A comparison of conditioning and psychotherapy in the treatment of functional enuresis.
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Adolescent↗
Biomedical subjects
G De Leon
Publications and source records attributed to G De Leon.
Classical conditioning and extinction of human systolic blood pressure.
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Adult↗
Classical conditioning of human systolic pressure: replication and extension using three stimulus durations.
Recent efforts have demonstrated classical conditioning of human systolic pressure (De Leon, 1972). The present research attempted a replication with longer sessions and to maximize the CS+, CS- differentiation by varying CS+ durations. Student volunteers (N = 64) underwent four, 50 minute sessions, three conditioning and one extinction, distributed over two weeks. Shock (UCS) occurred intermittently in light-on (CS+) and never in light-off (CS-). Results closely replicated the earlier work, revealing a characteristic UCR, a significant CS+, CS- differential and, conditioned elevations failed to adapt within and across sessions. The pressure differential was inversely related to CS+ duration. Clarification of conditioning influences requires follow-up research on these clients outside of the laboratory. Nevertheless, these studies provide firm experimental evidence for implicating stimulus variables in the origins of certain hypertensive states.
Adolescent↗
Fixed and dynamic predictors of client retention in therapeutic communities.
This exploratory study assessed the value of fixed and dynamic variables for predicting client retention in therapeutic communities. Fixed variables included demographic and background characteristics that had been used to predict client retention and outcomes in previous research. Dynamic variables included circumstances under which clients joined programs and their motivations for seeking treatment. The sample comprised 753 admissions to 5 traditional therapeutic communities for substance abusers. Although both fixed and dynamic variables predicted client retention, the strongest predictors were two dynamic variables. One was ex-addict interviewers' predictions of whether clients would stay long enough in the program to benefit from treatment. The other was whether clients had spent most of their time with large groups of people, as opposed to spending most of their time with small groups or alone, before using drugs. Program and treatment variables need to be taken into account along with client variables to better understand and improve retention in therapeutic communities and other types of drug abuse treatment programs.
Adult↗
Therapeutic communities: AIDS/HIV risk and harm reduction.
The limited survey data available suggest that therapeutic communities have increasingly organized themselves to develop HIV prevention programs and to integrate HIV-infected and AIDS clients into the treatment community while providing specialized program as necessary. Nonetheless, there remains a need for a comprehensive survey of the response of therapeutic communities to AIDS and the risk of HIV infection. There is need as well for studies that can build on findings linking retention in the therapeutic community to strategies that focus on clients' motivation or readiness for treatment. In addition, therapeutic community programs can ally with outreach programs both to provide priority admission to seropositive clients, women with children, adolescents, and criminal justice clients, and to provide harm reduction services to those unwilling to enter treatment while also taking incremental steps to engage those clients in ever increasing behavior change initiatives.
Acquired Immunodeficiency Syndrome↗
Modified therapeutic community treatment for homeless dually diagnosed men. Who completes treatment?
We studied a modified therapeutic community designed for the treatment of patients with combined substance abuse and psychiatric disorders. This model has been ap117117plied on a limited basis in clinical practice, and little is known about the characteristics of patients who are likely to complete the prescribed stay in such a program. In this report, we present characteristics of 189 homeless dually diagnosed men who entered a shelter-based, modified therapeutic community with a prescribed 6-month stay. Thirty-four percent of admissions completed the prescribed stay. These patients were more likely to have fewer inpatient psychiatric admissions and more job experience than those who did not complete their stay. Findings are discussed in terms of their similarities and differences to findings from traditional therapeutic communities for the singly diagnosed.
Adult↗
Modified therapeutic community for homeless mentally ill chemical abusers. Sociodemographic and psychological profiles.
This paper, the first in a series of reports from a field study on the efficacy of modified therapeutic community (TC) treatment for homeless mentally ill chemical abusers, presents sociodemographic profiles, psychiatric diagnosis, and psychological symptom data on 342 homeless mentally ill chemical abusing clients seeking treatment in mental health community residence settings. The findings reflect the multidimensional deficits, social dysfunctionality, and severity of psychopathology of the study sample. The paper discusses the implications of these findings for program design and program planning, with special reference to modified TC programs.
Adult↗
Circumstance, motivation, readiness and suitability as correlates of treatment tenure.
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Adolescent↗
Psychiatric diagnoses among substance abusers in therapeutic community treatment.
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Adolescent↗
Psychopathology and substance abuse: what is being learned from research in therapeutic communities.
The pervasive use of drugs in the general population and the clearly established relationship between drug abuse and psychological disorder emphasizes the importance of diagnoses and treatment in both the mental health and the drug abuse service systems. Therapeutic community (TC) research findings on psychopathology are highlighted on the prevalence, trends, and impact of treatment, which indicate that TCs have evolved a potent model for modifying drug abuse behavior and reducing psychological symptoms. Although its success has been most evident with the primary substance abuser, the TC has much to offer the increasing numbers of dually diagnosed individuals who manifest their dysfunctionality both through drug abuse and psychological maladjustment.
Humans↗
Is the therapeutic community culturally relevant? Findings on race/ethnic differences in retention in treatment.
The therapeutic community (TC) views cultural diversity as an essential ingredient in its treatment approach. However, based on clinical observation and some research, questions persist concerning the relevance of TC programming for numerical race/ethnic minorities. This article briefly reviews pertinent research and presents findings from recent studies on race/ethnic differences in readiness and suitability for, and retention in, TC treatment. A framework is outlined for the empirical study of cultural relevance issues in TCs.
Culture↗
Residential therapeutic communities in the mainstream: diversity and issues.
Not all residential drug abuse treatment programs are therapeutic communities (TCs), not all TCs are in residential settings, and not all programs that call themselves TCs employ the same social and psychological models of treatment. The term "therapeutic community" is widely used to represent a distinct approach in almost any setting, including community residences, hospital wards, prisons, and homeless shelters. One effect of this labeling has been to cloud understanding of the TC as a drug abuse treatment approach, how well it works, where it works best, and for which clients it is most appropriate. This article attempts to further a general understanding of residential TCs. Distinctions are drawn between residential drug abuse treatment and residential TCs. The diversity of programs within the TC modality is described in terms of modifications of the model and applications to special populations; and the essential elements of the TC program model are briefly outlined. Finally, movement into the mainstream has surfaced issues for the TC in terms of policy and practice, several of which are highlighted.
Humans↗
Residential drug abuse treatment research: are conventional control designs appropriate for assessing treatment effectiveness?
There has been renewed interest in residential drug abuse treatment research since the late 1980s. Earlier research employed control group designs. This article argues that for today's treatment research, the applicability of control groups created by either matched groups or by random sampling is limited. Four difficulties with control group designs are (1) client differences make assembling matched treatment and control groups untenable, (2) implementing random designs is practically impossible in field research, (3) there are ethical, political, and legal dilemmas in withholding treatment from a control group, and (4) randomly selected client populations will behave differently from the more realistic treatment circumstance involving client populations who are selected based on need and motivation. A more applicable perspective for drug abuse treatment research than the control group design needs to recognize that the client influences the treatment as well as that the treatment influences the client. Also, it must be understood that most clients view residential treatment as only one aspect of their life. Most importantly, individual differences must be taken into account when predicting outcome. A perspective that incorporates these concepts can use client history or baseline as its no-treatment comparative condition, and make use of multivariate analyses to help account for many other influences on outcome.
Humans↗
Treatment for MICAs: design and implementation of the modified TC.
This article describes the main features of an innovative therapeutic community (TC) model adapted for use with mentally ill chemical abusers (MICAs). It describes the rationale for use of the modified TC with MICAs, the treatment structure and environment created, the essential components of the modified TC program, staffing, and the process and goals of client change. Details are given regarding issues and strategies for the implementation of the new program in terms of program planning, staff training, and system initiation. Evaluation data from the authors' research is summarized to support the adoption of the modified TC model. The article makes clear the feasibility of a modified TC model of established effectiveness with a MICA population. This model has now been successfully introduced into mental health, drug treatment, shelter, and correctional settings.
Aftercare↗
Adolescents in therapeutic communities: one-year posttreatment outcomes.
Given the dearth of information concerning outcomes for adolescents who have been in treatment for substance abuse and related problems, the purpose of the present article is to examine the posttreatment status of adolescents who have been in residential therapeutic communities (TCs). One-year posttreatment outcome data are described for 485 adolescents, and separately for treatment "completers" and "noncompleters." The majority of the sample had been mandated to treatment by the criminal justice system. Most reported marijuana as their main drug of abuse. There were significant reductions in drug use and criminal activity, and the most consistent predictors of positive outcomes were completion of treatment and not associating with deviant peers posttreatment. The findings were obtained on a treatment sample for whom there is relatively little research to date; they provide important evidence for the effectiveness of the therapeutic community for this population.
Adolescent↗
Adolescent amphetamine users in treatment: client profiles and treatment outcomes.
This study compares client profiles of adolescent amphetamine users to those of nonusers and examines the multivariate prediction of posttreatment drug use, criminal, and HIV risk behavior outcomes in the year following their separation from treatment. Data were collected as part of a larger longitudinal study on a sample of 938 adolescents who were admitted to residential therapeutic community drug treatment programs across the eastern United States and Canada from April of 1992 through April of 1994. A subsample of 485 adolescents were reinterviewed one year after their separation from treatment. Findings indicated that amphetamine users tended to be white, older, and have parents with higher education and occupational levels than nonusers. However, they also had more psychopathology, more extensive drug use and criminal histories, and engaged in more HIV-risk behaviors than nonusers. Additionally, amphetamine users tend to come from homes where one or both parents used illicit drugs, drank regularly, or had a mental illness, and they often reported histories of childhood maltreatment. Analyses of the one-year follow-up data indicated that being an amphetamine user was not related to treatment outcome after the client's demographic characteristics, overall drug use severity, and treatment completion were taken into account. Therefore, therapeutic community treatment appears to be an effective means of treating adolescent amphetamine users.
Adolescent↗
Male and female drug abusers: social and psychological status 2 years after treatment in a therapeutic community.
A sample of male (N = 214) and female (N = 74) dropouts and graduates from the 1974 population in Phoenix House were followed 2 years after treatment. The sample was mainly opioid abusers, Black, and 19-26 years of age. A 4-h face-to-face interview traced social adjustment from 1 year pre- through all years posttreatment. Clients were retested with a psychological battery initially given at admission or during treatment. Results showed that success (no crime and no opioid use and/or no use of a nonopioid primary drug) was maintained throughout 2 years of follow-up by 38% of the males (dropouts 32.9%, graduates, 73.9%) and 42% of the females (dropouts 40.7%, graduates 50.0%); improvement (change from pretreatment status) occurred in over 59% of the males and 60% of the females; success and improvement increased by time in program for both sexes; psychological improvement during treatment and at follow-up was correlated with posttreatment success status. Among successes, the female improvement was significantly larger. The psychological improvement for women appears related to social-role factors that are modified during residency in the therapeutic community.
Adult↗
Therapeutic communities: diversity in treatment elements.
This study addresses the need to describe the diversity of therapeutic community (TC) programs. The Survey of Essential Elements Questionnaire (SEEQ) was used to develop a typology of TC programs based on 19 programs that identified themselves as traditional or modified TCs in the Drug Abuse Treatment Outcome Studies (DATOS). These traditional and modified TCs differed in adherence to the elements of TC treatment, on operational characteristics, and in client mix. Differences in treatment philosophy and approach included the emphasis on self-reliance, and the use of work as a therapeutic agent for traditional TCs. There were also trends for traditional TC programs to utilize community-as-method, provide educational and vocational training, and include family members as part of therapy. Modified programs showed a greater tendency to rely on counselors. Implications of the findings for program quality, health care policy, and research are discussed.
Combined Modality Therapy↗