Evaluation of an Enhanced Drug Treatment Court Santa Barbara County, California,USA

Transcription

1 Evaluation of an Enhanced Drug Treatment Court Santa Barbara County, California,USA Merith Cosden June 19, 212 Drug Court Enhancements Address clients trauma Serve adults with co-occurring disorders Implement evidence-based treatments MARS treatment program Seeking Safety Matrix Model of substance abuse treatment Relapse prevention groups Individual counseling Case management Psychiatrist Medication (as needed) 1

2 Cognitive behavioral approach to reducing substance abuse Developed in 1984 and studied and adapted for use across substances Motivational enhancement, contingency management, relapse prevention Adapted from original 4-month model to fit drug court Group setting with trained alcohol and drug counselors Evidence-based group therapy Cognitive-behavioral Achieve safety from dangers associated with PTSD & substance abuse Substance use to address trauma symptoms may increase danger of further trauma Addresses trauma and substance abuse concurrently Not for personal exploration of trauma Not safe while using May trigger others in group Relate trauma to current problem behavior & coping Najavits, L.M. (22). Seeking Safety: A treatment manual for PTSD and substance abuse. New York, NY: Guilford Press. 2

3 Addiction Severity Index (ASI) McLellan, A. T., et al. (1992).The Fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9, Trauma History Screen (THS) Carlson et al. (211). Development and validation of a brief self-report measure of trauma exposure: The Trauma History Screen. Psychological Assessment. Adverse Childhood Experiences (ACEs) Felitti, V. J. et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14, Trauma Symptom Inventory (TSI) Briere, J. (1995). Trauma Symptom Inventory professional manual. Odessa, FL: PAR. Structured interview Seven psychosocial areas Medical problems Employment/education Drug use Alcohol use Legal problems Family/social support Sexual abuse Physical abuse Psychiatric problems Administered at intake and after six months McLellen et al. (1992) 3

4 The events below may or may not have happened to you: a. A really bad car, boat, train, or airplane accident b. A really bad accident at work or home c. A hurricane, flood, earthquake, tornado, or fire d. Getting beat up or attacked- as a child e. Getting beat up or attacked- as an adult f. Forced sex- as a child g. Forced sex- as an adult h. Attacked with a gun, knife, or weapon i. During military service, seeing something horrible or being badly scared j. Sudden death of a close family or friend k. Seeing someone badly hurt or killed Abuse Emotional Physical Sexual Neglect Emotional Physical Household dysfunction Mother treated violently Household substance abuse Household mental illness Parental separation or divorce Incarcerated member of family FELITTI ET AL., 1998; 4

5 Ten Clinical Subscales Three Summary Scores Trauma Intrusive Experiences Impaired Self Reference Sexual Concerns Dysphoria Anger/Irritability Defensive Avoidance Dysfunctional Sexual Behavior Depression Dissociation Anger/Irritability Anxious Arousal Briere, 1995 Demographic Characteristics N % Gender Female Male Ethnicity Latino/a White Other 21 2 Age Group

6 Percent of Participants 8/29/ Men Women Reasons for Discharge 51 % of women and 38% of men graduated 33% of participants with dual diagnosis (DDX) 52% of regular SATC participants graduated Left on own 9% Referral to other Program 1% Incarcerated 28% Nonparticipation 4% Rule Violation 2% Death 1% Graduated 46% 6

7 Composite Score Severity Rating 8/29/ Intake 6-months 12-months Intake 6-months 12-months Psychosocial Domain 7

8 Severity rating Severity Rating 8/29/212 Differences in Severity Ratings for DDX and SATC Severity Ratings at Intake Significant differences between DDX and other SATC participants on Severity Ratings for: Medical Psychiatric Alcohol SATC DDX Changes in Severity Ratings for DDX Significant changes in: Alcohol Drug Family Psychiatric Intake 6-months 1 8

9 Composite Score Composite scores 8/29/212 Differences in Composite Scores for DDX and SATC Participants at Intake Significant differences between DDX and other SATC participants on Composite Scores for: Medical Psychiatric SATC DDX Change in ASI Composite Scores for DDX Significant improvements on: Employment Drug Intake 6-months 9

10 Percent of Participants Percent of Participants 8/29/ Trauma SS Self SS Dysphoria SS DDX SATC 5% 4% 3% Intake 6-months 2% 1% % Trauma Score Self Score Dysphoria Score 1

11 Percent of Participants Percent of Participants 8/29/212 5% 4% Intake 6-months 3% 2% 1% % Trauma Score Self Score Dysphoria Score 5% 4% Intake 6-months 12-months 3% 2% 1% % Trauma Score Self Score Dysphoria Score 11

12 Mean T- Score 8/29/ Trauma Score Self Score Dysphoria Score Intake 6-months 12-months 42 Strongly Agree or Agree Service providers help me develop alcohol and drug free ways of coping with my moods and emotions 98% Service providers help me develop alcohol and drug free ways of coping with my moods and emotions 98% Service providers help me think about how my sexual and 92% physical abuse experiences, mental health problems, and substance abuse are connected in my life Service providers are helping me recover from 9% the traumas in my life I feel safe when talking to service providers about my 9% experiences with violence and abuse 12

13 Jail Days 12 Months Prior to Program Entry, 12 Months after Entry, and 12 Months Post Discharge or Graduation Graduated Discharged Jail Days N M N M t 12 Months Prior Months in Treatment * 12 Months Post * * p<.5 No Jail Days 12 Months Prior to Program Entry, 12 Months after Entry, and 12 Months Post Discharge or Graduation Graduated Discharged Jail Days N % N % No Jail Days Year Prior 41 89% 44 86% No Jail Days 12 Months In 45 98% 18 67% No Jail Days 12 Months Post 44 96% 42 82% 13

14 46% of clients successfully completed the program Others making satisfactory progress Participants had significant reductions in drug and alcohol problems Participants had significant reductions in trauma symptoms which were retained at the 12 month follow-up. Participants from the DDX court had more severe mental health problems than did those in the SATC. Less successful in the program, Still showed improvements across many areas of functioning. Recidivism, as measured by jail days 12 months after leaving the program, was significantly reduced for graduates Not reduced for those who were unsuccessful 1) Use comprehensive assessments of substance abuse, trauma and psychological distress; 2) Implement interventions that address mental health and substance abuse problems concurrently; 3) Provide gender-sensitive assessment and treatment; 4) Hold community-based trainings on best-practices for treatment; 5) Maintain collaborative meetings between service providers and criminal justice system; and 6) Continue research on interventions that contribute to the treatment component of drug treatment courts. 14

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