Improving the retention rate for residential treatment of substance abuse by sequential intervention for social anxiety.

INTERVENTION: The focus of this study is to examine whether addressing social anxiety disorder (SAD) symptoms, which are directly related to residential substance abuse treatment, improves engagement and retention in individuals with comorbid SAD and substance use. Participants randomly assigned to the intervention will receive 2 individual and 2 group sessions of SAD symptom‐targeted psychological therapy prior to inpatient treatment at Odyssey House, a residential drug and alcohol therapeutic community based in the outer suburbs of Melbourne, Victoria. The group sessions will generally consist of only of 3‐4 participants, and will be facilitated by a registered and experienced psychologist. An additional two therapeutic 'booster' telephone counselling sessions will be delivered within the first few weeks of the client's residency at the Therapeutic Community (TC). The psychological intervention includes psychoeducation, cognitive challenging, reality testing, attention training and facing feared situations in a gradual way. Two randomised control trials support the effectiveness of the program in reducing social anxiety symptoms and other related psychological problems (Rapee, Abbott, Baillie, & Gaston, 2007; Wilson & Rapee, 2005). CONDITION: Alcohol and drug use Social Anxiety PRIMARY OUTCOME: Improve retention rate for residents of the TC who have comorbid substance use and social anxiety disorders: comparison of TC residential retention rates and length of stay (LOS) between intervention and control group. Reduce wait list attrition for individuals with comorbid substance use and social anxiety disorders who are awaiting entry to TC: comparison of TC wait list retention rates between intervention and control group. SECONDARY OUTCOME: Reduce social anxiety symptoms directly assoicated with entry and residence in TC for people with comorbid drug and alcohol dependence: Liebowitz Social Anxiety Scale (LSAS; Liebowitz 2002), Brief Fear of Negative Evaluation Scale (BFNE; Watson & Friend, 1969), MINI International Neuropsychiatric Interview (Sheehan, Lecrubier, Sheehan, Amorim, Janavs, Weiller, Hergueta, Baker & Dunbar, 1998), Beck Anxiety Inventory (BAI; Beck & Steer, 1990), Beck Depression Inventory (BDI; Beck & Steer, 1987), Sensitivity to Punishment Sensitivity to Reward Questionnaire (SPSRQ; Torrubia et al., 2001), Willingness to Communicate Scale (WTC; McCroskey & Baer, 1985). To reduce dependence on drugs and/or alcohol for people with comorbid social anxiety symptoms: The timeline follow back (TLFB; Maisto, Sobell & Cooper, 1979), MINI International Neuropsychiatric Interview (Sheehan, Lecrubier, Sheehan, Amorim, Janavs, Weiller, Hergueta, Baker & Dunbar, 1998), Alcohol, Smoking and Substances Involvement Screening Test (ASSIST; WHO, 2002), Circumstances, Motivation and Readiness Scales for Substance Abuse Treatment (CMR; De Leon, Melnick, Kressel, & Jainchill, 1994), I7 Impulsiveness Questionnaire (I7 EIS; Eysenck, Pearson, Easting & Allsopp, 1985). Urine samples are also collected from a random sample of people to confirm participant self‐report of substance use. INCLUSION CRITERIA: Meet criteria for current substance use dependence AND have at least moderate symptoms of social anxiety disorder as indicated by the Liebowitz Social Anxiety Scale (LSAS; Liebowitz 2002).