Annotated bibliography: Teenagers and substance use

Annotated bibliography

August PD Blog

Professional development

You can add to the professional development post by commenting below or emailing the library.

Online resources

Webpage

Youth alcohol and other drugs learning hub for workers provides access to free self-directed learning modules

Read – professional reading  

Available from the library database

Atkinson, J. A., Prodan, A., Livingston, M., Knowles, D., O’Donnell, E., Room, R., … & Wiggers, J. (2018). Impacts of licensed premises trading hour policies on alcohol‐related harms. Addiction.

Couto E Cruz, C., Salom, C., Maravilla, J., & Alati, R. (2018). Mental and physical health correlates of discrimination against people who inject drugs: A Systematic Review. Journal of Studies on Alcohol and Drugs, 79(3), 350-360.

Geia, L., Broadfield, K., Grainger, D., Day, A., & Watkin‐Lui, F. (2018). Adolescent and young adult substance use in Australian Indigenous communities: a systematic review of demand control program outcomes. Australian and New Zealand Journal of Public Health, 42(3), 254-261.

Hawke, L. D., Koyama, E., & Henderson, J. (2018). Cannabis use, other substance use, and co-occurring mental health concerns among youth presenting for substance use treatment services: Sex and age differences. Journal of Substance Abuse Treatment, 91, 12-19.

McKetin, R., Lubman, D. I., Baker, A., Dawe, S., Ross, J., Mattick, R. P., & Degenhardt, L. (2018). The relationship between methamphetamine use and heterosexual behaviour: evidence from a prospective longitudinal study. Addiction.

Whiteside, M., MacLean, S., Callinan, S., Marshall, P., Nolan, S., & Tsey, K. (2018). Acceptability of an Aboriginal wellbeing intervention for supporters of people using methamphetamines. Australian Social Work, 1-9.

Open Access Articles

Moss, M. J., Warrick, B. J., Nelson, L. S., McKay, C. A., Dubé, P. A., Gosselin, S., … & Stolbach, A. I. (2018). ACMT and AACT position statement: preventing occupational fentanyl and fentanyl analog exposure to emergency responders. Clinical Toxicology, 56(4), 297-300.

Mustonen, A., Niemelä, S., Nordström, T., Murray, G. K., Mäki, P., Jääskeläinen, E., & Miettunen, J. (2018). Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis. The British Journal of Psychiatry, 212(4), 227-233.

Thompson, T. P., Taylor, A. H., Wanner, A., Husk, K., Wei, Y., Creanor, S., … & Wallace, G. (2018). Physical activity and the prevention, reduction, and treatment of alcohol and/or substance use across the lifespan (The PHASE review): protocol for a systematic review. Systematic Reviews, 7(1), 9.

Young, J. T., Heffernan, E., Borschmann, R., Ogloff, J. R., Spittal, M. J., Kouyoumdjian, F. G., … & Kinner, S. A. (2018). Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort study. The Lancet Public Health, 3(5), e237-e248.

Open access online journal

QNADA Focus: The latest edition focusses on LGBTIQ+ issues

Useful resources

Psychology tools – the library has just purchased Professional Team Membership for HOA  to the leading online resource for therapy tools.

Overview of Aboriginal and Torres Strait Islander Health Status Report 2017

NHRMC Comorbidity newletter New Horizons includes an article on developing a culturally appropriate AOD prevention program for Aboriginal and Torres Strait Islander young people.

Positive choices This contains resources including factsheets and videos about AOD use in youth aimed at teachers, youth and parents. There are also resources specific to Aboriginal and Torres Strait Islanders and youth that are Culturally and Linguistically Diverse

CleanM8 provides digital tools to provide support for those suffering from addiction, along with their significant others and clinicians, particularly in regional areas. It has been developed by the University of Newcastle

Lowitja Institute provides access to free e-books and reports pertaining to Aboriginal and Torres Strait Islander health research

 

e-Book of the month

Helping Male Survivors Of Sexual Violation To Recover : An Integrative Approach – Stories From Therapy  by Sarah Van Gogh

Placing the experiences of men at the heart of this book, Sarah Van Gogh outlines an integrative approach to effective therapeutic treatment of male sexual abuse. In a culture where to be male is often to be expected to embody strength, power and being in control, male victims of sexual abuse can be particularly challenging to help. This book outlines seven composite detailed case studies representing men from a wide range of backgrounds and demographics. It lays out how the author’s pioneering model of an integrative approach which includes psychodynamic, humanistic, relational, cognitive/behavioural, body-based and arts-based approaches can offer an effective model for working with this client group. This key text provides a valuable resource for all those working with male survivors of sexual abuse.

(copied from EBSCO site)

Free to download for all HOA staff from the library catalogue on work computers

Attend – informal learning sessions, journal club, seminar series

Insight Queensland

Free training sessions including:

1st August, 09:00-16:30 – AOD Crash Course at St George

2nd August, 08:30-12:30 – Crystal Clear: Responding to Methamphetamine Use at St George

2nd August, 13:00-16:30 – Brief Interventions at St George

9th August, 09:00-16:30 – Advanced Harm Reduction at Toowoomba

10th August, 09:00-16:30 – Introduction to Withdrawal Management at Toowoomba

16th August, 09:00-16:30 – Introduction to Withdrawal Management at the Gold Coast

23rd August, 09:00-16:30 – AOD Crash Course at Ipswich

 

30th August, 09:00-16:30- Advanced Harm Reduction at the Sunshine Coast

Attend – conferences 

The 16th Annual Conference for the Australia & New Zealand Academy for Eating Disorders will be taking place at the Melbourne Convention Centre on the 3rd & 4th of August, 2018. The theme for  this year will be Courageous Conversations: Furthering Understanding, Embracing Change. See the conference website:  http://conference.2018.anzaed.org.au for more info and details on how to register.  Cost $100-660

Write – presentations and papers

Call for papers: Australian Social Work  – Working with involuntary clients. Guidelines available here.

Listen – podcasts, webinars

Insight presentation recordings available now here

LGBTIQ young people share their stories on the podcast “Hear and queer

Assessed learning – short courses, certificates, diplomas, bachelors, post-grad

Lighthouse resourses

6th August: Assessing family dynamics: cost  $245

29th-31st August: Introduction to a strengths approach: cost $660

Workshop Venue: Lighthouse Resources Upstairs Training Room, Kyabra Street RUNCORN, QLD. 4113

Moss, M. J., Warrick, B. J., Nelson, L. S., McKay, C. A., Dubé, P. A., Gosselin, S., … & Stolbach, A. I. (2018). ACMT and AACT position statement: preventing occupational fentanyl and fentanyl analog exposure to emergency responders. Clinical Toxicology, 56(4), 297-300.Moss, M. J., Warrick, B. J., Nelson, L. S., McKay, C. A., Dubé, P. A., Gosselin, S., … & Stolbach, A. I. (2018). ACMT and AACT position statement: preventing occupational fentanyl and fentanyl analog exposure to emergency responders. Clinical Toxicology, 56(4), 297-300.

April PD

Professional development

You can add to the professional development post by commenting below or emailing the library.

Online resources

Webpage

Queensland Government  – Drug use: help and treatment

Read – professional reading

Available from the library database

  • Heward-Belle, S., Laing, L., Humphreys, C., & Toivonen, C. (2018). Intervening with Children Living with Domestic Violence: Is the System Safe?. Australian Social Work, 1-13.
  • Jiang, M. Y., & Vartanian, L. R. (2018). A review of existing measures of attentional biases in body image and eating disorders research. Australian Journal Of Psychology, 70(1), 3-17.
  • Kaplan, L. M., Greenfield, T. K., & Karriker‐Jaffe, K. J. (2017). Examination of associations between early life victimisation and alcohol’s harm from others. Drug and Alcohol Review.
  • Massey, S. H., Newmark, R. L., & Wakschlag, L. S. (2017). Explicating the role of empathic processes in substance use disorders: a conceptual framework and research agenda. Drug and Alcohol Review.
  • Pennay, A., McNair, R., Hughes, T. L., Leonard, W., Brown, R., & Lubman, D. I. (2018). Improving alcohol and mental health treatment for lesbian, bisexual and queer women: Identity matters. Australian And New Zealand Journal Of Public Health, 42(1), 35-42.

Open Access Articles

Open access online journal

Journal of Eating Disorders

A peer-reviewed open access journal exploring eating disorders

Open access textbooks

College open  textbooks: psychology

Useful resources

Australian College of Community Services Facebook page

ACCS is a not-for-profit Registered Training Organisation and national provider of professional development across various industries.

e-Book of the month

Howard, A., Katrak, M., Blakemore, T., & Pallas, P. (2016). Rural, Regional and Remote Social Work : Practice Research From Australia. London: Routledge.

This book gives voice to the direct practice experience of social workers working in rural and remote contexts using Australia as the primary case-study. The authors undertake a qualitative research project, conducting in-depth interviews to examine social work theory and practice against the reality of rural and remote contexts. Practice examples provide the reader with an insight into the diverse and complex nature of social work in rural and remote Australia and the role of contemporary social work. Through placing rural and remote social work in its historical, theoretical and geographical contexts, this work explores a range of considerations. These include isolation; ethical dilemmas when working with small and closely linked communities; climate, disaster relief and the environment; community identity and culture; working with indigenous communities in remote contexts; and social work education. Based on direct practice research, this book challenges existing theories of practice and reframes those to reflect the reality of practice in rural and remote communities. As social work must continue to critically reflect on its role within an ever changing and individualistic society, lessons from rural and remote settings around engagement, sense of place and skillful, innovative practice have never been more relevant. (abstract from EBSCO)

Free to download for all HOA staff from the library catalogue on work computers

Attend – informal learning sessions, journal club, seminar series

Insight Queensland

Free training sessions at Biala Community Health Centre in Brisbane, unless otherwise specified including:

  • April 6, 8:30-16:00 at Townsville: AOD Clinical assessment
  • April 17, 9:00-13:00: Crystal clear- responding to methamphetamine use
  • April 17, 9:00-16:30 at Bundaberg: AOD crash course- one day introduction to AOD
  • April 18, 9:00-16:30 at Bundaberg: Family inclusive practice in AOD treatment
  • April 24, 9:30-11:30: The problem gambling severity index- a screen for problem gambling in AOD and mental health populations
  • April 17, 9:00-16:30: Sensory approaches for AOD practice
  • April 26, 9:00-16:30 at the Gold Coast: AOD crash course- one day introduction to AOD

To register and for more details go their website

Online induction modules are a prerequisite to some of the courses. To access and download them visit www.insightqld.org

Attend – conferences 

Health in difference is Australia’s premier conference on the health and wellbeing of lesbian, gay, bisexual, trans, intersex, queer and sexuality, gender, and bodily diverse people and communities throughout Australia. Held at Sydney on 11-13 April costing from $345-780 for the full conference. Program details available and include mental health issues effecting the population. Register here

Write – presentations and papers

Get your work published in the Australian Journal of Psychology. Author guidelines are available here

 Listen – podcasts, webinars

Insight webinar: Overview of the ADIS service, April 18, 10:00-11:00

The Alcohol and Drug Information Service (ADIS) has operated for over 30 years as Queensland’s 24/7 hotline for anyone experiencing issues with alcohol or other drugs and their families. This presentation outlines service directions and insights from the ADIS dataset including over 540,000 calls across 14 years of data collection.

Presented by Dr Hollie Wilson – Allied Health Manager, Alcohol and Drug Information Service

Access at www.insight.qld.edu.au and enter participant code: 52365378

Insight presentation recordings available now on YouTube

Positive Choices drug and alcohol information webinars including:

Drug and alcohol and the maturing adolescent brain

How do mental health and substance use disorders affect young people?

 Assessed learning – short courses, certificates, diplomas, bachelors, post-grad

The Absurd Word: Creative Writing for Self-Supervision

Date: 24th April 2018, 9:30-16:30, $220 before 24/03/2018 and then $240

Venue: Lighthouse Resources Upstairs Training Room, Kyabra Street RUNCORN, QLD. 4113

This workshop uses creative writing to explore the challenges and successes in your practice. You will experience Five writing exercises that support self-awareness, critical reflection and potential lightbulb moments.  You may also unearth parts of yourself you had forgotten, not been aware of or had underestimated their impact on your practice.

Register here

My Heart Art: Image Making for Self-Supervision

Date: 30th April 2018, 9:30-16:30, $230 before 30/03/2018 and then $250

Venue: Lighthouse Resources Upstairs Training Room, Kyabra Street RUNCORN, QLD. 4113

This workshop uses painting, drawing and collage to explore the emotions of working in the human services field. You will experience art based exercises that support you to be aware of the emotions of your clients and of yourself, highlighting transference, countertransference and the dynamics of your working alliance. These exercises can be used for your own continued Self-Supervision and in your work with community members.

Register here

Annotated bibliography: Consumer participation in treatment programs

Annotated bibliography

Becan, J. E., Knight, D. K., Crawley, R. D., Joe, G. W., & Flynn, P. M. (2015). Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change. Journal of Substance Abuse Treatment, 50(1), 38-49.

The aim of this study was to assess the effectiveness of the Treatment Readiness and Induction Program (TRIP) for treating for motivating adolescents involved in treatment programs. Motivation is a crucial factor in the success of treatment for substance abuse and includes problem recognition, a desire to seek help and a readiness to change. The authors stated that interventions that facilitate this are particularly important for adolescents. The data was collected from 519 adolescents from six residential programs. They completed assessments at treatment intake and again 35 days after admission. The study included a control sample (n = 281) that had commenced treatment prior to the implementation of TRIP, which were compared against clients who received standard treatment enhanced by TRIP (n = 238). Motivational levels were conceptualised utilising statistical tools, which allowed for variables such as gender and drug use severity. The adolescents using TRIP demonstrated greater levels of gains in problem recognition and TRIP was linked indirectly with gains in the desire to seek help and readiness for treatment. Limitations include that the study was confined to those in residential care and were still in treatment 35 days after admission.

Durbeej, N., Palmstierna, T., Berman, A. H., Kristiansson, M., & Gumpert, C. H. (2014). Offenders with mental health problems and problematic substance use: Affective psychopathic personality traits as potential barriers to participation in substance abuse interventions. Journal of Substance Abuse Treatment, 46(5), 574-583.

Treatment for substance abuse may reduce recidivism in offenders as substance abuse has been linked to re-offending. Participation in substance abuse treatment programs by offenders may be associated with severity of substance use and social problems, violence risk and psychopathic personality traits. This study examined the relationships between these characteristics and participation in substance abuse programs in Swedish offenders with comorbid mental illness and problematic substance abuse. The data was collected by interviews on three occasions: at the beginning of the study, shortly before release and at the end of the treatment period (mean time = 20.8 months) and standard assessment tools were used including the Alcohol Use Disorders Identification Test (AUDIT). The data was collected from 134 offenders who voluntarily participated in the study. It indicated that problem severity predicted participation in intervention but that affective psychopathic personality traits were negatively associated with intervention participation. It concluded that psychopathic personality traits should be considered when planning interventions and that cognitive behavioral therapy and dialectical behavioral therapy may be more applicable for these offenders. One of the limitations of the study is that it utilised an observational study design so was reliant on observed associations between variables, which may result in researcher bias.

Garrett, S. B., Doyle, S. R., Peavy, K. M., Wells, E. A., Owens, M. D., Shores-Wilson, K., & … Donovan, D. M. (2018). Age differences in outcomes among patients in the “Stimulant Abuser Groups to Engage in 12-Step” (STAGE-12) intervention. Journal of Substance Abuse Treatment, 84(1), 21-29.

Young adults (aged 18-29 years) have the potential to benefit from participating in twelve-step programs, but their uptake in these programs is relatively low. The aim of this study was to examine if age did effect attendance at twelve-step interventions and how it affected substance use. Data was obtained using a multi-site randomised controlled trial with assessments performed at baseline, mid-treatment (week 4), end-of-treatment (8 weeks) and at 3 and 6 months post treatment. The participants were all diagnosed with stimulant abuse or dependence utilising DSM IV (n = 450) and were enrolled in ten intensive outpatients substance use treatment programs in the USA. The study found that younger age was associated with improved treatment outcomes and that abstinence was greater in those who had participated in 12-step programs as opposed to treatment as usual (TAU). Conversely, for those who did not remain abstinent during treatment, younger age was associated with greater rates of stimulant use at follow up for those in 12-step as opposed to those in TAU. There were greater rates of participation in activities in young adults in 12-step programs than those in TAU programs. Users of non-stimulant drugs exhibited no differences in age by treatment interactions, but younger users were less likely to be abstinent at follow-up regardless of the treatment they had received. The study recommends ongoing assessment of the consumer’s readiness to change to guide the focus of treatment and that age appropriate treatment may benefit clinical outcome. Data collected was self-reported and was identified as a limitation of the study.

Hatch-Maillette, M., Wells, E. A., Doyle, S. R., Brigham, G. S., Daley, D., DiCenzo, J., & … Perl, H. I. (2016). Predictors of 12-Step Attendance and Participation for Individuals with Stimulant Use Disorders. Journal of Substance Abuse Treatment, 68(1), 74-82.

The authors of this study identified a gap in the research examining the effectiveness of 12-step peer recovery programs for drug use. They conducted a multi-site randomised clinical trial of 12-step facilitation on individuals with cocaine or methamphetamine use disorders (n =471) attending in one of ten settings. Participants were randomly assigned to 12-step with TAU or TAU alone for an eight week intervention. They were then assessed at 4 week and 8 weeks into treatment and again at 3 and 6 months after treatment commencement. Four outcome variables were examined:

  1. To what extent do treatment-seeking stimulant users choose 12-step interventions
  2. Do the factors, which predict 12-step participation in people with alcohol use disorders, apply in stimulant users?
  3. Which baseline “12-step readiness” factors predict program attendance and participation?
  4. Does choice of stimulant predict participation and attendance in 12-step programs?

The study found that attendance, speaking, allocated duties and peer were unrelated to demographics and substance use history or severity. Cocaine users were more likely to attend follow up meetings at 1, 3 and 6 months than methamphetamine users, as were those who perceived the groups as being beneficial to their recovery. Consumers who had attended the program prior to the study were also more likely to attend follow up sessions and participate in self-help activities, whereas those who perceived barriers to 12-step groups prior to the study were less likely to participate in these. Those who participated in self-help activities were more likely to volunteer for group duties. It concluded that continuity, prior attendance and active involvement with the 12-step programs were the main predictors for future program involvement and participation. The study was limited in that it only studied participants in a select set of treatment programs

Ibabe, I., Stein, J. A., Nyamathi, A., & Bentler, P. M. (2014). Predictors of substance abuse treatment participation among homeless adults. Journal of Substance Abuse Treatment, 46(3), 374-381.

This study examines the relationships among a history of trauma, a history of substance abuse, chronic homelessness and emotional distress in predicting participation in drug treatment programs, as enrolment and retention of clients in these programs is difficult, particularly among homeless people. Structural equation modelling was used, which indicated an association between chronic homelessness, trauma history and substance use history. This association significantly predicted recent emotional distress in the 853 participants, who were all homeless adults living in Los Angeles. Those with recent emotional distress were less likely to participate in substance abuse treatment, both formal and self-help. However, those with only a history of substance use were more likely to participate in treatment. It recommends providers focusing on dual-diagnosis interventions in order to encourage engagement and participation amongst this client group. They also cite the success of outreach services in establishing an initial contact with treatment services for this group as a method of reducing barriers to treatment seeking, including distrust. The authors state the over reliance on self-reporting is a limitation in this research.

Jaffe, A., Du, J., Huang, D., & Hser, Y. (2012). Drug-abusing offenders with comorbid mental disorders: Problem severity, treatment participation, and recidivism. Journal of Substance Abuse Treatment, 43(2), 244-250.

The aim of this study was to examine problem severity, treatment participation and recidivism in 1016 drug-abusing offenders who had a co-existing mental disorder. The participants were first assessed utilising the Addiction Severity Index (ASI) and their mental health diagnoses, treatment program participation and arrest records were obtained. The severity of their mental health disorder was then classified as mild or severe based on their specific diagnoses. Ordinal logistic regression was then used to examine predictors of recidivism separately for those with mild or severe mental health disorders. It was indicated that previous arrests, education level and treatment participation are predictors of recidivism generally. However, gender, age, primary drug, ASI score and treatment method are differentially important depending on the severity of the offender’s mental illness. The report recommends intervention strategies focusing on dual-diagnosis among offenders, to take into consideration the severity of their mental illness in order to increase their effectiveness and reduce recidivism. The data obtained is mainly self-reported which is identified as a limitation of the study.

Knight, D. K., Joe, G. W., Crawley, R. D., Becan, J. E., Dansereau, D. F., & Flynn, P. M. (2016). The Effectiveness of the Treatment Readiness and Induction Program (TRIP) for Improving During-Treatment Outcomes. Journal of Substance Abuse Treatment, 62(1), 20-27.

Engagement in treatment is an important factor in its success and this is consistently predicted by motivation. As problem recognition is an important aspect of motivation, it is essential to target efforts to improve this to achieve sustained recovery following treatment. This study aimed to compare the effectiveness of Standard Operating Practice (SOP) against SOP plus 8 sessions of TRIP on cognitive indicators and engagement in treatment for young people in 5 residential substance abuse treatment centres. The original sample consisted of 1228 adolescents (SPO = 749, TRIP = 479), which had reduced to 729 (SPO = 445, TRIP = 274) at the end of the study. Data was collected using the Texas Christian University Adolescent Screening and Assessment Package on admission (Time 1) and 30-45 days into treatment (Time 2), which was usually at the completion of the program. The study found that adolescents who received TRIP demonstrated higher problem recognition, decision-making and treatment engagement than those who received SOP only. This was true even when controlling for background factors such as demography and drug use severity. A limitation of this study was that only youths who completed the treatment were included in the final analysis.

McKay, J. R., Van Horn, D., Rennert, L., Drapkin, M., Ivey, M., & Koppenhaver, J. (2013). Factors in sustained recovery from cocaine dependence. Journal of Substance Abuse Treatment, 45(2), 163-172.

This study aimed to establish factors that predicted abstinence from cocaine use and shifts from use to abstinence over a 24-month period. The participants (n = 268) were recruited from three centres which provided intensive outpatient programs. The data was collected over 24-months and the participants were assessed within 2 weeks of admission and then at 3-monthly periods thereafter using a variety of screening tools. It identified that both abstinence from cocaine and transitioning into abstinence at the next follow-up were associated with older age, less education and lower severity of alcohol and cocaine use at baseline. Additional factors contributing to abstinence and transition to abstinence were higher self-efficacy, readiness to change, better social networks, lower depression and lower severity of co-existing problems. A limitation of the research was that it was correlational, so it is not conclusive if the variables resulted in the changes in cocaine use or if it was the changes in the predictors (e.g. raising self-esteem) that caused the reduction in cocaine use

Timko, C., Below, M., Schultz, N. R., Brief, D., & Cucciare, M. A. (2015). Patient and Program Factors that Bridge the Detoxification-Treatment Gap: A Structured Evidence Review. Journal of Substance Abuse Treatment, 52(1), 31-39.
Completion of detoxification and transitioning to substance use disorder (SUD) treatment and/or mutual self-help groups (MSHG) predict improved consumer outcomes. However, many consumers do not complete detoxification or receive SUD treatment afterwards. The authors conducted a structured evidence review on 26 articles to ascertain consumer, program and other factors associated with the successful completion of detoxification and transitioning to SUD treatment and/or MSHG. They found wide variations in the studies, between 45-95% of consumers completed detoxification and 14-92% transitioned to SUD treatment and/or MSHG. Family support and motivational-based approaches both contributed to completion of detoxification and transition to SUD care and/or MSHG. They suggest targeting these approaches at young people, who are less likely to complete detoxification and that barriers to detoxification and the subsequent transition to SUD care and/or MSHG can be overcome to improve consumer outcomes. The authors of this study relied on one database (PubMed) to collect their data, which is a major limitation of the study.

Zemore, S. E., & Ajzen, I. (2014). Predicting substance abuse treatment completion using a new scale based on the theory of planned behavior. Journal of Substance Abuse Treatment, 46(2), 174-182.

This study evaluated whether a 9-item scale based on the theory of planned behaviour (TPB) predicted the completion of substance abuse treatment. TPB is a general, social cognitive model of behaviour that has been useful in modelling a range of public health behaviours and can be applied to predicting treatment completion for SUDs. The data was collected from clients (n = 200) at a public outpatient program. The participants had all initiated treatment and baseline data was collected using surveys, which included attitudes towards treatment and perceived control and intention. The participants status on discharge was then collected using program records. TPB attitude and control components independently predicted intention and intention was positively related to treatment outcomes. TPB components were frequently related to readiness and were predictive of increased levels of coercion. Results indicate that the use of TPB improves treatment completion. A limitation of the study is the sample size and that the data was obtained from a single treatment program.