Outcomes with the ARISE Approach to Engaging Reluctant Drug‐ and Alcohol‐Dependent Individuals in Treatment

Abstract

Our goal was to explore, through a Stage I NIH clinical study, the effectiveness of a manual-driven, timely response method for helping the "concerned other" get resistant substance abusers into treatment/self-help with minimum professional time/effort. A manual-driven protocol, "A Relational Sequence for Engagement (ARISE)," was applied with 110 consecutive, initial calls/contacts from concerned others; no cases excluded for research, refusal, or other reasons. The research was conducted at two upstate New York outpatient drug/alcohol clinics. Participants were concerned others who called regarding a cocaine, alcohol, or "other drug" abuser (N = 110); participating family/friends: 11 ARISE clinicians; and 110 substance abusers. ARISE is a graduated continuum starting with the least demanding option/stage, increasing effort as needed to engage substance abusers in treatment/self-help. Stage I: Coaching the concerned other to arrange a meeting of significant others, inviting the substance abuser; Stage II: 1 to 5 additional meetings (median = 2); Stage III: A modified Johnson "Intervention." Primary outcome variables were substance abuser engagement (or not) in treatment/self-help; days between first call and engagement; clinician time/effort. Predictors were concerned other, substance abuser, and clinician demographics; number of participants per case; and Collateral Addiction Severity Index. ARISE resulted in an 83% success rate (55% at Stage I). Median days to engagement was 7 (IQR = 2 to 14). Average total time (telephone, sessions) per case was 1.5 hours. Treatment/self-help chosen was 95% treatment and 5% self-help. Number of family/ friends involved correlated 0.69 with a success/efficiency index. Conclusions. A call from a family member or concerned other for help in getting a loved one into treatment is a rich opportunity for treatment professionals and agencies to engage substance abusers in treatment. These initial calls are similar to referral calls from EAPs or probation officers looking to get an individual started in treatment. ARISE provides an effective, swift, and cost-efficient option for engaging substance abusers in treatment or self-help. The more significant others involved, the greater the success of treatment engagement.

Assessment and Support Consultation: Enhancing Social Support for Sexual Offenders

“…The use of a collaborative approach also provides an opportunity to address shame and guilt, and has been used effectively with internet pornography addiction (Landau, Garrett, & Webb, 2008). Although this method appears to be costeffective, easily applied, and effective at increasing engagement, the impact on treatment retention and/or outcome is not yet known (Landau et al, 2004).…”

Hacia una perspectiva clínica psicodinámica de la intervención de las adicciones

“…Con el fin de lograr dimensionar lo complejo de la instauración de la demanda de tratamiento, es necesario entender cómo llega el sujeto a terapia y el contexto que rodea la demanda, ya que estas condiciones darán matices importantes para el tratamiento y esto tiene que ver con la forma en que se logra que el miembro con el problema tome la decisión de entrar, ya que se ha visto que esto influirá en la manera en que se desarrollará el tratamiento (Loneck, Garret & Banks, 1996) y de lo anterior se puede deducir que no sólo es relevante, lograr que el sujeto decida entrar a tratamiento, sino también la forma en que ésta, se ha producido (Landau, 2004). El pedido de tratamiento generalmente surge cuando hay un fracaso en la operación pharmakon, cuando no les garantiza la anestesia o cuando la prótesis no es la más adecuada (Djambolakdjian, 2007, 171).…”

Fatores associados à adesão a um programa de tratamento de alcoolistas

“…Ainda que diferentes estudos não tenham conseguido chegar a conclusões consistentes e definitivas, características já associadas à adesão ao tratamento de alcoolistas incluem: o envolvimento de familiares ou pessoa próxima e significativa 4 ; ordenação judicial 5 ; gênero 6 ; idade 7 ; uso de outras substâncias psicoativas e psicopatologia comórbida 8,9 ; intensidade e duração do tratamento 10,11 . Aparentemente, descrença na gravidade clínica das conseqüências do uso de álcool pode resultar a falta de adesão ao tratamento 12 .…”