Title

Relationship of Mutually Perceived Treatment Values and Purposes to Patients' recovery in addiction treatment

Date of Award

1996

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology

First Advisor

William C. Goggin

Advisor Department

Psychology

Abstract

The effects of the therapeutic environment on psychiatric recovery have been a focus of research since the beginning of this century. The processes by which a therapeutic environment achieves change have been studied in terms of structure, psychodynamics, and social relations. The current study examined the influence of therapeutic culture components (e.g., values, expectations, perceptions) on psychiatric recovery, particularly with regard to addiction recovery. Following the lead of Manning and Blake (1979), who found that patients' values tend to converge with those of the community (i.e., staff) as they progress through treatment, the current study was designed to examine convergence of treatment culture perceptions, and the effects of this convergence on addiction recovery. Twenty-seven staff members and 87 patients, from a state hospital's chemical dependence unit, completed the Community-Oriented Programs Environment Scale (COPES; Moos, 1988) as a measure of their perceptions of the expectations and values of their treatment environment. Staff members were assessed once, to provide a criterion measure of the "ideal" set of values exhibited by the treatment culture whereas patients were assessed twice (during their first and fifth weeks of treatment) to provide relative pretreatment and posttreatment measurement. Differences in patients' and staff members' perceptions of the culture (deviation scores) were calculated for both assessment intervals. Deviation scores were compared with addiction pathology scores from the MMPI-2 and the SASSI-2 (Miller, 1994), which also were administered during the first and fifth weeks of treatment. Results of the current study showed that perceptions of the treatment culture did not consistently converge as the patients passed through treatment. Rather, the variability across time, among change in patients' perceptions of the milieu and change in patients' level of addiction, suggests the need for examination of additional variables that may influence milieu perceptions. Results of the current study also demonstrate the need for multifaceted assessment of addiction. Current results provided only partial support for a direct, positive relationship between change in perceptions of the treatment culture and change in addiction pathology.