Academic journal article Health and Social Work

Engaging and Retaining Women in Outpaient Alcohol and Other Drug Treatment: The Effect of Referral Intensity

Academic journal article Health and Social Work

Engaging and Retaining Women in Outpaient Alcohol and Other Drug Treatment: The Effect of Referral Intensity

Article excerpt

Women with alcohol and other drug (AOD) problems experience a range of difficulties, including health problems, psychological problems, reproductive and sexual problems, and increased risk of abuse and sexually transmitted diseases; they frequently have been the victims of physical or sexual abuse before the onset of their drinking or drug problems (Abbott, 1994; Blume, 1990; Freeman, 1992; National Institute on Alcohol Abuse and Alcoholism [NIAAA], 1993; Nelson-Zlupko, Kauffman, & Dore, 1995; Swett, Cohen, Surrey, Compaine, & Chavez, 1991; Swett & Halpert, 1994; Wallen, 1992; Wilke, 1994). The AOD problems of women can also adversely affect others in their social network, leading to fetal alcohol syndrome or effects in children, marital discord and divorce, and child abuse or neglect (Freeman, 1992; NIAAA, 1993).

Given this range of difficulties, women with AOD problems frequently request services from social services agencies, and their issues highlight the need for social workers to successfully engage and retain them in treatment. The study discussed in this article assessed the effect of referral intensity on engagement and retention of women with AOD problems in outpatient treatment. This is a significant issue because, although high-intensity referrals to outpatient treatment have been shown to be more effective than low-intensity referrals in the general population, they have not been assessed for women only.


Rates of entry, retention, and completion of AOD treatment are lower for women than for men (Nelson-Zlupko et al., 1995), possibly because of two critical barriers women face when attempting to get help. First, treatment, particularly inpatient treatment, is expensive, and many women with AOD problems depend on family members or public assistance to meet financial needs and thus lack the money to pay for treatment (Nelson-Zlupko et al., 1995; Schliebner, 1994; Sisco & Pearson, 1994). Second, women frequently have primary responsibility for the care of their children, and few treatment centers have extended child care available (Abbott, 1994; Finkelstein, 1994; Nelson-Zlupko et al., 1995; Schliebner, 1994; Tracy, 1994).

Recently, there has been movement away from inpatient treatment to less expensive outpatient treatment (Schmidt & Weisner, 1993). For women with AOD problems, outpatient treatment offers a more affordable alternative to inpatient treatment, an alternative for which insurers or Medicaid may be more likely to pay. In addition, because there are usually fewer contact hours in outpatient treatment, the need for extended child care is reduced or eliminated. However, in the general population, retention rates are lower for outpatient than for inpatient treatment (Bell, Williams, Nelson, & Spence, 1994).

Part of the reason for low retention rates in outpatient settings stems from the type of referral to treatment. Classifying referral types into mutually exclusive and exhaustive categories, we have identified five types:

1. The "Johnson Intervention" is a therapeutic technique in which members of the person's social network confront him or her about the damage the drinking or drug use has caused and the action they will take if the client does not enter treatment. This confrontation follows a period of formal training and behavioral rehearsal for members of the social network and is approached from a posture of care and concern (Beamer & Collins, 1983; Johnson, 1980; Johnson Institute Books, 1987; King, 1986).

2. The "unrehearsed intervention" is one in which members of a person's social network do not undergo formal training and rehearsal; instead, a counselor facilitates the intervention as the session unfolds. This intervention is a less intense variation of the Johnson Intervention.

3. The "unsupervised intervention," another less intense variation of the Johnson Intervention, is one in which members of the social network receive formal training but conduct the intervention without the help of a facilitator. …

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