Solving Substance Abuse

About 70 percent of Freer's clients abuse alcohol and drugs to some extent. The Outdoor Behavioral Healthcare Research Cooperative (OBHRC) studied this issue in another extensive research program with results published in 2006 by Dr. Keith Russell, who directed the study. (No. 20d.) It established that 77 percent of the OBHRC study's clients had either substance abuse diagnoses or dual diagnoses in mental health as well as in substance abuse (49 percent.) The remaining 23 percent had mental health diagnoses only. A long and well constructed questionnaire, the Personal Experience Inventory (PEI) indicated that:

• Prior to treatment OBHRC clients with substance abuse problems scored almost as high as adolescents in CD residential programs, and both scored much higher than a community sample.
• Six months after completion of treatment, on the five scales dealing with basic use issues, the OBHRC clients' scores improved significantly on 8 of 10 measures, and their scores were about the same as those of the community sample. (Some of the community sample were no doubt using drugs too, but these results suggest wilderness treatment of substance abuse may be unusually successful.)
• Taking all the OBHRC clients together, 20 percent said they had not used alcohol in the three months before treatment, and another 40 percent reported using it just one to five times during those three months, so 60 percent were either abstinent or using lightly.
• At the six-month follow up, 42 percent said they had not used at all in the prior three months, and 30 percent reported one to five uses, for a total of 72 percent abstinence or light use. At follow up about 8 percent said they had used alcohol 10 or more times in the prior three months, vs. about 23 percent using that much pre-treatment.
• The marijuana use figures were similar, with 45 percent reporting no use to five uses in the three months before treatment, and 44 percent using 10 to 40 or more times.
• After treatment, 50 percent reported abstinence for the three months prior to follow up, and 39 percent reported one to five uses, for a total of 89 percent abstinent or light users. The number using regularly dropped from 44 percent to 3 percent.

OBHRC clinical follow-up information nicely supplement the six-month PEI results. Eighty-eight of the kids and families from OBHRC's first big study, in 2002, were called two to three years later by trained interviewers and invited to participate in a structured interview about how they were doing. The substance abuse portion of that interview, published in 2004, showed these results for the 71 clients who did have substance abuse problems when they started treatment: (No. 19.)

• 27 percent of them had abstained entirely.
• 73 percent had used or were still using at the time of the follow-up interviews. Among this group, 15 percent (12 families) reported substance abuse as a "significant problem" still. The other teenagers and their parents said that their use was not a significant problem.
• 34 percent went on to therapeutic boarding schools or NATSAP residential treatment programs; 47 percent got out-patient aftercare; only 16 percent got no aftercare treatment.
• Parents and kids reported that getting through school and finding new, healthier friends was a long, difficult process.

Freer's very first in-house study, done in 1994, shed some early light on long-term CD outcomes for us. Sue Parrish, one of our wilderness therapists, had a baby and retired from the field. She pulled a sample of 47 trek files from Freer's first four years and managed to reach 40 of the families for structured telephone interviews with parents and kids. Their overall reports were similar to those we have gotten in more recent research, though not quite as good in the long term results. Our interviewees reported moderate to significant improvement at one month (79 percent), dropping a little at six months (62 percent), then rising again, to 67 percent at one year and 74 percent long term (1 ½ to 4 years.) Other scores followed that pattern with approximately the same scores except for getting over alcohol and drug abuse or dependence. There, the scores were 51 percent at six months, 43 percent at one year and 55 percent long term. We considered 25 of the kids at risk for addiction; they rated themselves only a little higher on their recoveries, except for a 75 percent doing better long term. Eight of them (32 percent) were drug free at one year, but three of those had attended another residential treatment program in the meantime. Those who were abusing drugs seriously before trek, or were considered already addicted, did less well. Half of them (7) went through additional residential treatment, and only 22 percent saw themselves as "significantly" improved in the long term (when they were interviewed.) Those clients who had also run away from home over night at least once prior to trek rated their alcohol and drug success even lower.

Those results are pretty much in keeping with those of standard indoor residential CD treatment, but they were quite a bit worse than our clients' progress in other areas, and we determined to improve in that area. We hired a very experienced CD clinical director from a Chicago program, and tasked him with teaching us all how to do a better job of CD therapy. Rick succeeded in that, and we have been a much better program for his efforts and results.

Learn more about our research:

• Research Results Summary
  
  
• Does Wilderness Therapy Work? Does it Last?
  
  
• Lifting the Fog of Depression
  
  
• Solving Substance Abuse
  
  
• Getting Motivated to Give Up Substance Abuse
  
  
• A Short Term Treatment for Incipient Character Disorders
  
  
• Family Functioning After Wilderness Therapy
  
  
• Strong Therapeutic Relationships
  
  
• Limits on Research with Adolescent Treatment Programs
  
  
• List of Catherine Freer Research