Alcohol and Other Drug Recovery

Alcohol and Other Drug Recovery

The Illawarra Institute for Mental Health has been engaged with The Salvation Army Recovery Services in collaborative research endeavours. By implementing routine use of contemporary measures to gauge client progress and large scale collection of data both during and post treatment, IIMH is supporting The Salvation Army Recovery Services to ensure delivery of best practice treatment. To date, the collaborative research activities have resulted in the publication of 19 peer reviewed articles and 25 conference presentations.

The following is a summary of research outputs.

Note: 2 publication links are provided for most articles.

The Submitted Version is accessible by anyone online through the University of Wollongong library, and represents the version submitted to the journal.

The Definitive Version is peer reviewed, edited and published in a journal. Access to these may require institutional login or purchase of the journal.

Sections

Drug and Alcohol Treatment

Health behaviours of people attending Recovery Service centres

On average, people with a history of substance abuse problems live between 20-27 years less than the general population. Cardiovascular disease and cancer are the leading causes of mortality for this clinical group. These chronic diseases result in enormous social and financial costs to the Australian population. The high rate of cardiovascular disease and cancer is largely the result of behavioural lifestyle factors common to this group. In addition to their extensive history of alcohol and illicit substance abuse, people with a history of substance abuse problems have extremely high rates of nicotine dependence, very poor dietary habits, and low levels of physical activity. Consequently, the adverse health impact of these behaviours is significant, and they interact to exponentially increase the risk of these diseases. Whilst substance abuse services provide a stable environment to target these multiple behavioural risk factors, these services tend to focus on the persons alcohol and illicit substance abuse problems.

A survey was conducted of clients attending The Salvation Army Recovery Services centres. It examined the health behaviours of people attending these programs (N = 228). Results from this study were invited for publication in a special edition of Drug and Alcohol Review (Kelly et al., 2012). The majority of participants were smokers (77%), with 32% reporting they had actually increased their smoking since attending residential treatment. Participants were 13-times more likely to smoke than people from the general population. Additionally, 55% of participants reported that they were not engaging in regular physical activity and 61% reported they were consuming a high fat diet whilst in treatment. Encouragingly, most participants reported that they were seriously considering quitting smoking (66%), improving their diet (56%), increasing their fitness levels (81%) and losing weight (67%). These findings suggest that many clients are contemplating change and they reinforce the need for a program to improve these health behaviours.

Kelly, P. J., Baker, A. L., Deane, F. P., Kay-Lambkin, F. J., Bonevski, B., & Tregarthen, J. (2012). Prevalence of smoking and other health risk factors in people attending residential substance abuse treatment. Drug and Alcohol Review, 31(5), 638-644.

Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=4080&context=hbspapers
Definitive version: onlinelibrary.wiley.com/doi/10.1111/j.1465-3362.2012.00465.x/full

Health Recovery: An 8-week group program

Healthy Recovery was developed in collaboration with The Salvation Army Recovery Services to specifically address the needs of people attending substance abuse treatment. It is delivered in a group format and is completed over 8 sessions. The program is focused on providing education regarding the relationship between risk behaviours (e.g., smoking, diet, sedentary behaviour) and chronic diseases. It also includes motivational interviewing, goal setting and ongoing monitoring to promote positive behaviour changes. Nicotine replacement therapy and contingency management are also used to promote goal attainment. The aims of the program are to reduce cardiovascular disease and cancer risk taking behaviours by helping participants to reduce or quit smoking, improve their diet and increase their level of physical activity. A pilot study of Healthy Recovery, funded by the Cancer Council NSW, was completed. This feasibility study utilised a pre-post treatment design with no control group (n = 50). The intervention was associated with a significant reduction in cigarettes smoked (14 cigarettes at baseline, to 8 cigarettes at 5-weeks). 42% of participants reduced cigarette use by at least 50% and 3% had quit at 5-weeks. There was also a significant increase in servings of fruit (.86 servings at baseline to 1.71 servings at 5 weeks), and vegetables (from 2.45 servings at baseline to 2.97 servings at 5 weeks). Levels of physical activity increased, although this was not statistically significant (Metabolic Equivalent of Task (MET): baseline = 3034; 5 weeks = 3121).

Building on this successful pilot study, a large randomised controlled trial is currently being conducted across The Salvation Army Recovery Service centres located in NSW and the ACT. The study is the first controlled trial of a healthy lifestyles intervention with a substance abuse population. The Cancer Institute NSW funded this study. To date, about 130 people have been recruited to the study, with the aim of recruiting about 180 people. If the intervention proves to be effective, it is hoped that Healthy Recovery will continue to be delivered across The Salvation Army Recovery Service centres.

Relative importance of abstinence in recovery

This study collected data on drug and alcohol workers’ (n = 55) and clients’ (n = 139) perspectives on what constitutes a “recovery” from substance use disorder. Data were collected during 2010 from four residential faith-based treatment programs across the east coast of Australia. Self-report surveys specifically designed for this study were administered.

Abstinence was seen as an important component of recovery by both staff and clients; however non-abstinent factors were also seen as having an important role. Staff placed more emphasis on clients taking responsibility for their problems and on the role of spiritual development. For clients, importance of non-abstinence components tended to increase with length of a person's time in treatment and perceived recovery.

The authors recommend that “treatment programs need to address a broad range of areas regarding life functioning for clients, and abstinence should not be the only measure used to determine their success in addressing substance use problems.”

Maffina, L., Deane, F. P., Lyons, G. C., Crowe, T. P., & Kelly, P. J. (2013). Relative Importance of Abstinence in Clients' and Clinicians' Perspectives of Recovery from Drug and Alcohol Abuse. Substance Use & Misuse, 48(9); 683-690.

Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=1427&context=sspapers
Definitive version: informahealthcare.com/doi/abs/10.3109/10826084.2013.782045

Self-forgiveness, shame and guilt in recovery

People with drug and/or alcohol problems often experience feelings of shame and guilt, which have been associated with poorer recovery. Self-forgiveness has the potential to reduce these negative experiences. The current study tested theorized mediators (acceptance, conciliatory behavior, empathy) of the relationships between shame and guilt with self-forgiveness. A cross-sectional sample of 133 individuals (74.4% male) receiving residential treatment for substance abuse completed self-report measures of shame, guilt, self-forgiveness, and the mediators. Consistent with previous research, guilt had a positive association with self-forgiveness, whereas shame was negatively associated with self-forgiveness. Acceptance mediated the guilt and self-forgiveness relationship and had an indirect effect on the shame and self-forgiveness relationship. These findings emphasize the importance of targeting acceptance when trying to reduce the effects of shame and guilt on self-forgiveness.

McGaffin, B. J., Lyons, G. C., & Deane, F. P. (2013). Self-Forgiveness, Shame and Guilt in Recovery from Drug and Alcohol Problems. Substance Abuse, 34(4); 396-404.

Submitted version: ro.uow.edu.au/sspapers/454/
Definitive version: www.tandfonline.com/doi/abs/10.1080/08897077.2013.781564

Predicting dropout in residential treatment

Premature termination from treatment is a major factor associated with poorer drug and alcohol treatment outcomes. The present study investigated client-related baseline predictors of dropout at 3 months from a faith-based 12-step residential drug treatment program. Data were collected over a period of 14 months from eight residential drug and alcohol treatment programs run by The Australian Salvation Army. The final sample consisted of 618 participants, including 524 men (84.8%) and 94 women (15.2%). Predictor variables of interest were age, gender, primary drug of concern, criminal involvement, psychological distress, drug cravings, self-efficacy to abstain, spirituality, forgiveness of self and others, and life purpose. At 3 months, 264 participants (42.7%) remained in the treatment program, and 354 participants (57.3%) had dropped out. Binary logistic regression revealed that individuals were more likely to drop out by the 3-month time frame if at intake their primary drug of concern was a drug other than alcohol or they reported greater forgiveness of self. To the authors’ knowledge, this is the first study to examine forgiveness as a predictor of dropout from a drug treatment program. Assessing patient’s primary drug of concern and levels of forgiveness may be useful for residential drug treatment providers in constructing programs that provide differential treatment based on the results of these assessments.

Deane, F. P., Wootton, D. J., Hsu, C.-I., & Kelly, P. J. (2012). Predicting dropout in the first 3 months of 12-step residential drug and alcohol treatment in an Australian sample.

Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=4072&context=hbspapers

Predicting intention to enter further treatment after detoxification

There has been limited research examining the impact of clients’ behavioural beliefs on whether they intend to access further treatment following residential drug and alcohol detoxification. Treatment post-detoxification is generally recommended to reduce relapse and for more sustained positive outcomes. The present pilot study examined the extent to which (1) primary components of the Theory of Planned Behaviour (TPB), (2) perceived barriers to accessing treatment and (3) the participants’ previous involvement in substance abuse treatment predicted intentions to enter further treatment following residential detoxification. One hundred and sixty eight participants accessing Salvation Army detoxification units in Australia completed a survey measuring the primary components of the TPB and treatment barriers. Logistic regression analyses indicated that the attitudes and perceived behavioural control components of the TPB significantly predicted intent to enter treatment following detoxification. The implementation of a longitudinal study to examine whether these intentions actually lead to people accessing further treatment is recommended, and possible clinical strategies to enhance intention are discussed.

Kelly, P. J., Deane, F. P., McCarthy, Z., & Crowe, T. P. (2011). Using the Theory of Planned Behaviour and barriers to treatment to predict intention to enter further treatment following residential drug and alcohol detoxification: A pilot study. Addiction Research & Theory, 19(3), 276-282.

Definitive version: informahealthcare.com/doi/abs/10.3109/16066359.2011.564690

Comorbid (Co-occurring) Substance Use and Mental Health Disorders

Comorbidity in detoxification

Co-occurring substance use and mental health disorders (CODs) are common. However, very little is known about individuals' recognition of, and perception of the relationship between these disorders. The current study aimed to examine problem recognition, perceived disorder relationships, treatment intentions, and treatment preferences of individuals attending Australian detoxification facilities. Questionnaires were completed by 225 participants, including the Mental Health Screening Form III and the Treatment Preferences Questionnaire.

Comorbid (co-occurring) mental health disorders are common; results indicated that 56.4% of participants screened positive for CODs over the preceding 30 days, with only 4.2% failing to recognise their mental health problems. 85% had experienced a mental health disorder in their lifetime. Participants perceived a functional relationship between disorders, where improvement/deterioration of one disorder leads to the improvement/deterioration of the other. Most (75%) describe the relationship between the two such that, as the symptoms of substance abuse disorders worsen, mental health symptoms become more pronounced. A smaller but important group of (15%) perceive an opposite effect, where reduced alcohol and drug use leads to an increase in mental health symptoms. Identification of clients who have this pattern of interaction between their substance use and mental health symptoms is likely to be important in helping them manage their comorbid disorders. It is also important to identify and educate clients who are unaware of or deny comorbid mental health disorders, as this can adversely affect their treatment intentions and outcomes. Recognition of mental health problems and perception of a functional relationship between disorders, predict high mental health treatment intentions. These findings have important clinical implications when planning treatment programs and counselling individuals with CODs.

The study also investigated the treatment preferences of comorbid disorder clients. Half (50%) of clients with both substance abuse and mental health disorders prefer treatment that addresses both disorders concurrently. Approximately a quarter prefer substance abuse treatment as a priority. Few (14%) prefer treatment for substance abuse only. Another finding from this study was that a single screening item was highly accurate at identifying those with comorbid mental health conditions, and could be effectively be used for this purpose with minimal demands on both clients and treatment staff.

Vella, V., Deane, F. P., & Kelly, P. J. (2015). Comorbidity in detoxification: Symptom interaction and treatment intentions. Journal of Substance Abuse and Treatment, 49, 35-42.

Definitive version: www.sciencedirect.com/science/article/pii/S0740547214001664

Screening for mental disorder comorbidity in residential treatment

There has been much international impetus to address the importance of identifying and treating clients experiencing both a substance use disorder and a mental disorder in treatment settings. Gaps in the literature still exist after a decade of research into this area. There is little research on the prevalence of co-occurring mental disorders (CODs) in the residential alcohol and other drug (AOD) treatment modality. In this study, the mental disorder status of 278 participants resident in AOD treatment settings across Australia was estimated using the Addiction Severity Index—Self Report (J.S. Cacciola, A. Pecoraro, & A.I. Alterman, 2008) and the Mental Health Screening Form III (J.F.X. Carroll & J.J. McGinley, 2001). The estimated rate of diagnosable Axis I mental disorder comorbidity varied from 64% to 71% depending upon which cutoff score was used with the MHSF-III. Missing data emerged as a major limitation of the self-report version of the Addiction Severity Index psychiatric composite score in this population.

Mortlock, K. S., Deane, F. P., & Crowe, T. P. (2011). Screening for mental disorder comorbidity in Australian alcohol and other drug residential treatment settings. Journal of substance abuse treatment, 40(4), 397-404.

Submitted version: works.bepress.com/fdeane/45/
Definitive version: www.sciencedirect.com/science/article/pii/S0740547211000092

Comparing outcomes of substance use disorder only and dual diagnosis clients

In a separate study of clients in Residential Treatment Service Centres, the 3 month telephone interview follow-up data was used to identify those who were likely to have a comorbid substance abuse and mental health disorder. Approximately two-thirds of clients were classified as likely to have comorbid disorders, with the remaining third classified as substance abuse only. Although those with comorbid disorders and those with only substance abuse disorder reported similar decreases in substance use problems, those with comorbid disorders perceived less improvement.

Clients with comorbid disorders entered treatment with higher symptom distress compared to those with substance abuse only. Although both groups improved at a similar rate, because those with comorbid disorders started treatment with greater symptom severity, they remained significantly more symptomatic at follow-up. This suggests that those with comorbid disorders may benefit from a different treatment approach (e.g., longer, more intense and/or different content) in order to achieve equivalent outcomes to those who have only a substance abuse disorder.

Cridland, E. K., Deane, F. P., Hsu, C.-l., & Kelly, P. J. (2012). A comparison of treatment outcomes for individuals with substance use disorder alone and individuals with probable dual diagnosis. International Journal of Mental Health and Addiction, 10(5), 670-683.

Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=4147&context=hbspapers
Definitive version: link.springer.com/article/10.1007/s11469-011-9364-z

Depression and substance abuse computer-based intervention

A large proportion of people attending residential alcohol and other substance abuse treatment have a co-occurring mental illness. Empirical evidence suggests that it is important to treat both the substance abuse problem and co-occurring mental illness concurrently and in an integrated fashion. However, the majority of residential alcohol and other substance abuse services do not address mental illness in a systematic way. It is likely that computer delivered interventions could improve the ability of substance abuse services to address co-occurring mental illness. This protocol describes a study in which we will assess the effectiveness of adding a computer delivered depression and substance abuse intervention for people who are attending residential alcohol and other substance abuse treatment.

Participants will be recruited from residential rehabilitation programs operated by the Australian Salvation Army. All participants who satisfy the diagnostic criteria for an alcohol or other substance dependence disorder will be asked to participate in the study. After completion of a baseline assessment, participants will be randomly assigned to either a computer delivered substance abuse and depression intervention (treatment condition) or to a computer-delivered typing tutorial (active control condition). All participants will continue to complete The Salvation Army residential program, a predominantly 12-step based treatment facility. Randomisation will be stratified by gender (Male, Female), length of time the participant has been in the program at the commencement of the study (4 weeks or less, 4 weeks or more), and use of anti-depressant medication (currently prescribed medication, not prescribed medication). Participants in both conditions will complete computer sessions twice per week, over a five-week period. Research staff blind to treatment allocation will complete the assessments at baseline, and then 3, 6, 9, and 12 months post intervention. Participants will also complete weekly self-report measures during the treatment period.

This study will provide comprehensive data on the effect of introducing a computer delivered, cognitive behavioural therapy based co-morbidity treatment program within a residential substance abuse setting. If shown to be effective, this intervention can be disseminated within other residential substance abuse programs.

Kelly, P. J., Kay-Lambkin, F. J., Baker, A. L., Deane, F. P., Brooks, A. C., Mitchell, A., . . . Dingle, G. A. (2012). Study protocol: a randomized controlled trial of a computer-based depression and substance abuse intervention for people attending residential substance abuse treatment. BMC public health, 12(1), 113-121.

Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=4032&context=hbspapers
Definitive version: www.biomedcentral.com/1471-2458/12/113

Dual diagnosis capability of residential addiction treatment centres

The Dual Diagnosis Capability of Addiction Treatment (DDCAT) index is used to assess the capacity of substance abuse services to work with individuals with co-occurring mental health problems. The current study aimed to: (i) examine the dual diagnosis capability of residential substance abuse programs in Australia; (ii) identify managers' perceptions regarding both priorities and confidence for change following the completion of the DDCAT; and (iii) to examine the usefulness of the DDCAT to residential substance abuse programs. The DDCAT was completed across 16 residential substance abuse units. An external researcher administered and scored the DDCAT. A Unit Manager from each site completed the Comorbidity Priorities and Confidence Survey following the completion of the DDCAT review. This survey examined the usefulness of the DDCAT, and the unit's priorities to improve its capability, and confidence to improve its DDCAT score. Across the services, program structure and staff training were the DDCAT domains that required the most improvement. While training was the highest endorsed priority area for improvement, program structure was the lowest priority. Overall the Unit Managers reported positive attitudes towards use of the DDCAT and were confident that their unit could improve their DDCAT scores. DDCAT scores of Australian residential substance abuse programs are comparable with previous published results. However, there is still substantial work required to improve the capability of these programs. Future research should examine strategies to promote sustained improvements in the capability of residential substance abuse programs.

Matthews, H., Kelly, P. J., & Deane, F. P. (2011). The dual diagnosis capability of residential addiction treatment centres: priorities and confidence to improve capability following a review process. Drug and Alcohol Review, 30(2), 195-199.

Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=1999&context=hbspapers
Definitive version: onlinelibrary.wiley.com/doi/10.1111/j.1465-3362.2010.00215.x/full

Faith-Based Treatment

Forgiveness, resentment and purpose in life

Faith-based treatment programs are a viable treatment option for many individuals with substance use disorders; however, the psychological mechanisms that explain the relationship between spirituality and a recovery from substance use disorders have not been established. The Spirituality, Forgiveness, and Purpose (SFP) model of recovery proposes that forgiveness and purpose in life may mediate the spirituality–recovery relationship. As a preliminary step in exploring this theory, a cross-sectional investigation of 277 clients of the Australian Salvation Army Rehabilitation Service Centres was performed. A multiple regression found that forgiveness of others, forgiveness of self, receiving forgiveness from others, and receiving forgiveness from God predicted resentment. Furthermore, multiple mediation analyses found that forgiveness of self and receiving forgiveness from others and God mediated the relationship between daily spiritual experiences and purpose and engagement in life.

Lyons, G. C., Deane, F. P., Caputi, P., & Kelly, P. J. (2011). Spirituality and the treatment of substance use disorders: An exploration of forgiveness, resentment and purpose in life. Addiction Research & Theory, 19(5), 459-469.

Submitted version: works.bepress.com/fdeane/37/
Definitive version: informahealthcare.com/doi/abs/10.3109/16066359.2011.555022

Recovery mechanisms of substance use disorders

Spirituality has often been associated with recovery from substance use disorders through its emphasis in faith-based rehabilitation programs. The purpose of this article is to describe some psychological dynamics that may explain how spirituality aids in the treatment of substance abuse and dependence. Forgiveness and purpose in life are proposed as “spiritual mechanisms” that partially mediate a spiritually directed recovery. Recent empirical studies on spirituality and recovery from substance use disorders are discussed in relation to 12-steps of Alcoholics Anonymous and Christian principles in order to describe how forgiveness and purpose in life interact with spiritual development in substance use disorder treatment programs. A theoretical model detailing the relationship between spirituality, forgiveness, purpose, and recovery is presented based on anecdotal and empirical literature.

Lyons, G. C., Deane, F. P., & Kelly, P. J. (2010). Forgiveness and purpose in life as spiritual mechanisms of recovery from substance use disorders. Addiction Research & Theory, 18(5), 528-543.

Submitted version: works.bepress.com/fdeane/12/
Definitive version: informahealthcare.com/doi/abs/10.3109/16066351003660619

The role of spirituality and religiosity in the management of cravings

The purpose of this study was to examine the relationship of spirituality, religiosity and self-efficacy with drug and/or alcohol cravings. A cross-sectional survey was completed by 77 male participants at an Australian Salvation Army residential rehabilitation service in 2007. The survey included questions relating to the participants' drug and/or alcohol use and also measures for spirituality, religiosity, cravings, and self-efficacy. The sample included participants aged between 19 and 74 years, with more than 57% reporting a diagnosis for a mental disorder and 78% reporting polysubstance misuse with alcohol most frequently endorsed as the primary drug of concern (71%). Seventy-five percent of the clients reported that spirituality and religious faith were useful components of the treatment program. A multivariate multiple regression analysis identified that spirituality and self-efficacy have significant relationships with cravings. Self-efficacy mediated the relationship between spirituality and drug and/or alcohol cravings. The limitations of this study included its cross-sectional design and a sample that was drawn from a faith-based program. Future research would benefit from the longitudinal examination of the relationship between spirituality, self-efficacy, and cravings; the exploration of a broader range of client-specific and interpersonal variables; and the inclusion of a control group from a secular treatment facility.

Mason, S. J., Deane, F. P., Kelly, P. J., & Crowe, T. P. (2009). Do spirituality and religiosity help in the management of cravings in substance abuse treatment? Substance use & misuse, 44(13), 1926-1940.

Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=1996&context=hbspapers
Definitive version: informahealthcare.com/doi/abs/10.3109/10826080802486723

Treatment provider attitudes towards spirituality, forgiveness and secular treatment components

Although spirituality and forgiveness components of substance abuse treatment programs are viewed as important by faith-based substance abuse treatment providers researchers have not compared their relative importance to other treatment components. This study evaluated the perceived importance of spiritually and forgiveness-based treatment components in comparison to other secular psycho-educational components in faith-based treatment programs. A brief survey was completed by 99 Salvation Army drug and alcohol treatment providers employed within Australian residential rehabilitation programs. The survey examined the relative importance treatment providers' placed on spiritual and secular components of treatment. Attitudes towards spiritual components of treatment, such as Christian education and spiritual development, were positive; however, treatment providers rated secular interventions such as relapse prevention and anger management as more important than spiritual components. Treatment providers also conceptualized forgiveness to primarily be a spiritual construct that was as important to treatment as other secular based components. Implications for treatment providers are discussed.

Lyons, G., Deane, F. P., & Kelly, P. J. (2011). Faith-based substance abuse treatment: Is it just about God? Exploring treatment providers' attitudes towards spirituality, forgiveness and secular components of treatment. Counselling and Spirituality, 30(1), 135-159.

Submitted version: ro.uow.edu.au/hbspapers/2204/
Definitive version: www.counsellingandspirituality.com/english/journal.php?annee=2011#resume (archived version of page)

Evidence-Based Practice

Intention to use evidence-based practice

There is considerable discrepancy between what is considered evidence-based practice (EBP) and what is actually delivered in substance abuse treatment settings. The Theory of Planned Behavior (TpB) is a well-established model that may assist in better understanding clinician's intentions to use EBPs. A total of 106 residential substance abuse workers employed by The Salvation Army participated in the current study. The workers completed an anonymous survey that assessed attitudes toward EBP and examined the constructs within the TpB. A linear regression analysis was used to predict clinicians' intentions to use EBPs. Overall, the model accounted for 41% of the variance in intentions, with attitudes, subjective norms, and perceived behavioral control all significant predictors. The discussion highlights the potential for social reinforcement in the workplace to promote the implementation of EBPs.

Kelly, P. J., Deane, F. P., & Lovett, M. J. (2012). Using the Theory of Planned Behavior to examine residential substance abuse workers intention to use evidence-based practices. Psychology of Addictive Behaviors, 26(3), 661.

Submitted version: ro.uow.edu.au/hbspapers/3030/
Definitive version: psycnet.apa.org/journals/adb/26/3/661/

Methodology

Clinical and Reliable Change

Although the Addiction Severity Index (ASI) is one of the most frequently used measures in alcohol and other drug research, it has rarely been used to assess clinical and reliable change. This study assessed clients’ clinical and reliable change at The Salvation Army residential substance abuse treatment centers in Australia. A total of 296 clients completed ASI interviews on admission to treatment and 3 months after discharge from treatment. Clients demonstrated significant improvement on all seven ASI composites. The range of reliable change for each ASI composite varied from 30% to 70%. More than two-thirds of clients experienced clinically significant improvement for alcohol and drug problems. Psychiatric distress was clinically reduced in 44% of clients. This research indicates that residential substance abuse treatment can make important differences in client's lives at a clinical and functional level. However, the research highlights the challenge of effectively targeting psychiatric comorbidity within alcohol and other drug abuse populations.

Deane, F. P., Kelly, P. J., Crowe, T. P., Coulson, J. C., & Lyons, G. C. B. (2013). Clinical and Reliable Change in an Australian Residential Substance Use Program Using the Addiction Severity Index. Journal of Addictive Diseases, 32(2), 194-205.

Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=1344&context=sspapers
Definitive version: www.tandfonline.com/doi/abs/10.1080/10550887.2013.795470

Feasibility of telephone follow-up interviews

Telephone follow-up interviewing is one method of monitoring treatment outcomes of individuals involved in drug and alcohol treatment programs. The present study is the first to examine the feasibility and generalizability of data obtained from telephone follow-up interviews after drug and alcohol treatment in Australia. Participants attended 1 of 8 Salvation Army Recovery Service Centres where staff administered outcome measures at intake. Three-month post-discharge telephone follow-up interviews were conducted by researchers from the Illawarra Institute for Mental Health, University of Wollongong. A sample of 700 clients was obtained for follow-up (582 males; 118 females). A 51% follow-up rate was achieved at a cost of US$82 per completed interview. No significant differences in baseline characteristics between responding and non-responding participants were found. Overall, the telephone methodology was shown to be feasible and relatively inexpensive. However, the introduction of outcome measures at the service level in parallel with follow-up data collection procedures complicated the collection of response data. The burden of introducing outcome measures in residential services may be reduced by utilizing a phased implementation strategy.

Deane, F. P., Kelly, P. J., Crowe, T. P., Lyons, G. C. B., & Cridland, E. K. (2014). Feasibility of telephone follow-up interviews for monitoring treatment outcomes of Australian residential drug and alcohol treatment programs. Substance Abuse, 35, 21-29.

Submitted version: ro.uow.edu.au/cgi/viewcontent.cgi?article=1783&context=sspapers
Definitive version: www.tandfonline.com/doi/full/10.1080/08897077.2013.789815

Validity of the Desires for Alcohol Questionnaire (DAQ) short form

Reductions in cravings have been associated with improved recovery from alcohol and other drug use problems. Self-report assessments of cravings provide a way of monitoring progress over the course of treatment particularly in residential settings. There is a need to develop brief craving measures suitable for repeat administration. The aim of the study was to assess the reliability and validity of a six-item version of the Desires for Alcohol Questionnaire (DAQ-6). In study 1 exploratory factor analysis involving 710 participants attending residential treatment revealed two factors: ‘expectancy of negative reinforcement’ and ‘strong desires and intentions’. In study 2 confirmatory factor analysis replicated this factor structure in an independent sample of 116 participants. Both studies provided evidence for convergent and discriminant validity of the DAQ-6 when compared to other measures. The DAQ-6 shows promise as a brief self-report measure of cravings but the utility of the separate subscales in treatment contexts requires further research.

Mo, C., Deane, F. P., Lyons, G., & Kelly, P. J. (2013). Factor analysis and validity of a short 6-item version of the Desires for Alcohol Questionnaire. Journal of Substance Abuse Treatment, 44(5), 557-564.

Definitive version: www.journalofsubstanceabusetreatment.com/article/S0740-5472%2812%2900450-3/abstract

Psychometric properties of the Recovery Assessment Scale

Conceptualisations of recovery from substance use disorder (SUD) and mental illness overlap significantly, and the rate of comorbidity of these problems is high. This study investigated the psychometric properties of the Recovery Assessment Scale (RAS), a measure originally developed for individuals with mental illness. A sample of 1094 people with SUD attending residential treatment services provided by the Australian Salvation Army completed the RAS and other outcome measures at admission. Confirmatory factor analysis (CFA) indicated a poor fit of the data to the five factor solution previously identified in mental illness samples. Exploratory factor analysis, however, produced three of the five factors included in the CFA, and two factors which arranged constructs in a slightly different manner from previous factor analytic studies in samples with mental illness. Correlations of these factors with other symptom distress and recovery measures indicated satisfactory convergent and divergent validity. The study provides modest support for the use of the RAS in groups with SUD.

Cale, E., Deane, F. P., & Kelly, P. J. (2015). Psychometric properties of the Recovery Assessment Scale in a sample with substance use disorder. Addiction Research & Theory, 23(1), 71-80.

Definitive version: informahealthcare.com/doi/abs/10.3109/16066359.2014.938061

Last reviewed: 9 February, 2017

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