Content area
Abstract
This secondary analysis of an ethnographic process evaluation describes the experiences of women clients in two distinctly different substance abuse treatment settings. Those settings, both located in a Northern California county, consisted of an inpatient, mixed-gender medical model program (N=43, average length of stay 7-10 days) and a women-only social model residential program (N=32) where clients spent an average of 2-3 months. For six months in 1995-96, a team from the Alcohol Research Group [ARG] in Berkeley created thick descriptions of the daily delivered content within those programs. The team generated a unique data set from within the "black box" of substance abuse treatment.
This research examines the ARG data under a fresh lens. Using a combination of deductive qualitative analysis (Gilgun, 2006) and the constant comparative method, it aims to discover patterns and themes reflecting clients' progress through the stages of change, a widely-used conceptual framework in addiction research also known as the Transtheoretical Model (Prochaska & DiClemente, 1982, 1996). By analyzing more than 3,200 pages of field notes, interviews, and memos, the researcher looked for similarities and differences in staff client interactions, peer relationships, and program content across the two settings. Open coding was followed by axial and theoretical coding to discern linkages between client-staff interactions and clients' stage status. The influence of single-gender versus mixed-gender environments on women clients' interactions with staff and peers and their ability to progress through the stages of change were also investigated.
A key finding was that medical model patients bifurcated into two distinct cohorts, with half the women remaining in the precontemplation stage while the rest demonstrated aspects of the preparation stage. Overall, social model residents progressed further along the stages of change than did medical model patients. Staff-client interactions carried more therapeutic benefits in the medical model, whereas peer relationships were the primary means of treatment delivery in the social model. Disparities in program content were less significant than differences in philosophy, in particular, the role of clients in governance of the respective programs. In closing, implications for social work research, policy, and practice with women substance abusers are explored.
