The Drug Abuse Treatment Outcome Study (DATOS) collected 1-year follow-up outcomes for 2,966 clients in outpatient methadone (OMT), long-term residential (LTR), outpatient drug-free (ODF), and short-term inpatient (STI) programs in 1991-1993. LTR, STI, and ODF clients reported 50% less weekly or daily cocaine use in the follow-up year than in the preadmission year. Reductions were greater (p < .01) for clients treated for 3 months or more. Clients still in OMT reported less weekly or daily heroin use than clients who left OMT. Multivariate analysis confirmed that 6 months or more in ODF and LTR and enrollment in OMT were associated with the reductions. Reductions of 50% in illegal activity and 10% increases in full-time employment for LTR clients were related (p < .01) to treatment stays of 6 months or longer. The results replicated findings from 1979-1981 for heroin use in OMT and illegal activity and employment for LTR but not for illegal activity in OMT and ODF.The Drug Abuse Treatment Outcome Study (DATOS) is the third in a series of studies

The majority of research on homeless youth has focused on the multitude of problems faced by this vulnerable population. The current study, while acknowledging the hazards of life on the streets, seeks to explore the personal strengths and informal resources street youth rely on to navigate their environments. Qualitative data from seven focus groups conducted with street youth ages 18-24 were analyzed using content analysis. These data, rich with interactions among youth participants, highlight three important themes: developing "street smarts," existence of personal strengths, and informal resources relied upon by youth to survive. Results provide valuable insights into the strengths of homeless youth that can be useful to providers in assessing street youths' service needs and increasing the likelihood of long-term positive outcomes.

Treatment programs are expected to change their clients. To adopt evidence-based practices to improve their therapeutic effectiveness in dealing with drug-related problems of clients, they also are expected to change themselves. The process of innovation adoption and implementation is the focus of studies included in this special journal issue. Collectively, this volume examines staff perceptions of program needs, organizational readiness for change (based on pressures, resources, staff attributes, and organizational climate), quality of workshop training, subsequent utilization of training materials, and client self-report of treatment engagement. Approximately 800 treatment programs nationwide contributed data for these studies. A standardized assessment of organizational functioning captured attributes that describe environments, settings, and staffs, and the findings are interpreted in the context of a stage-based approach to program changes. A conceptual model is used to help organize and summarize longitudinal results within the organizational context and according to implementation influences related to qualities of the innovations.

Medication-assisted treatment (MAT) is underutilized in the treatment of drug-dependent, criminal justice populations. This study surveyed criminal justice agencies affiliated with the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) to assess use of MAT and factors influencing use of MAT. A convenience sample (N=50) of criminal justice agency respondents (e.g., jails, prisons, parole/probation, and drug courts) completed a survey on MAT practices and attitudes. Pregnant women and individuals experiencing withdrawal were most likely to receive MAT for opiate dependence in jail or prison, while those re-entering the community from jail or prison were the least likely to receive MAT. Factors influencing use of MAT included criminal justice preferences for drug-free treatment, limited knowledge of the benefits of MAT, security concerns, regulations prohibiting use of MAT for certain agencies, and lack of qualified medical staff. Differences across agency type in the factors influencing use and perceptions of MAT were also examined. MAT use is largely limited to detoxification and maintenance of pregnant women in criminal justice settings. Use of MAT during the community reentry period is minimal. Addressing inadequate knowledge and negative attitudes about MAT may increase its adoption, but better linkages to community pharmacotherapy during the reentry period might overcome other issues, including security, liability, staffing and regulatory concerns. The CJ-DATS collaborative MAT implementation study to address inadequate knowledge, attitudes and linkage will be described.

Risk assessments generally rely on actuarial measures of criminal history. However, these static measures do not address changes in risk as a result of intervention. To this end, this study examines the basic psychometric properties of the TCU Criminal Thinking Scales (TCU CTS), a brief (self-rating) instrument developed to assess cognitive functioning expected to be related to criminal conduct. Findings demonstrate that these scales have good psychometric properties and can serve as a short but reliable self-reported criminal thinking assessment. Their applications as part of an assessment system to determine offender progress and effectiveness are discussed.

This paper explores the epidemiology of co-occurring disorders with an emphasis on the implications of study findings for the functioning and potential of substance abuse treatment. Severity of disorder is discussed as an issue that may have particular significance for the selection of specialized as opposed to traditional substance abuse treatment forms. Exploration is made, as well, of the resources currently available to substance abuse treatment, especially the human resources available, and the implications of resource availability for undertaking initiatives specific to co-occurring disorder. Findings from standard and enhanced treatment for comorbid individuals are examined in an effort to clarify areas of need for specialized and typical treatment personnel. Issues are raised for consideration by the clinical research and treatment provider communities in terms of assessment and diagnosis, manpower and training, and response to the challenge of relapse in this population.

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Counselors are a critical component of substance abuse treatment programming, but their working experiences are not yet well understood. As treatment-improvement efforts focus increasingly on these individuals, their perceptions of program leadership, emotional burnout, and job satisfaction and related attitudes take on greater significance. This study explores counselor views and the impact of organizational context using data from a nationwide set of 94 outpatient drug-free (ODF) treatment programs in a hierarchical linear model (HLM) analysis. Results show counselors hold generally positive opinions of program director leadership and job satisfaction, and have low levels of burnout, but they also have important variations in their ratings. Higher counselor caseloads were related to poorer ratings, and leadership behaviors predicted both satisfaction and burnout. These findings add further evidence that treatment providers should also address the workplace environment for staff as part of quality-improvement efforts.