Residential treatment addresses severe substance use disorder by removing a young adult from their high-risk environmental context while helping them begin to build recovery coping skills. Because residential programs primarily focus on substance use, they may lack a broader focus on wellbeing. This study examined whether adding a mindfulness and strengths-based group intervention improved their outcomes.
l
Recovery from substance use disorders typically involves both a) improvements in substance use either through reductions to non-symptomatic levels or abstinence and b) improvements to other aspects of quality of life, well-being, and overall functioning. For young adults, these recovery processes are occurring also in the context of achieving developmental milestones (for example, completing high school or starting full-time employment or college). For those at the most severe end of the spectrum of substance use disorders, residential treatment can help address an individual’s immediate and long-term needs by removing an individual from their high-risk environmental context, providing detoxification and medical stabilization, and giving them specific forms of treatment to address their substance use disorder. Ideally, this treatment provides an individual with skills that they can use when they exit treatment and return to their home, neighborhood, and place of work or school. Quality residential programs also help assertively link individuals to outpatient treatment and recovery support services in the community.
Although residential treatment programs focus on addressing substance use, as well as on developing related life skills and improving mental health to varying degrees, they can often lack a broader focus on social, emotional, physical, and psychological wellbeing. Programs which focus on foundational concepts related to improving different domains of wellbeing may have a greater chance of success of facilitating long-term stable recovery among young adults. Although there is evidence for the positive impact of residential treatment, there is mixed evidence on what programs can do in order to achieve this consistently for young adults and whether interventions offered in residential programs produce lasting effects.
This study examined if adding a strengths-based group intervention (labeled the Grit Wellbeing and Self-regulation Program) could improve outcomes among young adults who attended residential treatment.
This was a cohort-controlled trial to examine whether among young adults in treatment, an additional group-based intervention produced meaningful recovery-related benefits. There were two participating residential treatment sites; patients attended the treatment site closest to where they lived (i.e., they were not randomized to attend a specific treatment site). Both provided similar standard 6-week residential treatment to adults, although one site served only 18–35-year-olds while the other served adults up to age 65. The site that served the younger adult population also provided an additional intervention, called “Grit,” which was described as a strengths-based, wellbeing and self-regulation program that incorporated some elements of mindfulness-based relapse prevention.
Grit was offered in 60-minute sessions given twice a week for 6 weeks by a clinical researcher and a member of the treatment staff. To be eligible for this study, patients had to be between the ages of 18-35 years old. Participants had assessments at baseline, treatment exit (6 weeks) and 3-, 6-, and 12-months after the baseline assessment.
Substance use outcomes were measured by the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST) a standardized scale that has been widely validated internationally. The key outcomes were (1) overall substance use score and (2) substance use score of the most common primary drugs of concern at the residential treatment centers (i.e., alcohol, methamphetamine, and cannabis). Secondary outcomes were well-being, mental health (depression and anxiety according to the PHQ-9 and the GAD-7), and past-month vocational engagement (defined as engaging in work or study).
In this analysis, the authors compared (1) baseline and 3-, 6-, and 12-month follow-ups for substance use and vocational engagement between the two conditions and compared (2) baseline to post-treatment (6 weeks) and 3-, 6-, and 12-month follow-ups for wellbeing and mental health between the two groups. All analyses controlled for key participant characteristics that differed between the two sites (i.e., age and having a child) and included all individuals who started the study regardless of whether they participated in follow-up assessments or not. For assessments not completed by a participant, the analytic approach functionally imputed missing scores by testing trajectories of participant outcomes. This approach is taken to decrease the chances that participant dropout will substantially impact the findings.
Of the sample of 230 young adults, the average age was 27 years old, 66% were male, 21% had a history of criminal justice involvement, and 35% had at least one child. The primary substances reported were amphetamines (45%: 93% of which was ice/crystal methamphetamine), alcohol (34%), and marijuana (15%). Participants remained in treatment (designed to last 6 weeks) for on average about a month (29 days). Participants who were in the treatment site where Grit was delivered had higher methamphetamine and marijuana use scores at baseline. They were also more likely to be readmitted to treatment following discharge than the standard treatment condition.
Intervention and comparison groups fared equally well on most outcomes.
Both groups reduced their overall and individual substance use scores (alcohol, marijuana, and methamphetamines). These reductions were maintained at the 12-month follow-up. Both groups also improved their well-being, increased their vocational engagement, and reduced symptoms of depression and anxiety.
The Grit group experienced a greater reduction in their methamphetamine use score compared to the standard treatment group from baseline to 3 months and a greater reduction in their marijuana use score compared to the standard treatment group over time, but the Grit group also had higher use scores of these substances at baseline and thus more room to improve. The Grit advantage was not maintained over time for methamphetamine use as both groups had similar reductions in methamphetamine use from baseline to 6- and 12-month follow-ups.
In this sample of young adults attending residential treatment, individuals experienced improvements in both their substance use as well as well-being, vocational engagement, and mental health. These gains were largely maintained out to 1 year after entering treatment. Yet, an additional intervention, Grit, focused on strengths-based, wellbeing and self-regulation was not linked to improved results on most outcomes. Although the residential program where patients had exposure to the Grit intervention showed some relative improvements on methamphetamine and marijuana scores compared to the standard treatment, this group had higher use scores at baseline on these substances and were also more likely to be readmitted to treatment following discharge. This suggests these participants might have had more severe substance use profiles compared to the participants in the non-Grit, standard treatment condition, with more room to improve their substance use and so the improved results may not be solely due to the Grit program.
As both study conditions involved participants in an intensive 6-week residential program, it is possible that the additional Grit intervention did not address enough unique components necessary or did not address them in the right way or as intensively as needed, to boost recovery compared to the treatment that participants were already receiving. The location of the GRIT intervention also served a younger adult profile (18–35-year-olds) whereas the location of the comparison group served adults up to ages 65, so any differences between the conditions could have been due to the existing programming at each site and its developmental appropriateness for the sample in this study. In addition, there is no information on additional recovery support services that these young adults engaged in following their treatment episode, which could have differed between groups and can strong influences on recovery outcomes over time. Also, while gains made during treatment are largely maintained out to 1 year, 35% were readmitted to the treatment center at 3 months and others had attended another treatment program (14 new admission episodes by the 3-month and 44 new admission episodes by the 12-month follow-ups). The impact of further treatment on outcomes was not examined.
That said, the study’s emphasis on examining outcomes beyond substance use such as well-being and vocational engagement is an important one for the field: these are important indicators of positive and healthy young adult development likely also to boost quality of life, community engagement, and the motivation needed for sustained recovery.
In this sample of young adults, standard residential treatment at both sites was associated with reductions in substance use scores and improvements in well-being, mental health, and vocational engagement that were maintained at the 12-month follow-up, but the addition of the novel Grit group intervention focused on improving well-being and self-regulation in part through mindfulness-based intervention did not, appear to have any meaningful or lasting effects.
Quinn, C. A., Walter, Z. C., de Andrade, D., Dingle, G., Haslam, C., & Hides, L. (2022). Controlled Trial Examining the Strength-Based Grit Wellbeing and Self-Regulation Program for Young People in Residential Settings for Substance Use. International Journal of Environmental Research and Public Health, 19(21), 13835. doi: 10.3390/ijerph192113835
l
Recovery from substance use disorders typically involves both a) improvements in substance use either through reductions to non-symptomatic levels or abstinence and b) improvements to other aspects of quality of life, well-being, and overall functioning. For young adults, these recovery processes are occurring also in the context of achieving developmental milestones (for example, completing high school or starting full-time employment or college). For those at the most severe end of the spectrum of substance use disorders, residential treatment can help address an individual’s immediate and long-term needs by removing an individual from their high-risk environmental context, providing detoxification and medical stabilization, and giving them specific forms of treatment to address their substance use disorder. Ideally, this treatment provides an individual with skills that they can use when they exit treatment and return to their home, neighborhood, and place of work or school. Quality residential programs also help assertively link individuals to outpatient treatment and recovery support services in the community.
Although residential treatment programs focus on addressing substance use, as well as on developing related life skills and improving mental health to varying degrees, they can often lack a broader focus on social, emotional, physical, and psychological wellbeing. Programs which focus on foundational concepts related to improving different domains of wellbeing may have a greater chance of success of facilitating long-term stable recovery among young adults. Although there is evidence for the positive impact of residential treatment, there is mixed evidence on what programs can do in order to achieve this consistently for young adults and whether interventions offered in residential programs produce lasting effects.
This study examined if adding a strengths-based group intervention (labeled the Grit Wellbeing and Self-regulation Program) could improve outcomes among young adults who attended residential treatment.
This was a cohort-controlled trial to examine whether among young adults in treatment, an additional group-based intervention produced meaningful recovery-related benefits. There were two participating residential treatment sites; patients attended the treatment site closest to where they lived (i.e., they were not randomized to attend a specific treatment site). Both provided similar standard 6-week residential treatment to adults, although one site served only 18–35-year-olds while the other served adults up to age 65. The site that served the younger adult population also provided an additional intervention, called “Grit,” which was described as a strengths-based, wellbeing and self-regulation program that incorporated some elements of mindfulness-based relapse prevention.
Grit was offered in 60-minute sessions given twice a week for 6 weeks by a clinical researcher and a member of the treatment staff. To be eligible for this study, patients had to be between the ages of 18-35 years old. Participants had assessments at baseline, treatment exit (6 weeks) and 3-, 6-, and 12-months after the baseline assessment.
Substance use outcomes were measured by the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST) a standardized scale that has been widely validated internationally. The key outcomes were (1) overall substance use score and (2) substance use score of the most common primary drugs of concern at the residential treatment centers (i.e., alcohol, methamphetamine, and cannabis). Secondary outcomes were well-being, mental health (depression and anxiety according to the PHQ-9 and the GAD-7), and past-month vocational engagement (defined as engaging in work or study).
In this analysis, the authors compared (1) baseline and 3-, 6-, and 12-month follow-ups for substance use and vocational engagement between the two conditions and compared (2) baseline to post-treatment (6 weeks) and 3-, 6-, and 12-month follow-ups for wellbeing and mental health between the two groups. All analyses controlled for key participant characteristics that differed between the two sites (i.e., age and having a child) and included all individuals who started the study regardless of whether they participated in follow-up assessments or not. For assessments not completed by a participant, the analytic approach functionally imputed missing scores by testing trajectories of participant outcomes. This approach is taken to decrease the chances that participant dropout will substantially impact the findings.
Of the sample of 230 young adults, the average age was 27 years old, 66% were male, 21% had a history of criminal justice involvement, and 35% had at least one child. The primary substances reported were amphetamines (45%: 93% of which was ice/crystal methamphetamine), alcohol (34%), and marijuana (15%). Participants remained in treatment (designed to last 6 weeks) for on average about a month (29 days). Participants who were in the treatment site where Grit was delivered had higher methamphetamine and marijuana use scores at baseline. They were also more likely to be readmitted to treatment following discharge than the standard treatment condition.
Intervention and comparison groups fared equally well on most outcomes.
Both groups reduced their overall and individual substance use scores (alcohol, marijuana, and methamphetamines). These reductions were maintained at the 12-month follow-up. Both groups also improved their well-being, increased their vocational engagement, and reduced symptoms of depression and anxiety.
The Grit group experienced a greater reduction in their methamphetamine use score compared to the standard treatment group from baseline to 3 months and a greater reduction in their marijuana use score compared to the standard treatment group over time, but the Grit group also had higher use scores of these substances at baseline and thus more room to improve. The Grit advantage was not maintained over time for methamphetamine use as both groups had similar reductions in methamphetamine use from baseline to 6- and 12-month follow-ups.
In this sample of young adults attending residential treatment, individuals experienced improvements in both their substance use as well as well-being, vocational engagement, and mental health. These gains were largely maintained out to 1 year after entering treatment. Yet, an additional intervention, Grit, focused on strengths-based, wellbeing and self-regulation was not linked to improved results on most outcomes. Although the residential program where patients had exposure to the Grit intervention showed some relative improvements on methamphetamine and marijuana scores compared to the standard treatment, this group had higher use scores at baseline on these substances and were also more likely to be readmitted to treatment following discharge. This suggests these participants might have had more severe substance use profiles compared to the participants in the non-Grit, standard treatment condition, with more room to improve their substance use and so the improved results may not be solely due to the Grit program.
As both study conditions involved participants in an intensive 6-week residential program, it is possible that the additional Grit intervention did not address enough unique components necessary or did not address them in the right way or as intensively as needed, to boost recovery compared to the treatment that participants were already receiving. The location of the GRIT intervention also served a younger adult profile (18–35-year-olds) whereas the location of the comparison group served adults up to ages 65, so any differences between the conditions could have been due to the existing programming at each site and its developmental appropriateness for the sample in this study. In addition, there is no information on additional recovery support services that these young adults engaged in following their treatment episode, which could have differed between groups and can strong influences on recovery outcomes over time. Also, while gains made during treatment are largely maintained out to 1 year, 35% were readmitted to the treatment center at 3 months and others had attended another treatment program (14 new admission episodes by the 3-month and 44 new admission episodes by the 12-month follow-ups). The impact of further treatment on outcomes was not examined.
That said, the study’s emphasis on examining outcomes beyond substance use such as well-being and vocational engagement is an important one for the field: these are important indicators of positive and healthy young adult development likely also to boost quality of life, community engagement, and the motivation needed for sustained recovery.
In this sample of young adults, standard residential treatment at both sites was associated with reductions in substance use scores and improvements in well-being, mental health, and vocational engagement that were maintained at the 12-month follow-up, but the addition of the novel Grit group intervention focused on improving well-being and self-regulation in part through mindfulness-based intervention did not, appear to have any meaningful or lasting effects.
Quinn, C. A., Walter, Z. C., de Andrade, D., Dingle, G., Haslam, C., & Hides, L. (2022). Controlled Trial Examining the Strength-Based Grit Wellbeing and Self-Regulation Program for Young People in Residential Settings for Substance Use. International Journal of Environmental Research and Public Health, 19(21), 13835. doi: 10.3390/ijerph192113835
l
Recovery from substance use disorders typically involves both a) improvements in substance use either through reductions to non-symptomatic levels or abstinence and b) improvements to other aspects of quality of life, well-being, and overall functioning. For young adults, these recovery processes are occurring also in the context of achieving developmental milestones (for example, completing high school or starting full-time employment or college). For those at the most severe end of the spectrum of substance use disorders, residential treatment can help address an individual’s immediate and long-term needs by removing an individual from their high-risk environmental context, providing detoxification and medical stabilization, and giving them specific forms of treatment to address their substance use disorder. Ideally, this treatment provides an individual with skills that they can use when they exit treatment and return to their home, neighborhood, and place of work or school. Quality residential programs also help assertively link individuals to outpatient treatment and recovery support services in the community.
Although residential treatment programs focus on addressing substance use, as well as on developing related life skills and improving mental health to varying degrees, they can often lack a broader focus on social, emotional, physical, and psychological wellbeing. Programs which focus on foundational concepts related to improving different domains of wellbeing may have a greater chance of success of facilitating long-term stable recovery among young adults. Although there is evidence for the positive impact of residential treatment, there is mixed evidence on what programs can do in order to achieve this consistently for young adults and whether interventions offered in residential programs produce lasting effects.
This study examined if adding a strengths-based group intervention (labeled the Grit Wellbeing and Self-regulation Program) could improve outcomes among young adults who attended residential treatment.
This was a cohort-controlled trial to examine whether among young adults in treatment, an additional group-based intervention produced meaningful recovery-related benefits. There were two participating residential treatment sites; patients attended the treatment site closest to where they lived (i.e., they were not randomized to attend a specific treatment site). Both provided similar standard 6-week residential treatment to adults, although one site served only 18–35-year-olds while the other served adults up to age 65. The site that served the younger adult population also provided an additional intervention, called “Grit,” which was described as a strengths-based, wellbeing and self-regulation program that incorporated some elements of mindfulness-based relapse prevention.
Grit was offered in 60-minute sessions given twice a week for 6 weeks by a clinical researcher and a member of the treatment staff. To be eligible for this study, patients had to be between the ages of 18-35 years old. Participants had assessments at baseline, treatment exit (6 weeks) and 3-, 6-, and 12-months after the baseline assessment.
Substance use outcomes were measured by the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST) a standardized scale that has been widely validated internationally. The key outcomes were (1) overall substance use score and (2) substance use score of the most common primary drugs of concern at the residential treatment centers (i.e., alcohol, methamphetamine, and cannabis). Secondary outcomes were well-being, mental health (depression and anxiety according to the PHQ-9 and the GAD-7), and past-month vocational engagement (defined as engaging in work or study).
In this analysis, the authors compared (1) baseline and 3-, 6-, and 12-month follow-ups for substance use and vocational engagement between the two conditions and compared (2) baseline to post-treatment (6 weeks) and 3-, 6-, and 12-month follow-ups for wellbeing and mental health between the two groups. All analyses controlled for key participant characteristics that differed between the two sites (i.e., age and having a child) and included all individuals who started the study regardless of whether they participated in follow-up assessments or not. For assessments not completed by a participant, the analytic approach functionally imputed missing scores by testing trajectories of participant outcomes. This approach is taken to decrease the chances that participant dropout will substantially impact the findings.
Of the sample of 230 young adults, the average age was 27 years old, 66% were male, 21% had a history of criminal justice involvement, and 35% had at least one child. The primary substances reported were amphetamines (45%: 93% of which was ice/crystal methamphetamine), alcohol (34%), and marijuana (15%). Participants remained in treatment (designed to last 6 weeks) for on average about a month (29 days). Participants who were in the treatment site where Grit was delivered had higher methamphetamine and marijuana use scores at baseline. They were also more likely to be readmitted to treatment following discharge than the standard treatment condition.
Intervention and comparison groups fared equally well on most outcomes.
Both groups reduced their overall and individual substance use scores (alcohol, marijuana, and methamphetamines). These reductions were maintained at the 12-month follow-up. Both groups also improved their well-being, increased their vocational engagement, and reduced symptoms of depression and anxiety.
The Grit group experienced a greater reduction in their methamphetamine use score compared to the standard treatment group from baseline to 3 months and a greater reduction in their marijuana use score compared to the standard treatment group over time, but the Grit group also had higher use scores of these substances at baseline and thus more room to improve. The Grit advantage was not maintained over time for methamphetamine use as both groups had similar reductions in methamphetamine use from baseline to 6- and 12-month follow-ups.
In this sample of young adults attending residential treatment, individuals experienced improvements in both their substance use as well as well-being, vocational engagement, and mental health. These gains were largely maintained out to 1 year after entering treatment. Yet, an additional intervention, Grit, focused on strengths-based, wellbeing and self-regulation was not linked to improved results on most outcomes. Although the residential program where patients had exposure to the Grit intervention showed some relative improvements on methamphetamine and marijuana scores compared to the standard treatment, this group had higher use scores at baseline on these substances and were also more likely to be readmitted to treatment following discharge. This suggests these participants might have had more severe substance use profiles compared to the participants in the non-Grit, standard treatment condition, with more room to improve their substance use and so the improved results may not be solely due to the Grit program.
As both study conditions involved participants in an intensive 6-week residential program, it is possible that the additional Grit intervention did not address enough unique components necessary or did not address them in the right way or as intensively as needed, to boost recovery compared to the treatment that participants were already receiving. The location of the GRIT intervention also served a younger adult profile (18–35-year-olds) whereas the location of the comparison group served adults up to ages 65, so any differences between the conditions could have been due to the existing programming at each site and its developmental appropriateness for the sample in this study. In addition, there is no information on additional recovery support services that these young adults engaged in following their treatment episode, which could have differed between groups and can strong influences on recovery outcomes over time. Also, while gains made during treatment are largely maintained out to 1 year, 35% were readmitted to the treatment center at 3 months and others had attended another treatment program (14 new admission episodes by the 3-month and 44 new admission episodes by the 12-month follow-ups). The impact of further treatment on outcomes was not examined.
That said, the study’s emphasis on examining outcomes beyond substance use such as well-being and vocational engagement is an important one for the field: these are important indicators of positive and healthy young adult development likely also to boost quality of life, community engagement, and the motivation needed for sustained recovery.
In this sample of young adults, standard residential treatment at both sites was associated with reductions in substance use scores and improvements in well-being, mental health, and vocational engagement that were maintained at the 12-month follow-up, but the addition of the novel Grit group intervention focused on improving well-being and self-regulation in part through mindfulness-based intervention did not, appear to have any meaningful or lasting effects.
Quinn, C. A., Walter, Z. C., de Andrade, D., Dingle, G., Haslam, C., & Hides, L. (2022). Controlled Trial Examining the Strength-Based Grit Wellbeing and Self-Regulation Program for Young People in Residential Settings for Substance Use. International Journal of Environmental Research and Public Health, 19(21), 13835. doi: 10.3390/ijerph192113835
SIGN UP FOR THE BULLETIN
