Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

548 V. TREATMENTS FOR ADDICTIONSvs. 49%), although this may be confounded by age, because the alcoholicsamples tended to be older.3. The overall engagement success rates for adolescent and adult drugabusers do not differ significantly.4. When a parent is the primary, or only, person mounting the engagementeffort (vs. a spouse/partner, other relative, or friend), the likelihoodof success is increased. This holds for both adolescent and adultcases.5. Engagement is also more likely, and requiring of less effort on the partof the engagement professional, when more people (family, friends,work associates, etc.) are actively involved in the effort. In particular,Landau and colleagues (2004) found a high, and statistically significant,correlation between (a) the number of people involved and (b)scores on an engagement success/efficiency index (r = .69, p < .0001).Stanton’s (2004) review also singles out the approaches that appear to bethe “best options” with particular kinds of cases (e.g., adult drug abusers, adultalcohol abusers, adolescent substance abusers) in terms of both success rate andcost-effectiveness. Regarding cost-effectiveness, specifically—that is, havingthe highest success rate for the least amount of professional effort—twoapproaches stand out, both of which are nonsecretive (in other words, the substanceabuser is informed of the effort from the very beginning). Both involvean average of only 1.5–2 hours of staff time to get most substance abusers intotreatment/self-help, and they generally accomplish this within 1–2 weeks.These approaches are: (1) for adolescents, the behaviorally based “intensiveparent and youth attendance intervention” by Donahue and colleagues (1998),which attained an 89% success rate through the use of a standardized telephoneprogram orientation with the parent to set up an appointment, plus motivationaltelephone reminder calls to both the parent and the youth 2–3 daysbefore the scheduled intake session; and (2) for adults, a TFT-based approachcalled “A Relational Intervention Sequence for Engagement” (ARISE; Garrett,Landau-Stanton, Stanton, Stellato-Kabat, & Stellato-Kabat, 1997), which hadengagement rates of 87% for drug abusers and 77% for alcohol abusers (Landauet al., 2004). ARISE uses a manual-guided, rapid-response, stepped approach inhandling the first call from someone who is concerned about a substanceabuser, as well as quickly expanding the system involved to both increase leveragewith the substance abuser and provide additional support to the person whooriginally called (Garrett et al., 1998, 1999; Landau et al., 2000).Convening DifficultiesOne of the problems identified by therapists working with substance abusersand their families is the difficulty in convening the whole family for therapy