Taking It To The Streets: Doing (Mostly) Substance Abuse Research in Community Agencies Eric E. McCollum – Virginia Tec

1. 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

2. 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

3. 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)

4. 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

5. Outpatient Couples • NIDA-funded 5 year research project • Abstinence-Based & Methadone Maintenance • Add-on Treatment • Integrated Treatment Model

6. Outpatient Couples Tx Model • Structural/Strategic • What’s the interpersonal problem? • Intergenerational • Why does it make sense? • Behavioral • What needs to change? • SCT & SIT

7. 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

8. 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

9. 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

10. Training CD Counselors • Develop a circumscribed intervention • Focus on basic skills • Incorporated Solution-Focused therapy

11. 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

12. 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

14. 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

15. 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

16. Group Therapy • Probationers with drug/alcohol involvement • Random assignment to SFGT or Hazelden • 6 week treatment • N = 39 (19 per group)

17. 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

18. 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

19. NIDA Funding • Currently have responded to the RFA for group treatments of substance abuse • ??????

20. Agency Issues • Agency Characteristics • Developing relationships • Leadership • Front line staff • Who will deliver the treatment? • Reconciling with disease-model approaches

21. 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

22. Working in Community Agencies • Agency culture • Relationships with agency staff • Clinical credibility • Using a treatment manual • Recruiting research participants • The wider social service context

23. 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?

24. Relationships with Agency Staff • Need to develop relationships at both line and administrative levels • Give back to the agency staff • Informal collaboration

25. 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

26. Participants • Underestimation of subject pool • Corrupting random assignment • Cast a wide net early • Use multiple modalities

27. 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