Drug Abuse Counseling
Cognitive skills training: impact on drug abuse counseling and readiness for treatment - [dagger]Michael Czuchry It is clear that substance abuse treatment can be effective (1,2) but is also in need of improvement (3,4). An essential component of many treatment approaches involves improving the cognitive skills of program participants (4-8). Cognitive skills training appears to be particularly warranted because many individuals, especially those in criminal justice settings, enter treatment with severe cognitive deficits that interfere with the process of treatment [e.g., Ref. (9)]. Although cognitive training has been incorporated into some prison and probationer programs (4,7), there has been little work on a wide-ranging "plug and play" system that can be transferred easily into a variety of treatment programs. To remedy this situation, we have taken a first step toward developing and evaluating such a training package. In addition, although the primary focus of cognitive training programs have typically targeted personal problem solving and decision making, we addressed a number of other important cognitive skills that have not received as much attention. These include memory techniques, comprehension strategies, self-regulation (mood management) skills, goal setting and planning approaches, and perspective taking methods. We suggest that these skills are not only important in coping with life situations after treatment but are also crucial in "getting the most out of treatment." Deficits in one or more of these skills could clearly impede the effectiveness of drug abuse counseling.
To address these issues, we developed the TCU Cognitive Skills Module (CSM) as a part of an NIDA-funded project entitled "Cognitive Enhancements for Treatment of Probationers (CETOP)." The general goal of this project has been to improve substance abuse treatment for probationers in a 4-month residential treatment program (followed by 3 months of aftercare) that uses a quasi-therapeutic community treatment approach. For the cognitive skills portion of the project, we developed 10 self-study booklets covering critical skills. The skills addressed were based on an examination of the cognitive deficit literature and through discussions with substance abuse counselors and researchers. (See Table 1 for brief descriptions of each of the booklets.) We designed the booklets by keeping in mind that our target audience may indeed have cognitive processing difficulties and, having been mandated to receive treatment, may have less motivation to be involved in treatment generally. As a result, we followed the following guiding principles in designing the booklets: 1) we provided variety and distinctiveness to hold readers' interest (e.g., novel formats, humor, indirect or contrary suggestions); 2) a substantial amount of reader response and writing activities; 3) an intermediate level of challenge (not too difficult nor too easy); 4) a generic "fit" regardless of program philosophy; and 5) a sense of mastery or self-efficacy when the booklets were completed.
In line with our past work (10,11), therapeutic communities in this project were randomly assigned to one of two treatment conditions. Standard treatment (as practiced by the participating facility) was either supplemented by the CSM (the enhanced communities) or not (the standard communities). The standard communities received treatment as usual. An extensive set of measures was then used to evaluate its effectiveness (see the Methods section for more detail on the instruments and procedures used for this project).
In the current study, our primary interest was to examine whether addition of the cognitive skills package improved perceived treatment outcomes during the 4-month residential phase of treatment. In particular, we were interested in probationer ratings (using peer ratings and a community survey) and counselor ratings of each resident's progress in treatment. These ratings are particularly important indicators of progress during the residential phase of treatment because more bottom-line behavioral indicators, such as the occurrence of "dirty" urines, are constrained due to the level of supervision residents receive and are thus less useful as measures of progress. Although program infractions can sometimes be used, we have observed low variability on this indicator as well in the current setting. Important to note is that it has been shown that client, peer, and counselor ratings have been shown to be a valid and meaningful way to assess during-treatment outcomes (12) and that such self-assessments are reliable, valid, and demonstrate good correspondence with behavioral measures [e.g., see Ref. (13) for a brief review].
Our previous research suggested that individual readiness for treatment is a strong predictor of their actions during treatment and on special enhancements (14). Additional research has shown that readiness for treatment is strongly related to favorable treatment outcomes (1,15-18). In general, individuals with high readiness report more positive reactions to treatment and are perceived by counselors and peers as doing better during the program. Similarly, it is clear that an individual must be willing to engage the thinking and behavior necessary completing the CSM to realize any benefits. Consequently, the current study also examines probationers' level of treatment readiness to see if sufficient treatment readiness is required for the cognitive skills package to be effective. We expected the cognitive skills package would be generally useful but perhaps most useful for those probationers with higher levels of treatment readiness.
METHOD
The study was conducted at a 140-bed substance abuse facility in Mansfield, Texas. Offenders are mandated to treatment for violating conditions of probation or parole, either in conjunction with or as a direct result of substance abuse problems. Communities of probationers (n [congruent to] 35) receive counseling (4 months of residential treatment and 3 months of aftercare) in the areas of life skills development (e.g., anger management, women's and men's issues), general equivalency degree (GED) training, computer skills, parenting, substance abuse education, and opportunities for experiential learning through activities such as a "ropes" course. The NIDA-funded CETOP project has also introduced and evaluated a set of additional therapeutic enhancements such as node-link mapping [a visual representational strategy that counselors and clients may use to "map-out" personal problems or other issues; see Refs. (19,20), for more information] and motivational activities and games to facilitate motivation for treatment (14,21). Therapeutic enhancements that were found to be effective in earlier phases of this project (10,11,14) were made available for the treatment of all probationers throughout the current investigation. In essence, then, the current study is a more stringent test of the potential advantages of the CSM, because standard treatment had already been improved to higher levels through earlier enhancements. In line with previous studies, communities were randomly assigned to receive either the standard components mentioned above (including therapeutic enhancements such as node-link mapping and motivational activities) or these components plus cognitive skills module (i.e., the CSM).
Participants
Residents
Probationers admitted to the substance abuse treatment facility between January 1998 and February 1999 formed the sample for this study. Of the 540 probationers admitted, 4 refused to participate and 84 either quit or were unable to participate. Of the 452 included in this sample (comprising a set of 14 communities: 7 cognitive skills training and 7 standard), 69% were male, 58% were white, 28% were African American, 11% were Hispanic, 2% American Indian, and 1% were of other ethnic backgrounds. The average age was 29.9. The percentage of weekly drug use in the 6 months prior to treatment (for each drug classification that follows) was as follows: 54% used alcohol, 40% used marijuana, 35% used crack or cocaine, and 13% used heroin.
Counselors
Ten counselors participated, including seven females, two African Americans, and eight whites. All had 4-year college degrees, one had a graduate degree, six were certified alcohol and drug abuse counselors, four were social-work certified, two had HIV training certification, and six had other relevant certifications.
Measures
As we have argued previously (12), it is important and beneficial to use multiple types and sources of measurement to assess treatment effectiveness. Evaluating probations in residential treatment is particularly challenging in this regard because traditional "bottom-line" behavioral measures, such as session attendance or drug screening, are either unavailable or less variable due to situational constraints and are thus less informative and discriminating. However, a combination of approaches (e.g., individual, peer, and counselor ratings) allows one to "triangulate" on perceived treatment effectiveness during the residential phase of treatment. The measures used in the current study are based on a comprehensive evaluation system developed previously (22) and which was elaborated and refined for the CETOP project.
Readiness for Treatment
Readiness for treatment was assessed by using the TCU Self-Rating Form in the first month of treatment, using a factor structure established previously (23). However, two items were removed in the current study, because they were not relevant to residential treatment. Probationers rated the extent to which they agreed with the following items, on 7-point Likert scales anchored at 1 with "disagree strongly," at 4 with "not sure," and at 7 with "agree strongly": 1) "you have too many outside responsibilities now to be in this treatment program (reflected)"; 2) "this treatment program seems too demanding for you (reflected)"; 3) "this treatment many be your last chance to solve your drug problems"; 4) "this kind of treatment program will not be very helpful to you (reflected)"; 5) "this treatment program can really help you"; and 6) "you want to be in a drug treatment program." The average of these six items were computed to attain an overall indication of readiness for treatment. In the current study, the alpha reliability coefficient for this factor was 0.76.
Peer Rating Scale
The peer-rating system asked residents to rate the following items for each member of the community on 7-point Likert scales anchored at 1 with "disagree strongly," at 4 with "not sure," and at 7 with "agree strongly": 1) "resident is `working the program' in a positive way" and 2) "resident is likely to stay `clean and sober' after leaving the program." In the current study, a mean was calculated for the ratings probationers received from their fellow community members both midway and toward the end of treatment. Previous work with this scale has indicated that peer ratings offer both unique and supporting information to counselor ratings (12).
Community Survey
The community survey is an instrument designed to capture probationers' perceptions of the proportion of community members who are positively engaged in treatment and who serve as positive sources of support for other community members. Raters indicated the number of probationers in their community and then estimated how many of these individuals were involved positively in the community by using 25 different indicators (e.g., the number of residents who paid close attention during group sessions, who were motivated to improve themselves, and who helped other residents). Proportions were calculated for each item by taking the number of individuals that the rater had indicated exhibited a given characteristic and then by dividing this number by the total number of probationers in the community. Factors were then constructed on the basis of a factor analysis that had been previously established (10). In the current study, alpha coefficient reliabilities were 0.94, 0.90, and 0.82 for community engagement, respect, and cohesion, respectively.
Counselor Evaluation of the Community
Counselors evaluated each member of their communities using 7-point Likert scales anchored at 1 with "disagree strongly," at 4 with "not sure," and at 7 with "agree strongly." Twenty-five items were preceded by the stem, "The client is," and sample items included the following: 1) easy to talk to; 2) warm and caring; 3) honest and sincere; 4) cooperative; and 5) in denial. A principal components analysis with varimax rotation was conducted with all 25 items. Three factors emerged with eigenvalues greater than 1. Factors were created for items that loaded greater than 0.65 using unit weightings. The first factor, labeled "focused," included the following items: 1) in denial (reversed); 2) motivated; 3) assertive; 4) sincerely participating in the treatment program (working the program in a positive way); 5) actively participating in group discussions; 6) thinking clearly/objectively; 7) paying attention; 8) clearly expressing thoughts/feelings; 9) easily distracted (reversed); 10) good at remembering; 11) using good problem solving strategies; and 12) gaining insight about self. The second factor, labeled "cooperative," included the following items: 1) warm and caring; 2) cooperative; 3) getting along with other residents; and 4) accepted by other residents. The third factor, labeled "negative mood," included the following items: 1) nervous or anxious and 2) depressed ("down"). Alpha reliability coefficients were 0.95, 0.90, and 0.84 for focused, cooperative, and negative mood, respectively.
Administration of Measures
Counselors and an on-site research assistant received training on how to administer all measures. In the first month of treatment, residents completed an intake assessment that included self-reported readiness for treatment. The peer ratings, community survey, and counselor ratings were collected midway (during the second month), and at the end (in the fourth month) of treatment.
Administration of Booklets
Residents had 1 week to complete 2 booklets, completing all 10 booklets over a 5-week period. At the end of each week, residents returned the books they had been working on so CETOP personnel could examine them and also completed a short multiple-choice examination on each booklet to ensure compliance and participation. Residents were informed at the beginning of the project that they would receive up to $7.00 for conscientious participation and completion of the booklets. The amount of award each client was to receive was distributed after completion of the end-term measures.
RESULTS
In the current study, because of the nature of the treatment program, it was necessary to assign communities to treatment conditions (rather than individuals). We are aware that traditional analysis of variance techniques, such as those used in the current study, may be at risk of inflating type I error under these conditions (24,25). An overly conservative approach is to use communities as the level of analysis (26). However, the greatly reduced degrees of freedom in such an approach increases the likelihood of committing a type II error, in effect, missing an effect that is truly there. Because the current study was exploratory in nature, we examined the data by using individuals as the unit of analysis. For balance, we provide a brief verbal description of the findings as they would occur with community as the level of analysis.
To examine readiness for treatment, we conducted a median split on the overall readiness for treatment factor. Probationers with scores in the lower half thus represent those individuals with relatively lower levels of treatment readiness, whereas those with scores in the upper half represent those with higher levels of treatment readiness.
Peer-Ratings Scale
A repeated-measures multivariate analysis of variance (MANOVA) was conducted, with group (CSM vs. standard) and readiness for treatment (low vs. high) as the independent variables, and mean ratings received by probationers from peers for "working the program" and likelihood of remaining "clean and sober" at mid and end term as the repeated multiple dependent variables. There was an overall multivariate effect for group, F(2,447) = 7.86, p < 0.001, as well as for readiness for treatment, F(2,447) = 9.97, p < 0.02, and an overall multivariate interaction between group and readiness for treatment, F(2,447) = 4.27, p < 0.02. Univariate analyses revealed significant main effects for group at mid and end term for ratings of working the program, F(1,448) = 11.57, p < 0.001, midterm, F(1,448) = 12.71, p < 0.001, end term, and for ratings of clean and sober, F(1,448) = 12.83, p < 0.001, midterm, and F(1,448) = 6.45, p < 0.02, end term. As can be seen in Table 2, the means for working the program and remaining clean and sober are higher at mid and end term for the group receiving the CSM. Univariate analyses also revealed significant main effects for readiness for treatment at mid and end term for ratings of working the program, F(1,448) = 16.54, p < 0.001, midterm, F(1,448) = 12.80, p < 0.001, end term, and for ratings of clean and sober, F(1,448) = 18.50, p < 0.001, midterm, F(1,448) = 16.26, p < 0.001, end term. As can be seen in Table 2, the means are higher for residents who began treatment with higher levels of readiness. These univariate main effects need to be understood in light of the overall multivariate interaction between group and readiness for treatment. Univariate analyses revealed significant interactions between group and readiness for treatment at mid and end term for ratings of working the program, F(1,448) = 6.14, p < 0.02, midterm, F(1,448) = 5.20, p < 0.02, end term, and for ratings of clean and sober, F(1,448) = 6.83, p < 0.01, midterm, F(1,448) = 7.57, p < 0.01, end term. Post hoc comparisons indicated that standard residents with lower readiness for treatment were significantly less likely to be working the program or remain clean and sober than their counterparts receiving CSM and standard and CSM residents with higher readiness for treatment. This pattern can be seen clearly in Table 2. There also was an overall multivariate effect for time, F(2,447) = 11.54, p < 0.001, and an overall multivariate interaction between group and time, F(2,447) = 8.78, p < 0.001. No other effects were significant. As can be seen in Table 2, residents improved over time with regard to both working the program and their likelihood of remaining clean and sober. The interaction between group and time is less clear. Two repeated measures analyses of variance (ANOVA's) were conducted to examine ratings of working the program and remaining clean and sober separately. These analyses did not reveal any significant group by time interactions.
Community Survey
A repeated-measures MANOVA was conducted, with group (CSM vs. standard) and readiness for treatment (low vs. high) as the independent variables, and the proportion of community engagement, respect, and cohesion at mid and end term as the repeated multiple dependent variables. There were overall multivariate effects for group, F(3,445) = 4.34, p < 0.01, time, F(3,445) = 4.37, p < 0.01, and an overall multivariate interaction between group and time, F(3,445) = 8.69, p < 0.01. Univariate analyses revealed significant main effects for group at midterm for both engagement, F(1,447) = 30.47, p < 0.001, and respect, F(1,447) = 21.33, p < 0.001. As can be seen in Table 3, means were higher for the group receiving the CSM. The multivariate effect for time appears to be driven by the fact that means generally increase over time. To examine the group by time interaction further, separate repeated measures ANOVAS were conducted, with group (CSM vs. standard) and readiness for treatment (low vs. high) as the independent variables, and proportion of community engagement, respect, or cohesion as dependent variables. There were significant group by time interactions for community engagement, F(1,448) = 17.76, p < 0.001, and community respect, F(1,447) = 18.63, p < 0.001. As can be seen in Table 3, ratings for community engagement and respect are higher at midterm for the CSM group, whereas the standard and CSM ratings are closer by end term. No other effects were significant.
Counselor Evaluation of Client
A repeated-measures MANOVA was conducted, with group (CSM vs. standard) and readiness for treatment (low vs. high) as the independent variables and counselor ratings of focused, cooperative, and negative mood at mid and end term as the repeated multiple dependent measures. There were overall multivariate effects for group, F(3,443) = 53.23, p < 0.001, readiness for treatment, F(3,443) = 4.84, p < 0.05, time, F(3,443) = 20.01, p < 0.001, and an overall multivariate interaction between group and time, F(3,443) = 10.91, p < 0.001. Univariate analyses revealed a significant main effect for group at mid and end term for focused, F(1,445) = 42.66, p < 0.001, midterm, F(1,445) = 15.46, p < 0.001, end term; and for negative mood, F(1, 445) = 62.02, p < 0.001, midterm, F(1,445) = 142.40, p < 0.001, end term. There was also a significant main effect for group at midterm for cooperative ratings, F(1,445) = 9.80, p < 0.01. As can be seen in Table 4, means are higher for the group receiving the CSM for focused and cooperative and lower for the negative mood. There also were univariate main effects for readiness for treatment at end term for focused, F(1,445) = 10.29, p < 0.001, and cooperative, F(1,445) = 6.03, p < 0.05, and at midterm for negative mood, F(1,445) = 6.70, p < 0.05. As can be seen in Table 4, means are higher for residents who begin treatment with higher levels of readiness for the focused, cooperative, and negative mood ratings. To examine the group by time interaction further, separate repeated measures ANOVAS were conducted, with group (CSM vs. standard) and readiness for treatment (low vs. high) as the independent variables, and focused, cooperative, or negative mood as dependent variables. There were significant group by time interactions for all three measures; F(1,447) = 9.41, p < 0.01, for focused, F(1,447) = 9.47, p < 0.01, for cooperative, and F(1,446) = 15.68, p < 0.001 for negative mood. As can be seen in Table 4, although the CSM group was rated higher at midterm for the focused and cooperative ratings, the standard group ratings increase to a greater degree over time. In comparison, the ratings for negative mood were lower for the CSM group compared to the standard group at midterm and end term, and the magnitude of this difference increased over time. There was also a significant univariate interaction between group and readiness for treatment for cooperative ratings at end term, F(1,445) = 3.99, p < 0.05. However, it should be noted that the overall multivariate interaction between group and readiness for treatment was not significant. No other effects were significant.
Results Using Community as the Unit of Analysis
Peer Ratings
There was a significant interaction between time and condition [F(2, 23) = 4.89, p < 0.05], such that CSM residents were rated as working the program to a greater degree and as more likely to be clean and sober at midterm than standard residents, but standard residents "closed the gap" by end term. The interaction between condition and readiness for treatment approached significance (p = 0.06) for peer ratings of working the program at midterm.
Community Survey
There was a significant interaction between time and condition [F(3, 22) = 3.77, p < 0.05], such that CSM residents were rated as having a higher proportion of community engagement and respect at midterm than standard residents, but standard residents had "closed the gap" by end term.
Counselor Ratings
There was a significant interaction between time and condition [F(3, 22) = 4.24, p < 0.05], such that CSM residents were rated as being more focused and having lower negative mood at midterm than standard residents, but standard residents "closed the gap" by end term on the focused ratings. In contrast, CSM residents appeared to demonstrate further reductions in negative mood over time than standard residents.
DISCUSSION
The current study explored a cognitive skills program that we developed (the CSM) for probationers receiving drug abuse treatment. Manuals were created to address specific problems related to areas such as memory, problem solving, emotions, and self-control. We used the same measurement system in this study that has been useful in exploring other programs we have developed (10,12). Based on the analyses using individuals as the unit of analysis, the current study found that the CSM was successful in increasing residents' involvement in treatment including increased treatment engagement, cooperation, respect for other residents, and decreased negative mood (depression and hostility). The decrease in negative mood is particularly encouraging because emotional control was one of the features targeted by the CSM (see Table 1). The CSM appeared to be effective both at midterm and end term, although it appears that it may have had its greatest impact midway through treatment (especially in light of the conservative analyses that used community as the unit of analysis). It should be noted that a lack of differences on certain variables (e.g., community cohesion) mitigate against a "placebo" (i.e., across the board) affect.
The current study also found that clients with higher levels of readiness demonstrate greater involvement in treatment (although they did indicate higher levels of negative mood as well). Previous research has likewise shown that readiness for treatment is related to positive treatment outcomes [e.g., Refs. (1,17,18)]. The fact that we did not find a main effect for readiness for treatment on the community survey was not expected because we did not expect individuals who differ in readiness for treatment to rate individuals differently. Instead, we expected individuals with higher levels of readiness for treatment to be more involved in treatment themselves, which was supported by the peer and counselor ratings.
There was also evidence that our program may be especially beneficial for residents who begin treatment with lower levels of readiness. This is opposite to what we expected. We expected that a certain level of readiness would be necessary for the CSM to be beneficial. It may be, however, that increasing one's cognitive skills increases self-efficacy, and this influences motivation for being involved in treatment (in essence, probationers' may come to believe they can be successful in treatment). Although the findings were particularly evident with use of the peer-rating methodology at the individual unit of analysis, an examination of the means for analyses conducted with counselor ratings reveals a similar pattern of results (particularly for the focused and cooperative factors). We suggest that the peer-rating methodology may decrease error by being collapsed across a greater number of raters. Peer ratings may be especially important within residential treatment settings because community members often interact with each other outside of the counseling session, providing access to a range of behaviors that may remain inaccessible to counselors. It should be noted, however, that the interactions between condition and readiness for treatment largely disappeared when examining the data with community as the unit of analysis. The community level analyses had dramatically fewer degrees of freedom, and thus are problematic for interpretation as well as they increased the likelihood of hiding true differences by committing a type II error [e.g., this could explain why a typically robust effect such as treatment readiness (based on previous literature) would largely disappear on the measures for which differences were found at the individual level]. Because the current study was exploratory in nature, we believe that the potential benefits for residents with low treatment readiness deserve special attention, given that these individuals are typically more difficult to treat [e.g., Refs. (1,17)] and often make up a high percentage of those in criminal justice treatment programs. Due to power limitations in the current study, further research is clearly needed.
The overall pattern of results does provide clear evidence that the CSM was generally beneficial, particularly midway through treatment but that some benefits (e.g., reductions in negative mood) increased over time. Our confidence in the potency of these results is heightened because standard treatment (the comparison group in this study) was already enhanced with activities that had been shown to be effective in earlier phases of the CETOP project (10,11,14). In addition, these findings are still evident with the more conservative (and less powerful) analyses conducted with community as the unit of analysis.
More generally, the CSM skills module provides a multifaceted therapeutic intervention that can be used in part or collectively to address cognitive deficits faced by probationers (e.g., memory problems, decision-making problems, mood regulation issues, and problems with planning and decision making). The current study shows that increasing efficiency in these areas facilitates treatment progress and program involvement of probationers. Although more research is clearly needed, we expect that the treatment benefits observed in the current study will transfer into long-term benefits because probationers will be better able to address personal and situational issues that develop outside of the treatment setting. We are continuing to examine and refine those components of the CSM that appear to be the most beneficial. In addition, we plan to examine what types of individuals (specifically those with perceived cognitive deficiencies) respond best to the CSM. Future research should examine whether the skills learned actually ameliorate targeted cognitive deficiencies, or whether the benefits observed in the current study operate through more indirect means, such as through increasing one's perceived self-efficacy for solving problems or regulating one's mood.
Table 1. The TCU cognitive skills module (CSM): abstracts
of the 10 booklets.
1. Thought team: part I
When an individual looks to other people for input about important
decisions and problem solving, outcomes can be better than when the
task is done individually (especially for individuals who do these
tasks poorly). This booklet provides a strategy for getting quality
viewpoints on any issue from a team of people who are visualized rather
than physically present. The reader assembles a "thought" team of
respected thinkers and then practices getting input from that team.
2. Problem solving
Having a general strategy for dealing with problems can make solving
specific problems easier. The approach here is to provide activities
that will show the reader a systematic way to 1) analyze the cause of
a problem and prevent it in the future and/or 2) analyze the
consequences of a problem and find ways to minimize or reduce the
negative effects of a something that has already happened.
3. The science of memory part I: memory tricks
The reader will discover that memory usually can be made much more
effective by using certain techniques and strategies. Opportunities
are provided to try these methods.
4. The science of memory part 2: practical suggestions
In Part I the reader discovered that memory usually can be made much
more effective by using certain techniques and strategies. Practical
suggestions are made about the use of these and other methods.
5. Planning and goal setting
Activities in this booklet direct the reader to see that major,
long-term goals in life actually involve a sequence of steps or
short-term goals. A strategy is outlined for systematically planning
these short-term goals and practice is provided.
6. Understanding the world
This booklet shows how beliefs ("Five Bad Assumptions") can cause
comprehension failures. Both misunderstanding and not understanding
are heightened by these beliefs (e.g., "I can always figure it out
by myself"). Strategies are provided for sidestepping these beliefs
and enhancing understanding.
7. Taking control of your life
Effective personal self-management strategies can be developed via
attention to four problematic, but very human, behaviors:
procrastination, habits, urges, and impulses (PHUI). The reader can
gain some insight into these issues as well as some practice with
strategies for dealing with them.
8. Decision making
Making good decisions can be a matter of learning to systematically
list the best alternatives and then to assess the costs and benefits
of each alternative. This booklet provides guidance and practice in
doing this.
9. Mood
The message of this booklet is that an individual can learn to
prevent bad moods and minimize the damage of a bad mood that wasn't
prevented. The reader gets a chance to analyze and plan for aspects
of his or her own mood problems around critical mood states: 1) anger
and aggression, 2) sadness and depression, 3) fear and anxiety, and
4) happiness.
10. Thought team: part II
The reader will use his or her already assembled thought team to
deal with a series of vignettes--tough situations that might readily
occur in the life of a substance abuser.
Table 2. Means and standard deviations for peer ratings of working
the program and clean and sober.
Mid term End term
Readiness
Factor Training level No. M SD M SD
Working the Low 120 5.21 0.71 5.36 0.85
program CSM High 112 5.31 0.63 5.46 0.76
Standard Low 107 4.82 0.75 4.93 0.83
High 113 5.25 0.72 5.36 0.68
Clean and CSM Low 120 4.84 0.73 4.93 0.81
sober High 112 4.95 0.66 5.02 0.80
Standard Low 107 4.41 0.75 4.54 0.79
High 113 4.89 0.78 5.04 0.69
Note: Univariate effects significant at p < 0.05; for working the
program, main effect of training group at mid and end term, main
effect of readiness for treatment at mid and end term, interactions
between training group and readiness for treatment at mid and
end term; for clean and sober, main effect of training group at
mid and end term, main effect of readiness for treatment at mid
and end term, interactions between training group and readiness
for treatment at mid and end term.
Table 3. Means and standard deviations for individual ratings of
community engagement, respect, and cohesion.
Midterm End term
Readiness
Factor Training level N M SD M SD
Engagement CSM Low 120 0.67 0.18 0.63 0.20
High 112 0.69 0.17 0.65 0.20
Standard Low 106 0.60 0.18 0.62 0.20
High 113 0.58 0.17 0.61 0.21
Respect CSM Low 120 0.27 0.22 0.26 0.24
High 112 0.26 0.19 0.24 0.22
Standard Low 106 0.19 0.15 0.25 0.22
High 113 0.19 0.13 0.25 0.22
Cohesion CSM Low 120 0.74 0.16 0.73 0.20
High 112 0.75 0.16 0.78 0.15
Standard Low 106 0.73 0.16 0.74 0.14
High 113 0.73 0.14 0.75 0.16
Note: Univariate effects significant at p < 0.05; for engagement,
main effect of training group at midterm, interaction between training
group and time; for respect, main effect of training group at midterm,
interaction between training group and time.
Table 4. Means and standard deviations for counselor ratings of
focused, cooperative, and negative mood.
Midterm End term
Readiness
Factor Training level No. M SD M SD
Focused CSM Low 120 4.82 1.29 4.77 1.44
High 110 4.96 1.14 5.06 1.09
Standard Low 106 4.03 1.07 4.23 1.14
High 113 4.30 1.17 4.69 1.17
Cooperative CSM Low 120 4.94 1.28 5.07 1.16
High 110 5.07 1.01 5.12 1.11
Standard Low 106 4.51 1.30 4.83 1.27
High 113 4.78 1.30 5.31 1.04
Negative CSM Low 120 3.18 1.50 2.64 1.42
mood High 110 3.40 1.48 2.70 1.33
Standard Low 106 4.30 2.10 4.21 1.72
High 113 4.97 2.11 4.72 1.88
Note: Univariate effects significant at p < 0.05; for focused, main
effect of training group at mid and end term, main effect of readiness
for treatment at end term, interaction between training group and time;
for cooperative, main effect of training group at midterm, main effect
of readiness for treatment at end term, interaction between training
group and time, interaction between training group and readiness for
treatment at end term; for negative mood, main effect of training group
at mid and end term, main effect of readiness for treatment at end
term, interaction between training group and time.
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Michael Czuchry * and Donald F. Dansereau
([dagger]) This work was supported by the National Institute on Drug Abuse (Grant No. R01 DA08608). The interpretations and conclusions, however, do not necessarily represent the position of NIDA or the Department of Health and Human Services. We thank the staff and counselors at the Tarrant County Correctional Facility in Mansfield, Texas, for their assistance in conducting this research project.
* Correspondence: Michael Czuchry, Ph.D., Texas Christian University, TCU Box 298920, Fort Worth, TX 76129, USA; E-mail: m.czuchry@tcu.edu.
COPYRIGHT 2003 Marcel Dekker, Inc.
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