Developing, Implementing, and Evaluating a Treatment Protocol for Rural Substance Abusers

Abstract

Substance abuse is a significant social and public health problem facing rural Americans. However, most treatment protocols have been developed in urban areas. This article describes the development, implementation, and evaluation of an innovative substance abuse treatment designed with the collaboration of rural professionals and consumers specifically for rural clients and delivered by rural clinicians. Results of the process evaluation of Structured Behavioral Outpatient Rural Therapy (SBORT) produced findings about the experiences of participating clients, clinicians, and program directors. Most clients perceived SBORT as a helpful learning process that used multiple treatment strategies and presented an alternative to 12-step programs. Clients also reported that treatment was stressful even when beneficial, and that clinician support was critical for remaining in treatment. Most clinicians found that SBORT challenged their "old" treatment frameworks, was demanding to learn and adopt, and that the training and supervision involved in the project implementation helped remedy rural isolation from the treatment community. Interestingly, agency approach to program implementation strongly influenced clinician responses to the innovation. Agency program directors' appraisals of SBORT included observations that the therapy was viable because of its rural-specific design and that most staff were able to adapt to the changes demanded by the manualized protocol. All three groups reported that they saw the emphasis and acceptance of motivation as an emergent process as important to the treatment. This project highlighted the challenge and importance of testing rural substance abuse treatment protocols in naturalistic settings.

An ongoing process: A qualitative study of how the alcohol-dependent free themselves of addiction through progressive abstinence

“…Movement throughout these stages is not necessarily a straight forward pathway from the initial pre-contemplation to maintenance stage [17]. The pattern of successful change is typically conceptualised to be spiral, with relapses to earlier stages and re-cycling through the stages, typically occurring prior to final remission (if successful), or the long-term maintenance stage, is attained [15,17-19]. The trans-theoretical model (TTM) implies that changes in healthy behaviours move in a spiral fashion.…”

Mental Health of Rural Young Adults: Prevalence of Psychiatric Disorders, Comorbidity, and Service Utilization

“…A major cause of concern, however, is the high prevalence of alcohol use disorders in this sample in conjunction with the low rate of service utilization among participants with substance use disorders. Research indicates that services for rural adolescents with substance use disorders need to be improved (Anderson & Gittler, 2005), and specialized treatment programs for rural substance abusers are being developed (Clark et al, 2002).…”

Supervision in Public Sector Behavioral Health: A Review

“…This diverse group of publications identified positive effects on supervisees that included decreased stress and emotional exhaustion or ''burnout'' (e.g., Perseius, Kaver, Ekdahl, Asberg, & Samuelsson, 2007), decreased professional isolation (e.g., Clark et al, 2002;McMahon & Patton, 2000), and enhanced feelings of self-competence, efficacy, and well-being (e.g., Vallance, 2005;Warman & Jackson, 2007). Supervision was also described as contributing to the effectiveness of specific trainings, increasing, for example, the acquisition, retention, and application of new knowledge by supervisees (e.g., Gilkerson & Kopel, 2005;Newton & Yardley, 2007).…”