Patient Specific Treatment

Substance abuse does not discriminate and when dealing with such a wide and varied population the use of one standardized treatment plan will not always be effective. The use of gender or culturally sensitive treatment modalities is another method that substance abuse treatment facilities can use in order to increase engagement. Recognizing that there are different approaches that can be used when dealing with different demographics, clinics will be able to create programs that are most effective for that particular population.

When evaluating the differences in problem severity and treatment engagement between men and women it is clear that efforts need to be made to more effectively engage and retain the female substance abusing population. Arfken et al (2001) reported on the problem severity and treatment retention of the female population presenting to Detroit’s publicly funded substance abuse system from 1995 – 1999. Women made up 27% of the sample. They presented to treatment with a greater problem severity and according to the ASAM-PPC would have been referred to more intensive treatment settings. Women had lower 30-day retention rates than men (62% to 75%) and completion rates (24% to 46%). The numbers show that even with increased attention paid to Women’s issues in treatment there is still much work to do.

The results from a recent review of literature discussing substance abuse treatment programs for women found generally positive outcomes. Ashley et al (2003) reviewed outcomes of 38 studies analyzing the effectiveness of treatment for women. They found that 6 components consistently led to improved outcomes: 1) providing child care, 2) offering prenatal care, 3) women-only admissions, 4) supplemental services and workshops that address women-focused topics, 5) mental health programming and 6) comprehensive programming. The studies found that among other encouraging results, treatment retention and completion were also positively affected.

One program noted by Marston’s article addressing the role of family in treatment engagement was the Engaging Mom’s (EM) program. Dakof et al (2003) present a study examining the effectiveness of this program in enrolling and retaining 103 African-American mothers. Building a strong and authentic relationship between mother and counselor is the key principle of the program. There are two phases, enrollment and retention. During the enrollment phase the counselor is single-mindedly focused on enrolling the mother in treatment. Unlike Motivational Interviewing, freedom of choice is not emphasized. The program assumes that untreated substance abusing women are unable to take responsibility for their treatment and the EM counselor takes responsibility for the mother’s entry into treatment. The EM counselor also works closely with the mother’s family, attempting to get them involved in the treatment process.

During the retention phase, the EM counselor continues to work with the mother for the first 4 weeks of treatment. Helping the mother adjust to treatment as well as deal with any outside pressures that may come up will hopefully lead to a higher rate of retention. Women were randomly assigned to either the EM group or a community services as usual group (control). 88% of women assigned to the EM group enrolled in treatment compared to 46% for the control group. Of those who entered treatment, 67% of the EM group completed 4 weeks of treatment. 39% of those in the control group completed 4 weeks of treatment. The results for 90-day retention showed no differences between the two groups. Only 20 women from the EM group and 18 women from the control group completed 90 days of treatment.

Treatment’s which target specific cultural issues have also been reported. Brief Strategic Family Therapy (BFST) was designed to match a treatment approach to the values reported by Cuban immigrants in Miami (Muir et al, 2004). Developed at the University of Miami’s Center for Family studies, this method was based on a survey used to gauge the value orientation of this population. Given the emphasis on family in Hispanic culture and a hierarchical value orientation among Cubans they created an intervention that would be family based. BFST emphasizes the family as the main agent of change.

The effectiveness of this model in engaging Hispanic adolescents with drug problems has been tested three times. The first study (Szapocznik et al, 1988) randomly assigned families to BFST + engagement as usual or BFST + BFST engagement. Engagement as usual involved approaching families in a way that resembled approaches used at most outpatient centers. Results were based on two measures, engaging families to attend an intake session and retaining the families to completion of treatment. 93% of the families in the BFST + engagement group attended the intake session. Only 42% of the engagement as usual group attended intake. 75% of the BFST + engagement group completed treatment compared to 25% of the families in the treatment as usual condition.

The second study replicated the first with a more stringent definition of success (Santisteban et al, 1996). Clients had to attend the intake session plus the first therapy session. 81% of the BFST + engagement group were successfully engaged compared to 60% for the control group. The third study (Coatsworth et al, 2001) compared the BFST + engagement to a community control condition. Again, 81% of the BFST + engagement participants were successfully enrolled in treatment. The community control condition enrolled 61% in treatment. Also, 71% of the BFST + engagement group completed treatment compared to 42% for the control group.