BackgroundResidential drug rehabilitation is often seen as a treatment of last resort for people with severe substance abuse issues. These clients present with more severe symptoms, and frequent psychiatric comorbidities relative to outpatients. Given the complex nature of this client group, a high proportion of clients seeking treatment often do not enter treatment, and of those who do, many exit prematurely. Given the highly social nature of residential drug rehabilitation services, it has been argued that social anxieties might decrease the likelihood of an individual entering treatment, or increase the likelihood of them prematurely exiting treatment. The current paper reports on the protocol of a Randomised Control Trial which examined whether treatment of social anxiety prior to entry to treatment improves entry rates and retention in residential drug rehabilitation.Method/designA Randomised Control Trial comparing a social skills treatment with a treatment as usual control group was employed. The social skills training program was based on the principles of Cognitive Behaviour Therapy, and was adapted from Ron Rapee’s social skills training program. A permutated block randomisation procedure was utilised. Participants are followed up at the completion of the program (or baseline plus six weeks for controls) and at three months following entry into residential rehabilitation (or six months post-baseline for participants who do not enter treatment).DiscussionThe current study could potentially have implications for addressing social anxiety within residential drug treatment services in order to improve entry and retention in treatment. The results might suggest that the use of additional screening tools in intake assessments, a focus on coping with social anxieties in support groups for clients waiting to enter treatment, and greater awareness of social anxiety issues is warranted.Australian New Zealand clinical trials registryAustralian New Zealand Clinical Trials Registry (ACTRN) registration number: ACTRN12611000579998

The aim of the study was to describe the psychological profile, as measured by the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), of 921 substance dependent clients assessed after five weeks admission to a Therapeutic Community (TC). Overall, the profile of the sample showed prominent peaks reflecting character disorder (high psychopathic deviate [Pd]) and disturbed thinking and affect (high schizophrenia [Sc]). The validity scales suggested that the sample was admitting to personal and emotional difficulties and requesting assistance with these problems. The psychotic triad was somewhat more elevated than the neurotic triad indicating distress about behaviours or symptoms related to psychotic disorders. Psychopathology was greater for women, who reported significantly higher scores on confusion, hypochondriasis, character disorder, and hysteria than men, although the shape of male and female MMPI-2 profiles was similar. Those aged up to 35 years scored significantly higher on five clinical scales (depression, character disorder, paranoia, Pd and Sc) than an older (35 and over) group; they also significantly differed on all the validity scales from their older counterparts. Clients who completed the MMPI-2 at five weeks but stayed less than four months at the TC were more likely to be younger, female and admit to psychopathology (lower defensiveness scores, higher mania) than those who went on to complete the first phase of treatment. The results suggest that substance dependent clients seeking treatment at a TC exhibit considerable psychological disturbance; more so for females and the younger cohort.

Summary A significant proportion of fathers living with their natural, adopted, step or foster children experience mental illness. Psychiatric illness among fathers can have a devastating impact on children's wellbeing, and even milder forms of paternal mental illness can have serious developmental effects on children. While several pathways linking paternal mental illness with poor child outcomes have been identified, fathers’ impaired parenting is an important, potentially malleable factor. Clinicians can assist fathers with mental illness and their families by proactively inquiring about children and by exploring fathering‐focused psychological support.

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Results indicated that treatment within the TC over this time span was associated with improved mental health. The present study suggests that residential rehabilitation's holistic approach provides a suitable treatment model for clients with co-occurring mental health and substance use disorders.

The Therapeutic Community (TC) model is considered an effective treatment for substance dependence, particularly for individuals with complex presentations. While a popular approach for this cohort across a number of countries, few studies have focussed on biopsychosocial and longer-term outcomes for this treatment modality. This study reports on substance use, dependence, and biopsychosocial outcomes up to 9 months post-exit from two TC sites. Methods: A longitudinal cohort study (n = 166) with two follow-up time points. Measures included substance use, dependence, subjective well-being, social functioning, and mental and physical health. Generalized Linear Models were employed to assess change over time. Results: At 9 months, 68% of participants reported complete 90-day drug abstinence. Alcohol frequency and quantity were reduced by over 50% at 9 months, with 32% of the sample recording 90-day abstinence at 9 months. Both alcohol and drug dependence scores were reduced by over 60%, and small to medium effect sizes were found for a range of psychosocial outcomes at 9 months follow-up, including a doubling of wellbeing scores, and a halving of psychiatric severity scores. Residents who remained in the TC for at least 9 months reported substantially better outcomes. Conclusions: With notably high study follow-up rates (over 90% at 9 months post-exit), these data demonstrate the value of the TC model in achieving substantial and sustained improvements in substance use and psychosocial outcomes for a cohort with severe substance dependence and complex presentations. Implications for optimal length of stay are discussed.

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