Treatment initiation is a major factor contributing to positive outcomes, but the supporting literature remains limited. It is difficult to draw conclusions regarding predictors of dropout, and the...

Treatment retention is a major factor contributing to favourable outcome in the treatment of substance misuse, but the literature remains very limited. Despite evidence of the association of personality with drug use experimentation and relapse, surprisingly little is known about its role in the treatment process. Clients’ personality functioning as measured by malleable and context sensitive characteristic adaptations in treatment are of concern. This study examines whether, and to what extent, personality functioning contributes to or hinders treatment completion. This paper examined the extent to which service users’ characteristic adaptations may be potential determinants of treatment completion. A longitudinal multi-site design was utilised, examining the therapy process in a naturalistic setting in five inpatient treatment units. The study examined whether service users’ characteristic adaptations (SIPP-118) predict completion, while controlling psychosocial, motivational and treatment engagement indicators involving n = 340 participants from 5 inpatient centres. Multivariate regression analyses were applied to examine the predictive role of characteristic adaptations on treatment completion. Findings indicated that certain dysfunctional characteristic adaptations emerged as strong predictors of treatment completion. Dysfunctional levels on Self-control and Social concordance were significant predictors of drop out from treatment. Individuals with low capacity to tolerate, use and control one’s own emotions and impulses were almost three times more likely to drop-out compared to those without [OR] = 2.73, Wald = 6.09, P = .014, 95% CI [1.2, 6.0]. Individuals with dysfunctional levels on the ability to value someone’s identity, withhold aggressive impulses towards others and work together with others were 2.21 more times more likely to complete treatment [OR] = 2.21, Wald = 4.12, P = .042, 95% CI [1.0, 4.7]. The analysis at the facet level provided additional insight. Individuals with higher adaptive levels on Effortful Control were 46% more times likely to complete treatment than the group [OR] = 4.67, Wald = 10.231, P = .001, 95% CI [1.81, 12.04], 47% more likely on Aggression regulation [OR] = 4.76, Wald = 16.68, P < .001, 95% CI [2.1, 10.3], and 26% more likely on Stable self-image [OR] = 2.62, Wald = 6.75, P < .009, 95% CI [0.9, 3.0]. These findings extend our knowledge of the predictive role of characteristic adaptations in treatment completion and highlight the clinical utility of capturing these individual differences early on. Delineating the role of characteristic adaptations in treatment may provide the basis for enhancing treatment effectiveness through individualized interventions that are scientifically driven and may open new avenues for the scientific enquiry of personality and treatment.

Medical education escape rooms are emerging as a viable technological resource for pedagogy-first, learner-centric educational activities. This work presents the evaluation results of the first flipped classroom implementation in medical education, thus utilizing a mobile-driven augmented reality (AR) escape room. A total of 21 first-year medical students attended a flipped classroom educational activity that aimed to acclimate the students with the workflows of basic life support. Knowledge acquisition and user perceptions were evaluated. Knowledge acquisition was evaluated with an ad hoc relevant instrument at three timepoints: (a) baseline at recruitment, (b) preclass after students had prepared for the episode, and (c) after class. Learner perceptions about the activity and the AR escape room were recorded at the activity’s end using a previously designed evaluation instrument. The results demonstrated sufficient knowledge acquisition only after completing the whole educational activity, while learners found the experience interesting, and the AR escape room challenging, thus reflecting an activity that was well formulated in structure and content. The challenges identified were the limited out of class collaboration capacity of the digital application and the highly gamified approach that at points counteracted the educational scope of the activity. Overall, these positive initial results demonstrate the potential of collaborative, escape based, activities for self-directed, learner-centric medical education.

Dimensional models for classifying personality have received extensive empirical support in the treatment of substance misuse. However, we do not currently understand whether and which dimensions of personality functioning are amenable to change. The aim was to examine whether there are clinically significant changes between pre- and during-treatment and assess whether these differ between those completing or dropping out of treatment. From the 200 participants from the outpatient and 340 from the inpatient treatment, a purposeful selection was utilised of 75 cases that participated in both phases and had complete datasets of the assessment battery. A quantitative multi-site individual follow-up design allowed the examination of the potential effects of treatment in personality functioning as well as the degree of clinical significant change of personality functioning. We use Jacob and Truax’s formula of reliable and clinically significant change. Five independent mixed between-within subject analyses of variance were performed. All personality adaptations changed towards higher-functioning levels, except Social Concordance, which remained stable. Compared to those dropping out, completers had significantly more changes towards functional characteristic adaptations and higher clinical improvement. The persistence of maladaptive characteristic adaptations may be an important risk marker for poor treatment outcomes, requiring therapeutic attention.