Psychotherapy Enhancement for Therapeutic Community (TC) Retention - 1

Therapeutic Community (TC) treatment can be effective psychosocial modality for addiction,
but premature dropout remains a major problem. Personality disorders are very common in
residential programs, and TCs regard personality disturbance as core to all people with
addiction. Severe personality dysfunction is associated with higher dropout rates from TCs,
and adding cognitive-behavioral treatments may improve retention and outcome. We hypothesize
that severe personality disturbance causes significant problems with an individual?s initial
adjustment and effective utilization of TC processes and techniques. We predict that a
behavioral therapy that targets personality pathology will result in better early retention
and engagement than will a more standard addiction counseling approach.

To begin to improve retention, TC research must begin to systematically evaluate the impact
of adding interventions targeted at decreasing premature dropouts through controlled
clinical trials. We have developed the first empirically tested treatment manual for the
full range of personality disorders in substance abusers and propose to conduct a randomized
clinical trial to evaluate the efficacy of Dual Focus Schema Therapy in comparison to
Individual Drug Counseling as 6-month manualized individual behavioral therapy enhancements
to the orientation/early treatment process of 100 TC residents. In addition to evaluating
retention differences, we will analyze the rate and degree of change for these two
conditions monthly and at 6, 12, 18, and 24-month follow-up for psychological indicators
related to personality disorder and therapeutic processes related to the TC.

Admission for residential TC treatment at APT Residential Services Division

Inclusion Criteria:

Adolescent or adult substance abuser; provide 2 or more contacts; ability to read and
speak English

Exclusion Criteria:

Acute suicidality, homicidality, psychosis, mania