Date of Award

2013

Degree Type

Thesis

Degree Name

Doctor of Psychology

School

School of Psychology and Social Sciences

Faculty

Computing, Health and Science

First Advisor

Dr David Ryder

Second Advisor

Professor Lynne Cohen

Third Advisor

Associate Professor Ken Greenwood

Abstract

Research undertaken in the last three decades has consistently reported that the length of time spent in inpatient and outpatient alcohol and other drug (AOD) treatment programs predicts treatment success (De Leon, Melnick, Kressel, & Jainchill, 1994; Hubbard, Craddock, & Anderson, 2003; Simpson, Joe, Fletcher, Hubbard, & Anglin, 1999). However, treatment attrition rates are high and present a major problem for improving treatment outcomes. Various factors that have been reportedly associated with increased AOD treatment attrition rates include being female, younger clients, clients using methamphetamines, and clients with elevated psychopathology scores. The aim of this thesis is to improve understanding of various factors reported in the research literature to influence AOD treatment retention, including client psychopathology, age, gender and primary drug of abuse. The research was conducted in two phases. Phase one involved an analysis of archival data of clients admitted to a single Australian therapeutic community (TC) program over a 6-year period (2000-2005).The second stage involved a focus group comprised of nine Australian and New Zealand therapeutic community managers and senior clinicians who discussed the findings from the first phase of the study and provided feedback on these findings. The focus group also discussed barriers and solutions to incorporating these findings in TC treatment services. The results from the first phase indicated that elevated anxiety and depression scores at entry to treatment were strong predictors of client retention at 8 weeks, and retention at 14 weeks was predicted by high self-esteem scores at entry. Clients receiving medication (primarily anti-depressant medication) were more likely retained at 14 weeks. Older clients (24 – 29 years, and 30 – 50 years) were significantly more likely to drop out of treatment by the 14 week stage compared with the younger client group (17 – 24 years). The second stage revealed general agreement with the findings, provided support for the efficacy of TC treatment for clients with comorbid mental health problems, highlighted challenges and benefits of working with mental health services, and suggested other factors influencing treatment retention. The first stage findings contribute to the understanding of TC treatment retention factors with an Australian population, but do not support previous findings that female clients, younger clients, clients with elevated anxiety or depression scores, or clients with methamphetamine abuse problems are more likely to drop out of TC treatment. This study involved the collection of a large client database from a single TC over six years, including the longitudinal collection of client psychometric data at various stages throughout treatment. This study makes an important contribution to the understanding of various client factors and their respective influence on client retention and attrition within an Australian therapeutic community. The study has relevance for residential substance abuse treatment services in many countries, but has special relevance within Australia where few studies focusing on TC retention have been undertaken. There have been even less studies focusing on TC retention that have included longitudinal psychometric data collected from a client population primarily comprised of young methamphetamine-users.

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