Effectiveness of the Living Skills Recovery Curriculum on Dual-Diagnosis Clients

PURPOSE: This study examined the following research question: Was the Living Skills Recovery Curriculum (LSRC; Precin, 2015) an effective intervention in reducing substance abuse and improving time and stress management, activities of daily living, and social skills in dual diagnosis (DD) clients (substance abuse and mental illness)?

BACKGROUND: Although there are many DD treatment facilities, few have standardized occupational therapy intervention or published outcomes. Skill training that does not integrate substance use cannot impact the brain’s addictive state or foster engagement in nonaddictive occupations (Gutman, Raphael-Greenfield, & Simon, 2016).

DESIGN: A 3-yr quasi-experimental controlled effectiveness study of the LSRC was performed using multifactorial analysis. The 164 participants were age 18 yr or older, had a DD, and were receiving treatment at an outpatient DD clinic in the United States. The experimental group (N = 99) received the LSRC while the control group (N = 65) did not. Clients were clinically assigned to groups in order to maintain ethical procedures of the clinic. Analysis showed no significant demographic differences between groups, allowing for comparison.

METHOD: The LSRC is a standardized integrated-treatment intervention for DD clients designed to incorporate the 12-step model into a living skills acquisition training program using a cognitive–behavioral, psychoeducational approach. Each skill is taught in relation to how it aids in relapse prevention and recovery for each client’s personal lifestyle and pattern of addiction. Two modules (time and stress management) of the LSRC were run by an occupational therapist simultaneously in the clinic for 4 mo. Each module met twice a week for 45 min with no more than 10 clients per closed group. Then, the other two modules (social skills and activities of daily living) were run for 4 mo. This pattern of LSRC intervention alternated over 2 1/2 yr.

The following outcome measures were gathered for each module (stress management, time management, social skills, activities of daily living) in the LSRC: pre- and posttest scores (10 items), attendance, number of objectives met each session, number of topic-related goals achieved during the 4-mo module, whether or not clients reported that they learned new material and made changes in their lives, staff observations, and clean time (i.e., negative urine samples). Paired (within-subjects) and independent (between-subjects) t tests, percentages, and Pearson product–moment correlations were used to examine the effect of the LSRC on living skills acquisition, and analyses of variance were used to examine the effect of the LSRC on clean time. The data distribution was evaluated using Levene’s test for equality of variance.

RESULTS: Clients receiving LSRC showed significantly more improvement (p ≤ .05) in time and stress management, social skills, and activities of daily living than clients in the control group. Stress management, social skills, and activities of daily living modules of the LSRC significantly increased clean time in the experimental versus control group (p ≤ .05); however, time management training did not.

CONCLUSION: The LSRC was found to be effective in reducing substance abuse and increasing living skills in DD clients from the clinic studied. Perhaps 4 mo of time management training was not sufficient to significantly increase clean time, even though improvements were seen in the ability to manage time. Based on these results, implementation of this curriculum at other DD clinics and randomized controlled trials are recommended. These findings provide initial support for occupational therapists to use the LSRC in the recovery process of DD clients.

References

Gutman, S. A., Raphael-Greenfield, E. I., & Simon, P. M. (2016). Feasibility and acceptability of a pilot housing transition program for homeless adults with mental illness and substance use. Occupational Therapy in Health Care, 30, 124–138. https://doi.org/10.3109/07380577.2015.1060660

Precin, P. (2015). Living Skills Recovery workbook. Brattleboro, VM: Echo Point Books and Media.