Two hundred forty five residents of CSLT were recruited into the study during their first week after entering the house. In order to maximize our ability to generalize results we employed few inclusion/exclusion criteria: all study participants were age 18 or older and competent to provide informed consent. See for a depiction of demographic characteristics of the sample. Most participants were men (77%), white (72.5%) and middle age (mean=38, s=0.65). Over three fourths had at least a high school education or GED and the average income from all sources the month before entering the SLH was $963 (se=$120). About half had never been married and slightly less (48%) had children under age 18. Nearly all the participants had a history of previous treatment (94%) and 60% had been admitted to a residential treatment program within the past 6 months (not shown in the table).
3.2 Baseline Characteristics
In addition to demographic characteristics, shows referral sources and pre-baseline functioning. The most common referral source was self, family or friend (44%). Although 29% were referred through the criminal justice system, a much higher 42% indicated that they had been arrested at least once over the past 6 months. Thus, having spent some time in a controlled environment before entering the SLH did not necessarily mean that the individual was referred to the SLH from that controlled environment. The most common substances that residents were dependent on during the past year were methamphetamine (53%) and alcohol (49%) (not shown in the table). Responses on the ASI for lifetime use of alcohol and drugs was extensive, with 97% of the sample reporting at least 3 years of substance use at baseline. The median number of years of substance us over participants’ lifetimes was 18.
shows values for study variables at all 4 time points. Relative to individuals entering treatment in our geographical area (e.g., Polcin & Beattie, 2007
; Polcin & Weisner, 1999
) residents entered with lower ASI alcohol (mean=0.16, se=0.02), drug (mean=0.08, se=0.01) and legal (mean=0.11, se=0.02) severity. Other baseline measures were of moderate to high severity, which included other ASI scales (family, medical and vocational) and the GSI. Measures that assessed the previous 6 months before residents entered the SLH revealed more extensive substance use. For example, the average Peak Density (maximum number of days of substance use per month) over the 6-month period prior to entering the house was 18.81 (se=0.83) within a potential range of 0 to 31.
Outcomes and Covariates at each Time Point.
3.3 Longitudinal Outcomes
The average length of stay in the SLHs was over 5 months but that varied considerably. At the 6-month time point, 42% were still residing in the SLHs. Residency dropped to 18% at 12 months and 16% at 18 months. shows significant findings for study outcome variables over the three follow up time points controlling for demographic factors. The coefficients (continuous variables) and odds ratios (dichotomous variables) show how each outcome measure at each time point compared to baseline. The coefficients and odd ratios showed improvement between baseline and 6 months and then remarkably little change between at 12 and 18 months. For example, ASI alcohol scores indicated low severity at baseline (mean=0.16, se=0.02) that nonetheless showed significant improvement at 6 months (mean=0.10, se=0.01). The improvement noted at 6 months did not decline at 12 or 18 months. In fact, we found the same coefficient at 6, 12 and 18 month follow up (−0.04[0.01], p<.01). Similarly, ASI drug coefficients showed that severity at 6 months (mean=0.05, se=0.01) declined relative to an already low severity at baseline (mean=0.08, se=0.01) and then varied by no more than .01 at 12 and 18 months. All time points were significant at the .05 or .01 significance level.
Outcome measures over time using generalized estimating equation (GEE) models
Other outcome variables also showed significant levels of improvement by 6 months that did not decline at 12 and 18 months, including, Peak Density (p<.001), abstinence (p<.001), ASI employment (p<.001) and arrests (p<.001). See for the coefficients and odds ratios at each time point. At baseline, we found that 19% of the sample had been abstinent from alcohol and drugs for 6 months. At the 6-month time point, that proportion increased to 39% and by 18 months it was 42% reporting complete abstinence. Peak Density (maximum number or days/month of alcohol or drug use) declined from a mean of 18.81(0.83) days per month at baseline to 10.35(0.93) at 6 months. This improvement continued to the 18-month time point (mean=11.73, se=0.97). We found the same pattern for ASI Employment, with a mean of 0.76 (0.02) at baseline, 0.53(0.2) at 6 months and 0.59(.02) at 18 months. For proportion arrested, there were 42% who had been arrested at least once in the 6 months before entering the SLH. That proportion decreased to 26% at 6 months and was 28% at 18 months.
Although GSI showed significant improvement between baseline and 6 months (−0.16, se=0.05, p<01) and baseline and 12 months (−0.14, se=0.05, p<.01), the difference between baseline and 18 months was not statistically significant. Nevertheless, we continued to see a statistical trend at 18 months (p=.058), which reflects some degree of ongoing improvement relative to baseline, despite a decline from 12 months.
ASI and substance use outcomes at 12 and 18 months changed very little despite the lower number of individuals still residing in SLHs. While 42% of the sample were still living in the SLHs at 6 months, that declined to 18% at 12 months and 9% at 18 months. When we used linear and logistic regression models to examine whether length of time in the SLH was associated with primary outcomes (ASI drug, ASI alcohol, Peak Density and abstinence) at 18 months, we found no significant relationships.
Outcomes that were assessed and not found to improve significantly over time included ASI legal, family and medical scales. However, there was a trend for improvement at the 12 month time point for family severity and all time points indicated less severity relative to baseline. As described below, we did find that several factors significantly impacted these variables despite their lack of improvement over time. Potential reasons for the lack of improvement are reviewed in the Discussion section.
3.4 Twelve-Step and Social Network Predictors of Outcome
In addition to tracking longitudinal changes over time, we were interested in factors that were associated with areas showing improvement (e.g., ASI scales, alcohol and drug use, GSI and arrests). Longitudinal models assessed how data collection time points were associated with outcome variables controlling for a variety of demographic factors. In general, few demographic characteristics were related to outcomes (see ). However, the notable exception was the relationship between age and abstinence. Older age categories were over twice as likely to be abstinent than those age 18–28. Not surprising, residents with at least a high school diploma had lower ASI employment severity. However, they also were nearly twice as likely to be abstinent over the past 6 months and about half as likely to be arrested.
Because involvement in 12-step recovery groups and developing a social network supportive of abstinence are central to the recovery philosophy of SLHs we wanted to see how these factors related to outcome measures. Twelve step involvement was relatively high across all 4 time points (>5 on a scale of 0 to 9), although there was an increase from baseline (mean=5.1, se=0.13) to 6 months (Mean=5.8, se=0.14) that was largely maintained at 12 months (5.5, se=0.15). There were similar patterns for alcohol and drug related social support. Across all time points, large majorities reported having no heavy drinkers or drug users in their social network. At baseline, 24%reported having at least one heavy drinker in their social network and that declined to 16% at 6 months. At 12 and 18 months it was 20% and 14% respectively. For heavy drug users, 22% of the participants reported having at least one heavy drug user in their social network at baseline. That was nearly cut in half by 6 months (12%) and stayed about the same at 12 months (12%) and 18 months (11%).
shows how involvement in 12 step groups and characteristics of the social network (drinking and drug use within the social network) predict outcome. These analyses show associations that include all 4 time points. Thus, builds on the outcomes exhibited in by adding an additional covariate to each model. Involvement in 12-step groups was strongly associated with outcome measures that assessed a 6-month time period (Peak Density, Abstinence and Arrests). In contrast, the social network variables were not only significant for these variables measuring a 6-month period of time, but with nearly all of our other outcome measures that showed improvement as well (i.e., ASI alcohol, drug and employment scales; psychiatric severity on the Global Severity Index). The only 2 non-significant associations for social network factors and outcomes were: 1) Drug use in the social network did not predict ASI employment and 2) Drinking in the social network did not predict GSI or arrests.
Covariates predicting outcome measures using generalized estimating equation (GEE) models