Drugs, and Getting Motivated to Give Them Up
Our most thorough outcome studies, actually a composite of four of them done with 872 clients, were published in 2006. It established that 77 percent of the outdoor behavioral healthcare clients had substance abuse diagnoses or dual diagnoses in mental health as well as substance abuse (49 percent.)
The remaining 23 percent had mental health diagnoses only, though some of them had begun to struggle with substance use as well. A long and well constructed questionnaire, the Personal Experience Inventory (PEI) indicated that the outdoor behavioral healthcare clients with substance abuse problems scored almost as high as adolescents in residential programs for chemical dependency treatment, and both scored much higher than a community sample. Taking all clients together, 20 per cent said they had not used alcohol in the three months before treatment, and another 40 percent reported that they had used alcohol just one to five times during those three months. In a follow-up study six months after program completion, 42 percent said they did not use at all from the fourth to the sixth month following treatment, and 30 percent reported using one to five times in those three months. About eight per cent reported 10 or more uses in the fourth to the sixth months after program completion, vs. about 23 percent using that much pre-treatment. The marijuana use figures were similar, with 45 percent reporting no use to 5 uses in three months before treatment, and 44 percent using 10 to 40 or more times. After treatment, 50 percent reported abstinence for months four to six, 39 percent reported one to five uses, and less than 3 percent said they used 10 or more times. Thus the number using not at all or infrequently increased from 45 percent to 89 percent, while the number using marijuana regularly dropped from 40 percent to 3 percent.
As is clear from the two/three year YOQ follow-up study, many outdoor behavioral healthcare clients quit using alcohol and drugs after treatment, while others do not quit entirely but seem rather to practice “harm reduction,” substantially reducing their frequency of use, and showing better control over their related behaviors. In that 2004 structured interview study of the clients in our first research program, substance abuse/dependence was a treatment issue for 75 or the 88 clients. In the two to three years since leaving wilderness treatment:
- 27 percent of them reported having abstained entirely.
- 73 percent had used or were still using at the time of the follow-up interviews. Among this group, 15 percent (12 families) reported substance abuse as a “significant problem” still.
- 34 percent went on to therapeutic boarding schools or NATSAP residential treatment programs.
- 47 percent got out-patient aftercare.
- 16 percent got no aftercare treatment.
- Parents and kids reported that getting through school and finding new, healthier friends was a long, often difficult process.
These numbers compare favorably with federally supported outcome results from public programs. A recent DATOS study, which included 90 days of residential treatment followed by three months of out-patient therapy showed the average change of marijuana use in the 90 days before treatment to the 90 days in outpatient therapy was from 63 days to 45 days. Those figures included only the adolescents who completed the program; an unspecified percentage quit during treatment and were not included in the outcome results.
In the chemical dependency treatment field “motivation to change” has become a big issue: most substance abusers enjoy that activity and don’t see a need to stop it, even though it may be very damaging to their lives. A test called the URICA has been designed to assess readiness for change and, using that with the clients in this study, Dr. Russell established that the drop in substance abuse following treatment was almost certainly due to the effectiveness of the treatment they experienced, because the programs were able to inspire their clients to want to give up on, or significantly reduce, their use of alcohol and drugs. Entering wilderness treatment, 73 percent of our clients either had no interest in changing their behavior, or, though they might be thinking about it, were reluctant to take any action. The rest had stopped trying to ignore the problem and were beginning to participate in efforts to change. By the end of their wilderness treatment, none of our clients were still in the first phase (“uninvolved”) and just nine percent were in the second phase (“reluctant.”) The other 90 percent were either in the active participation phase or, having worked through the issues and decided to quit or seriously reduce their use, had gone on to the final phase, “maintenance” of their decisions. There was some backsliding at the six month follow up, but of the 229 clients who filled out this questionnaire at six months, 182 fit the “participation/maintenance” profile (79 percent) while 21 percent fit the “reluctant” profile. None were “uninvolved.” It is rare in the evaluation of treatment to see such strong results.
- Russell, K.C.(2007). Adolescence substance use treatment: Service delivery, research on effectiveness, and emerging treatment alternatives. Journal of Groups in Addiction and Recovery,2(2-4), 68-96.
- Russell, K.C. (2006). Depressive symptom and substance use frequency outcome in outdoor behavioral healthcare. Technical Report 1, December 2006, Outdoor Behavioral Healthcare Research Cooperative, College of Education and Human Development, University of Minnesota, Minneapolis, MN. 62 pp.