Outcome evaluation of a 12 step long term recovery program for adolescent addiction
Authors:
Michael Patton, Gerald V. Goresky, F Dean Vause,
Peter Choate, and Natalie Lirenman
Abstract
• This is an outcome evaluation for the Alberta Adolescent Recovery Centre. Using retrospective self-report, 100 graduates (8 months to 5.5 years post graduation), 30 parents of interviewees and 11 of 15 parents of unavailable graduates were selected for interview. Questions evaluated substance use and recovery, social functioning, and emotional sobriety. Significant improvement in education, employment, family relationships, social relationships, and mental health functioning following graduation were demonstrated. For Attention Deficit Disorder (37.2%) and mental illness(32.9%), the need for prescription medication was eliminated. Since graduation 48% of the sample reported continuous sobriety, with confirmed sobriety in 85% at time of interview.
Key Words
Addiction, adolescent
Substance abuse treatment
Evaluation, self report
This work was carried out at the Alberta Adolescent Recovery Centre, 303 Forge Road SE, Calgary, Alberta, Canada, T2H 0S9. Michael Patton, PhD is an independent consultant. Gerald V. Goresky, MDCM, FRCPC, is a Professor of Anaesthesia and Paediatrics at the University of Calgary, and is the Chair of the Clinical Committee at the Alberta Adolescent Recovery Centre. F. Dean Vause, PhD is the Executive Director and Natalie Lirenman, BA is a member of the Clinical Staff at AARC. Peter Choate, MSW consults at AARC, independently assessing client level of dependence and to confirming diagnosis.
1. INTRODUCTION
Evaluation of treatment outcomes of adolescent drug addiction is important for validation of success of the treatment model used and for comparing the success of different treatment interventions. The Alberta Adolescent Recovery Centre (AARC) has provided a long term treatment program for the last 12 years, and, at the time of initiating this research, had graduated approximately 218 clients. This evaluation was undertaken to assess a broad range of measures of success of this recovery program.
Definitions of addiction applied for the purpose of this evaluation are Substance Dependence Disorder and Substance Abuse Disorder as defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, Version IV (DSM-IV) (Association, 1994). The outcome measures selected are guided primarily by the Drug Abuse Treatment Outcome Studies (DATOS), which showed the value of evaluating substantial lifestyle changes over time.(Etheridge, Hubbard, Anderson, Craddock, & Flynn, 1997; Fletcher, Tims, & Brown, 1997)
This evaluation was initiated to assess abstinence from substance abuse, lifestyle changes, changes in emotional functioning, and participation in continued recovery programs following graduation from long-term, family-centered treatment at the Alberta Adolescent Recovery Centre, for graduates from 1998 to 2003.
2. METHODS
This study was reviewed and approved by the Institutional Ethical Review Committee at the Alberta Adolescent Recovery Centre. Subjects and parents either gave informed consent, if over the age of majority, or consent was given by a legal guardian for those who had not achieved the age of majority. Consents were obtained by phone and witnessed by another party confirming the verbal granting of consent. Minors were acknowledged to have the right to refuse to participate, even if their parents offered consent.
A naturalistic retrospective approach was used. The process of participant selection is outlined in Figure 1. From 281 graduates, a sample, consisting of 100 sequential graduates from 1998 to 2003 was selected for interview.
Place Figure 1 here.
2.1 Interview Process and validation of information
An interview schedule was developed specifically for this research. Prior to use, it was tested, modified and retested on graduates who were not part of the research sample. In questioning graduates and parents, subjects were asked to evaluate consequences of use; the impact upon and involvement in support systems, including 12 step programs; the presence of a dual diagnosis; subsequent use patterns and rates; frequency of use; peer influences; forensic and legal complications; and some success factors other than sobriety and family conflict(Bauman & Ennett, 1996; Doyle, Delaney, & Tobin, 1994; Emerick, 1979; Hanstein, 2000; Miller & Sanchez-Craig, 1996; Moggi, Ouimette, Moos, & Finney, 1999; Moos, Finney, & Moos, 2000; Needle, 1988; Simpson, ; Spicer, 1991; Stout, Brown, Longabaugh, & Noel, 1996; Wilens, 1995). Four time frames were considered – pre-treatment; during treatment; following treatment and at the time of the interview.
Following the completion of the client graduate interviews, 30 parents were randomly selected for interview, using a second questionnaire. This was designed to elicit corroborative information about substance use, social functioning, and emotional sobriety. In addition, 11 of 15 parents of those client graduates not interviewed were available for and underwent interview to collect data about the remaining 15 client graduates. Proxy information on the graduate population who were not accessible was collected from parent interviews only, where available.
In order to validate co morbidity, clinical records were provided. These included assessment records and treatment records. All of the graduates had been interviewed at the time of admission, and the presence or absence of co morbidities had been identified. The criteria of DSM IV(Association, 1994) were used to classify the presence of a substance abuse or substance dependence disorder or other mental health diagnosis. All 100 graduates from the sample completed the Substance Abuse Subtle Screening Inventory – Adolescent version at the time of admission.
Once consent was obtained, all questionnaires were numbered and stored in a confidential manner by one of the researchers. Collation and collection of information was maintained by number of each questionnaire only, to preserve the confidentiality of the information and the anonymity of subjects.
Interviews were conducted by telephone by two of the researchers, following the interview schedule set out in the questionnaire. The interviewer recorded subject answers, including verbatim recording of comments where the subject was invited to offer observations. All client interviews were conducted over a three month period, from April to July of 2003.
2.2 Statistical Analysis
Data was transferred to the Statistical Program for the Social Sciences (SPSS) and analyzed. Statistical methods are provided where a statistical test was conducted. The sections in which statistical procedures were used and identified for the edification of the presented material are: legal—Cochran’s Q; family—t-tests; peer relationships—Cochran’s Q; recreation—Cochran’s Q; and self-esteem—Cochran’s Q.
In order to assess whether parent and adolescent information was concordant in regard to length of sobriety Kappa was used to assess dichotomous variables. Kappa was computed based on a three-by-three cross tabulation.
3. RESULTS
85 of 100 client graduates were available for and consented to the interview. These 85 client graduates interviewed represented 39% of the total graduate population (218 graduates) at the time that the research was undertaken. When proxy information from parents was combined with client information, the completed interview process provided information regarding sobriety of 96 of the sample of 100 graduates.
Table 1 demonstrates substance use frequency by time since graduation, and Table 2 shows the longest period of continuous sobriety maintained by interviewed clients since graduation. On average, 2 years and 3 months had elapsed from the time of graduation to the time of interview. Mean age was 17.48 (SD = 1.75) years at the time of graduation from the program, and participants averaged 19.93 years of age (SD = 2.10), at the time of interview. Of the 85 graduates interviewed, 54.1% were male.
Place Table 1 and Table 2 here.
For the time interval over which this sample was taken (5.5 years), fifteen clients started, but did not complete the program. Reasons for non completion included voluntary withdrawal (6), termination for parental noncompliance (4), termination for client noncompliance (2), or referral to another institution (3).
3.1 Co morbidity
On admission to treatment, all 85 interviewed clients met the criteria for a Substance Dependence Disorder, according to SASSI, Adolescent version Of those matching this level, 85.8% of the 85 interviewed qualified for two or more drugs. The primary drugs were marijuana (95.2%) and alcohol (78.8%), with several other drugs also identified. For the purposes of this classification, we accept that dependence does occur with marijuana.(Association, 1994; Earleywine, 2002)
For 91.7% of interviewed clients, Substance Abuse Disorder was a co morbid diagnosis, 76.9% for more than one drug. Within this classification, drugs identified were psilocybin mushrooms (67%), LSD (41.1%), cocaine (35.2%) and Ecstasy (24.7%). Our expectation is that we would see changes in drug selection with time. Changes in social trends for drug preferences will vary with time, in accordance with drug availability, and cost.
A second, non substance-related diagnosis was found in 85.9% of the interviewed subjects as defined by DSM IV(Association, 1994). The most common co-existing disorders were Conduct Disorder (28.2%), Oppositional Defiant Disorder (24.7%), Attention Deficit Hyperactivity Disorder (27%) or a mood disorder (25.8%).
Psychosocial problems included academic difficulties (78.8%), family discord (76.4%), and involvement with the child welfare system (23.5%). Academic difficulties included lack of attendance at school, behavioral difficulties at school, lack of academic success (failing grades), and poor or intermittent attendance. Involvement in criminal behavior prior to admission to AARC was reported by 63.5% of the subjects. It should be noted that this is distinct from involvement in the criminal justice system, but rather represents self reported involvement in behavior that, if caught, would represent the basis for criminal charges. This would be classified as psychosocial and environmental problems which DSM IV(Booth & Kwiatkowski, 1999) usually considers on Axis IV.
Learning disorders were included with a primary diagnosis on Axis 1.
On the Global Assessment of Functioning, at the time of admission, all clients were found to be at or below a level of 55.
3.2 Gender
Patterns of drug use and social behaviors differ between males and females who enter and complete the AARC program. Use of substances multiple times per day “prior to attending AARC was reported by 56.4% of females as compared to 93.5 % of males (p< .001). Prior to attending AARC, 56.4% of females reported no employment compared 23.9% of males (p< .05). Involvement with the Criminal Justice System prior to AARC was less frequent for females (38.5%) compared with males (71.7%) (p< .01). A greater proportion of females (87.2%) than males (63.0%) reported “very negative” self-esteem in the time period prior to attending AARC (p< .05). Only 20.5% of females compared with 52.2% of males were diagnosed with ADD/ADHD prior to attending AARC (p < .05). Almost half (46.2%) of females reported being diagnosed with a mental illness prior to attending AARC compared to 21.7 % of males (p< .05). Since graduation, this difference persisted, as 10.3% of females reported being diagnosed with a mental illness since attending AARC compared with 0% of males (p< .05). For the graduates surveyed, we observed a difference between males and females in regard to frequency of use, involvement with the Criminal Justice System, self esteem, incidence of ADD/ADHD, and frequency of diagnosis of mental illness.
Place Table 3 here.
3.3 Personal & Social Functioning
Participation in school and academic performance improved since the time of AARC graduation. Of those currently enrolled in school, 82% reported their attendance was “much improved.” Similarly, much improved school attitudes (87%), school behavior (84%) and school performance (82%) were reported.
Changes in completion of academic goals increased following graduation. High school completion increased from 5.9% prior to AARC to 23.53% since graduation, (Cochran’s Q = 9.00, p < .01). College/university completion increased from 1.2% prior to attending AARC to 9.41% since AARC graduation, (Cochran’s Q = 7.00, p< .01).
Involvement with, and attendance at work was significantly improved following AARC graduation. Prior to AARC, 10.6% of interviewed graduates worked full-time. This increased to 40.0% during AARC program participation, (Cochran’s Q = 20.16, p< .001). There was a significant change in the percentage of respondents that reported being employed at some time prior to AARC (61.2%) and since graduation (100%), (Cochran’s Q = 33.00, p< .001). At the time of the interview, 57.6% were working full-time, 17.6% part-time, 2.4% intermittently part-time, and 22.4% were unemployed. The majority of working participants rated their work behavior (89%), work performance (86%), and work attendance (82%) as “much improved”.
Family relationships improved. Graduates were asked to describe their relationships with their family on a 5-point Likert scale ranging from 1 (“Very positive”) to 5 (“Very Negative”). Relationships with family were rated more positively for the period since AARC graduation (M = 2.02, SD = .83) compared to the period prior to AARC participation (M = 4.54, SD = .61), (t (84) = 23.32, p < .001).
Place Figure 2 here.
Figure 2 displays the percentages of the sample rating their relationships as “very positive, mostly positive, equally positive/negative, mostly negative, and very negative” for the period prior to the AARC and at the time of the interview. At the time of interview, 84.7% reported either “very” or “mostly positive” family relationships at the time of interview, in comparison with 94.1% who reported “very” or “mostly negative” family relationships prior to AARC.
A significant number of graduates reported a reduction in family conflict since graduation from AARC. Participants were asked to rate the degree of conflict within the family on a 4-point Likert scale ranging from 1 (“A lot”) to 4 (“none”). The degree of family conflict improved from a mean rating of 1.14 (SD = .41) for the period prior to the AARC to 2.93 (SD = .72) for the period since graduation (t (84) = -20.92, p < .001).
Place Figure 3 here.
This is graphically demonstrated in Figure 3, comparing the period prior to AARC and the time of the interview. At the time of interview 90.6% reported “a little” or “none” conflict, compared with 88.2% that reported a “a lot” of family conflict prior to AARC.
A reduction in involvement with the criminal justice system, as reflected in civil or criminal charges was reported. Prior to attending AARC, 56.5% of respondents reported having been charged with a crime. Since graduation, this figure dropped to 17.6% (Cochran’s Q = 27.92, p < .001), and, at time of interview, 4.7%.
A change in peer relationships was demonstrated as one of the most consistent changes since graduation. Only 3.5% of the sample reported having “mostly” or “very positive” peer relationships in the time prior to AARC. That proportion increased to 92.9% at the time of interview (Cochran’s Q = 64.06, p < .001).
With graduation from AARC, those responding report a significant change in their involvement with recreation activities. The percentage of the sample who reported being “somewhat” or “very” active recreationally increased from the period prior to the AARC (35.3%) to the period since AARC graduation (89.4%) (Cochran’s Q = 39.19, p < .001).
3.4 Self Esteem
The proportion of interviewed graduates rating their self-esteem as “mostly” or “very positive” increased significantly between the period prior to the AARC (1.2%) to the period since AARC graduation (74.1%), Cochran’s Q = 62.00, p < .001.
3.5 Attention Deficit disorder
Symptoms of, and treatment for ADD/ADHD were reported as substantially different following graduation from AARC. Participants were asked to indicate whether they had been diagnosed with ADD or ADHD at different time periods. Among participants, 37.6% reported having been diagnosed with ADD/ADHD prior to AARC, with 27% still meeting the criteria at the time of admission. At the time of interview, 3.5% of clients reported this diagnosis, since completing AARC. Among those diagnosed, 90.6% reported having been prescribed medication for ADD/ADHD prior to AARC attendance. No participants reported being prescribed medication either since AARC graduation or at the time of the interview. Additionally, 73% of those who had been previously diagnosed indicated their symptoms had decreased since graduation.
Youth who entered AARC with an ADD/ADHD diagnosis experienced improvements with family relationships. Specifically, this group rated their family relationships significantly more positively (M = 2.03, SD = .82) for the time period since AARC participation compared to the time period prior (M = 4.59, SD = .50), t (28) = 15.80, p< .001. Ratings of peer relationships also improved for the time period prior to AARC (M = 4.03, SD = .78) to the period since completing the AARC program. (M = 1.93, SD = .75), t (28) = 10.82, p < .001.
For those diagnosed with ADD/ADHD prior to AARC admission, employment increased from 65.52% prior to AARC entry to 100% since AARC graduation (Cochran’s Q = 10.00, p < .01). Prior to attending the AARC, 65.52% of this group reported having been charged with a crime. Since graduation, this figure dropped to 24.14% (Cochran’s Q = 10.29, p < .01). Although the proportion that completed high school increased following completion of the AARC program (6.90% vs 27.59%), the difference was not statistically significant (Cochran’s Q = 3.60, p = .058).
3.6 Mental health.
Participants were asked to indicate whether they had been diagnosed with a mental illness. Among respondents, 32.9% reported having been diagnosed with a mental illness prior to AARC, 4.7% since AARC, and 3.5% at the time of the interview. Of those graduates reporting a mental health diagnosis at the time of treatment entry, 88.5% had been prescribed medication prior to entering the AARC, 3.8% since the AARC, and 0% were prescribed medication at the time of the interview. Of those diagnosed with mental illness, 92.6% indicated their symptoms had decreased since completing treatment at AARC.
Family relationships improved amongst youth who entered AARC with a diagnosis of mental illness. Specifically, this group rated their family relationships significantly more positively (M = 2.21, SD = .93) for the time period since AARC participation compared to the time period prior ((M = 4.79, SD = .42), t (23) = 13.63, p < .001). Ratings of peer relationships also improved for the time period prior to AARC (M = 4.29, SD = .62) to the period since AARC participation (M = 2.00, SD = .89), t (23) = 9.68, p< .001.
3.7 Twelve Step Program Involvement
At AARC, the program is based on Twelve Step participation, and this is reflected in active involvement during, and participation after, graduation from AARC. None of the participants indicated they were “very involved” in Twelve Step programs prior to entering AARC. That proportion increased to 96.5% who rated being “very involved” in a Twelve Step program during the AARC program, Cochran’s Q = 82.00, p < .001. For the time period since AARC, the percentage of graduates who reported being “very involved” in a Twelve Step Program dropped to 52.9% (Cochran’s Q = 33.39, p < .001).
Regardless of the decrease in participation with time after graduation, the majority of graduates acknowledged the usefulness of a Twelve Step program. During AARC treatment, 90.0% of this group rated Twelve Step programs as being “very useful,” (Cochran’s Q = 62.00, p < .001). Among the entire sample, including those with no Twelve Step experience prior to AARC treatment entry, 91.8% rated a Twelve Step program as “very useful” during their treatment at AARC.
3.8 Feedback on the AARC Recovery Process
Graduates were asked to rate the impact of AARC treatment on their lives. The impact was rated as being “very” or “mostly positive” by 95.3%. The majority of graduates (70.6%) stated they were very satisfied with the services they received while attending AARC.
3.9 Interviews of parents
Of the 30 interviewed parents, 90% confirmed the reported sobriety of their child. Amongst the parents of non-respondent clients, 18.2% (2 of 11) reported their son/daughter had been sober at the time of interviews.
The impact participation in AARC had on their son’s/daughter’s alcohol and drug use was rated as “mostly” or “very positive by 96.6% of respondent parents and 81.8% of non-respondent parents.
Similar to the report compiled from the AARC client graduate responses, parental reports confirmed decreases in substance use and improvements in education, employment, family relationships, social relationships, and mental health functioning from the time prior to attending AARC to the time following graduation.
Of interest are the responses of parents to the following two questions. The first question was, “In your own words, please describe how your son’s/daughter’s involvement at AARC has impacted their life.” The second question was, “On a personal note, what has your son’s/daughter’s involvement at AARC meant for you?”
4. DISCUSSION:
4.1 The AARC Treatment Model
The Alberta Adolescent Recovery Centre (AARC) is a 12-step recovery orientated long-term drug and alcohol treatment program for adolescents between the ages of 12-21. The program model has been previously described(Vause, 1994).
In the program description, Vause describes the majority of AARC’s clients as “compulsive, poly-drug users who have serious family and psychological problems…with turbulent or chaotic behavior, compounded with immaturity and a general lack of no chemical coping skills” Vause further explains that lack of maturity and emotional development are a result of the developmental arrest caused by prolonged drug use. It is for this reason that the average length of treatment for AARC’s clients and families is 10 months to a year.(Vause, 1994)
Vause describes that AARC functions upon the disease model of addiction, as follows. Chemical dependence is a “chronic, progressive, primary, psychosocial, biochemical, genetic, and relapsing condition which affects every domain of the adolescent’s life and family”. Although AARC’s philosophy is derived from the disease concept, it incorporates the bio/psycho-social/spiritual approach to the treatment of adolescent addiction. Because the primary symptom of chemical dependence is continued drug and alcohol use despite bio-psycho-socio-spiritual deterioration, it is essential that AARC clients achieve abstinence during and post treatment in order to fully recover from the devastating consequences of addiction. Abstinence and recovery from addiction are sought through the adoption of the Alcoholics Anonymous 12 steps of recovery.(Alcoholics Anonymous World Services, 1976) These steps are incorporated into the program, as follows.
AARC is comprised of 4 treatment levels, each level consisting of 2 or more of the 12 steps of recovery. Each level incorporates a set of rules and a level completion criterion. AARC clients graduate the program once they have grasped the concepts of the 12 steps of recovery and completed the outlined criteria of each treatment level.
Each AARC client graduates the program once he or she has grasped the concepts of the 12 steps of recovery through completion of the outlined criteria of each treatment level.
The AARC treatment program does not focus solely on the client. The family is required to participate in treatment and embrace recovery, as well. Management of the client includes comprehensive assessment, treatment, and aftercare. Family treatment includes frequent participation in group counseling sessions, peer counseling, and participation in activities which facilitate recovery for the family – through a confrontational and caring therapeutic process.
4.2 The need for evaluation
Substance abuse and addiction have become of increasing concern within the adolescent population, with perhaps up to 10% of those who use drugs becoming addicted. Similar concerns appear to exist in other countries, such as the United States(Harrison & Asche, 2001). Clearly, substance abuse and addiction is a major problem in our communities. Intervention for adolescent addiction is conducted in many ways, and there are many possibilities for treatment – crossing the spectrum from short term non professional intervention to spiritual intervention, to long term intensive family-centered care(Latimer, Winters, Stinchfield, & Traver). The lack of homogeneity in regard to adolescent treatment makes program-to-program comparisons difficult, if not, impossible.
4.3 Study design and selection of sample
The nature of this evaluation did not permit constructing a randomized controlled trial with a group of untreated individuals – addiction, by its nature, induces isolation and resentment, and an untreated control group would not be reachable. It is also difficult to make a comparison with another long term residential program for adolescents, as no program using comparable client selection, treatment intervention and treatment duration is currently known. This is the first evaluation of treatment at AARC, and we chose as large a sample size as we could effect, acknowledging the constraints of obtaining access to all graduates.
A self report structured interview was used, and self report can yield valid, useful estimates of drug usage(Brener, 2003; Smith, 1995).
4.4 Gender
We observed a difference between males and females in regard to client profile. Females demonstrated less frequent daily usage of substances, less employment, less involvement with the Criminal Justice System, and lower self esteem. In regard to psychiatric diagnosis, females had a lower frequency of ADD/ADHD diagnosis and a higher frequency of diagnosis of mental illness prior to entering the AARC program. We are unable, in this study, to confirm whether these differences are specific to this population, or whether they are simply a reflection of a broad societal trend amongst adolescents.
4.5 Limitations
This evaluation design will not permit either generalization of the results beyond AARC’s own implementation or disaggregation of multiple dimensions of the intervention to test alternative attribution hypotheses.
AARC clients are admitted frequently on referral from the court, on recommendation from Child Welfare Services, or at direction of their parents -- an involuntary basis which eliminates follow up research bias associated with self selection, yet the nature of admission and the disease process mitigated against initiating a comparative study with a control (non treated) group.
This is a treatment-completion outcomes study that includes only those AARC graduates who successfully finished the program. As such, outcomes reported here likely reflect the upper limits of outcome and would change if the sample included those who left the program under different circumstances. We have not correlated measurements of recovery with time since graduation, but it is acknowledged that the longer a client is graduated from a program, the more non treatment factors are likely influencing the client’s current status. If it was projected the 15 clients not available for interview were not abstinent, then the result for the entire population of 100 would result in an abstinent rate of 85% at the time of interview. As with all naturalistic studies, the lack of no-treatment or other control conditions precludes causal statements about the role treatment specifically played in the improved functioning of the sample following graduation.
There is debate about significance of the duration of time out of treatment required for meaningful evaluation in relation to defining successful treatment, be it abstinence from drug use or “harm reduction”.(McLellan et al., 1994; Rivers, Greenbaum, & Goldberg, 2001) In comparing treatment modalities, a measure of consistency would be provided by assessing the treatment outcomes at a consistent interval following treatment; we currently are unable to do this. For the purpose of this evaluation, we were seeking to assess the pattern of recovery post treatment in this program.
Abstinence rates are impacted by the length of time after discharge (with relapse rates increasing as a function of time out of treatment). For the purpose of this study, use frequencies since graduation were broken down by time since graduation.
Descriptions of involvement with the criminal justice system may not fully reflect changes in behavior, as this evaluation documented criminal or civil charges only, as opposed to involvement in crime for which the client may not have been caught.
Questions of validity and reliability of data are always raised when self-report is the primary source of information, regardless of the steps taken to minimize socially desirable response sets. Also, because this was a retrospective study, memory distortion may have impacted self-report. Finally, participants were asked about their functioning as it occurred “prior” to and “since” graduation. As such, time periods were not held constant and made direct comparisons between the time periods difficult. For example, for a given participant the time period prior to AARC may refer to a period of 15 years whereas the time since AARC may refer to a period of 2 years. Differences in length of time since graduation between participants also occurred. For example, one graduate may have been out for 1 year; another may have been out for 3 years. We acknowledge that the longer a client is out of the treatment program the more non-treatment factors are likely influencing the client’s current status As a result, “before and after” comparisons must be interpreted with caution, even though they are an essential measure of program performance. We have attempted to use the parent questionnaires for validation of client information, particularly in relation to sobriety, reducing the uncertainty of using self report as a sole source of information.
It will be important in the future, to assess sobriety of all graduates at a consistent time interval following completion of treatment. A suitable mechanism could be implemented to obtain consent for and collect information regarding recovery and family functioning at fixed intervals following graduation.
5. Conclusions
The long term, intensive AARC program provides significant, sustainable changes for a large number of adolescents admitted to treatment with severe substance dependency disorders. These changes include sustaining both sobriety and the many lifestyle changes that support sobriety. For male and female clients, physical, emotional, and behavioral characteristics all demonstrated improvements. Decreases in substance use with improvements in education, employment, family relationships, social relationships, and mental health functioning have been demonstrated. For clients with either ADD/ADHD or other mental health disorders prior to AARC, the need for continuation of medication was eliminated. For all recovery criteria evaluated, this outcome evaluation demonstrates significant improvement in the vast majority of clients, when compared with pre treatment. For adolescents with a Substance Dependence Disorder and Global Assessment of Functioning at a level 55 or lower, the AARC treatment model demonstrates a high measure of success.
Acknowledgments
This outcome study was conducted by Michael Patton, and the analysis of data was conducted by Reid Zimmerman and Valerie Slaymaker, PhD, LP from the Butler Center for Research of the Hazelden Foundation. We are grateful for the assistance of Joanne Miller for review of the data collection and statistical analysis, and suggestions regarding improvement of the manuscript. The evaluation was funded by a donation from an anonymous donor specifically for the purpose of conducting an outcome study of the AARC Recovery Program.
Table 1 Percentage of interviewed graduates reporting substance use frequency by time since graduation
Post graduation None One time Monthly Weekly Daily Multiple/day
1 year or less (n=10) 90 0 0 0 0 10
13-24 months (n=30) 60 3.3 6.7 3.3 16.7 10
25-36 months (n=21) 52.4 4.8 9.5 4.8 23.8 4.8
>36 months (n=24) 41.7 4.2 4.2 12.5 25 12.5
Table 2 Longest period of continuous sobriety of interviewed graduates, maintained by time since graduation
Time since graduation One month Six months Twelve months or more
One year or less (n=29) 0% 6.9% 93.1%
Two to three years (n=42) 2.49% 4.8% 92.9%
Four or more years (n=14) 0% 14.3% 85.7%
Table 3 Positive changes identified in personal and social functioning of graduates.
All graduates who were interviewed identified:
• Increased high school completion (p < .01)
• Increased College or University completion (p < .01)
• Increased working full time (p < .001)
• Improved employment and work behaviors (p < .001)
• Positive family relationships (p < .001)
• Lesser degree of family conflict (p < .001)
• Fewer charged with a crime (p < .001)
• “Mostly” or “very positive” peer relationships (p < .001)
• “Somewhat” or “very” active recreationally (p < .001)
• Self-esteem rated “mostly” or “very positive” (p < .001)
• Graduates “very involved”, 12 Step program (p < .001)
Graduates with previous diagnosis of ADD/ADHD identified:
• No medication
• Family relationships more positive (p < .001)
• Peer relationships also improved (p < .001)
• Employment increased (p < .01)
• Fewer charged with a crime (p < .01)
Graduates with a previous Mental Health diagnosis identified:
• No medication
• Family relationships more positive (p < .001)
• Peer relationship ratings improved (p < .001)
Figure Captions
Figure 1. Participant selection and interview process. Page 19
Figure 2. Self-reported quality of family relationships – rated prior to AARC admission and at time of interview of clients. Page 20
Figure 3 Self-reported amount of family conflict – rated prior to AARC admission and at time of interview. Page 21
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