Therapeutic recreation interventions in substance abuse treatment programs - includes a bibliography - Research Update

Parks & Recreation, Oct, 1996 by Marjorie J. Malkin, John J. Benshoff, Melissa Beck, Paul J. Toriello

The 1990 conference on the efficacy of therapeutic recreation, culminating in the publication of the text entitled Benefits of Therapeutic Recreation. A Consensus View, was a milestone in the field. Summarizing the results of the three-year project, Rancourt (1991) analyzed the literature to date concerning therapeutic recreation interventions in substance abuse treatment, and called for further research in the following areas: interdisciplinary research; research concerning ethnic groups; life span issues; longitudinal studies; gender research; and outcome research.

Other recommendations included research on theory based interventions, a focus on student drug use and abuse, the relationships between drug use and stress, poly-drug use, and the effectiveness of self-help groups. Methodology suggested included descriptive research to develop a body of knowledge, outcome research, with follow-up studies extending 18-24 months, qualitative research, and inductive, exploratory, and experimental (controlled) research.

Based upon these needs and suggestions for future research from 1991, a comprehensive literature search was undertaken to assess the "state of the art" of research on the use and effectiveness of therapeutic recreation interventions in substance abuse treatment programs published in 1991 and subsequent years. The majority of the research at this point in time is either theory-based and programmatic, or descriptive. There are many and varied published approaches to therapeutic recreation program planning in this specialty area, but space allows only for review of a selected few.

Theory Based Intervention

Pearson (1992) and Aguilar and Munson (1992) present theory and rationale for the inclusion of leisure education and counseling within substance abuse treatment programs. Pearson bases his model upon the literature on addiction and lifestyle, as well as upon leisure research indicating negative attitudes toward leisure and lower activity participation rates of persons addicted to alcohol. He reviews literature also cited in Rancourt (1991) indicating that involvement in leisure and recreational pursuits has been associated with recovery. A needs based model for leisure education is developed by Pearson, which is implemented within an interdisciplinary treatment approach. Pearson reiterates the need for thorough assessment of leisure satisfactions, history, and interests.

Aguilar and Munson focus on the needs of adolescents who abuse substances. They state that correlational research has provided support for theories of progressive substance use and social skills deficits in adolescents, but causal research is still needed to investigate motivational factors.

Their approach is based upon psychosocial theories of both substance abuse and leisure, including theories of Newlinger and Iso-Ahola (cited in Aguilar & Munson, 1991) on definitions of leisure and substitutability of leisure experiences respectively. Aguilar and Munson reiterate the importance of leisure as a critical component for both substance abuse prevention and intervention.

Another theory-based programmatic approach was that of Francis (1991) who based his recommendations upon Czikszentmihalyi's theory of flow (1975, cited in Francis, 1991). This state of optimal psychological arousal can be achieved in activities "where challenges and skills are ideally matched" (Francis, 1991, p. 42). Francis compares the experiences of euphoria stimulated by mood-altering substances and by recreational activities. He reiterates characteristics of substance "misusers" which have been reported consistently in the literature: stress; inadequate self-esteem and self-concept; leisure dissatisfaction; and boredom. He further recommends strategies for facilitating flow states for substance misusers.

Family dysfunction is another component appearing consistently in the substance abuse literature. Baker, Harding and Hadwen (1994) report a family component in their therapeutic recreation program for the treatment of chemical dependency. A family leisure education program, The Family Lab, has been developed by Malkin, Phillips, and Chumbler (1991). This program is based upon theories of substance abuse, leisure education and code-pendency, and involves a inter-disciplinary program including assessment, parenting training, family leisure education, and experiential activities.

Interventions focus on issues of enjoyment, trust, emotions, and communications. A final theory-based program is that of Malkin (1993) concerning intervention and treatment for cocaine-affected infants and children. Based on child development theory and the medical literature, interventions recommended include "baby holders," family interventions, and teaching strategies to deal with the myriad of physical, emotional, social and cognitive difficulties experienced by these children.

While these and other programmatic approaches appear to be grounded in relevant theoretical bases, there is little evidence that empirical studies have been conducted to date in order to validate the outcomes of such programs in substance abuse treatment.