The process of change for people with cognitive impairment in a residential rehabilitation program for substance problem
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(2019) 14:13
RESEARCH
Open Access
The process of change for people with cognitive impairment in a residential rehabilitation program for substance problems: a phenomenographical analysis Julaine Allan1* , Susan Collings2 and Alice Munro1,3
Abstract Cognitive impairment is prevalent among people with substance problems and a factor affecting retention in treatment. Empirical phenomenography was used to systematically explore how people with cognitive impairment viewed a novel residential rehabilitation program – Project RE PIN – designed with cognitive compensatory behaviour change activities and from a strengths-based approach. Twelve participants took part in semi-structured interviews and cross-case analysis identified the overarching theme of change. Key program elements were the safe environment, structured routines, modified psycho-educational material and staff support. Critical changes that participants attributed to the program were in dealing with their own and others’ emotions, experiencing daily life without drugs or alcohol and reframing their self-view. Fear and anxiety about relapse were common and few participants had strategies or support to cope in the future. This study demonstrates that program activities changed participants’ thoughts, feelings and behaviours about themselves and their substance use. The results indicate that RE-PIN’s modified content and processes can benefit people with cognitive impairments in treatment. The study highlights that some treatment users may be vulnerable to resumption of drug use despite gains made during a residential program and their desire to remain substance-free. Keywords: Cognitive impairment, Residential rehabilitation, Behavior change, Treatment programs
Introduction Drug and alcohol treatment interventions aim to change a regular harmful behaviour. Current approaches to drug and alcohol treatment predominantly use psycho-social methods, usually cognitive behaviour therapy (CBT), as an adjunct to medication within individual and group counselling and residential rehabilitation programs. Relapse after substance treatment is reported to be commonplace, with studies suggesting 94% of people have used at least once 12 months post-treatment [1] and between 40 and 60% of people returning to substance dependence [2, 3]. Behaviour change theories and relapse prevention models identify environmental triggers such as contact with other drug users and drug availability [4]; * Correspondence: [email protected] 1 Lives Lived Well, 91 Dalton st, Orange, NSW 2800, Australia Full list of author information is available at the end of the article
psycho-biological cravings [5], mood instability [1] and limited self-efficacy [6, 7] as important factors in high relapse rates. To minimise relapse, high intensity treatment options are recommended for severe and chronic substance dependence where reducing or abstaining from drug use is perceived to be more difficult [8, 9]. Residential rehabilitation is the most established treatment option for people with severe
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