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Therapeutic recreation programs for adolescents in substance abuse treatment facilities.

The purpose of this study was to determine the extent and focus of therapeutic recreation programs offered within substance abuse treatment facilities for adolescents. Randomly selected activity therapists were asked to identify their job title, as well as characteristics of their agency, staff, and therapeutic recreation programs. The modal Mode-oriented. A modal operation switches from one mode to another. Contrast with non-modal.

1. modal - (Of an interface) Having modes. Modeless interfaces are generally considered to be superior because the user does not have to remember which mode he is in.
 response to job title was department head. Fewer than half the facilities offered a therapeutic recreation program for adolescents. Leisure education/counseling, sports, and community leisure activities were the most frequently offered programs. The goals most often cited were to improve social skills, improve self-esteem/self-efficacy and improve the level of cooperation/trust. Factors that inhibited in·hib·it  
tr.v. in·hib·it·ed, in·hib·it·ing, in·hib·its
1. To hold back; restrain. See Synonyms at restrain.

2. To prohibit; forbid.

 the development of a comprehensive recreational therapy recreational therapy Play therapy 'Any free, voluntary and expressive activity…(which may be)…motor, sensory, or mental, vitalized by the expansive play spirit, sustained by deep-rooted pleasurable attitudes and evoked by whole emotional  program were shortages in staff, recreational resources and space, and funding for services. Types of assistance needed to improve programming were a list of how to initiate activities for adolescent ad·o·les·cent
Of, relating to, or undergoing adolescence.

A young person who has undergone puberty but who has not reached full maturity; a teenager.
 substance abusers, consultation by a Certified See certification.  Therapeutic Recreation Specialist (CTRS CTRS Centers (street suffix)
CTRS Containers
CTRS Certified Therapeutic Recreation Specialist
CTRS Conventional Terrestrial Reference System
CTRS Center for Technology Risk Studies (University of Maryland) 
), and printed resources on leisure education/counseling.

According to according to
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

 Newcomb and Bentler (1988), the use and abuse of psychoactive psychoactive /psy·cho·ac·tive/ (-ak´tiv) psychotropic.

Affecting the mind or mental processes. Used of a drug.
 chemicals, including illicit drugs illicit drug Street drug, see there , alcohol, prescription and over-the-counter medication and cigarettes has become a major national and international problem affecting all segments of society. Embedded Inserted into. See embedded system.  within the context of this growing problem is the use and abuse of drugs and alcohol by youth. A 1990 report issued by the National Institute of Mental Health The National Institute of Mental Health (NIMH) is part of the federal government of the United States and the largest research organization in the world specializing in mental illness.  stated that America is wasting its most precious natural resource: its children and youth" (Babor, Del Boca, McLaney, Jacobi, Higgins-Biddle, & Hass, 1991, p. 77). Babor et al. (1991) report that over 12 percent of America's children and adolescents suffer from mental disorders mental disorders: see bipolar disorder; paranoia; psychiatry; psychosis; schizophrenia. , many of which are associated with drug and alcohol use, and substance abuse has been implicated im·pli·cate  
tr.v. im·pli·cat·ed, im·pli·cat·ing, im·pli·cates
1. To involve or connect intimately or incriminatingly: evidence that implicates others in the plot.

 in increased rates of adolescent suicide, violence, and homicide homicide (hŏm`əsīd), in law, the taking of human life. Homicides that are neither justifiable nor excusable are considered crimes. A criminal homicide committed with malice is known as murder, otherwise it is called manslaughter.  (Hanson & Venturelli, 1995). Alcohol and drug related accidents are the number one cause of death for adolescents and young adults in this country (Edwards, 1989). Indeed, Center for Disease Control statistics (Cited in Edwards, 1989) demonstrate a continuing trend of shortened short·en  
v. short·ened, short·en·ing, short·ens
1. To make short or shorter.

 life expectancy Life Expectancy

1. The age until which a person is expected to live.

2. The remaining number of years an individual is expected to live, based on IRS issued life expectancy tables.
 for persons ages 15 to 24 clearly related to alcohol and drug use. It has been noted (Newcomb & Bentler, 1988) that adolescent experimentation is not the issue; real concerns emerge when the experimental use leads to regular use or abuse.

Newcomb & Bentler (1988) have asserted that teenagers who use psychoactive chemicals may inhibit inhibit /in·hib·it/ (in-hib´it) to retard, arrest, or restrain.

1. To hold back; restrain.

 important developmental tasks and growth may be stunted stunt 1  
tr.v. stunt·ed, stunt·ing, stunts
To check the growth or development of.

1. One that stunts.

2. One that is stunted.

 or delayed. Other risk factors related to alcohol and drug use include environmental, behavioral, psychological, and social attributes (Newcomb & Bentler, 1988). The 1992 and 1993 National Household Survey on Drug Abuse (SAMHSA SAMHSA Substance Abuse and Mental Health Services Administration , 1995) confirm recent increases in drug abuse by youth and "reveal that many of these young substance abusers are experiencing significant problems because of their use" (p. 9). Furthermore. a recent study of alcohol and drugs on American college American College is the name of:
  • American College Dublin, Dublin, Ireland
  • The American College in Madurai, Tamil Nadu, India
  • The American College of the Immaculate Conception, Leuven (also known as Louvain), Belgium
 campuses (Presley, Meilman, & Lyerla, 1995) reiterates that alcohol and drug use on campus negatively effect individual students and the entire campus community. Alcohol continues to be most common drug of choice for college students and the heaviest drinkers receive the lowest grades. Students perceived legal difficulties. violence, and suicidal su·i·cid·al
1. Of or relating to suicide.

2. Likely to attempt suicide.
 thoughts as consequences of drinking, and binge drinking binge drinking An early phase of chronic alcoholism, characterized by episodic 'flirtation' with the bottle by binges of drinking to the point of stupor, followed by periods of abstinence; BD is accompanied by alcoholic ketoacidosis–accelerated lipolysis and  was a prevalent pattern of use. Other drugs used frequently were tobacco and marijuana marijuana or marihuana, drug obtained from the flowering tops, stems, and leaves of the hemp plant, Cannabis sativa (see hemp) or C. indica; the latter species can withstand colder climates.  (24.2%). Significantly, more than 50% of students responding to this national survey were under 20 years old.

Many programs have been developed to promote prevention, or to provide treatment for adolescents with substance abuse problems. The models of substance abuse treatment for adolescents have emphasized treating the "whole person" and the need for overall lifestyle change (Kunstler, 1992). However, Babor et al. (1991) report that while progress has been made in the development of treatment services, the complex child and adolescent service system is expensive, uncoordinated un·co·or·di·nat·ed  
1. Lacking physical or mental coordination.

2. Lacking planning, method, or organization.

, and of unknown effectiveness.

Therapeutic recreation has become a prominent modality modality /mo·dal·i·ty/ (mo-dal´i-te)
1. a method of application of, or the employment of, any therapeutic agent, especially a physical agent.

 in substance abuse treatment programs, but its role, according to Kunstler (1992), may not be fully realized. Hawkins & Catalano (1985) reported that the involvement in active recreational leisure activities shows a consistent positive relationship to reduced drug and alcohol use and physical activity and exercise can be beneficial in the treatment of substance abusers (Murray, 1986).

One of the primary purposes of therapeutic recreation is to encourage participation in non-psychoactive chemical activities where abusers can learn to experience fun and pleasure while feeling in control (Kunstler, 1992). Some of the deficit areas of individuals who abuse substances are their lack of stress management techniques, social skills, and assertiveness assertiveness /as·ser·tive·ness/ (ah-ser´tiv-nes) the quality or state of bold or confident self-expression, neither aggressive nor submissive.  (Kunstler, 1992). All of these areas are addressed in leisure education programs and may be ameliorated through recreation participation. According to Kunstler (1992), recreational activities require skills for participation, have rules and goals, provide immediate and concrete feedback, and offer novelty Novelty is the quality of being new. Although it may be said to have an objective dimension (e.g. a new style of art coming into being, such as abstract art or impressionism) it essentially exists in the subjective perceptions of individuals.  and opportunities to experience control.

Kunstler (1992) also pointed out that lack of involvement in active recreation.. along with absence of a positive social network and inability to cope with stress, can cause relapse. However when exposed to leisure alternatives, clients in substance abuse treatment are more likely to participate in positive recreational opportunities after discharge.

Consequently, it is relevant to more closely and empirically examine the development of a therapeutic recreation program component in the treatment of adolescent substance abusers. Although the literature suggests the importance of recreational therapy as a treatment component for substance abusers very little research has been done to determine what therapeutic recreation programs are offered to adolescents in substance abuse treatment facilities.

Purpose and Research Questions

The purpose of this study was to determine the extent and focus of therapeutic recreation programs offered within substance abuse treatment facilities for adolescents. Specifically, it sought to determine: (1) the nature of leisure/recreation programs being offered to adolescents in substance abuse treatment programs; (2) the job titles and roles of staff members offering therapeutic recreation programs; (3) the goals of those leisure/recreation programs in these facilities and; (4) factors which inhibit the development and initiation of a comprehensive therapeutic recreation program.


Description of Sample

A random sample of 250 substance abuse treatment facilities was drawn from the 1992 National Directory of Drug Abuse and Alcoholism alcoholism, disease characterized by impaired control over the consumption of alcoholic beverages. Alcoholism is a serious problem worldwide; in the United States the wide availability of alcoholic beverages makes alcohol the most accessible drug, and alcoholism is  Treatment and Prevention Programs, published by the National Institute on Drug Abuse The National Institute on Drug Abuse (NIDA) is a United States federal-government research institute whose mission is to "lead the Nation in bringing the power of science to bear on drug abuse and addiction.  and the National Institute on Alcohol Abuse and Alcoholism The National Institute on Alcohol Abuse and Alcoholism (NIAAA), as part of the U.S. National Institutes of Health, supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. . Facilities from all fifty states were included in this selection process. Each state was designated as an independent area and five facilities from each state were randomly selected using a table of random numbers.

Description of Questionnaire

A research questionnaire was developed incorporating relevant variables identified in the literature. In addition, questions from a survey by Voss (1991) related to the study of activity therapy programs in substance abuse treatment facilities, and a study by Fazio (1987) concerning the nature of recreation and leisure programs offered to adults with traumatic brain injury Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. TBI can result from a closed head injury or a penetrating head injury and is one of two subsets of acquired brain , were reviewed and modified for the study questionnaire. The draft questionnaire was reviewed by a panel of experts including practitioners and academicians from therapeutic recreation and rehabilitation rehabilitation: see physical therapy.  disciplines. The study was approved by the Human Subjects Committee at Southern Illinois University Southern Illinois University, main campus at Carbondale; state supported; coeducational; est. 1869, opened 1874 as a normal school, renamed 1947. It has a center for archaeological investigation and a fisheries research laboratory. There is also a campus at Edwardsville.  at Carbondale.

The activity/recreational therapy staff from each surveyed facility were asked to complete the 20 question survey concerning the characteristics of the facility and therapeutic recreation staff, and types of recreation programs offered by the facility. Questions 1-7 were related to facility and staff, question 8 was related to types of therapeutic recreation or leisure assessment procedures utilized; questions 9-16 were related to the types of therapeutic recreation programs, program length and frequency, and program facilitator. Questions 17-19 were related to therapeutic recreation program goals and Program development, and question 20 solicited additional comments concerning the therapeutic recreation program at each facility.

Data Collection

Each selected facility was mailed a questionnaire and cover letter explaining the purpose of the study and instructions for completing the questionnaire. The respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy.  were assured of the confidentiality of their individual responses. Following a two week period, all nonrespondents were sent a reminder letter and a second questionnaire.

Following the initial mailing, 21 questionnaires were returned to the sender. Reasons given for their return were change of address, no forwarding address forwarding address forward nadresse f de réexpédition , or forwarding time expired. Twenty-one new agencies were randomly selected from the 1992 National Directory of Drug Abuse and Alcoholism Treatment and Prevention Programs. In addition, nine completed questionnaires were unusable because the surveyed agency did not serve adolescents or the survey was inapplicable in·ap·pli·ca·ble  
Not applicable: rules inapplicable to day students.

 to the agency. One hundred usable USable is a special idea contest to transfer US American ideas into practice in Germany. USable is initiated by the German Körber-Stiftung (foundation Körber). It is doted with 150,000 Euro and awarded every two years.  surveys were received for a 40% return rate. Data were coded and analyzed an·a·lyze  
tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es
1. To examine methodically by separating into parts and studying their interrelations.

2. Chemistry To make a chemical analysis of.

, and descriptive statistics descriptive statistics

see statistics.
 (frequencies, percentages, and mean responses) were calculated to create a profile of the respondents and the programs they represented.


Characteristics of Facilities and Staff

Each survey sent to a facility was addressed to the activity therapist. Job titles of the current position of the individuals responding to the survey included: department head (37%), activity therapy supervisor (5%), recreational therapy supervisor (10%), staff therapist (22%), and other (24%). The "other" (8%) category included drug/alcohol counselors, prevention specialists, directors, etc. About half (49%) of the 100 responding agencies offered an activity/recreational therapy program for adolescents.

Question 2 concerned types of services offered by facilities and multiple responses were possible. The predominant pre·dom·i·nant  
1. Having greatest ascendancy, importance, influence, authority, or force. See Synonyms at dominant.

 type of services were outpatient outpatient /out·pa·tient/ (-pa-shent) a patient who comes to the hospital, clinic, or dispensary for diagnosis and/or treatment but does not occupy a bed.

 (62%), crisis intervention/detox (23%), and residential/therapeutic community (22%). Over 20% of the respondents provided both inpatient inpatient /in·pa·tient/ (in´pa-shent) a patient who comes to a hospital or other health care facility for diagnosis or treatment that requires an overnight stay.

 and outpatient services outpatient services Hospital-based services Managed care Medical and other services provided, to a nonadmitted Pt, by a hospital or other qualified facility–eg, mental health clinic, rural health clinic, mobile X-ray unit, free-standing dialysis unit Examples . The "other" (8%) facilities offered: aftercare af·ter·care
Follow-up care provided after a medical procedure or treatment program.


the care and treatment of a convalescent patient, especially one that has undergone surgery.
, prevention/early intervention, and school peer groups. Nearly all of the 51 facilities (96%) that had no recreational therapy program provided outpatient services only. Fewer than 1% of the inpatient and residential/therapeutic community services failed to provide recreational therapy services. Reported lengths of stay in treatment included: under 21 days (9%); 21-28 days (17%); 2-3 months (16%); 3-6 months (29%); and 6 or more months (24%).

Respondents were asked to list the total number of activity therapy staff employed and to differentiate between credentialed cre·den·tial  
1. That which entitles one to confidence, credit, or authority.

2. credentials Evidence or testimonials concerning one's right to credit, confidence, or authority:
 and non-credentialed staff. These responses were categorized cat·e·go·rize  
tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es
To put into a category or categories; classify.

 into two groups: full-time staff with a mean of 1.13, and a range from 0 to 55, and part-time staff with a mean of .5 1, and a range of 0 to 25. The number of certified therapeutic recreation specialists (CTRS) employed in responding agencies ranged from 0 to 14, with the mean number of CTRS's at 0.29.

The majority (77.9%) of facilities reported that of recreation/leisure programs are facilitated by activity therapy staff. Multiple responses indicated that joint facilitation Facilitation

The process of providing a market for a security. Normally, this refers to bids and offers made for large blocks of securities, such as those traded by institutions.
 of programs by recreation and other staff occurred. Although most planned activities are facilitated by recreation staff members, other staff members responsible for facilitating programs include counselors, therapists, social workers, aides, nursing staff, and volunteers.

The reported procedures which were used within the activity/therapeutic recreation component to assess clients were observation (76%), interview (72%), leisure interest inventory (41%), and institutional/facility designed assessment (39%), standardized standardized

pertaining to data that have been submitted to standardization procedures.

standardized morbidity rate
see morbidity rate.

standardized mortality rate
see mortality rate.
 TR instruments (7%), and none of the above (9%). Multiple responses indicated that facilities utilized more than one procedure for assessment.

Characteristics of

Therapeutic Recreation Programs

Types of programs One of the main foci of this study was to examine the types of therapeutic recreation programs offered within substance abuse treatment facilities for adolescents (see Table I). The program types included: leisure education/counseling (94%), sports/team and individual (88%), community leisure activities (82%), wellness/physical fitness (78%), games (66%), outdoor/adventure (58%), arts & crafts/hobbies (56%), and family leisure activities (41%). Activities offered once a week or less on average were: games, with a range of 0 to 20 times per month; community leisure activities, with a range of 0 to 16 times per month; outdoor/adventure, with a range of 0 to 28 times per month; and family leisure activities, with a range of 0 to 4 times per month. Activities offered an average of almost 3 or 4 times a week included: leisure education/counseling, with a range of 0 to 60 times per month; wellness/physical fitness, with a range of 0 to 32 times per month; sports/team and individual, with a range of 0 to 28 times per month; and arts & crafts/hobbies, with a range of 0 to 20 times per month.

Table I Therapeutic Recreation Programs Offered by Reporting Facilities
Program Type          Facilities   Sessions/Month
                      & (%)

Leisure Ed.            46 (94%)         15.6

Sports (Team           43 (88%)         11.9
& Individual

Community              40 (82%)          4.1
Leisure Activities

Wellness/              38 (78%)         13.9
Physical Fitness

Games                  33 (66%)          5.0

Outdoor/Adven.         28 (58%)          3.8

Arts, Crafts, Hobby    27 (56%)         11.4

Family Leisure         20 (41%)          2.4

                      Mean Length of
                      Sessions (Minutes)

Leisure Ed.                  89

Sports (Team                 98
& Individual

Community                    143
Leisure Activities

Wellness/                     76
Physical Fitness

Games                         77

Outdoor/Adven.               238

Arts, Crafts, Hobby           86

Family Leisure               155

                        Offered By         Offered by
                        University         Other Staff
                        of Illinois CTRS

Leisure Ed.                    14              39

Sports (Team                   12              38
& Individual

Community                       8              35
Leisure Activities

Wellness/                      12              33
Physical Fitness

Games                          10              27

Outdoor/Adven.                 10              26

Arts, Crafts, Hobby             8              22

Family Leisure                  6              16

n = 49

Length of programs Those activities that lasted under two hours (120 minutes) per session included: wellness/physical fitness, with a range of 0 to 3 hours; games, with a range of 0 to 4 hours; arts & crafts/hobbies, with a range of 0 to 2 hours; leisure education/counseling, with a range of 0 to 7 hours; and sports/team and individual, with a range of 0 to 4 hours. Activities that lasted more than two hours per session included: community leisure activities, with a range of 0 to 8 hours, and outdoor/adventure, with a range of 0 to 8 hours.

Programs Offered by Certified Therapeutic Recreation Specialists Programs that involved a high frequency of CTRS's in implementation encompassed: leisure education/counseling (14), wellness/physical fitness (12), sports/team and individual (12), outdoor/adventure (10) and games (10). Programs that involved a high frequency of other staff in implementation included: leisure education/counseling (39), sports/team and individual (38), community leisure activities (35), wellness/physical fitness (33) and games (27).

Activity Program Goal Areas

The survey listed a variety of goals for therapeutic recreation programs. Each goal was rated on a scale that ranged from "extremely important" (5) to "not important" (1). Improving basic social skills (90%), improving self-esteem/self-efficacy (87%), improving the level of cooperation/trust (84%), increase leisure awareness and develop leisure skills (68%), and increase sense of responsibility (66%) were ranked as very important to extremely important goal areas. Goals that were not considered very important were improving time management skills (30%) and providing opportunities for family leisure (26%) (see Table II).

Table 2 Activity Program Goal Areas
Goal/Importance        Extremely   Very Important   Important

Improve Wellness       7 (15%)       19 (39%)       16 (33%)

Improve Basic          21 (43%)      23 (47%)        5 (11%)
Social Skills

Improve Level of       24 (49%)      17 (35%)        6 (13%)

Increase Leisure       18 (37%)      15 (31%)       12 (25%)
Awareness &
Developmental Skills

Provide Oppportun.      5 (11%)       7 (15%)       14 (29%)
for Family Leisure

Improve Time            6 (13%)       8 (17%)       13 (27%)
Management Skills

Increase Sense of      14 (29%)     18 (37%)        14 (29%)

Improve Self-esteem/   33 (68%)      9 (19%)         5 (11%)

                      Somewhat    Not Important

Improve Wellness        6 (13%)       0 (0%)

Improve Basic           0 (0%)        0 (0%)
Social Skills

Improve Level of        0 (0%)        0 (0%)

Increase Leisure        4 (9%)        0 (0%)
Awareness &
Developmental Skills

Provide Oppportun.      2 (4%)        0 (0%)
for Family Leisure

Improve Time
Management Skills      18 (37%)       3 (7%)

Increase Sense of       2 (4%)        0 (0%)

Improve Self-esteem/    0 (0%)        0 (0%)

Factors Inhibiting in·hib·it  
tr.v. in·hib·it·ed, in·hib·it·ing, in·hib·its
1. To hold back; restrain. See Synonyms at restrain.

2. To prohibit; forbid.

 Development of Recreational Therapy


The most frequently cited factors which inhibit the development of a comprehensive therapeutic recreation program were shortage of staff to implement programs (68%), shortage of recreational services (60%). High caseload case·load  
The number of cases handled in a given period, as by an attorney or by a clinic or social services agency.

 was also reported by 33% as an inhibiting factor (see Table III).

Table 3 Factors Inhibiting Development of Therapeutic Recreation Services
Factors                   Number of            Percentage
                          Agencies Reporting    (n = 49)

Shortage of Staff                 33               67%

Shortage of                       29               60%
Resources & Space

Agency Lacks Awareness            13               27%
of Value of Leisure

Lack Skills & Knowledge           12               25%
to Develop TR Programs

Shortage of Funding               29               60%

Short Length of Stay              12               25%

High Case Load                    16               33%

No Response                        3                7%
n = 49

Forms of Assistance Needed to Improve Recreational Therapy


The respondents were asked to check all factors that would be necessary to improve the quality of therapeutic recreation services at their facility. The most important forms of assistance needed are a list of how to initiate activities for adolescent substance abusers (62%), consultation by a CTRS (58%) and in-service training on recreational therapy (49%). Printed resources in leisure education and leisure assessment tools were noted, also. Additional CTRS staff was indicated by 45% of respondents as necessary in order to improve recreational therapy services.

Summary, Conclusion, Discussion, and

Recommendations for Further Research

The purpose of this study was to examine the extent and focus of recreational therapy programs offered within substance abuse treatment facilities for adolescents. Several authors have indicated that therapeutic recreation is an important component in the rehabilitation of individuals who abuse psychoactive chemicals (Kunstler, 1992; Faulkner, 1991). However, the results of this study reveal that not quite half of surveyed facilities (49%) offered a recreational therapy program for adolescents. The therapeutic recreation programs offered the most were leisure education/counseling, sport/team and individual, and community leisure activities. The predominant goals of the therapeutic recreation programs in the surveyed facilities were to improve social skills, self-esteem/self-efficacy and the level of cooperation/trust. Additional comments by respondents indicated that the development and implementation of comprehensive leisure/recreational programs are inhibited by shortages of staff, recreational resources and space, and funding for services.

Facility and Staff Characteristics

Fleisch (1991) asserts that programs designed to serve chronic adolescent substance abusers should be intensive and long enough to ensure that therapeutic changes can be internalized. However, the majority of treatment facilities for adolescents responding to this survey were outpatient, and none offered therapeutic recreation programs. Outpatient treatment is viewed as more cost-effective, and less intrusive in·tru·sive  
1. Intruding or tending to intrude.

2. Geology Of or relating to igneous rock that is forced while molten into cracks or between other layers of rock.

3. Linguistics Epenthetic.
 in the lives of program participants and is replacing inpatient treatment as the predominant treatment setting. Participants in outpatient programming may be in treatment for a longer period of time (weeks or months) but at a lower level of intensity (1 or 2 hours per week) and diversity of service. Consequently, while the prevalence of outpatient facilities in this sample may have influenced the length of stay upwardly, adolescents in treatment may receive fewer and less comprehensive services.

The modal length of stay among residential facilities was 3-6 months or longer. Fleisch (1991) points out that residential treatment programs usually provide recreation services and often include wilderness experiences to develop cooperative behavior and foster self-esteem. It is significant that these were the two most strongly supported goal areas for all respondents. Both of these areas were listed as important goals for their activity therapy programs. However, outdoor/adventure programs, commonly perceived as popular and typical program offerings, were available in only (58%) of the therapeutic recreation programs and were offered only four times per month on average. These data may reflect the lack of inpatient or residential treatment programs in the survey sample. Outpatient programs may not have the time, staff and facility resources to offer adventure/wilderness programming.

Respondents reported that shortage of staff is a major inhibiting factor in the development and implementation of comprehensive therapeutic recreation programs. Voss (1991) and Kremer, Malkin and Benshoff (1995) found that adult substance abuse treatment facilities employed three to four full-time activity staff, as compared to fewer than a 1/3 full-time equivalent Full-time equivalent (FTE) is a way to measure a worker's involvement in a project, or a student's enrollment at an educational institution. An FTE of 1.0 means that the person is equivalent to a full-time worker, while an FTE of 0.5 signals that the worker is only half-time.  in adolescent treatment facilities. From these findings it would appear that adolescents with substance abuse problems are significantly less likely to receive professionally guided therapeutic recreation services. Rather, it appears that CTRS's may design or consult about therapeutic recreation programs which are then implemented by other staff not specifically trained in therapeutic recreation. Therapeutic recreation programs were implemented by other staff (counselors, social workers, therapists and aides/technicians) almost 50% of the time. Multiple responses indicated that many programs are co-facilitated by more than one staff member.

Moreover, anecdotal anecdotal /an·ec·do·tal/ (an?ek-do´t'l) based on case histories rather than on controlled clinical trials.
anecdotal adjective Unsubstantiated; occurring as single or isolated event.
 comments from respondents revealed a lack of understanding and support for a recreational therapy program at adolescent substance abuse treatment facilities. The most discussed area of concern involved the lack of support and understanding from other staff about the importance of recreational therapy. Cooperation in facilitating programs and being considered an unimportant un·im·por·tant  
Not important; petty.

unim·portance n.
 component in the treatment process was a problem reported by many of the respondents to an open-ended question A closed-ended question is a form of question, which normally can be answered with a simple "yes/no" dichotomous question, a specific simple piece of information, or a selection from multiple choices (multiple-choice question), if one excludes such non-answer responses as dodging a . Comments included: "the activity therapy staff and the CTRS are not a priority"; "the counselors and staff refuse to support or encourage clients about the importance of leisure activities."; "staff employed for 15 to 20 years have old fashioned n. 1. A cocktail consisting of whiskey, bitters, and sugar, garnished with with fruit slices and often a cherry.

Noun 1. old fashioned - a cocktail made of whiskey and bitters and sugar with fruit slices
 views concerning recreation." While facilities and the literature may assert the importance of therapeutic recreation, professional peer recognition and support does not appear to be forthcoming.

Frequently, long-ten-n inpatient programs for adolescents provide services not typically found in adult programs. Adolescent programs usually offer educational programming for their residents, often in response to state mandates. This provision of educational services, along with treatment services, may crowd therapeutic recreation from the schedule of activities in adolescent treatment programs. Paradoxically par·a·dox  
1. A seemingly contradictory statement that may nonetheless be true: the paradox that standing is more tiring than walking.

, students in the public school system receive education in leisure education and wellness programming through health and physical education classes, as well as therapeutic recreation as a support service for students with special needs.

External factors may influence the availability of therapeutic recreation programs and staff in adolescent treatment programs. State licensure licensure
 regulations and accrediting body standards (Joint Commission on Accreditation of Healthcare Organizations Joint Commission on Accreditation of Healthcare Organizations, the United States body that accredits healthcare organizations.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO/TJC),
 and Commission on Accreditation accreditation,
n a process of formal recognition of a school or institution attesting to the required ability and performance in an area of education, training, or practice.
 of Rehabilitation Facilities) may require the provision of therapeutic recreation services. However, state funding authorities and private insurance carriers may balk balk

the action of a horse when it refuses to obey a command to which it usually responds. See also jibbing.
 at funding services which they view as non-essential or non-therapeutic in the more traditional sense. Consequently, facilities are faced with the difficult reality of being required to provide therapeutic recreation services without adequate financial reimbursement Reimbursement

Payment made to someone for out-of-pocket expenses has incurred.
. One result of this dilemma may be to keep certified therapeutic recreation staff complements at low levels.

The program offered most frequently by facilities with therapeutic recreation components (94%) was leisure education/counseling. while the most common forms of recreation participation were sports (team and individual) and community leisure activities. These types of recreation participation are diversional and not educational in nature and require fewer staff and less skilled staff. Consequently, these large group activities are cost effective. Additionally, approximately 80% of the surveyed facilities did offer wellness/physical fitness programs. This finding was consistent with Voss (1991) and Kremer (1993).

Goals and Programs Offered

Activity therapy goal areas ranked by facilities as "very important to extremely important" were: improving basic social skills, improving self-esteem/self-efficacy, and improving the level of cooperation/trust. These goals are consistent with the treatment needs of adolescents who have substance abuse problems (Faulkner, 1991; Kunstler, 1992; Sneegas, 1989). Many adolescents may consume their first drink or drug in the context of leisure activities, and ongoing drug and alcohol use may occur during social activities including parties, other social gatherings, or concerts (Aguilar & Munson, 1992). Gang involvement may play a prominent role in substance abuse for some teens (Hanson & Venturelli, 1995). Unfortunately, adolescents with substance abuse problems may not know appropriate leisure activities or social skills devoid de·void  
Completely lacking; destitute or empty: a novel devoid of wit and inventiveness.

[Middle English, past participle of devoiden,
 of drug or alcohol use. Leisure education/counseling addresses basic social skills (Kunstler, 1992), and Sneegas (1989) argues that social skills, including trust and cooperation, can best be developed through recreation participation. Other recreation activities that improve self-esteem/self-efficacy, problem solving problem solving

Process involved in finding a solution to a problem. Many animals routinely solve problems of locomotion, food finding, and shelter through trial and error.
, and the level of cooperation and trust include wilderness challenge programs and games ("New Games" and initiatives). Witman (1987) asserts that completion of adventure activities regarded as challenging will lead to greater confidence and a sense of self-empowerment. However, this type of programming was offered least by facilities with games ranked fifth and wilderness challenge programs ranked sixth of the eight program areas surveyed. Reasons for lack of wilderness programming often involved funding, shortage of space, longer periods of time to implement activities, liability and shortage of staff qualified to initiate such programs. Both games and wilderness activities take substantial external resources, space and time to implement. They are likely to require specialized spe·cial·ize  
v. spe·cial·ized, spe·cial·iz·ing, spe·cial·iz·es

1. To pursue a special activity, occupation, or field of study.

 equipment and specially trained staff, also.

Family leisure programming was offered by fewer than 50% of the respondents on the average of 2.4 times per month, and only 26% of the respondents rated the provision of family leisure opportunities as an "important to very important" goal. From a holistic Holistic
A practice of medicine that focuses on the whole patient, and addresses the social, emotional, and spiritual needs of a patient as well as their physical treatment.

Mentioned in: Aromatherapy, Stress Reduction, Traditional Chinese Medicine
 viewpoint, many of the factors that lead to a adolescent's eventual involvement in psychoactive chemicals can be traced to the lack of trust, communication, and other dysfunctionality that occurs within the family system (Simons & Robertson, 1989) and a number of authors have asserted the importance of family involvement in treatment (Fleisch, 1991; Polcin, 1992). One of the reasons for limited family programming may be low level of involvement by family members concerning their child's treatment. Often adolescents in substance abuse treatment are from dysfunctional families dysfunctional family Psychology A family with multiple 'internal'–eg sibling rivalries, parent-child– conflicts, domestic violence, mental illness, single parenthood, or 'external'–eg alcohol or drug abuse, extramarital affairs, gambling,  in which one or both parents has a substance abuse problem. These parents may be unwilling to expose or confront their own substance abuse behavior through participation in treatment for their children. Geographic factors or practical realities may play a role in limiting family programming, also. Families who live some distance away from residential facilities may not have the time or economic resources to participate in treatment. For other families, the demands of jobs and raising other children may curtail cur·tail  
tr.v. cur·tailed, cur·tail·ing, cur·tails
To cut short or reduce. See Synonyms at shorten.

[Middle English curtailen, to restrict
 involvement in either outpatient or inpatient family programming. Nevertheless, Newcomb and Bentler (1988) point out that programs that focus on the developmental needs of adolescent and involve families in treatment are most successful. Malkin, Phillips, and Chumbler (1991) address family leisure issues and suggest the importance of a family leisure education program for adolescents in substance abuse treatment. Interestingly, Voss (1991) also found a low level of both family and outdoor/adventure programming offered in facilities serving adults with substance abuse problems.

Factors Inhibiting Services and Types of Assistance Required

Participants reported a number of factors that inhibited the development of a comprehensive recreational therapy program including shortage of recreational resources and space, shortage of funding for recreational services, and shortage of staff to implement programs. Suggestions were made concerning areas of assistance needed to improve the adequacy of services. The most commonly requested types of assistance were information on how to initiate activities for adolescent substance abusers and the need for periodic consultation with a Certified Therapeutic Recreation Specialist. The respondents also stressed the importance of employment of additional CTRS's and in service training on therapeutic recreation.

One complication complication /com·pli·ca·tion/ (kom?pli-ka´shun)
1. disease(s) concurrent with another disease.

2. occurrence of several diseases in the same patient.

 related to initiating activities for adolescents is the lack of research related to therapeutic recreation services for adolescent substance abusers. Research supports the enhancement of self-concept and cooperation and trust with delinquent delinquent 1) adj. not paid in full amount or on time. 2) n. short for an underage violator of the law as in juvenile delinquent.

DELINQUENT, civil law. He who has been guilty of some crime, offence or failure of duty.
 and at risk-youth through participation in areas such as wilderness challenge programs (Witman, 1987) and the development of a comprehensive activity therapy program(Faulkner, 1991) for substance abusers. However, there is little information available related the design and implementation of recreation programs specific to adolescent substance abusers, and little research on the efficacy of such programs.

One contributing factor related to the respondents' reported need for periodic consultation and information on how to initiate programming for adolescents, is that the number of CTR's employed by each agency is less than one full time position. Voss (1991) and Kremer (1993) found that facilities serving adults employed approximately 2 full-time CTRS's. Kunstler (1992) points out that in order to develop and implement a comprehensive therapeutic recreation program, the service of a CTRS may be necessary.

Recommendations For Further Research

The following recommendations for future research are based on the findings and conclusions of this study. Additional research is needed to ascertain the effects or outcomes of specific therapeutic recreation programs for adolescents with substance abuse problems. Little outcome information exists at present. Strategies to examine the status of Certified Therapeutic Recreation Specialists should be considered. In particular, issues of professional recognition, collegial col·le·gi·al  
a. Characterized by or having power and authority vested equally among colleagues: "He . . .
 support, and the influence of accreditation standards and funding sources seem to have relevance in the employment of Certified Therapeutic Recreation Specialists in adolescent substance abuse treatment.


Aguilar, T. E., & Munson, W. W. (1992). Leisure education and counseling as intervention components in drug and alcohol treatment for adolescents. Journal of Alcohol and Drug Education, 37(3), 23-34.

Babor, T. F., Del Boca, F. K., McLaney, M. A., Jacobi, B., Higgins-Biddle, J., & Haas, W. (1991). Just say Y.E.S.: Matching adolescents to appropriate interventions for alcohol and other drug-related problems. Alcohol Health and Research World, 15(1), 76-86.

Edwards, D. (1989). Who's winning the war on drugs? Adolescent Counselor, 1(6), 31- 35, 62.

Faulkner, R. W. (1991). Therapeutic recreation protocol for treatment of substance addictions. State College, PA: Venture.

Fazio, S. M. (1987). A survey of leisure and recreation programs offered by agencies serving traumatic brain injured in·jure  
tr.v. in·jured, in·jur·ing, in·jures
1. To cause physical harm to; hurt.

2. To cause damage to; impair.

 adults. Unpublished master's thesis, Southern Illinois University, Carbondale.

Fleisch, B. (1991). Approaches in the treatment of adolescents with emotional and substance abuse problems: Technical assistance publication series number 1 (DHHS DHHS Department of Health & Human Services (US government)
DHHS Dana Hills High School (Dana Point, California)
DHHS Deaf and Hard of Hearing Services
DHHS Deaf and Hard of Hearing Services
 Publication No. ADM See add/drop multiplexer.

(language) ADM - A picture query language, extension of Sequel2.

["An Image-Oriented Database System", Y. Takao et al, in Database Techniques for Pictorial Applications, A. Blaser ed, pp. 527-538].
 91-1744). Rockville, MD: U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Health and Human Services, HHS

Hanson, G., & Venturelli, P. J. (1995). Drugs and society, 4th ed., Boston: Jones and Bartlett Publishers.

Hawkins, J. D., & Catalano, R. F. (1985). Aftercare in drug abuse treatment. The International Journal of the Addictions, 21(6&7), 917-945.

Kremer, D. L. (1993). Physical activities programs offered in substance abuse treatment facilities. Unpublished master's thesis, Southern Illinois University, Carbondale.

Kunstler, R. (1992). TR's role in treating substance abuse. Parks and Recreation, 27(4), 58-60.

Malkin, M. J., Phillips, R. W., & Chumbler, J. A. (1991). The Family Lab: An interdisciplinary in·ter·dis·ci·pli·nar·y  
Of, relating to, or involving two or more academic disciplines that are usually considered distinct.

 family leisure education program. Annual in Therapeutic Recreation, 2, 25-36.

Murray, P. A. (1986). Fitness and recovery. Alcohol Health and Research World, 2(1), 30-32, 72.

Newcomb, M. D., & Bentler, P. M. (1988). Consequences of adolescent drug use: Impact on the lives of young adults. Newbury Park, CA: Sage.

Newcomb, M. D., & Bentler, P. M. (1989). Substance use and abuse among children and teenagers. American Psychologist The American Psychologist is the official journal of the American Psychological Association. It contains archival documents and articles covering current issues in psychology, the science and practice of psychology, and psychology's contribution to public policy. , 44(2), 242-248.

Polcin, D. L. (1992). A comprehensive model for adolescent chemical dependency chemical dependency
A physical and psychological habituation to a mood- or mind-altering drug, such as alcohol or cocaine.

chemical dependency 
 treatment. Journal of Counseling and Development, 70, 376-382.

Presley, C. A., Meilman, P. W., & Lyerla, R. (1995). Alcohol and drugs on American college campuses: Use, consequences, and perceptions of the campus environment (Vol. 11: 1990-92). Carbondale, IL: Southern Illinois University.

Simons, R. L., & Robertson, J. F. (1989). The impact of parenting factors, deviant deviant /de·vi·ant/ (de´ve-int)
1. varying from a determinable standard.

2. a person with characteristics varying from what is considered standard or normal.

 peers, and coping style upon adolescent drug use. Family Relations, 38, 273-281.

Sneegas, J. J. (1989). Social skills: An integral component of leisure participation and therapeutic recreation services. Therapeutic Recreation Journal, 23(2), 30-40.

Substance Abuse and Mental Health Services Administration The Substance Abuse and Mental Health Services Administration (SAMHSA), an operating division of the Health and Human Services Department (HHS), was established in 1992 by the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act (Pub. L. No. 102-321). . (1995, Spring). Significant substance abuse-related problems found among youth. SAMHSA News, 3(2), 9.

Voss, M. A. (1991). A study of activity therapy programs in substance abuse treatment facilities. Unpublished master's thesis, Southern Illinois University, Carbondale.

Witman, J. P. (1987). The Efficacy of adventure programming in the development of cooperation and trust with adolescents in treatment. Therapeutic Recreation Journal, 22(2), 22-29.
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Author:Malkin, Marjorie M.
Publication:The Journal of Rehabilitation
Date:Oct 1, 1996
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