Demand characteristics of residential substance abuse treatment programs

Purpose: This study examined the objective demand characteristics of treatm ent programs in which substance abuse patients, or psychiatric patients, we re residing. It also examined associations of objective demand with substan ce abuse patients' perceived expectations for functioning during treatment and patients' in-program participation. Methods: A total of 994 patients li ving in 79 programs took part. Results: When patients had a substance abuse rather than a psychiatric problem, objective demand was higher: program po licies had higher requirements for functioning and more resident control; p rograms offered fewer health-treatment services; and the physical design pr ovided fewer safety features and social-recreational aids. Compared to subs tance abuse patients in low-demand programs, patients in high-demand progra ms perceived the program to have higher expectations, in that the treatment climate exerted more press to develop relationships, set goals, and be org anized. Patients in high-demand programs engaged more in self-initiated act ivities and participated more in treatment services and program-organized e vents. Substance abuse patients' activity and participation levels were det ermined jointly by the level of demand and by the expectations for patients ' expressiveness and self-understanding of their personal problems. Implica tions: The findings illustrate the importance of considering objective indi ces of demand in conjunction with perceived expectations to improve patient s' treatment outcomes. (C) 2001 Elsevier Science inc. All rights reserved.