Advertisement

Community Clinics

  • Jesse B. Milby
  • Kimberly Crouch
  • Adam Perkins
  • Octavia Jackson
Chapter

Abstract

This chapter reviews community services available for the group treatment of substance use disorders. Sources of this investigation include data from national surveys and clinical trials, literature from leading scholars and agencies, and peer-reviewed articles. Community substance use disorder treatments are discussed in historical context beginning pre-Civil War through the present and the influences of legislative acts, changes in societal attitudes, availability of funding and resources, and fluctuations in illicit drug trade are noted. Current community group treatment approaches are described in detail and the implementation of various services is compared across public and private sectors; a comparison of for-profit and non-profit treatment agencies is also included. The current problems in treatment fidelity are highlighted, specifically regarding the standardization of treatment, employee retention and education, and institutional instability. Lastly, the authors stress the need for all community substance use disorder treatment services to employ evidence-based practice.

Keywords

Substance abuse group treatment Community substance abuse treatment Substance abuse treatment fidelity Community substance abuse evidence-based treatment 

References

  1. 1.
    Alessi SM, Hanson T, Wieners M, Petry NM (2007) Low-cost contingency management in community clinics: delivering incentives partially in group therapy. Exp Clin Psychopharmacol 15(3):293–300PubMedCrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn, text revision. Washington, DCGoogle Scholar
  3. 3.
    American Psychological Association Statement: Policy Statement on Evidence-Based Practice in Psychology (2005) American Psychological Association, Washington DCGoogle Scholar
  4. 4.
    Ball JD, Ross A (1991) The effectiveness of methadone maintenance treatment. Springer, New YorkCrossRefGoogle Scholar
  5. 5.
    Bartholomew NG, Joe GW, Rowan-Szal GA, Simpson DD (2007) Counselor assessments of training and adoption barriers. J Subst Abuse Treat 33(2):193–199PubMedCrossRefGoogle Scholar
  6. 6.
    Brecher EM (1972) Licit and illicit drugs. Little Brown, BostonGoogle Scholar
  7. 7.
    Carey KB (1996) Substance use reduction in the context of outpatient psychiatric treatment: a collaborative, motivational, harm reduction approach. Community Mental Health J 32:291–306CrossRefGoogle Scholar
  8. 8.
    Carroll K, Rounsaville B, Keller D (1991) Relapse prevention strategies for the treatment of cocaine abuse. Am J Drug Alcohol Abuse 17(3):249–265PubMedCrossRefGoogle Scholar
  9. 9.
    Carroll KM (1997) Manual-guided psychosocial treatment. A new virtual requirement for pharmacotherapy trials? Arch Gen Psychiatry 54(10):923–928PubMedCrossRefGoogle Scholar
  10. 10.
    Carroll KM, Fenton LR, Ball SA, Nich C, Frankforter TL, Shi J, et al (2004) Efficacy of disulfiram and cognitive behavior therapy in cocaine-dependent outpatients. Archiv Gen Psychiatry 61:264–272CrossRefGoogle Scholar
  11. 11.
    Carroll KM, Onken LS (2005) Behavioral therapies for drug abuse. Am J Psychiatry 162(8):1452–1460PubMedCrossRefGoogle Scholar
  12. 12.
    Carroll KM, Rounsaville BJ, Nich C, Gordon LT, Wirtz PW, Gawin F (1994) One year follow-up of psychotherapy and pharmacotherapy for cocaine dependence: delayed emergence of psychotherapy effects. Archiv Gen Psychiatry 51:989–997CrossRefGoogle Scholar
  13. 13.
    Chambers CD (1972) The detoxification of narcotic addicts in outpatient clinics. In: Brill L, Lieberman L (eds) Major modalities in the treatment of drug abuse. Behavioral Publications, New YorkGoogle Scholar
  14. 14.
    Cnaan RA, Boddie SC (2002) Charitable choice and faith-based welfare: a call for social work. Social Work 47(3):224–235PubMedCrossRefGoogle Scholar
  15. 15.
    Condelli WS, Hubbard RL (1994) Client outcomes from therapeutic communities. In: Tims FM, De Leon G, Jainchill N (eds) Therapeutic community: advances in research and application. NIDA Research Monograph 144 (NIH Publication No. 94-3633), Rockville, MD, pp 80–98Google Scholar
  16. 16.
    Crits-Christoph P, Siqueland L, Blaine J, Frank A, Luborsky L, Onken LS et al (1999) Psychosocial treatments for cocaine dependence: national institute on drug abuse collaborative cocaine treatment study. Archiv Gen Psychiatry 56:493–502CrossRefGoogle Scholar
  17. 17.
    Davidson L, White W (2007) The concept of recovery as an organizing principle for integrating mental health and addiction services. J Behav Health Services Res 34:109–122CrossRefGoogle Scholar
  18. 18.
    De Leon G (1994) The therapeutic community: toward a general theory and model. In: Tims FM, De Leon G, Jainchill N (eds) Therapeutic community: advances in research and application. NIDA Research Monograph 144 (NIH Publication No. 94-3633), Rockville, MD, pp 16–52Google Scholar
  19. 19.
    DHHS (2006) National survey of substance abuse treatment services (N-SSATS): 2006, data on substance abuse treatment facilities. Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Rockville, MDGoogle Scholar
  20. 20.
    Dole VP, Nyswander ME (1965) A medical treatment for diacetylmorphine (heroin) addiction: a clinical trial with methadone hydrochloride. J Am Med Assoc 193(8):80–84CrossRefGoogle Scholar
  21. 21.
    Dole VP, Nyswander ME (1967) Heroin addiction – a metabolic disease. Archiv Intern Med 120:19–24CrossRefGoogle Scholar
  22. 22.
    Dole VP, Nyswander ME, Warner A (1968) Successful treatment of 750 criminal addicts. J Am Med Assoc 206:2708–2711CrossRefGoogle Scholar
  23. 23.
    Dole VP, Robinson W, Orraca J, Towns E, Searcy P, Caine E (1969) Methadone treatment of randomly selected criminal addicts. N Engl J Med 280(25):1372–1375PubMedCrossRefGoogle Scholar
  24. 24.
    Drake RE, Green AL, Mueser KT, Boldman HH (2003) The history of community mental health treatment and rehabilitation for persons with severe mental illness. Community Mental Health J 39(5):427–440CrossRefGoogle Scholar
  25. 25.
    Drake RE, Mueser KT, Brunette MF (2004) A review of treatments for people with severe mental illnesses and co-occurring substance use disorders. Psychiatric Rehabil J 27:360–374CrossRefGoogle Scholar
  26. 26.
    Epstein J, Barker P, Vorburger M, Murtha C (2002) Serious mental illness and its co-occurrence with substance use disorders. Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Rockville, MDGoogle Scholar
  27. 27.
    Fals-Stewart WO, O’Farrell TJ, Birchler GR (2001) Behavioral couples therapy for male methadone maintenance patients: effects on drug-using behavior and relationship adjustment. Behav Therapy 32:391–411CrossRefGoogle Scholar
  28. 28.
    Gawin FH, Kleber HD (1984) Cocaine abuse treatment: an open pilot trial with lithium carbonate and desipramine. Archiv Gen Psychiatry 41:903–910CrossRefGoogle Scholar
  29. 29.
    Gawin FH, Kleber HD (1986) Abstinence symptomatology and psychiatric diagnosis in cocaine abusers: clinical observations. Archiv Gen Psychiatry 47:861–868Google Scholar
  30. 30.
    Gay G, Matzger A, Bathurst W, Smith D (1971) Short-term heroin detoxification on an outpatient basis. Int J Addictions 6:259–260Google Scholar
  31. 31.
    Greenfield SF, Trucco EM, McHugh RK, Lincoln M, Gallop RJ (2007) The women’s recovery group study: a Stage I trial of women-focused group therapy for substance use disorders versus mixed-gender group drug counseling. Drug Alcohol Depend 1(6):39–47CrossRefGoogle Scholar
  32. 32.
    Guess LL, Tuchfeld BS (1977) Manual for drug abuse treatment program self-evaluation supplement II: CODAP tables. U.S. Government Printing Office, Washington, D.C.Google Scholar
  33. 33.
    Hall SM, Loeb PC, Kushner M (1984) Methadone dose decreases and anxiety reduction. Addict Behav 9:11–19PubMedCrossRefGoogle Scholar
  34. 34.
    Higgins ST, Delaney DD, Budney AJ, Bickel WK, Hughes JR, Foerg F et al (1991) A behavioral approach to achieving initial cocaine abstinence. Am J Psychiatry 148(9):1218–1224PubMedGoogle Scholar
  35. 35.
    Himmelsbach CK (1942) Clinical studies of drug addiction: physical dependence, withdrawal, and recovery. Archiv Intern Med 69:766CrossRefGoogle Scholar
  36. 36.
    Huber A, Ling W, Shoptaw S, Gulati V, Brethen P, Rawson R (1997) Integrating treatments for methamphetamine abuse: a psychosocial perspective. J Addictive Dis 16:41–50Google Scholar
  37. 37.
    Ingersoll R (2001) Teacher turnover and teacher shortages: an organizational analysis. Am Educ Res J 38:499–534CrossRefGoogle Scholar
  38. 38.
    Joe GW, Simpson DD (1974) Research on patient retention in treatment. Paper presented at the American Psychological Association, New OrleansGoogle Scholar
  39. 39.
    Jones H (2007) Addiction and pregnancy. In: Henningfield JE, Santora PB, Bickel WK (eds) Addiction treatment: science and policy for the twenty-first century. Johns Hopkins University, BaltimoreGoogle Scholar
  40. 40.
    Kang SY, Kleinman PH, Woody GE, Millman RB, Todd TC, Kemp J, Lipton DS (1991) Outcomes for cocaine abusers after once-a-week psychosocial therapy. Am J Psychiatry 148(5):630–635PubMedGoogle Scholar
  41. 41.
    Kimberly J, McLellan T (2006) The business of addiction treatment: a research agenda. J Subst Abuse Treat 31(3):213–219PubMedCrossRefGoogle Scholar
  42. 42.
    Kirk C, Amaranth K (1998) Staffing issues in work with women at risk for and in recovery from substance abuse. Women’s Health Issues 8(4):261–266PubMedCrossRefGoogle Scholar
  43. 43.
    Kleber HD (1977) Detoxification from methadone maintenance: the state of the art. Int J Addictions 12(7):807–820Google Scholar
  44. 44.
    Kleber HD, Riordan CE (1982) The treatment of narcotic withdrawal: a historical review. J Clin Psychiatry 43(6.2):30–34PubMedGoogle Scholar
  45. 45.
    Knudsen HK, Johnson A, Roman PM (2003) Retaining counseling staff at substance abuse treatment centers: effects of management practices. J Subst Abuse Treat 24(2):129–135PubMedCrossRefGoogle Scholar
  46. 46.
    Ledgerwood DM, Petry NM (2006) Does contingency management affect motivation to change substance use? Drug Alcohol Depend 83:65–72PubMedCrossRefGoogle Scholar
  47. 47.
    Marlatt GA, Gordon JR (1985) Relapse prevention: maintenance strategies in the treatment of addictive behaviors. Guilford, New YorkGoogle Scholar
  48. 48.
    Maude-Griffin PM, Hohenstein JM, Humfleet GL, Reilly PM, Tusel DJ, Hall SM (1998) Superior efficacy of cognitive-behavioral therapy for crack cocaine abusers: main and matching effects. J Consult Clin Psychol 66:832–837PubMedCrossRefGoogle Scholar
  49. 49.
    Maurer DW, Vogel VH (1973) Narcotics and narcotic addiction, 4th edn. Charles C. Thomas, Springfield, ILGoogle Scholar
  50. 50.
    McCarty D, Fuller B, Kaskutas LA, Wendt WW, Nunes EV, Miller M et al (2008) Treatment programs in the national drug abuse treatment clinical trials network. Drug Alcohol Depend 92:200–207PubMedCrossRefGoogle Scholar
  51. 51.
    McLellan AT, Carise D, Kleber HD (2003) Can the national addiction treatment infrastructure support the public’s demand for quality care? J Subst Abuse Treat 25(2):117–121PubMedCrossRefGoogle Scholar
  52. 52.
    Milby JB (1981) Addictive behavior and its treatment. Springer, New YorkGoogle Scholar
  53. 53.
    Milby JB (1988) Methadone maintenance to abstinence: how many make it? Journal of Nervous and Mental Diseases, 176(7), 409–422CrossRefGoogle Scholar
  54. 54.
    Milby JB, Garrett C, Meredith R (1980) Latrogenic phobic disorder in methadone maintenance treated patients. Int J Addictions 15(5):747–757Google Scholar
  55. 55.
    Milby JB, Hohmann AA, Gentile M, Huggins N, Sims MK, McLellan AT et al (1994) Methadone maintenance outcome as a function of detoxification phobia. Am J Psychiatry 151(7):1031–1037PubMedGoogle Scholar
  56. 56.
    Milby JB, Schumacher JE, McNamara C, Wallace D, Usdan S, McGill T et al (2000) Initiating abstinence in cocaine abusing dually diagnosed homeless persons. Drug Alcohol Depend 60(1):55–67PubMedGoogle Scholar
  57. 57.
    Milby JB, Schumacher JE, Raczynski JM, Caldwell E, Engle M, Michael M et al (1996) Sufficient conditions for effective treatment of substance abusing homeless persons. Drug Alcohol Depend 43(1–2):39–47PubMedCrossRefGoogle Scholar
  58. 58.
    Milby JB, Schumacher JE, Vuchinich RE, Freedman MJ, Kertesz S, Wallace D (2008) Toward cost-effective initial care for substance-abusing homeless. J Subst Abuse Treat 34(2):180–191PubMedCrossRefGoogle Scholar
  59. 59.
    Milby JB, Schumacher JE, Vuchinich RE, Wallace D, Plant MA, Freedman MJ et al (2004) Transitions during effective treatment for cocaine-abusing homeless persons: establishing abstinence, lapse, and relapse, and reestablishing abstinence. Psychol Addict Behav 18(3):250–256PubMedCrossRefGoogle Scholar
  60. 60.
    Milby JB, Schumacher JE, Wallace D, Freedman MJ, Vuchinich RE (2005) To house or not to house: the effects of providing housing to homeless substance abusers in treatment. Am J Public Health 95(7):1259–1265PubMedCrossRefGoogle Scholar
  61. 61.
    Moos RH (2007) Theory based active ingredients of effective treatments for substance use disorders. Drug Alcohol Depend 88(2–3):109–121PubMedCrossRefGoogle Scholar
  62. 62.
    Mueser KT, Noorday DL, Drake RE, Fox L (2003) Integrated treatment for dual disorders: a guide to effective practice. Guilford, New YorkGoogle Scholar
  63. 63.
    National Institute on Drug Abuse (1999) Principles of drug addiction treatment: a research-based guide. NIH Publication No. 99-4180, Washington DCGoogle Scholar
  64. 64.
    Petry NM, Peirce JM, Stitzer ML, Blaine B, Roll JM, Cohen A et al (2005) Effect of Prize-based Incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs. Archiv Gen Psychiatry 62:1148–1156CrossRefGoogle Scholar
  65. 65.
    Project MATCH Research Groups (1997) Matching alcoholism treatments to client heterogeneity: project MATCH posttreatment drinking outcomes. J Studies Alcohol 58(1):7–29Google Scholar
  66. 66.
    Rawson R, Obert JL, McCann MJ, Ling W (1991) Psychological approaches for the treatment of cocaine dependence—a neurobehavioral approach. J Addictive Dis 11(2):97–120CrossRefGoogle Scholar
  67. 67.
    Rawson R, Shoptaw S, Obert JL, McCann M, Hasson A, Marinelli-Casey P et al (1995) An intensive outpatient approach for cocaine abuse: the matrix model. J Subst Abuse Treat 12(2):117–127PubMedCrossRefGoogle Scholar
  68. 68.
    Rawson RA, Huber A, McCann M, Shoptaw S, Farabee D, Ling W (2002) A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Archiv Gen Psychiatry 59:593–600CrossRefGoogle Scholar
  69. 69.
    Ridgely MS, Goldman HH, Willenbring M (1990) Barriers to the care of persons with dual diagnoses: organizational and financing issues. Schizophr Bull 16:123–132PubMedCrossRefGoogle Scholar
  70. 70.
    Rodgers JH, Barnett PG (2000) Two separate tracks? A national multivariate analysis of differences between public and private substance abuse treatment programs. Am J Drug Alcohol Abuse 26(3):429–442PubMedCrossRefGoogle Scholar
  71. 71.
    Roman R, Ducharme L, Knudsen H (2006) Patterns of organization and management in private and public substance abuse treatment programs. J Subst Abuse Treat 31(3):235–243PubMedCrossRefGoogle Scholar
  72. 72.
    SAMHSA (2004) National survey on drug use & health. Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Rockville, MDGoogle Scholar
  73. 73.
    Schumacher JE, Mennemeyer ST, Milby JB, Wallace D, Nolan K (2002) Costs and effectiveness of substance abuse treatments for homeless persons. J Mental Health Policy Econ 5(1):33–42Google Scholar
  74. 74.
    Schumacher JE, Milby JB, Wallace D, Meehan DC, Kertesz S, Vuchinich R et al (2007) Meta-analysis of day treatment and contingency-management dismantling research: Birmingham homeless cocaine studies (1990–2006). J Consult Clin Psychol 75(5):823–828PubMedCrossRefGoogle Scholar
  75. 75.
    Sheffet A, Quinones M, Lavenhar MA, Doyle K, Prager H (1976) An evaluation of detoxification as an initial step in the treatment of heroin addiction. Am J Psychiatry 133(3):337–339PubMedGoogle Scholar
  76. 76.
    Shoptaw S, Rawson RA, McCann MJ, Obert JL (1994) The matrix model of outpatient stimulant abuse treatment: evidence of efficacy. J Addict Dis 13(4):129–141PubMedCrossRefGoogle Scholar
  77. 77.
    Siegler M, Osmond H (1968) Models of drug addiction. Int J Addict 3:3–24Google Scholar
  78. 78.
    Simpson DD, Sells SB (1982) Effectiveness of treatment for drug abuse: an overview of the DARP research program. Adv Alcohol Subst Abuse 2(1):7–29CrossRefGoogle Scholar
  79. 79.
    Tellez M (2004) Isn’t an alcohol- or drug-addicted adolescent worth a penny? Self-funding programs can make a difference. J Emerg Nursing 30(3):284–286CrossRefGoogle Scholar
  80. 80.
    Tims F, Jainchill N, De Leon G (1994) Therapeutic communities and treatment research. In: Tims FM, DeLeon G, Jainchill N (eds) Therapeutic community: advances in research and application. NIDA Research Monograph 144 (NIH Publication No. 94-3633), Rockville, MD, pp 1–15Google Scholar
  81. 81.
    Volkow ND (2004) The reality of co-morbidity: depression and drug abuse. Biol Psychiatry 56:714–717PubMedCrossRefGoogle Scholar
  82. 82.
    Wallace BC (1991) Crack cocaine: what constitutes state of the art treatment? J Addiction Dis 11(2):79–95CrossRefGoogle Scholar
  83. 83.
    Washton AM, Stone-Washton N (1990) Abstinence and relapse in outpatient cocaine addicts. J Psychoactive Drugs 22(2):135–147PubMedCrossRefGoogle Scholar
  84. 84.
    Weiss RD, Griffin ML, Kolodziej ME, Greenfield SF, Najavits LM, Daley DC et al (2007) A randomized trial of integrated group therapy versus group drug counseling for patients with bipolar disorder and substance dependence. Am J Psychiatry 164(1):100–107PubMedCrossRefGoogle Scholar
  85. 85.
    Wilson BD, Elms RR, Thompson CP (1975) Outpatient versus hospital methadone detoxification: an experimental comparison. Int J Addictions 10:13–21Google Scholar
  86. 86.
    Zarkin G, Galinis D, French M, Fountain D, Ingram P, Guyett J (1995) Financing strategies for drug abuse treatment programs. J Subst Abuse Treat 12(6):385–399PubMedCrossRefGoogle Scholar
  87. 87.
    Ziedonis DM, Fisher W (1996) Motivation-based assessment and treatment of substance abuse in patients with schizophrenia. Directions Psychiatry 16:1–7Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Jesse B. Milby
    • 1
  • Kimberly Crouch
    • 1
  • Adam Perkins
    • 1
  • Octavia Jackson
    • 1
  1. 1.Consortium for Substance Abuse Research and Training Program, Department of PsychologyUniversity of AlabamaBirminghamUSA

Personalised recommendations