Social problem-solving interventions in medium secure settings for women.

Problem-solving interventions are a feature of overall medium secure treatment programmes. However, despite the relevance of such treatment to personality disorder there are few descriptions of such interventions for women. Beneficial effects for women who completed social problem-solving group treatment were evident on a number of psychometric assessments. A treatment non-completion rate of one-third raises questions of both acceptability and timing of cognitive behavioural interventions.

Women in medium secure care: tracking treatment progress for changes in risk profiles and treatment engagement.

The treatment and risk management programmes in a women's medium secure service are described. Changes in risk profiles and its relationship to treatment engagement are examined in a cohort of women during their stay in a medium secure service. Findings show that clinically significant reductions in risk behaviours were paralleled by increases in treatment engagement. The clinical healthcare implications of these findings are discussed along with the need for further research.

Within-program factors as predictors of drinking outcome following cognitive-behavioral treatment.

The relationship between a variety of within-treatment factors and the outcome of treatment for alcoholism was examined. One hundred and twenty-eight male and 68 female participants (consecutive referrals with an ICD-10 diagnosis of alcohol dependence syndrome) were followed at 12 months following in- and day-patient cognitive behavioral treatment on an addiction unit. Within-treatment factors (of self-efficacy, psychological symptoms, expectations for treatment, treatment satisfaction, treatment climate, therapeutic alliance, and treatment evaluation), were assessed to determine their relationship to global outcome categorization into abstinent, nonproblem drinker, drinking but improved, and unimproved participant groups. A logistic regression analysis identified five variables that were predictive of a more favorable outcome: higher self-efficacy in positive social situations, greater treatment program involvement, a lower perception of staff control, a greater perception of treatment as helpful, and a reduction in psychological symptoms during treatment. Findings confirm previous research that pinpoints the importance of self-efficacy as a treatment variable of significance in treatment planning and delivery. It also highlights the prognostic significance of a reduction in psychological distress and, thus, the value of dynamic predictors of treatment outcome. The failure of the therapeutic alliance to predict outcome is discussed. It is concluded that time-limited alcoholism treatment programs need to give equal emphasis to within-treatment change via the promotion of patient confidence and the perception of helpfulness, as well as to skill-based relapse prevention strategies.

Program accreditation and correctional treatment.

In the correctional field, treatment program accreditation requires the support of correctional administrators and program providers for successful introduction. How accreditation criteria are developed and a support structure for the process in corrections is achieved is in itself an interesting story. Her Majesty's Prison Service has, in 3.5 years, accelerated the effectiveness of correctional treatment programming, established a platform for program integrity, obtained acceptance by the institutional leadership, and increased pride and morale among prison officers. In this article we describe the development, structure, content, and benefits of correctional treatment program accreditation as it has occurred in England and Wales.

Self-efficacy, outcome expectations, and fantasies as predictors of alcoholics' postreatment drinking.

The usefulness of distinguishing between alcoholic patients' expectations and their fantasies about treatment outcome was examined. Results at 6 and 12 months follow-up did not support the results of research with nonalcoholic participants which related better outcomes to a combination of positive expectations and negative fantasies about future drink-related situations. Higher self-efficacy expectancy at intake, however, was associated with better clinical outcome. Findings supported Bandura's (1986) contention that outcome expectations add little information on prediction beyond that explained by self-efficacy expectancy. The clinical implications of these results are discussed.

Treating alcohol problems: a study of programme effectiveness and cost effectiveness according to length and delivery of treatment.

AIMS: To compare effectiveness and cost-effectiveness of a 5-week inpatient and a two week in- and day-patient regime. DESIGN: Pre-post assessment of consecutive treatment referrals with follow-up at 6 and 12 months. In a sequential study design, 112 patients underwent a 5-week residential programme while a subsequent 100 patients underwent a 2-week in- and day-patient programme. To investigate the effect of changing programme delivery, patient groups from before and after the programme changes were compared. SETTING: Addiction treatment unit in an independent hospital. PARTICIPANTS: One hundred and thirty-six males and 76 female patients with an ICD-10 diagnosis of Alcohol Dependence Syndrome. MEASUREMENTS: Self-report (Comprehensive Drinkers Profile: Follow-Up Drinkers Profile: SADQ), collateral report (Collateral Interview Form) and blood test (MCV & GGT) data were used to categorize patients into abstinent, non-problem drinker, drinking but improved and unimproved groups. Percentage of days abstinent, intensity of drinking, length of time in treatment, treatment cost and use of aftercare were also measured. FINDINGS: Abstinence or non-problem drinking was achieved by 55.6% of all patients at 1 year. Change in programme delivery did not affect outcome but treatment costs and mean length of stay for the revised programme were significantly reduced. CONCLUSIONS: A two week in- and day-patient treatment was more cost effective than a 5-week inpatient treatment. Design limitations make these conclusions tentative pending a randomized controlled trial.

Adolescents' experiences of anger in a residential setting.

There is a substantial literature, covering a range of populations, looking at the phenomenon of anger and its expression. However, remarkably little is known about adolescent experiences of anger. The present study looks at adolescent anger within the confines of a residential establishment. Using a qualitative methodology to consider young peoples' own account of anger-provoking incidents, a description is given of typical settings, reactions, and outcomes in angry incidents. The implications of this information for both staff training and anger management programmes is explored.

Staff perceptions of organization change of treatment delivery on an addiction unit.

The Work Environment Scale was used to assess staff perceptions of a change in a treatment programme for problem drinkers. A more cost-effective 2-week research-based day-patient programme, which included the concept of matching, replaced a 5-week cognitive behavioural in-patient programme. The maintenance of a positive work environment was attributed to the meeting of staff expectations, a cognitive behavioural ideology, and the establishment of a research culture. The study highlights the importance of the thorough preparation of staff for change, and their active involvement in the process in settings where work satisfaction is already above the average level for mental health facilities.

The behavioral treatment of self-starvation and severe self-injury in a patient with borderline personality disorder.

The successful treatment by behavioral methods of self-starvation and self-injury in a 35-year-old psychiatric in-patient, with a diagnosis of borderline personality disorder, is described. An individualized program using positive and negative reinforcers to increase food and fluid intake was used, while a token economy therapeutic milieu with time out was used to decrease acts of self-injury and aggression. Progress in treatment generalized to a non-secure treatment environment, and was maintained at an 8-month follow-up. The study illustrates the differential response of active and passive self injurious behaviors to group-based and individual treatments, respectively.

Social functioning and delinquency: a return to basics.

Studies of social functioning among delinquent samples have traditionally looked at social performance skills and various aspects of social cognition. The social skills model proposed by Argyle and Kendon (1967) offers one way to understand the inter-relationships between these various components of social functioning. The present study is a preliminary attempt, with a delinquent sample, to examine the association between social cognition and social performance. In keeping with previous studies, the findings showed overall that the social functioning of the delinquent sample showed a degree of disadvantage. Sex offenders did not differ from non-sex offenders on any of the measures. However, while social perception scores correlated with social performance scores; scores on a social problem-solving task did not correlate with either social perception or social performance. The implications of the study for future methodology and theory are discussed.

Self-help manuals for problem drinking: the relative effects of their educational and therapeutic components.

This study was concerned with the effects of a self-help manual, administered under conditions of minimal therapist contact, on the alcohol consumption of 26 media-recruited volunteers. It was found that the self-help programme was effective in bringing about a reduction in self-reported alcohol consumption. In addition, the order of presentation of the health education and self-management components of the self-help manual was important with respect to outcome. The group receiving the components in the order self-management followed by education showed a better outcome, in terms of lowered alcohol consumption, than a group receiving the same material in the reverse order. An explanation for this is advanced in terms of the model for process of change put forward by Prochaska & DiClemente (1983). Noting that the use of self-help is best documented for those with less severe alcohol dependency, a number of points for both practice and future research are made.

Consistency of alcohol self-report measures in a male young offender population.

The consistency among a number of measures of self-report of alcohol consumption in imprisoned male young offenders was studied by asking 56 young offenders to report, based on a 'typical week', how many days they had consumed alcohol, how many days they were drunk and how much alcohol they had consumed. They were asked to rate their confidence in the accuracy of their self-report and to complete the short EPQ-R, which contains a Lie Scale. Results show that self-report in this population is reliable over time and that different indices of alcohol consumption correlate significantly with each other. Young offenders report a moderate degree of confidence in their accuracy of self-report and the mean EPQ-R Lie Scale score is within 1 standard deviation of the norm for a comparable sample.

The Short Alcohol Dependence Data (SADD) questionnaire: norms and reliability data for male young offenders.

The Short Alcohol Dependence Data (SADD) questionnaire was administered to 100 male young offenders. The mean score was 8.09. Eighty subjects were available between 19 and 40 days later for retest. Of these, 44 were given the original SADD, resulting in a test-retest correlation of 0.87. The remaining 36 young offenders were given at retest a version of the SADD reworded to eradicate difficult words and ambiguous items. The test-retest reliability using the reworded SADD was 0.88 and the split-half reliability of the reworded SADD was 0.85. Thus, the SADD is shown to be reliable over time and the reworded SADD is a satisfactory alternative to the original SADD with this population.

Lay explanations of delinquency: global or offence-specific?

Lay explanations of delinquency have been shown to be both complex and multidimensional and to vary according to factors such as respondent age and sex. However, previous research has treated crime as a global construct, although some studies have highlighted specific attitudes towards individual crimes such as violence and sexual assault. The first of the studies described here directly compared lay explanations for three types of crime-burglary, robbery and sexual assault. Using previously validated scales to assess lay explanation of crime, it was found that there were significant differences in the rated importance of the various scales for the three types of crime. Whilst burglary and robbery were most likely to be explained by failings in education and parenting, sexual assault was most strongly explained in terms of mental instability. Some variation according to age and sex of respondent was also found. A second experiment replicated several of these findings for the crimes of robbery and rape. The race of offender did not, however, significantly influence the explanations for these two offences. Finally, the potential implications of these results are briefly discussed.

Young offenders and alcohol: a survey of the drinking behaviour of a Borstal population.

The results of a survey, based on previous Scottish studies, of the drinking behaviour of 100 English Borstal trainees are reported. It was found that a large proportion (38 per cent) of the young offenders in the sample reported drinking immediately before committing either their present or a previous offence. Whilst little evidence for different criminal behaviour in this "alcohol group" was found, substantial differences in drinking behaviour were reported and examined. These differences included amount typically drunk, frequency of drunkenness and motivation for drinking. It is suggested that whilst a direct causal relationship between alcohol and crime remains to be satisfactorily proved, the present results strongly indicate the need for alcohol treatment programmes in young offender establishments and seek to contribute towards a basis from which such programmes might be built.