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The Phoenix House Academy is a 150-bed, residential therapeutic community for adolescents ages 13–17 with histories of problem behaviors and substance abuse. The Phoenix Academy treatment model has been implemented in 11 programs in seven States. It uses an enhanced therapeutic community (TC) treatment approach to treat youths who have substance abuse problems. All adolescents are eligible for admission. For the vast majority of clients entering the academy, marijuana and alcohol—used in combination—are the primary drugs of choice. The ethnic and racial mix of academy residents is varied. The academy serves young men and young women both. The primary referral sources are probation departments. Other referring agencies include child welfare agencies, mental health agencies, and the courts. Nongovernment referrals come from health maintenance organizations, employee assistance programs, family members and friends, and a variety of community-based sources such as schools, churches, social service agencies, and health care providers.
The major programmatic principle of the TC philosophy is mutual self-help. All activities are designed to help youths address their alcohol or other drug abuse issues and learn to act in their own best interests, as well as in the best interests of their peers and families. During what is planned as a 9- to 12-month treatment, residents progress through three phases (orientation, stabilization, and primary treatment) of residential treatment. This system is based on the understanding that behaviors required for lasting recovery from substance abuse are best learned in increments that build on progress made in earlier phases of treatment. The beginning of the program is designed to foster bonding with program staff and peers while minimizing negative self-images and expectations. Later phases stress the importance of independent decision-making and responsibility to self, family, and community. As participants integrate and learn to apply the TC lessons and positive messages, they earn increased responsibility and autonomy. Typical days in the facility are highly structured, with most waking hours spent in the onsite school. Activities include peer support groups, family services, didactic sessions and workshops, house meetings, and recreation. All program elements are guided by a core set of beliefs about addiction, recovery, and “right living” common to most TC treatments. Professional program staff include psychiatrists, psychologists, social workers, and counselors. Many staff members are themselves in recovery.
Upon completion of the residential portion the program, youths participate in the nonresidential aftercare program for up to 1 year to support their reintegration and readjustment into society. After successful completion of this year of services (in increments of decreasing frequency managed by their counselors), clients are eligible for formal graduation from the program.
This evaluation used a quasi-experimental nonequivalent comparison group design. The study population was drawn from all cases referred by probation to Phoenix House or six other group homes during the recruitment period. Youths eligible for the study were required to a) be 13 to 17 years old at study entry, b) provide a written informed assent to participate in the research, and c) provide permission to notify a parent or legal guardian of study participation. A total of 574 youths were potentially eligible to participate because they were referred to one of the seven participating group homes and met the age inclusion criterion. Of these, 125 were not recruited for various reasons. The remaining 449 youths were enrolled in the study as Phoenix Academy condition youths, if they were admitted to that program—or as comparison condition youths if they were not. Study follow-up retention was excellent. At each of the 3-, 6-, and 12-month assessments, more than 90 percent of the baseline sample (n=449) was located and successfully interviewed (3 months, n=406; 6 months, n=410; 12 months, n=408). The principal data collection instrument at each of the four assessment periods was the Global Appraisal of Individual Needs (GAIN). The GAIN has established norms for both adults and adolescents and contains eight main sections: background, substance use, physical health, risk behaviors, mental health, environment, legal, and vocational. Substance use, crime, and psychological distress outcomes were assessed using GAIN scales. Repeated measures analyses were conducted on each of these outcomes.
The results of this study suggest that the Phoenix Academy treatment model is associated with better outcomes than the average expected outcome of alternative probation dispositions. Phoenix Academy youths had significantly better outcomes for most substance use and psychological functioning outcomes. Specifically, Phoenix Academy youths showed the same trend toward increasing substance use in months 3 to 12 as did the comparison youths; however, because Phoenix Academy youths’ problems did not accelerate faster than the comparison group, 12 months after intake the Phoenix Academy youth outcomes were significantly better than comparison youth outcomes on all substance use measures (excluding tobacco). The size of these effects (–.25) is generally referred to as between a small and medium-sized effect. Participation in the Phoenix Academy was also associated with significant psychological benefits over time relative to the comparison group. In other words, although no significant group differences were found in the first 3 months after treatment entry, Phoenix Academy youths reported significantly greater reductions in psychological symptoms during months 3 through 12. These differences resulted in treatment effect sizes favoring Phoenix Academy that were small to medium in magnitude. In contrast, although Phoenix Academy youths showed greater declines in mean scores over the 12 months than the comparison youths on arrests, property crimes, violent crimes, and crime days, crime outcomes did not differ significantly between the groups. The failure to detect differences may be the result of many possible effects, including the possibility that the analyses merely lacked the statistical power to detect the true effects on crime.
Jaycox, Lisa H., Grant N. Marshall, and Andrew R. Morral. 2002. Phoenix Academy at Lake View Terrace, Calif.: Clinical Manual and Program Description of an Adolescent Therapeutic Community. Santa Monica, Calif.: RAND.
Morral, Andrew R., Lisa H. Jaycox, W. Smith, K. Becker, and P. Ebener. 2003. “An Evaluation of Substance Abuse Treatment Services for Juvenile Probationers at Phoenix Academy of Lake View Terrace.” In S. Stevens and Andrew R. Morral (eds.). Adolescent Substance Abuse Treatment in the United States: Exemplary Models From a National Evaluation Study. New York, N.Y.: Haworth Press, 213–34.
Morral, Andrew R., Daniel F. McCaffrey, and Greg Ridgeway. 2004. “Effectiveness of Community-Based Treatment for Substance Abusing Adolescents: 12-Month Outcomes From a Case-Control Evaluation of a Phoenix Academy.” Psychology of Addictive Behaviors 18(3):257–68.
Morral, Andrew R., M. Reti, Daniel F. McCaffrey, and Greg Ridgeway. 2001. “Phoenix Academy Treatment Outcomes: Preliminary Findings From the Adolescent Outcomes Study.” NIDA Research Monograph 182:111–12.
Mitchell S. Rosenthal
Phoenix House Foundation
164 West 74th Street
New York, NY 10023
Phone: (212) 595-5810
E-mail: mrosenthal@phoenixhouse.org
Web site: http://www.phoenixhouse.org
James Dahl
Phoenix House Foundation
164 West 74th Street
New York, NY 10023
Phone: (212) 595-5810
E-mail: Jdahl@phoenixhouse.org
Web site: http://www.phoenixhouse.org
