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Correlates of therapeutic involvement among adolescents in residential drug treatment

Josephine Hawke

Adolescents are notoriously difficult to engage and retain in treatment, which is documented by several studies (1-5) that report high dropout rates for adolescents in treatment. Compared to adults, adolescents also may require longer treatment tenures to produce similar positive treatment outcomes e.g., Burkstein (6), Hubbard et al. (2) Jainchill et al. (7), Sells and Simpson (4), Brown et al. (8). These findings underscore the need to understand the factors that affect the early engagement of adolescents in the therapeutic process.

Relatively few studies have examined treatment process among adolescents in residential drug treatment, especially those with severe psychiatric symptoms – see reviews by Burkstein (6), Catalano et al. (9), Lipsey and Wilson (10), Weisz et al. (11), Williams and Chang (5). As a result, there is a critical need for research on the therapeutic involvement (TI) among adolescent substance users in treatment. Toward this end, the current study reports on the psychometric properties of measures of therapeutic involvement that were derived from therapeutic involvement scales that have been widely used among adults and examines the correlates of therapeutic involvement among a sample of adolescents in residential drug treatment.

Therapeutic involvement and the services that clients receive during treatment are among the best predictors of treatment retention and are associated through retention to post-treatment outcomes. Models of therapeutic involvement in treatment link higher levels of therapeutic involvement to increased odds of client retention and better posttreatment outcomes, e.g., De Leon et al. (12), Joe et al. (13), Simpson et al. (14). However, most theoretical models of therapeutic involvement and treatment progress, as well as how to measure concepts like treatment engagement and counselor rapport, have stemmed from research on adult populations. Studies of adolescent populations that use proxies of therapeutic involvement such as overall treatment service intensity, types of services, unmet needs, counselor rapport, and satisfaction with treatment to examine the treatment process also find similar results among youths, e.g., Hser et al. (15).

Conceptually, therapeutic involvement refers to clients' active engagement in the therapeutic process and acceptance of their own contributions to problem maintenance and resolution. Therapeutic involvement facilitates the recovery process. Clients who participate more fully in the therapeutic process develop key recovery skills such as emotional self-regulation, effective coping, and better understanding of self--factors critical to a successful recovery process, see Winters (16). Another aspect of therapeutic involvement includes feeling a positive rapport with treatment staff; as clients become more involved in the therapeutic process, they are more likely to become more trusting of their counselors and consequently engage more in the program and its staff. Therapeutic involvement is related to other client factors that are associated with client treatment, engagement, and retention, such as gender, psychiatric symptoms, drug use severity, self-esteem, and family characteristics (6, 15-22). Joe et al. (13) found that adolescents who reported more social support at entry to residential drug treatment exhibited significantly higher levels of therapeutic involvement during treatment. Other studies document the positive impact of better social supports on treatment retention and post-treatment outcomes, e.g., Coughey et al. (23), Richter et al. (24), Siddall and Conway (25), Simpson et al. (14).


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(21.) Hawke JM, Jainchill N, De Leon G. The prevalence of sexual abuse and its impact on onset of drug use among adolescents in therapeutic community drug treatment. J Child Adolesc Subst Abuse 2000; 9(3):35-49.

(22.) Hser YI, Polinsky ML, Maglione M, Anglin MD. Matching clients' needs with drug treatment services. J Subst Abuse Treat 1999; 16(4):299-305.

(23.) Coughey K, Feighan K, Cheney R, Klein G. Retention in an aftercare program for recovering women. Subst Use Misuse 1998; 33(4):917-933.

(24.) Richter S, Brown S, Mott M. The impact of social support and self-esteem on adolescent substance abuse treatment outcome. J Subst Abuse 1991; 3:371-385.

(25.) Siddall JW, Conway GL. Interactional variables associated with retention and success in residential drug treatment. Int J Addict 1988; 23(12): 1241-1254.

Hawke, J.M. (2005). Correlates of therapeutic involvement among adolescents in residential drug treatment.
American Journal of Drug and Alcohol Abuse, February 2005.

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