Do relationship education programs reduce relationship aggression? A meta-analytic study.

There is an increasing focus on evaluating the effectiveness of Relationship Education (RE) programs on reducing relationship aggression. Nevertheless, there has been little by way of a systematic quantitative synthesis of research to date. The primary aim of this research was to conduct a meta-analysis into the effects of RE programs on relationship aggression and provide a comprehensive assessment as to the moderating effects of various methodological characteristics of studies. A secondary aim was to determine whether RE programs reduce negative aspects of relationship functioning that are known to exacerbate relationship aggression. Thirty-one studies (n = 25,527) were included comprising of pre-post comparison studies and control trials. Overall, RE programs were significantly associated with reductions in relationship aggression (d = 0.11, p = .001). Pre-post studies yielded a significantly larger effect size (d = 0.28, p < .001) than RCT studies (d = 0.05, p = .10). Subgroup analysis revealed that participants who reported moderate to severe relationship aggression upon RE program entry demonstrated large reductions in physical (d = 0.66, p = .01) and psychological (d = 0.85, p < .001) aggression compared to those who reported minimal to low relationship aggression on entry (physical aggression d = 0.07, p = .009; psychological aggression d = -0.04; p = .17). Amongst participants who reported moderate to severe relationship aggression, RE programs were also found to reduce controlling behavior (d = 0.20, p < .01) and conflict behavior (d = 0.40, p < .001). Findings demonstrate the emerging efficacy of RE programs for reducing relationship aggression and conflict behavior, particularly in those with a history of moderate to severe levels of relationship aggression.

Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence.

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.

Improving the retention rate for residential treatment of substance abuse by sequential intervention for social anxiety.

BACKGROUND: Residential 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/DESIGN: A 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). DISCUSSION: The 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 REGISTRY: Australian New Zealand Clinical Trials Registry (ACTRN) registration number: ACTRN12611000579998.

Fathers with mental illness: implications for clinicians and health services.

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.

Mental health improvements of substance-dependent clients after 4 months in a Therapeutic Community.

INTRODUCTION AND AIMS: Odyssey House Victoria's Therapeutic Community (TC) accepts substance-dependent clients, including those with co-occurring mental health issues. American data suggest that TCs are effective in rehabilitating such clients; however, Australian research is limited. The aim of the study was to examine Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profiles of Odyssey House TC residents early in their residency and again after 4 months, to chart changes in MMPI-2 profiles and compare them with norms for psychological health. DESIGN AND METHODS: The sample comprised 351 clients who were part of the residential program between 1997 and 2007, and who remained in treatment at the TC for at least 4 months. They were administered the MMPI-2 after 5 weeks in treatment and again after 4 months. RESULTS: At the first assessment, the validity scales of the MMPI-2 plus the clinical scales Depression, Psychopathic Deviate, Paranoia, Psychasthenia and Schizophrenia were in the clinical range. At the second assessment, mean scores on all clinical scales except Mania were significantly or near significantly lower and, except for Psychopathic Deviate, within the normal range. The validity scales also demonstrated improvement, although two of the three remained in the clinical range. DISCUSSION AND CONCLUSIONS: 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.