The Effectiveness of the Treatment Readiness and Induction Program (TRIP) for Improving During-Treatment Outcomes.

Treatment engagement is a primary pathway to change. Because motivation consistently predicts engagement and sustained recovery following treatment, targeted efforts at improving problem recognition (i.e., a significant ingredient in motivation) during early weeks of treatment are critical. The purpose of this study is to compare the effectiveness of Standard Operating Practice (SOP) versus SOP plus an 8-session Treatment Readiness and Induction Program (TRIP; delivered in the first weeks of treatment) on cognitive indicators and treatment engagement among youth in 5 residential substance use treatment settings. Structural Equation Modeling (SEM) documented higher problem recognition, decision making, and treatment engagement (participation, satisfaction, counselor rapport) among youth receiving TRIP (compared to SOP only), even when controlling for background characteristics such as age, race-ethnicity, gender, baseline drug use severity, etc. Findings suggest that TRIP is an effective induction tool that directly impacts targeted constructs (i.e., problem recognition, decision making), and also directly affects indicators of engagement.

Effectiveness of a theoretically-based judgment and decision making intervention for adolescents.

Although adolescents demonstrate capacity for rational decision making, their tendency to be impulsive, place emphasis on peers, and ignore potential consequences of their actions often translates into higher risk-taking including drug use, illegal activity, and physical harm. Problems with judgment and decision making contribute to risky behavior and are core issues for youth in treatment. Based on theoretical and empirical advances in cognitive science, the Treatment Readiness and Induction Program (TRIP) represents a curriculum-based decision making intervention that can be easily inserted into a variety of content-oriented modalities as well as administered as a separate therapeutic course. The current study examined the effectiveness of TRIP for promoting better judgment among 519 adolescents (37 % female; primarily Hispanic and Caucasian) in residential substance abuse treatment. Change over time in decision making and premeditation (i.e., thinking before acting) was compared among youth receiving standard operating practice (n = 281) versus those receiving standard practice plus TRIP (n = 238). Change in TRIP-specific content knowledge was examined among clients receiving TRIP. Premeditation improved among youth in both groups; TRIP clients showed greater improvement in decision making. TRIP clients also reported significant increases over time in self-awareness, positive-focused thinking (e.g., positive self-talk, goal setting), and recognition of the negative effects of drug use. While both genders showed significant improvement, males showed greater gains in metacognitive strategies (i.e., awareness of one's own cognitive process) and recognition of the negative effects of drug use. These results suggest that efforts to teach core thinking strategies and apply/practice them through independent intervention modules may benefit adolescents when used in conjunction with content-based programs designed to change problematic behaviors.

Improving Adolescent Judgment and Decision Making.

Human judgment and decision making (JDM) has substantial room for improvement, especially among adolescents. Increased technological and social complexity "ups the ante" for developing impactful JDM interventions and aids. Current explanatory advances in this field emphasize dual processing models that incorporate both experiential and analytic processing systems. According to these models, judgment and decisions based on the experiential system are rapid and stem from automatic reference to previously stored episodes. Those based on the analytic system are viewed as slower and consciously developed. These models also hypothesize that metacognitive (self-monitoring) activities embedded in the analytic system influence how and when the two systems are used. What is not included in these models is the development of an intersection between the two systems. Because such an intersection is strongly suggested by memory and educational research as the basis of wisdom/expertise, the present paper describes an Integrated Judgment and Decision-Making Model (IJDM) that incorporates this component. Wisdom/expertise is hypothesized to contain a collection of schematic structures that can emerge from the accumulation of similar episodes or repeated analytic practice. As will be argued, in comparisons to dual system models, the addition of this component provides a broader basis for selecting and designing interventions to improve adolescent JDM. Its development also has implications for generally enhancing cognitive interventions by adopting principles from athletic training to create automated, expert behaviors.

Trust-Based Relational Intervention (TBRI): A Systemic Approach to Complex Developmental Trauma.

Children and youth who have experienced foster care or orphanage-rearing have often experienced complex developmental trauma, demonstrating an interactive set of psychological and behavioral issues. Trust-Based Relational Intervention (TBRI) is a therapeutic model that trains caregivers to provide effective support and treatment for at-risk children. TBRI has been applied in orphanages, courts, residential treatment facilities, group homes, foster and adoptive homes, churches, and schools. It has been used effectively with children and youth of all ages and all risk levels. This article provides the research base for TBRI and examples of how it is applied.

Addiction treatment outcomes, process and change: Texas Institute of Behavioral Research at Texas Christian University.

For more than 40 years the Texas Institute of Behavioral Research (IBR) has given special attention to assessment and evaluation of drug user populations, addiction treatment services and various cognitive and behavioral interventions. Emphasis has been on studies in real-world settings and the use of multivariate methodologies to address evaluation issues within the context of longitudinal natural designs. Historically, its program of addiction treatment research may be divided into three sequential epochs-the first era dealt mainly with client assessment and its role in treatment outcome and evaluation (1969-89), the second focused upon modeling the treatment process and the importance of conceptual frameworks (1989-2009) in explaining the relationships among treatment environment, client attributes, treatment process and outcome, and the third (and current) era has expanded into studying tactical deployment of innovations and implementation. Recent projects focus upon adapting and implementing innovations for improving early engagement in adolescent residential treatment settings and drug-dependent criminal justice populations. Related issues include the spread of human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases, organizational and systems functioning, treatment costs and process related to implementation of evidence-based practices.

Gender differences in psychosocial functioning across substance abuse treatment.

The present study investigated gender differences in psychosocial functioning among clients mandated to substance abuse treatment. In the current study, 210 probationers' self reports of depression, anxiety, self esteem, decision-making, life beliefs, role modeling, cooperation, and AIDS risky behavior were gathered. Ratings were collected at intake as well as midway and toward the end of the residential phase of treatment. A series of growth curve models were used to examine changes in psychosocial functioning across these time periods. Improvements were recorded in several areas of psychosocial functioning over the course of treatment (including anxiety, depression, self esteem, decision-making, role modeling, and life beliefs). Importantly, significant gender by time interactions indicated that females showed greater rates of change than their male counterparts in such areas as self esteem, decision-making, and role modeling. The importance of psychosocial change and the implications of these gender differences are discussed.

Visual representation tools for improving addiction treatment outcomes.

To examine the effectiveness of two visual representation counseling techniques for reducing illicit drug use, participants were randomly assigned to receive standard treatment "as usual" or standard treatment supplemented with free mapping or free plus guide mapping. Each counselor delivered all types of treatment to participants to control for differences in counselor characteristics (e.g., experience, empathy). Eighty-two participants who had received one year of methadone maintenance treatment and had urinalysis and self-report data for illicit drug use six months after treatment were examined. Compared to participants receiving standard treatment, participants randomly assigned to the free plus guide mapping condition had significantly lower opiate use based on urinalysis and self-report data. These results support the use of the free plus guide visual representation strategy and provide evidence for the concurrent validity of self-report measures of illicit drug use.

Assessing organizational functioning as a step toward innovation.

Innovate and adapt are watchwords for substance abuse treatment programs in today's environment of legislative mandates, effective new interventions, and competition. Organizations are having to evolve - ready or not - and those that are ready have superior chances for success and survival. The Texas Christian University Organizational Readiness for Change (ORC) survey is a free instrument, with supporting materials, that substance abuse treatment programs use to assess organizational traits that can facilitate or hinder efforts at transition. This article presents organizational change as a three-stage process of adopting, implementing, and routinizing new procedures; describes the use of the ORC; and outlines a step-by-step procedure for clearing away potential obstacles before setting forth on the road to improved practices and outcomes.

Using motivational activities to facilitate treatment involvement and reduce risk.

The current study examined the effectiveness of motivational modules the authors designed to enhance motivation and confidence for treatment. One hundred and forty-six (146) probationers either received treatment as usual ("standard treatment") or standard treatment enhanced with the motivational modules. The results indicate that probationers who received the motivational activities were more motivated to be involved in treatment and reduce risky behaviors (e.g., drinking, drug use, risky sex) toward the end of the residential phase of treatment. Methods to improve the intervention, including the development of 10 to 15 minute long micromodules to serve as booster sessions, are discussed.

Node-link mapping in individual counseling: treatment impact on clients with ADHD-related behaviors.

Three types of individual drug abuse counseling were investigated in a private methadone clinic in order to replicate and extend previous work on node-link mapping techniques (two dimensional graphic approaches for visualizing problems and solutions). Standard counseling, enhanced counseling with free-form maps (f-maps), and enhanced counseling with both f-maps and guide-maps (g-maps) were compared at six and 12 months of treatment. Also assessed were differential effects of these counseling conditions on clients with low and high levels of behaviors related to attention deficit hyperactivity disorder (ADHD; low-problem versus high-problem clients). Dependent variables included the number of scheduled sessions attended per month, counselor ratings of session characteristics (e.g., powerful, valuable), client psychological status ratings (i.e., self-esteem, depression, and anxiety) and treatment retention (i.e., the number of months clients remained in treatment). Findings replicate and extend prior work indicating the positive impact of using node-link maps in individual drug abuse counseling. Particular benefits were found for clients with high levels of ADHD-related problems.

The importance of need for cognition and educational experience in enhanced and standard substance abuse treatment.

The current study examined the relationship between need for cognition (i.e., cognitive motivation or "will") and educational experience (i.e., cognitive ability or "skill") to perceived improvements during treatment of probationers receiving residential treatment within the criminal justice system. Probationers were randomly assigned to either receive motivational activities developed by the authors (the "enhanced" condition), or treatment as usual (but with access to general reading materials in lieu of the motivational activities). Need for cognition and educational experience were assessed and used as blocking variables, and ratings of progress were assessed midway and toward the end of treatment. The results indicate that both need for cognition and educational experience are important predictors of improvement during treatment, and that the motivational activities developed by the authors were particularly valuable for clients with lower levels of need for cognition.

Cognitive skills training: impact on drug abuse counseling and readiness for treatment.

As part of an NIDA-sponsored project, the current study investigated the effectiveness of a skills program we developed called the TCU Cognitive Skills Module (CSM). The program was developed to address cognitive deficits that may impede substance abuse treatment within the criminal justice system. Probationers in a 4-month residential program (followed by 3 months of aftercare) were randomly assigned (by community) to receive standard treatment or treatment enhanced with the CSM program. Peer ratings, individual ratings of the community, and counselor assessments revealed that the CSM was effective in increasing perceived treatment effectiveness (particularly midway through the program). There was also some support for the CSM being especially effective for probationers who enter treatment with lower levels of treatment readiness.

A model of the effects of node-link mapping on drug abuse counseling.

This paper examines the effectiveness of a promising cognitive enhancement technique called node-link mapping. Maps provide a concrete, visual, and computationally efficient means for exploring personal issues, and have received substantial empirical support. We introduce two models to provide a framework for understanding how node-link mapping improves substance abuse counseling. The TCU Process Model reviews the general process of substance abuse treatment. The second model reflects an effective treatment session. Implications of the models and node-link mapping findings are discussed, as well as future research directions.

Mapping training: the transfer of a cognitive technology for improving counseling.

To provide information that will reduce the gap between research and practice, the transfer of a complex drug abuse counseling technology is examined. This technology, cognitive mapping, is a graphic tool shown to effectively facilitate communication and problem solving in group and individual counseling sessions. Unlike some techniques, mapping requires substantial counselor time, effort, and expertise to learn and to use. This article briefly describes the development and evolution of mapping and supporting research. It then focuses on our efforts to develop mapping training that will facilitate use of this evidence-based technique in drug abuse treatment. Major training and transfer pitfalls are noted, and strategies for successful training are recommended.