The relationship between length of stay in drug-free therapeutic communities and neurocognitive functioning

Abstract

The relationship between neurocognitive functioning and length of stay in drug-free therapeutic communities (TCs) was investigated. The Wechsler Adult Intelligence Scale (WAIS) was administered to 495 patients admitted to a therapeutic community. It was hypothesized that Digit Symbol and Block Design, which have been found to be more sensitive to diffuse neuropsychological impairment than other WAIS subtests, would be significant predictors of length of stay. A hierarchical regression analysis was performed, and both subtests were found to be predictive of time-in-residence. These findings are congruent with recent investigations that have found a relationship between cognitive impairment and treatment process and outcome in substance abuse treatment.Of the roughly 500 drug-free residential treatment centers in the United States, 25% are long-term therapeutic communities (TCs). Though diverse in size and clientele served, traditional TCs are similar in planned duration of treatment (12-24 months), staffing John Schafer is in the Joint Doctoral Program in Clinical Psychology. Correspondence should be addressed to William Fals-Stewart,

Neurocognitive functions in pathological gambling: a comparison with alcohol dependence, Tourette syndrome and normal controls

“…Deficits in EFs are proposed as important mediators in drug bingeing [15], and several studies suggest that impairments in EFs have a negative impact on treatment success and relapse in substance dependence [100][101][102][103]. The EF deficits as found in PG as well as AD in this study may therefore foster the continuation of these disorders, limit the impact of psychosocial treatment and promote relapse after discontinuation of PG or AD.…”

Behavioral Therapies Trials

“…Research has shown that stress is associated with initiation of substance use in vulnerable individuals and with relapse following abstinence (Sinha, 2001). Given that successful outcomes for therapeutic communities are correlated highly with time in treatment Fals-Stewart & Schafer, 1992;Toumbourou, Hamilton, & Fallon, 1998), adding stress reduction techniques to the therapeutic community curriculum may assist clients in managing the inherently stressful environment and prevent attrition.…”

Neural Correlates of Reward-Based Spatial Learning in Persons with Cocaine Dependence

“…Accordingly, addiction is conceptualized as a disorder of learning wherein the transition from casual to habitual cocaine use is associated with progressive adaptations in corticostriatal circuits that strengthen stimulus-response learning and erode the episodic memory processes that support flexible, goal-directed behaviors (Hyman et al, 2006;Kalivas and O'brien, 2008). Performance deficits on behavioral tasks of episodic memory predict poor treatment outcomes in individuals who use cocaine (Aharonovich et al, 2006;Fals-Stewart and Schafer, 1992;Fox et al, 2009;Turner et al, 2009). Thus, intact episodic memory may be required to support the cognitive effort required in psychotherapies for CD.…”