SELF-EFFICACY, DRUG TREATMENT AND RELAPSE: A SAMPLE OF FEDERAL PRISONERS

Executive Summary - 2000

Overview of Study

Results from the Treating Inmates Addicted to Drugs (TRIAD) study found that the Federal Bureau of Prisons’ residential drug abuse program (DAP) reduced relapse to drug use in the six months following subjects’ release from prison, taking into account the effects of self-selection into treatment. The TRIAD study improved upon previous research by considering the entire population of eligible subjects in comparing the outcomes for those who entered and completed treatment and those who did not.

Theory-driven program evaluation holds that effective treatment programs help their clients by having a direct impact on "proximal" or short-term outcomes (e.g., behavior changes that occur during treatment), and that, in turn, the proximal outcomes mediate the program’s impact on the "distal" or long-term outcomes (e.g., behavior changes that occur after treatment) of interest. The causal link between treatment and outcomes is strengthened when there is a strong association between proximal outcomes and distal outcomes. To follow the principles of theory-driven evaluation, this study tested the hypothesis that the DAP program was successful in increasing drug-taking self-efficacy (proximal outcome) and that this had the effect of reducing post-release drug use (distal outcome).

The sample consisted of 234 male and female residential drug abuse treatment program (DAP) graduates who had at least one urinalysis test in the first six months after release. Self-efficacy was measured at the beginning and end of treatment with the Drug-Taking Confidence Questionnaire (DTCQ) and post-release drug use was assessed by probation officers using urinalyses techniques during the 6 months following release. The DTCQ asks individuals to rate their confidence in resisting the urge to use drugs in 50 different situations. The response scale for each item ranged from zero to 100 percent confidence and the total score represented the average confidence levels across all items. We assessed the extent to which DTCQ scores were associated with post-release drug use, taking into account the effects of a variety of other factors thought to be related to post-release drug use such as gender, race, age, degree of drug dependence, previous history of violence, and prior commitment.

The results indicated that 29% of subjects relapsed during the 6-month follow-up period and that subjects’ self-efficacy increased during the course of treatment from an average of 77 to 86. Although the numerical increase in self-efficacy was not associated with a reduction in the likelihood of relapse, the self-efficacy levels reported at the end of treatment were associated with relapse. Individuals with higher levels of self-efficacy at the end of treatment were less likely to relapse following release from prison. These results represent the first examination of the relationship between self-efficacy and relapse among incarcerated offenders in prison-based treatment programs.

Clinical Implications

The increase in self-efficacy between the beginning and end of treatment suggests that positive cognitive changes occur during DAP treatment. However, the results of this study also suggest that the increases in self-efficacy scores between the beginning and end of treatment may be an incomplete representation of the cognitive changes which occur during treatment. An individual may have experienced cognitive changes in self-efficacy during treatment but may not have had a change in numerical score when self-efficacy was measured at only two times points. Therefore, our results support the utility of assessing self-efficacy at various points during treatment, focusing on the clients’ perceived skill level with respect to successfully engaging in a coping response in a high risk situation. All clients would likely benefit from a similar treatment foundation built upon skills acquisition. As treatment progresses and/or the likelihood of encountering high risk situations increases, self-efficacy appraisals can be expected to be based on more realistic information. Additional formative assessments of self-efficacy during the course of treatment could provide information about the clinical intervention needed to improve clients’ skill mastery and related self-efficacy. Because clients will face a greater number of high-risk situations upon release, it is crucial that a focus upon self-efficacy be maintained during post-release treatment.