Improving the retention rate for residential treatment of substance abuse by sequential intervention for social anxiety

BACKGROUND Residential drug rehabilitation is often seen as a treatment of last resort for people with severe substance abuse issues. These clients present with more severe symptoms, and frequent psychiatric comorbidities relative to outpatients. Given the complex nature of this client group, a high proportion of clients seeking treatment often do not enter treatment, and of those who do, many exit prematurely. Given the highly social nature of residential drug rehabilitation services, it has been argued that social anxieties might decrease the likelihood of an individual entering treatment, or increase the likelihood of them prematurely exiting treatment. The current paper reports on the protocol of a Randomised Control Trial which examined whether treatment of social anxiety prior to entry to treatment improves entry rates and retention in residential drug rehabilitation. METHOD/DESIGN A Randomised Control Trial comparing a social skills treatment with a treatment as usual control group was employed. The social skills training program was based on the principles of Cognitive Behaviour Therapy, and was adapted from Ron Rapee's social skills training program. A permutated block randomisation procedure was utilised. Participants are followed up at the completion of the program (or baseline plus six weeks for controls) and at three months following entry into residential rehabilitation (or six months post-baseline for participants who do not enter treatment). DISCUSSION The current study could potentially have implications for addressing social anxiety within residential drug treatment services in order to improve entry and retention in treatment. The results might suggest that the use of additional screening tools in intake assessments, a focus on coping with social anxieties in support groups for clients waiting to enter treatment, and greater awareness of social anxiety issues is warranted. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY Australian New Zealand Clinical Trials Registry (ACTRN) registration number: ACTRN12611000579998.This research was supported under Australian Research Council's Linkage Projects funding scheme (project number: LP0990162)

Improving the retention rate for residential treatment of substance abuse by sequential intervention for social anxiety

Background: Residential drug rehabilitation is often seen as a treatment of last resort for people with severe substance abuse issues. These clients present with more severe symptoms, and frequent psychiatric comorbidities relative to outpatients. Given the complex nature of this client group, a high proportion of clients seeking treatment often do not enter treatment, and of those who do, many exit prematurely. Given the highly social nature of residential drug rehabilitation services, it has been argued that social anxieties might decrease the likelihood of an individual entering treatment, or increase the likelihood of them prematurely exiting treatment. The current paper reports on the protocol of a Randomised Control Trial which examined whether treatment of social anxiety prior to entry to treatment improves entry rates and retention in residential drug rehabilitation. Method/design: A Randomised Control Trial comparing a social skills treatment with a treatment as usual control group was employed. The social skills training program was based on the principles of Cognitive Behaviour Therapy, and was adapted from Ron Rapee's social skills training program. A permutated block randomisation procedure was utilised. Participants are followed up at the completion of the program (or baseline plus six weeks for controls) and at three months following entry into residential rehabilitation (or six months post-baseline for participants who do not enter treatment). Discussion: The current study could potentially have implications for addressing social anxiety within residential drug treatment services in order to improve entry and retention in treatment. The results might suggest that the use of additional screening tools in intake assessments, a focus on coping with social anxieties in support groups for clients waiting to enter treatment, and greater awareness of social anxiety issues is warranted

Multi-state Modeling of Biomolecules

Multi-state modeling of biomolecules refers to a series of techniques used to represent and compute the behavior of biological molecules or complexes that can adopt a large number of possible functional states. Biological signaling systems often rely on complexes of biological macromolecules that can undergo several functionally significant modifications that are mutually compatible. Thus, they can exist in a very large number of functionally different states. Modeling such multi-state systems poses two problems: the problem of how to describe and specify a multi-state system (the “specification problem”) and the problem of how to use a computer to simulate the progress of the system over time (the “computation problem”). To address the specification problem, modelers have in recent years moved away from explicit specification of all possible states and towards rule-based formalisms that allow for implicit model specification, including the κ-calculus [1], BioNetGen [2]–[5], the Allosteric Network Compiler [6], and others [7], [8]. To tackle the computation problem, they have turned to particle-based methods that have in many cases proved more computationally efficient than population-based methods based on ordinary differential equations, partial differential equations, or the Gillespie stochastic simulation algorithm [9], [10]. Given current computing technology, particle-based methods are sometimes the only possible option. Particle-based simulators fall into two further categories: nonspatial simulators, such as StochSim [11], DYNSTOC [12], RuleMonkey [9], [13], and the Network-Free Stochastic Simulator (NFSim) [14], and spatial simulators, including Meredys [15], SRSim [16], [17], and MCell [18]–[20]. Modelers can thus choose from a variety of tools, the best choice depending on the particular problem. Development of faster and more powerful methods is ongoing, promising the ability to simulate ever more complex signaling processes in the future

Intimacy, fathers, best friends and the well-being of young adult males

Studies of relationship intimacy have relied heavily on concepts such as emotional self-disclosure. When intimacy has been examined in this 'traditionally female' way, men have generally reported less intimacy in their relationships than women. Few studies, however, have examined broader indicators of intimacy, or the diversity of intimate experiences within each gender. The present study investigated differences in the way 194 young, heterosexual adult men experienced and expressed intimacy within their relationships, particularly with their fathers and with a best male friend. Five groups of men with different relationship patterns were identified using a clustering procedure. The clusters were based on men's relationships with their mothers and fathers, their best male friend, their approach to romantic relationships with women, and their masculinity ideologies. The five groups, labelled Secure, Anxious, Resilient, Foreclosed, and Fearful were then compared on measures of psychological well-being. Men with Secure and Foreclosed relationship patterns reported the highest levels of well-being. While Secure men experienced intimacy in broad ways and had all-round positive relationships, Foreclosed men expressed traditionally masculine views and reported ideal parental relationships, but were less emotionally expressive and had poorer peer relationships. In contrast, men with Resilient and Anxious relationship patterns reported moderate levels of well-being. Despite some mild depression and problematic drug use, Resilient men had largely overcome very negative relationships with their fathers and had been able to establish positive peer relationships that were characterised by high levels of emotional expression. On the other hand, Anxious men had experienced inconsistent and unreliable fathering and had subsequently experienced high levels of anxiety in their romantic relationships. Finally, Fearful men indicated very low levels of well-being and had all-round poor relationships that lacked most aspects of intimacy. Themes within respondents' memories of their fathers and best male friends were also analysed. Qualitative examples of these themes are presented to highlight and explore differences between the five groups of men in their profiles and their relationship working models. The roles that fathers and male best friends play in young men's lives are also discussed, as are the implications of the findings for counselling theory and practice

Rates of alcohol usage among Vietnamese Australian communities : a literature review

Census data indicates a steady increase in the number of Vietnamese people migrating to Australia. Despite this there is a paucity of research examining alcohol usage within this community. A review of the literature was undertaken to examine the prevalence of alcohol use, related harms, and health service use. Vietnamese Australians were found to consume alcohol at a rate lower than that of Australians in general. However, the relevant research may not be generalizable, alcohol usage and associated harms may be under-reported, and prevalence rates contradicted the breadth and frequency of harms reported. These issues are discussed. © 2010 Informa UK Ltd

MMPI-2 profiles of clients with substance dependencies accessing a therapeutic community treatment facility

The aim of the study was to describe the psychological profile, as measured by the MMPI-2, of 921 clients assessed after five weeks admission to a Therapeutic Community (TC). Overall, the profile of the sample showed prominent peaks reflecting character disorder (high Pd) and disturbed thinking and affect (high Sc). The validity scales suggested that the sample was admitting to personal and emotional difficulties and requesting assistance with these problems. The psychotic triad was somewhat more elevated than the neurotic triad indicating distress about behaviours or symptoms related to psychotic disorders. Psychopathology was greater for women, who reported significantly higher scores on confusion (F), hypochondriasis (Hs), character disorder (Pd), and hysteria (Hy) than men, although the shape of male and female MMPI-2 profiles was similar. Those aged up to 35 years scored significantly higher on five clinical scales (depression (D), character disorder (Pd), paranoia (Pa), psychopathic deviate (Pd) and schizophrenia (Sc)) than an older (over 35) group; they also significantly differed on all the validity scales from their older counterparts. Clients who completed the MMPI-2 at five weeks but stayed less than four months at the TC were more likely to be younger, female and admit to psychopathology (lower K-defensiveness scores, higher mania) than those who went on to complete the first phase of treatment. The results suggest that substance dependent clients seeking treatment at a TC exhibit considerable psychological disturbance; more so for females and the younger cohort

Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence

The Therapeutic Community (TC) model is considered an effective treatment for substance dependence, particularly for individuals with complex presentations. While a popular approach for this cohort across a number of countries, few studies have focussed on biopsychosocial and longer-term outcomes for this treatment modality. This study reports on substance use, dependence, and biopsychosocial outcomes up to 9 months post-exit from two TC sites. Methods: A longitudinal cohort study (n = 166) with two follow-up time points. Measures included substance use, dependence, subjective well-being, social functioning, and mental and physical health. Generalized Linear Models were employed to assess change over time. Results: At 9 months, 68% of participants reported complete 90-day drug abstinence. Alcohol frequency and quantity were reduced by over 50% at 9 months, with 32% of the sample recording 90-day abstinence at 9 months. Both alcohol and drug dependence scores were reduced by over 60%, and small to medium effect sizes were found for a range of psychosocial outcomes at 9 months follow-up, including a doubling of wellbeing scores, and a halving of psychiatric severity scores. Residents who remained in the TC for at least 9 months reported substantially better outcomes. Conclusions: With notably high study follow-up rates (over 90% at 9 months post-exit), these data demonstrate the value of the TC model in achieving substantial and sustained improvements in substance use and psychosocial outcomes for a cohort with severe substance dependence and complex presentations. Implications for optimal length of stay are discussed

Gender differences in response to psychological treatment for social anxiety disorder in those with comorbid drug dependence

Introduction Individuals with social anxiety disorder do poorly in residential treatment programs for the treatment of drug dependence. This is not surprising given the social nature of residential rehabilitation where group work and close social interactions are required. Objectives Given the social nature of residential rehabilitation, we were interested in exploring whether we could address social anxiety symptoms prior to treatment entry and therefore enhance the likelihood that an individual would enter treatment and stay in treatment. Aims To conduct a randomised control trial to evaluate whether treatment of social anxiety symptoms prior to treatment entry improves treatment entry and retention. Method Treatment seeking substance users (n = 105) completed intake assessment interviews for entry into a residential rehabilitation program. Assessment comprised the Mini International Neuropsychiatric interview (Mini), the alcohol, smoking and substance involvement screening test (ASSIST), the Liebowitz Social Anxiety Scale (LSAS). Participants were randomised to either a foursession social anxiety intervention or treatment as usual (which was to remain on the waiting list until treatment entry). A survival analysis was conducted to examine whether the intervention impacted on treatment retention. Results The treatment did not significantly impact on treatment but the intervention group were significantly more likely to remain in treatment and this effect was only found in women. Conclusion For individuals with social anxiety disorder brief evidence based intervention focused on ameliorating social anxiety symptoms (e.g., cognitive behavioural treatment) may improve the retention in treatment. This effect appears to be gender specific. Disclosure of interest The authors have not supplied their declaration of competing interest

The use of alcohol by Vietnamese living in Melbourne, Australia

Background: The size of the Vietnamese community residing in Melbourne, Australia has continued to grow steadily over the past decades; however, little is known about their level of alcohol consumption. Aims: To collect data on alcohol consumption and consider the impact of demographic variables such as age and gender. Method: A questionnaire was administered to 1080 people recruited through Vietnamese organizations and the media. The survey questions were drawn from existing and validated instruments and demographic questions such as age and gender. Results: The findings suggest that Vietnamese Australians in Melbourne consume alcohol at a lower rate than the general population, but higher than the Vietnamese community in Sydney and Western Australia. Conclusions: Due to the limited research in this field, these findings make an important contribution to understanding the alcohol consumption patterns of Vietnamese Australians