A mixed-methods study of treatment adherence and progress for offenders referred to community-based drug addiction treatment

The current study used a mixed-method design to examine the influence of client- and counselor-level factors on treatment adherence and progress for offenders referred to community-based drug addiction treatment. The sample included 90 client participants and 7 counselor participants from community-based treatment in a Midwest metropolitan area. A multilevel modeling technique was conducted to examine the influence of victimization and violence history, psychiatric disorders (i.e., psychiatric symptoms, anxiety, depression), social functioning (i.e., social support, self-esteem), drug use severity, and treatment motivation on treatment adherence, satisfaction, and progress after controlling for counselor-level variances. Multilevel modeling also was employed to test the mediation and moderation of treatment satisfaction on the relationship between client-level factors and treatment progress. The results revealed that treatment satisfaction moderated the relationship between victimization and treatment progress, whereby a lower level of victimization was associated with more treatment progress among clients with high treatment satisfaction; there was no significant relationship between victimization and treatment progress among clients with low treatment satisfaction. Moreover, psychiatric symptoms predicted treatment adherence. Social support was correlated with treatment satisfaction which in turn was associated with treatment progress; social support also directly predicted treatment progress. A lower level of depression and a higher level of treatment motivation predicted greater treatment progress. Despite the nonsignificant findings, the association of client drug use severity and treatment motivation with treatment progress differed between counselors. Qualitative analyses that were derived from counselors' perception of factors that influence successful recovery yielded five prominent themes comprised of reducing resistance and enhancing treatment motivation, building strong therapeutic alliance, encouraging empowerment, reducing relapse and recidivating risks, and recognizing practical considerations (e.g., transportation assistance). The findings collectively underscore the importance of integrated interventions, social support, treatment motivation, satisfaction, and therapeutic alliance on treatment outcome. Also, the current findings highlight the importance of relatively small counseling groups, collaborating with community corrections, and teaching clients strategies for dealing with deviant peers in facilitating client recovery.