Improving aftercare for substance abusers

by Jordan Zivitz

A Concordia-based research team has produced a report that suggests that substance-abuse centres need to develop more individualized programs for their patients.

The report, titled Experimental Manipulation of Treatment Aftercare Regimes for the Substance Abuser, is the end result of a four-year clinical study funded by Health Canada that examined the effects of two different aftercare programs on alcoholics and drug addicts.

Patients who participated in the study at three Montreal-area treatment centres were randomly assigned to either a 12-step program based on the principles of Alcoholics Anonymous, or a relapse prevention (RP) program. RP attempts to identify environmental factors that might have caused substance abuse, and teaches the patient how to deal with those factors.

The report clearly indicates that not all substance abusers benefit from the same aftercare treatment. Certain demographic groups made notable progress with RP treatment, while the 12-step program was more effective for other groups.

The report strongly implies that the use of a universal aftercare program for substance abuse is questionable, and that patients can benefit from a more individualized aftercare regime.

Principal researcher and Concordia Psychology Professor Peter Seraganian said that his team's study emerged from the research literature as well as from the changes advocated by a recent provincial government bill, Bill 120, which urged health care providers to adapt services to user needs.

"[At the time of Bill 120,] too many clinical sectors were trying to push health care users into pre-existing services that may not have fit very well with what they needed," explained Seraganian, who developed his study with fellow Concordia Psychology Professors and researchers Thomas Brown and Jacques Tremblay, and Toronto-based researcher Helen Annis. "[Our] study explored whether a greater variety in treatment did in fact help the [substance abuser]."

The belief that substance abusers could benefit from a wide range of treatment options available to them led Seraganian and his team to use the RP aftercare program as a component in their study. Since the RP approach focuses on teaching the individual substance abuser new behaviour rather than a belief in his or her powerlessness, it is easily tailored to each patient's needs.

When devising the methodology for their study, the research team members took pains to ensure that their study sample was representative of patients currently seeking treatment. A similar study recently carried out by a research group in the United States focused on pure alcoholics rather than multiple substance abusers.

The result was a statistically tidy study, but one that included anyone who used both drugs and alcohol -- a significant portion of the average substance abuse centre's population. Seraganian and his associates wanted the participants of their study to approximate the make-up of patients seen in substance abuse centres, and therefore included multiple substance abusers in their work.

The three centres in which Seraganian's team carried out their studies -- Pavillon Foster, Maison Jean-Lapointe and le Virage -- were not simply convenient clinical environments for the researchers. The employees of the centres were actively involved in the study, receiving training in the RP and 12-step aftercare programs if needed. Seraganian stressed that the support of the centres' employees was integral to the success of the project.

"If staff in the centres have reservations and fail to support research efforts, they can undermine the whole project," he said. "The patients pick up on the enthusiasm of the staff. If the staff is really sold on the potential benefits, both for the patients and for the treatment centres involved in this research, it comes across quite clearly in the patients."

The study's strong roots in the substance abuse research community were apparent at a recent information and feedback session held by Seraganian, Brown, and Tremblay. Speaking to representatives from all three participating centres, the researchers carefully outlined their report and kept their audience well informed of all findings.

"[We held the session to] maintain the centres' high level of involvement," Seraganian said. "We, as researchers, can't just disappear after we gather our data. If we did, we'd never be able to get back into the centres."