcomes and in overall improvement in well-being [18].

Research has established that environmental features such as length of stay, treatment setting and engagement with specific programs are important but another important predictor of good outcomes is motivation. Motivation to seek help and reduce substance use has been recognized as an important predictor of engagement with treatment options and with outcomes [1]. Motivation can be either intrinsic or extrinsic. Many individuals reach a point in life where they decide they need help to make significant changes in their life around their substance use. These individuals may choose a residential facility as the option for change. Often this is not their first choice but comes after a series of attempts to change their drug or alcohol habits in other ways with varying levels of success. There are other young people, who are given a choice of a residential rehabilitation facility or incarceration. These individuals can be seen as extrinsically motivated to make changes in their life [19,20]. This extrinsic motivation has the ability to impact on internal motivation through a process that [21] call internalization. This internalization can occur when the external environment impacts on the personal belief system of an individual. External motivation, coupled with internalisation is likely to lead to successful behaviour change for individuals [19]. In an adolescent population [1] indicate that adolescents are less likely than adults to be intrinsically motivated to change their alcohol and drug taking behaviours and often enter rehabilitation facilities because of pressure from family, friends or the law [22]. found that emerging adults are less likely to admit or recognize that their drug or alcohol use is problematic. However, external pressures and then internalisation as described by Deci and Ryan [21] can lead to positive outcomes for young people where sufficient support is in place.

Another factor for success in adolescent populations is the motivation for rehabilitation provided by social networks of friends [1]. In their study they found that for emerging adults and young adults, their social network was influential in both choosing to enter a rehabilitation program as well as remaining in the program. The peer influence according to Breda and Heflinger [23] can be stronger than the family influence especially when the family is disorganized or dysfunctional.

Research indicates that young men are seven times more likely than young women to engage in drug and/or alcohol abusive behaviours [10]. Research is also ambivalent about the best practice for rehabilitation of these young men [8]. Given the prevalence of young men involved in drug abuse and need for successful programs of rehabilitation, best practice requires evaluation of existing programs. In Australia, many residential programs exist for drug and alcohol rehabilitation for young men but relatively few evaluative studies have been conducted [24].

In this study, the aim was (1) to examine the levels of distress before and after treatment (six months apart);(2) to examine their levels of depression, anxiety and stress before and after treatment (six months apart) and (3) to examine participants perceptions of the residential programs effectiveness over the six months period.

Evaluation Method

The quantitative analysis was a test-retest design( Time 1 and Time 2) using the same participants both times and involved collecting data twice at a 6 month interval from a total of 43 resident participants at ONE80TC which is a residential Christian facility. The data was taken from 4 instruments. Three of the instruments were used twice The Addiction Severity Index was only used once as an initial measure of participants drug and alcohol use. Qualitative data from one focus group was also collected in order to examine qualitatively participant’s perception of the intervention.

Participants

The participants were men who were residents at a drug and alcohol rehabilitation facility. They were aged from 18-39 with a median age of 24. Forty percent of participants had been in the facility for less than one month while the remainder had been there for more than one month at the first data collection point. They had a mean of 9.8 years of completed formal education.

Instruments used

The quantitative data collected came from 4 questionnaires. These were:

1. The Addiction Severity Index (ASI) [25]. This was used as a questionnaire and covers seven areas of a client’s life. It covers medical, employment/support, drug and alcohol use, legal, family history, family/social relationships and psychiatric problems.

2. The Depression Anxiety and Stress Scale-21 (DASS-21) [26]. The Dass-21 is a questionnaire consisting of 21 questions that examine levels and severity of depression, anxiety and stress. It uses a 4 point likert scale and asks respondents to report behaviours based on the previous week.

3. The Kessler-10 questionnaire (K-10) [27]. The K-10 is based on 10 questions about negative emotional states experienced during the 4 week period leading up to the assessment. For each item there is a five level response scale based on the amount of time the respondent reports experiencing the particular problem. The response options are none of the time, a little of the time, some of the time, most of the time, and all of the time.

4. The Short Health Form-36 [28] The Health Survey-36 questionnaire examines an individual’s self- report of their state of health using 36 questions. Some require a yes/no response and others require either a 3 or 5 point level of response.

All data except the Addiction Severity Index were collected twice at six month intervals.

The qualitative data was collected from an in-depth semistructured interview format as a focus group. Eight participants were asked about their experiences of the program and perceptions from their involvement.

Procedure

Human research ethics approval was sought and granted from the UWS Human Research Ethics Committee (Approval No H8982).

Explanation of the research was made to all residents at ONE80TC by the researcher speaking with the group of men, handing out information sheets and participant consent forms. Invitations to be involved were given to the residents. One week after the initial information session, written consent was obtained from willing participants. All participants were given the four questionnaires to complete at ONE80TC at a mutually appropriate time, by the researcher. Staff and the researcher were available to answer questions or help to read the questions during this process.

All materials were then collected and later coded and entered into a statistical package (SPSS 17.0). Descriptive statistics were determined.

Six months later, a second wave of data was collected in a similar way to the first data collection procedure. This wave of data was obtained from the same group of participants but there had been a 35% attrition rate of participants for Time 2 data collection. Some of the attrition was due to original participants having left the residential placement but some participants chose not to be involved in Time 2 data collection.

The Addiction Severity Index was not repeated because it was used as a measure of drug or alcohol use as a pre-entry measure. Any evidence of drug or alcohol use by the participants while in residence resulted in them being asked to leave. This data was also coded, descriptive statistics obtained and analysed.

For the qualitative data an in-depth semi-structured interview format was used to conduct the focus group. All participants were asked about their experiences of the program and perceptions from their involvement. In the focus group, the following broad questions were used to guide the interview discussion:

• What is your contribution and involvement in the ONE80TC program?

• What are the positive aspects of this program?

• What are the changes you observe in the resident students here?

• What would you do differently if you could?

• What are the negative aspects of this program?

• What else would you like to implement in this program?

The interview was recorded by a digital recorder and later sent to a transcribing service and transcribed verbatim.

Data analysis and interpretation

All data from questionnaires was coded and entered into the statistical package SPSS 17.0. Descriptive statistics were obtained and graphed or tabled. Time One data was compared to Time Two data to determine if scores have changed over time.

Interview data was thematically analysed into dominant themes. The analytic process was both inductive and deductive [29]. This was done by reading and re-reading the data to tease out similar themes expressed by the participants. Data were manually coded to obtain the main ideas, concepts and themes. Categories of responses were determined. The relative importance of categories and relationships between them were established. As suggested by Matthew and Huberman [30], other researchers also examined the qualitative data and independently determined themes and then comparisons were made to minimize data bias. Interview data were manually coded and organised. A content analysis was conducted with the frequency of responses coded thematically.

Results

Demographic information

Some general demographic information about participants is contained in the (Table 1)

Relationship Status N %
Single 31 72.1*
Married / De Facto 6 14
Separated / Divorced 5 11.6
Children    
No Children 24 55.8*
Children 16 37.2
Race    
Caucasian 30 69.8*
Asian or Pacific Islander   14
Hispanic 2 4.7
Aboriginal 1 2.3
Religious Preference    
Protestant 10 23.3*
Catholic 6 14
Islamic 1 2.3
Not specified 22 51.2

Table 1: The demographic information indicates that the majority of men in this residential facility were single Caucasian men with no specified religion.

The demographic information indicates that the majority of men in this residential facility were single Caucasian men with no specified religion.

Addiction severity index

All men who completed this questionnaire had already been part of the rehabilitation program and hence the valid use of this instrument needs to be challenged. For this reason it was not repeated for Time 2. Nevertheless it produces valuable information about past behaviours and present status.

The results from this addiction severity scale indicate that 37% of the men reported serious levels of alcohol and drug (dual addiction) as the main problem, with 23% reporting polydrug abuse as their most serious problem of addiction, with heroin, cocaine and cannabis individually reported by 4.7% of participants. One participant reported just alcohol as a serious problem of addiction.

Table 2 below shows lifetime use of drugs by individuals, their individual histories of abuse and their self- reported psychiatric status.

Drug Use by Type Lifetime Use (%) Use Within Past Month (%)
Alcohol 79 25
Cannabis 74 14
Amphetamines 67 7
Alcohol to intoxication 65 23
Cocaine 41 4
Heroin 39 6
Hallucinogens 37 2
Other opiates/analgesics 30 2
Other sedatives/tranquilisers 20 4
Inhalants 11 7
Methadone 11 0
Barbiturates 9 2
History of Abuse Lifetime (%) Past month (%)
Emotional Abuse 33 5
Sexual Abuse 9 2
Physical Abuse 28 4
No Abuse 34  
Self- reported psychiatric history Lifetime (%) Past month (%)
Depression 35 25
Anxiety/Tension 30 35
Hallucinations 14 2
Trouble concentrating/memory 16 39
Trouble controlling violent behaviour 26 28
 Serious suicidal thoughts 28 14
Attempted suicide 23 2
Prescribed meds for psych problem 16 14
No reported psychiatric problems   20
History of Medical problems Lifetime (%)* Past Month (%)
Medical problems 58 41
No medical problems 25 44

Table 2: Below shows lifetime use of drugs by individuals, their individual histories of abuse and their self- reported psychiatric status.

Table 2 shows clearly some of the areas of problem for these young men both within the past month as well as in their lifetimes. There is a self- reported history of varied drug and alcohol use and a background of abuse and co-morbid psychiatric illness as well as medical problems.

Table 3 shows clearly positive and negative activities that participants have been involved with. Difficulties with the law are obvious from the table. The table also clearly shows the social supports that they use. Friends are partners are the most usual supports that these participants reported.

The depression, anxiety and stress scale-21 (DASS-21)

All participating residents completed the questionnaire on two occasions approximately six months apart. There was a level of attrition (35%) of participants from Time 1 to Time 2.

Table 4 below shows the results of paired t-tests conducted on the DASS-21 for the three sub-scales

At Time 1 on the Depression scale (DASS-21), 9.3% of participants reported severe levels of depression, with 27.9% reporting moderate levels of depression and 9.3% reporting mild levels of depression. At Time 2 on the Depression Scale (DASS-21), 6.7% reported severe levels of depression, with 13.3% indicating moderate levels and 6.7% reporting mild levels of depression. This reflects a significantly lower level of depression at Time 2 compared to Time 1.

Employment Status Percentage (%)
Have a profession, skill or trade 37
Have no profession, skill or trade 58
Usual employment (past 3 years)  
Full time 39
Part-time 16
Student 4
Unemployed 28
Retired/Disability 2
Legal Status Percentage (%)
Basis of admission to residential facility  
Court Order/legal requirement 32
Other 55
Probation/Parole Status  
On probation/parole 35
Not on Probation/parole 55
History of Criminal Activity Arrested/charged (N)
Assault 22
Drug charge 20
Driving while intoxicated 19
Major driving violation 19
Shoplifting/vandalism 16
Burglary/larceny/break and enter 16
Weapons Offence 16
Parole/probation violation 15
Robbery 14
Unspecified 9
Disorderly conduct/public intoxication 7
Contempt of court 4
Arson 4
Forgery 3
History of Incarceration Percentage (%)
Incarcerated 49
Never incarcerated 39
No answer 12
Family and Social Relationships  
Usual living arrangements Percentage (%)
With sexual partner and children 14
With family 14
No stable arrangements 14
With friends 12
With parents 9
Alone 9
Controlled environment 9
With sexual partner alone 7
With children alone 2
Free time spent Percentage (%)
With friends 37
With family 27
Alone 19
With friends and alone 4
With family and friends 2

Table 3: Summarises some of the other important facts from the Addiction Severity Scale.

  Mean SD Sig.
Depression T1 15.87 10.54  
      0.004*
Depression T2 7.21 8.37  
Anxiety T1 11.68 8.10  
      0.092
Anxiety T2 7.00 7.95  
Stress T1 17.45 11.03  
      0.005*
Stress T2 9.13 7.52  
Kessler Psychological Distress Scale (K-10)      
K-10 T1 24.88 9.69  
      0.001*
K-10 T2 17.00 6.12  
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