PROGRAM EVALUATION

ANNUAL UPDATE REPORT OF THE RETREAT MODEL MINNESOTA

February 2009

Executive Summary

This is the annual update of a longitudinal evaluations effort conducted by Herbert & Louis, LLC, an independent evaluation company, for The Retreat. The findings discussed in this report confirm and reinforce positive findings reported in past evaluations. The findings include the entire sample (previous years 2001 - 2007, n = 1511) and the current year registrations (calendar 2008, n=520).

There were some statistically significant demographic changes noted in the current year sample when compared to the all year sample. Average age of guests registering during the report period was 39.3 years up from 38.6 years across all previous years, and males tended to be younger than males. The proportion of male and female guests did not significantly differ from previous years. Guests were primarily Caucasian (90.9%) across previous years with an increase to 97.8% for the current year. In the current year sample approximately 47.1% were single, 27.2% married, and 16.6% divorced. Eighty-five percent had received education beyond high school. Nearly 44.6% were unemployed and 31.0% employed full-time with 56.4% reporting an income of $50,000 or over and 18% with an income of less than $20,000.

At the time of registration, the most commonly used substance was alcohol 95.0% compared to 92.0% overall. Marijuana/Hashish (44%) was the second most frequently used substance followed by prescription medications (40%), cocaine (38.7%), other opiates (23.8%), crack (23.3%), illegal prescriptions (22.7%), and sedatives (21.7%).

A hallmark of the findings has been the consistency of very positive outcomes. At 12 months post departure, 50.2% reported no substance use and 36.6% reported less use than prior to enrollment across previous years. With over 87% reporting improvement in the single most important indicator of substance use, there is little question regarding the strength of the experience at The Retreat. Importantly, 91% reported high levels of satisfaction in their overall quality of life at 12-month follow-up. Seventy-two percent and higher of past guests reported improved relationships with their spouses/SO, children, friends, and other family members. A similar range also reported improvement in the self-image, physical health, ability to solve problems, and with their employment.

In addition to the experience, knowledge, and skills garnered from the stay at The Retreat, the data suggests that continued activity with self-help, such as Alcoholics Anonymous plays an important role in remaining sober.

At the time of departure, a very strong 96.7% of the guests expressed a willingness to recommend The Retreat to others.

Table of Contents

Executive Summary	................................................. i
Table of Contents	................................................ ii
Introduction	................................................ 1
Enrollment Demographics	................................................ 2
Satisfaction at Time of Departure	.............................................. 13
Findings at Six-Month Follow-Up	.............................................. 18
Findings at Twelve-Month Follow-Up	.............................................. 23
The Impact of Sober Housing	.............................................. 30
Summary & Conclusions	.............................................. 33

Introduction

This report is an annual update for the period of January 1, 2008 through December 31, 2008 of an evaluation project that was started in early 2001. The report provides cumulative data comparisons of all previous years with current period information for critical indicators.

At the time of registration, all guests are requested to complete an enrollment survey comprised of several domains including general demographics (i.e., age, gender, income), substance use, prior year health care access, prior year involvement in the legal system, self-help participation, employment, and quality of life. This enrollment survey contains 53 questions consisting of checklists and Likert-type response scales with which respondents can indicate their level of agreement with statements (i.e., very great extent, great extent, some extent, little extent, or very little extent.)

Guests are requested to complete a satisfaction survey at the time of departure from The Retreat. This 23-question survey contains 20 questions with Likert-type scales covering the domains of satisfaction with facilities, assistance received, critical life-relationships, quality of life, and willingness to recommend The Retreat to others. The final three questions are open-ended seeking responses regarding the most helpful and least helpful experiences during their stay as well as requesting suggestions or comments for program improvement. All guests are also invited by Retreat staff at the time of registration to participate in the longitudinal follow-up at six and twelve months following their departure. Those who volunteer for this element of the program evaluation complete an informed consent to participate form and provide contact information to the evaluator. At six and twelve months post departure, guests are contacted to complete the survey. Contact is first attempted by the contractor with up to two US Postal Service First Class mailings. If the instruments are not returned, the evaluator then attempts telephone contact up to five times during different times and on different days. Failing this attempt, a contact person, identified by the guest, is contacted in an attempt to locate the guest. For the report period, the six-month follow-up completion rate was 67.1% and the 12-month follow-up completion rate was 62.2% which are considered very good for the level of funding for the follow-up.

For the most part, the follow-up survey is a mirror of both the enrollment and departure satisfaction surveys containing the same questions; the form also includes additional questions regarding current drug use compared to drug use prior to their stay at The Retreat.

This is an interim report of the key findings to date and should be viewed as dynamic with the expectation that some changes over time will be seen. The report contains a discussion of the guest demographics, findings at departure, the impact of sober housing on recovery rates, as well as outcomes at six and twelve months.

Enrollment Demographics

Since inception of the current evaluation protocol, demographic information was received for 1511 prior guests with a total of 520 guests reported during the current year.¹

The average age of previous guests was 38.6 years which did not differ significantly from the current year guests. In 2008, males were significantly ² more likely to be younger than females, although the actual average difference was small. This year a tendency was noted for females to be less likely to register than in previous years but not significantly so. (Table 1)

Table 1. Age and Gender
	Previous Years				Current Year
	n	Age	sd		n	Age	sd
All	1511	38.6	11.3		500	39.3	12.4
Males	973	37.9	11.3		334	38.4	12.4
Females	515	40.0	11.3		166	41.2	12.3

The guests of The Retreat have remained predominantly Caucasian (90.9%) overall and comprised 97.8% of the sample for the current year. This change in race is statistically significant ³, but most likely due to better reporting. (Table 2)

Table 2. Race/Ethnicity (In Percent)
	Previous Years	Current Year
Caucasian	90.9	97.8
Latino	0.5	0.2
Black/African American	0.5	1.0
Asian	0.5	0.0
Native American	0.1	0.2
Other/Not Reported	7.5	0.8

Of the guests registering during the current period, the largest portion (47.1%) were reported as single (never married) followed in frequency by married (27.2%), divorced (16.6%), separated (5.0%), living as married (2.9%), and widowed (1.2%). Values were statistically similar to previous year’s numbers. (Table 3)

Table 3. Marital Status (In Percent)
	Previous Years	Current Year
Single	42.5	47.1
Married	26.9	27.2
Divorced	21.7	16.6
Separated	5.3	5.0
Living as Married	2.1	2.9
Widowed	1.5	1.2

¹ The number in each of the samples reported varies due to missing data in some fields. No estimations were done to fill in missing data. Also not all quests provided consent for follow-up and not all guests completed the registration survey.
² p < .05
³ chi square p < .01

The education level of guests remained high when compared to other programs. Approximately 26.0% reported having a college degree, 41.7% with some college level academic preparation, and only 12.3% with just high school diplomas. There
was some shifting of the education level from last year, but the changes were inconsequential. (Table 4)

Table 4. Education (In Percent)
	Previous Years	Current Year
Education
Not Completed HS Graduate	2.6	2.5
HS Graduate	11.3	12.3
Some College/Trade School	45.5	41.7
College Graduate	25.0	26.0
Post-graduate Course Work	5.7	6.3
Post-graduate Degree	10.0	11.2

The employment status of guests at the time of registration remained relatively stable compared with the previous period. Approximately 45% were unemployed, 31.0% working full-time, 5.5% working part-time, 4.3% working irregular hours, 5.1% homemakers, 4.7% students, and 4.7% retired. (Table 5)
Across previous years, approximately 20.1% reported they were self-employed, which remained relatively consistent into the current year at 16.9%.

Table 5. Employment Status (In Percent)
	Previous Years	Current Year
Status
Unemployed	40.5	44.6
Full-time	32.7	31.0
Part-time	6.4	5.5
Irregular	5.9	4.3
Homemaker	5.4	5.1
Student	4.8	4.7
Retired	4.4	4.7

 

Table 6. Income (In Percent)
	Previous Years	Current Year
Dollars (in thousands)
< 20	18.1	18.0
20 to 29.9	8.5	6.4
30 to 39.9	9.8	10.7
40 to 49.9	8.7	8.6
> 50	54.9	56.4

Approximately 55% of the guests reported earning an annual income of $50,000 or more and 18.0% reported less than $20,000. The remainder of guests’ income was relatively evenly separated among the other income categories (though with a higher percentage earning >50K likely representing married guests) and statistically similar to values reported this year. (Table 6) Current year data revealed approximately 34.0% of the guests reported having been promoted at work at least once during the 12 months prior to registration and 31.1% reported starting a new job. Approximately 30% reported being fired from at least one job during thecurrent period. Six percent reported being involved in at least one accident at work and 4.5% reported filing a Workers Compensation claim. Grievances had been filed by 1.0% of guests and 21.9% had received at least one formal disciplinary action. (Table 7)

Table 7. Job Related Indicators (In Percent)
Question	Never		One Time		Two Times		Three Times		More Than Three Times
	All Years	Current Year	All Years	Current Year	All Years	Current Year	All Years	Current Year	All Years	Current Year
Promoted	67.4	66.0	16.0	17.8	7.2	8.5	2.7	2.2	6.7	5.5
Took a New Job	66.1	68.9	18.7	16.2	6.1	8.2	2.6	2.2	6.5	4.5
Fired From Job	69.9	70.9	21.1	19.7	4.8	5.3	1.8	2.0	2.4	2.1
On Job Accident	91.5	94.1	6.2	4.5	1.4	0.6	0.3	0.4	00.6	0.4
Filed Work Comp Claim	94.0	95.5	5.7	3.1	0.1	1.0	0.0	0.0	0.2	0.4
Filed Grievance	98.1	99.0	1.6	1.0	0.2	0.0	0.0	0.0	0.1	0.0
Formal Disciplinary Action	78.7	78.2	11.6	14.4	5.6	4.5	1.6	1.4	2.5	1.6

The survey provides a question for respondents to indicate all the substances they have used in the past 12 months prior to registration. (Table 8) There was some shifting regarding the substances reported used by the current year sample. Alcohol was more likely to be reported this year when compared to previous years as were most other drugs. Exceptions included cocaine, crack, methamphetamines, other stimulants, over-the-counter drugs, and other substances which saw decreases in use.

Table 8. Substances Used – Prior to Registration (In Percent)
	Previous Years	Current Year		Previous Years	Current Year
Substance			Substance
Alcohol	92.0	95.0	Sedatives	20.5	21.7
Marijuana/Hash	43.6	44.0	Illegal Rx	20.2	22.7
Cocaine (Powder)	41.7	38.7	Hallucinogens	19.5	20.0
Prescription	37.2	40.0	Heroin	13.7	14.8
Crack	27.6	23.3	Other Stimulants	11.1	9.8
Other Opiates	21.4	23.8	Inhalants	7.8	8.3
Meth/amphetamines	20.7	17.9	Other Substances	6.3	5.8
Over the Counter	20.6	18.8

Across previous years, nearly 57.4% of the guests reported the negative impact of their substance use to a very great extent, 31.6% to a great extent, and 9.6% to some extent, 0.9% reported little extent, and 0.4% to no extent.  This important marker has shifted little over the life of the project. Current year responses showed 62.7% answering to a very great extent, 27.8% to a great extent, 8.1% some extent, 1.2% little extent, and 0.2% no extent. (Chart 1)  Responses were statistically similar to the all year sample although those reporting drugs to a very great extent negatively effected their lives showed a significant increase (p>.05).

Approximately 26.3% of the current year guests reported they had received detoxification one time during the past 12 months, 12.8% reported two detoxification episodes, another 6.6% three times, and 7.8% more than three times. Again there were no statistical differences between the previous years and current year samples. (Table 9)

Table 9. Treatment History Detoxification Episodes (Past 12 Months)
	Previous Years	Current Year
Number of Times	%	%
None	48.6	46.5
One Time	24.8	26.5
Two Times	13.2	12.8
Three Times	6.3	6.6
More than Three Times	7.1	7.8

The number of outpatient treatment episodes during the 12 months prior to registering at The Retreat was similar to that previously reported with 25.8% having one episode of care, 7.7% two episodes, and 4.9% with three or more episodes of care. (Table 10)

Table 10. Treatment History Outpatient Episodes (Past 12 Months)
	Previous Years	Current Year
Number of Times	%	%
None	61.6	61.6
One Time	24.4	25.8
Two Times	7.7	7.7
Three Times	2.2	1.6
More than Three Times	4.1	3.3

The frequency of admission into residential treatment in the past 12 months was also similar to that previously reported with 26.4% having one episode of care and 31.2% having two or more episodes of care. (Table 11)

Table 11. Treatment History Residential Episodes (Past 12 Months)
	Previous Years	Current Year
Number of Times	%	%
None	46.9	42.4
One Time	26.0	26.4
Two Times	12.8	14.8
Three Times	6.7	6.8
More than Three Times	7.6	9.6

Approximately 23% reported being hospitalized once during the 12 months prior to registration for care relating to substance dependency and 22.2% reported two or more times in which they were hospitalized. (Table 12)

Table 12. Treatment History Hospitalization Episodes (Past 12 Months)
	Previous Years	Current Year
Number of Times	%	%
None	60.2	54.7
One Time	19.6	23.1
Two Times	9.0	10.0
Three Times	4.2	4.9
More than Three Times	7.0	7.3

Utilization for other services, such as general hospital care for problems other than those related to substance abuse, emergency room visits, and hospitalization remained high when compared to the general population within this age group. Approximately 22% had been hospitalized at least once for physical problems, 44.8% had been to an emergency room at least once, and 13.1% had been hospitalized for a mental illness. (Table 13)

Table 13. Other Service Utilization (Past 12 Months)
Question	None		One Time		Two Times		Three Times		More Than Three Times
	All Years	Current Year	All Years	Current Year	All Years	Current Year	All Years	Current Year	All Years	Current Year
Hospitalization (Physical Problem)	79.3	78.5	12.3	11.3	4.2	4.9	1.6	0.8	2.7	4.5
Emergency Room	52.9	55.2	24.6	23.3	10.5	9.8	5.0	4.7	6.9	7.0
Hospitalization (Mental Problem)	86.0	86.9	9.0	7.8	3.2	2.9	0.7	1.2	1.1	1.2

Guests were also frequent users of counselor or therapist services with nearly 63.3% reporting at least one visit to a counselor and 14.4% reporting more than 20 visits during the 12 months prior to registration. (Table 14)

Table 14. Treatment History Counselor/Therapist Visits (Past 12 Months)
Number of Visits	Previous Years	Current Year
	%	%
None	33.3	36.7
One to Five	28.1	28.6
Six to Ten	13.1	8.9
Eleven to Twenty	10.3	11.4
More than Twenty	15.3	14.4

Of new guests, 50.4% reported either no or only one attendance a month at Alcoholics Anonymous or other 12-Step Fellowship meetings in the 12 months prior to registration. Conversely, 21.0% reported attending more than three times per week, 15.8% two to three times per week, and 12.8% once a week. Interestingly, 60.2% reported no contact with a sponsor while 10.3% reported contact more than three times per week, 8.8% contact two to three times per week, 12.9% weekly contact, and 7.8% reported monthly contact with a sponsor. Fifteen percent of those reporting indicated that their spouse or significant other attended a self-help program such as Alanon. About one-third reported some level of prayer or meditation in the previous 12 months; however, only a little less than one-third reported such practices were regular. (Table 15)

Table 15. Self Help Participation (Past 12 Months)
Question	> 3 Per Week		2-3 Per Week		1 Per Week		1 Per Month		<1 or None Per Month
	All Years	Current Year	All Years	Current Year	All Years	Current Year	All Years	Current Year	All Years	Current Year
Attend AA/Self Help	19.9	21.0	19.8	15.8	13.4	12.8	7.6	7.6	39.4	42.8
Contact Sponsor	13.0	10.3	10.3	8.8	12.3	12.9	6.2	7.8	58.2	60.2
Spouse Attend Self Help	3.2	2.4	3.7	2.4	7.5	5.8	3.8	4.4	81.9	84.9
Prayer/Mediatation	27.3	26.8	15.7	14.4	13.5	10.1	7.8	5.2	35.7	43.5

Approximately 8.3% of the guests in the current period sample indicated they had spent time in a half-way house averaging a stay of 99 days during the 12 months prior to registration and 17.3% reported living in a sober house with an average stay of 111 days. Current year guests indicated that 25.4% had been incarcerated, 18.4% arrested for driving while intoxicated, 18.1% arrested for another alcohol or drug (A/D) related crime, 8.9% for possession, and 13.4% for crimes not related to A/D related offenses. (Table 16)

Table 16. Legal Involvement (Past 12 Months)
Question	None		One Time		Two Times		Three Times		More Than Three Times
	All Years	Current Year	All Years	Current Year	All Years	Current Year	All Years	Current Year	All Years	Current Year
Driving While Intoxicated	76.4	81.7	17.2	12.1	3.6	3.5	1.4	1.6	1.5	1.2
Arrested A/D Related Crime	79.4	82.0	12.6	11.0	4.2	3.1	1.5	1.8	2.2	2.2
Arrested for Possession	92.5	91.2	5.5	6.5	1.4	1.4	0.4	0.4	0.3	0.6
Arrested for Other	86.3	86.7	8.3	8.6	2.7	2.2	0.6	1.0	2.1	1.6
Offenses Incarcerated	70.4	74.7	19.5	17.1	5.8	4.7	1.6	1.8	2.7	1.8

Confirmation of the poor quality of life prior to registering at The Retreat can be found in the guests’ responses to a question exploring to what extent they were satisfied with the overall quality of their life. Approximately 25% of current guests reported satisfaction was very little, 32.9% little, 31.7% some, 9.3% great, and only 1.2% responded they were satisfied to a very great extent. (Chart 2) Statistical comparisons of these key wellness indicators at follow-up points are provided below.

 

In addition to the general satisfaction with life question, the survey asked respondents to quantify the extent to which they were satisfied with key social relationships. As can be seen in Chart 3, the guests reported varying levels of satisfaction with their key relationships.

For the most part, guests report the highest levels of satisfaction with the relationship with their children and the lowest levels of satisfaction with their Higher Power followed by their relationship with AA or 12-Step Fellowships. Current year satisfaction indicators relating to relationships with friends significantly decreased (p<.05) from highest ratings compared to
previous years.

While ratings for the parent/child relationships remained relatively high, there was a significant decrease in satisfaction with the dynamic compared to previous years. These questions are asked, as discussed above, to provide a baseline for comparison at follow-up and changes in guest responses over time are discussed in more detail

with the follow-up data. Six additional questions are asked that pertain to other key life satisfaction indicators including self-image, physical health, ability to effectively handle problems, job in general, performance at work, and performance at school. ⁴ Again, the current year sample closely mirrored the all year sample presented in the chart with the exception of performance at work which saw a significant decrease from the highest satisfaction levels (P<.01). (Chart 4)

⁴ For those attending school.

Table 17. Key Support
	Previous Years	Current Year
Relationship	%	%
Friend	27.7	23.7
Spouse/Significant Other	21.9	23.2
Counselor	12.7	10.9
12-Step Sponsor	10.9	13.1
Parent	9.2	12.7
Preist, Minister, Rabbi	1.8	1.5
Child	1.5	1.5
Other	3.7	3.8
Did not Talk to Anyone	10.5	9.7

The final baseline quality of life indicator is the identification of the person with whom the guest talks to about personal problems. As can be seen in Table 17, guests were most likely to talk with a friend about personal problems followed by spouse/SO and a 12-step sponsor. Nearly 10% percent of the guests indicated that they had no one to talk with prior to registering at The Retreat. An additional question asked respondents to indicate the level of satisfaction they experience with this confidant relationship. Approximately 13% of the current year sample reported very great satisfaction with this relationship, 29.9% great satisfaction, 41.3% some, 10.1% little, and 5.7% very little satisfaction. There was some minor shifting in the distribution from previous year responses, but nothing of significance.

Satisfaction at Time of Departure

One of the more important global measurements for quality control and improvement at the time of departure is a guest’s expressed willingness to refer others to The Retreat. A normal rule of thumb expectation is that a minimum of 85% of the respondents will indicate a favorable response to the question regarding willingness to refer. Of the sample of departing guests participating across previous years (n=1367), 83.1% reported they were willing to refer others to The Retreat to a very great extent, 13.8% percent to a great extent, 2.3% some extent, 0.4% to little extent, and 0.3% very little extent. This 96.9% positive response rate indicates guests had a very beneficial experience while at The Retreat and is considered a very high rate of approval. This finding has been remarkably consistent over the life of the project. Current year findings (n=521) revealed a similar pattern with 80.7% reporting willingness to recommend to a very great extent, 16.0% great extent, 2.9% some extent, 0% little extent, and 0.4% a very little extent. ⁵ (Chart 5)

⁵ This critical consumer satisfaction marker is tracked and reported to The Retreat monthly.

A little over 89% indicated a positive response (42.4% very great extent, 46.7% great extent) to the question “the problems that brought me to The Retreat have improved.” Approximately 10% indicated the problems had improved to some extent and 0.5% to a little extent. Only 0.1% responded to a very little extent to the question. Current year data found a fairly similar pattern with 40.2% very great, 46.6% great, 12.5% some, and 0.4% little, and 0.4% reported very little extent. (Chart 6)

In response to the question regarding the guests’ perception of the helpfulness of the assistance received while at The Retreat, across previous years, 53.0% responded agreement to a very great extent, while 39.8% responded to a great extent. Approximately 6.3% responded to some extent, 0.8% responded to little extent, and 0.1% to a very little extent. A similar distribution was found in responses from current guests regarding The Retreat staffs’ “concern for them.” Approximately 54.5% of the guests responded to a very great extent, 32.8% to a great extent, 10.9% to some extent, 0.8% responded to a little extent, and 1.0% reported to a very little extent. (Chart 7) 

The satisfaction survey also contained a sub-domain relating to guests’ satisfaction with the facility, facility grounds, individual accommodations, recreation facilities, and food services. In the past, guests’ satisfaction remained strong and stable essentially across all areas. Current year data showed little change in satisfaction with the recreational opportunities with 34.2% responding agreement to a very great extent, 31.8% to a great extent, 25.6% to some extent, 6.4% to a little extent, and 2.0% to very little extent. (Chart 8)

As mentioned above, the departure satisfaction survey contained three open-ended questions focusing on what were “most helpful,” “least helpful,” and “other suggestions.” These key indicators are monitored and reported monthly to staff and have been remarkably stable since the inception of the evaluation effort. The most common responses from current year guests included the focus on Big Book studies and the fellowship felt with other guests. The program’s spiritual components, staff and volunteers, and meditation were also repeatedly mentioned as being helpful. It should be noted that there was a high frequency of individual staff being named as the “most helpful” suggesting a strong relationship connection between guests and staff. The frequency with which the “least helpful” items were endorsed was very small in comparison to the strength of the endorsements of the “most helpful.” With the relatively large sample size of those departing The Retreat, items can be generally grouped into differences in personal preferences and not be of concern for quality management. Nonetheless, two items appeared again this year that might be of interest for quality improvement. About 19% of the departing guests indicated that meditation and yoga were not helpful. On closer analysis, it appears that the issues may be related to the delivery styles of those leading the activities. In fact, the evaluator again noted a couple of counselor’s names appear with a much higher than expected frequency in response to the least helpful. Responses to “other suggestions” demonstrated a variety of personal preferences which were not possible to consolidate into general themes.

A statistically significant 6 level of improvement was found across all expected outcome indicators from enrollment to departure including the overall quality of life. During the current year, 14.4% of guests report agreement to a very great extent with the question regarding their level of satisfaction with the overall quality of their lives at the time of departure. Nearly 49% reported satisfaction to a great extent, 31.0% to some extent, 4.5% to a little extent, and 1.2% to a very little extent. (Chart 9) Results closely mirror that of previous years.

⁶ ANOVA p < .01

Importantly, a statistical comparison of pre and post responses to satisfaction with relationships with spouse, children, friends, other family members, and a Higher Power revealed statistically significant improvements for both the previous and current year data. Significant improvements were also reported in guests’ self- image, physical health, and ability to effectively handle problems. (Table 18) ⁷

Table 18. Key Quality of Life Indicators Significant Changes at Departure
Indicator	Level of Confidence
Relationship with Spouse/SO	p < .01
Relationship with Children	p < .01
Relationship with Friends	p < .01
Relationship with Other Family	p < .01
Higher Power	p < .01
AA or 12-Step Fellowship	p < .01
Self-image	p < .01
Physical Health	p < .01
Ability to Effectively Handle Problems	p < .01
Overall Quality of Life	p < .01

Findings at Six-Month Follow-Up

At the six-month follow-up, current year data suggested a slight, non-significant decrease in use with 55.0% reporting no use, 31.5% less use, and 7.8% reporting same level of use as before registration, and balancing the decreases is a non-significant increase in those reporting more use (4.7%). (Chart 10) Of those who used, 32.3% indicated they had used once, stopped, and then remained abstinent and another 22.2% reported they had used two or more times, but had been abstinent for the past 30 days prior to completing the survey.

Approximately 23% indicated they had used two or more times and had been abstinent for the past 60 days, and 22.2% reported they had used “more or less continuously” since departure from The Retreat approximately six months prior. Across the previous years’ sample, 57.4% of the respondents indicated that they had not used substances since departing The Retreat, while 32.4% indicated that although they used, the use was less than before enrolling. Slightly more than 7% reported their level of use as about the same as before enrolling, and 2.8% reported their use had increased.

⁷ These changes are based on individually matched pre and post response scores.

For those who reported using at 6-month follow-up, the primary substance of choice was alcohol (36.5%) followed by cocaine powder/crack (5.4%), sedatives/tranquilizers (3.3), marijuana/hash (1.2%), methamphetamines/amphetamines (0.4%), and (0.4%) reported no primary preference in the substance used. Although there were some differences in the previous years’ sample, these differences were not significant. (Table 19)

Table 19. Primary Drug At 6-Month (In Percent)
Drug	Previous Years	Current Year
Alcohol	31.3	36.5
Cocaine/Crack	5.6	5.4
Sedatives/Tranq.	3.2	3.3
Marijuana/Hash	1.4	1.2
Amphetamines	1.5	0.4
Heroin	1.2	0.4
No single drug	42.2	46.7
Other	2.6	1.2

Overall quality of life was reported by 53.6% as much improved and by 36.2% as improved at six months. (Chart 11) Previous years’ data saw a very similar distribution of responses to previous years data.

Current guests reported significant improvement in a variety of relationships since departing The Retreat (n=244). Over 75% of the respondents reported either much improved or improved relationships with their children, other family members, Higher Power, and AA/Self Help fellowships. (Chart 12) Findings followed suit with those seen previously though somewhat more improvement was reported in the relationship with their higher power.

Similarly, nearly 80% or more reported much improvement or improvement since leaving The Retreat in their problem solving abilities, job in general, their performance at work, and job satisfaction. (Chart 13)

These findings were quite similar to the across year data though there was a significant increase in job satisfaction in 2008.

As has been consistently reported in previous findings, at 6 months after leaving The Retreat, past guests reported significant decreases in utilization of the medical related key indicators except hospitalizations for general medical problems not associated with alcohol and drug use and visits with a counselor or therapist. (Table 20)

Table 20. Treatment Utilization Registration to 6 Months
Indicator	Level Of Confidence
Detoxification	p < .05
Outpatient A&D Treatment	ns
Residential A& D Treatment	ns
Medical Hospitalizations Related to A&D	ns
Visits with Counselor or Therapist	ns
Medical Hospitalizations Other	ns
Emergency Room Care	p < .01
Hospitalization for Emotional/Mental	p < .01

Current year findings continue to demonstrate significant increases in attendance at 12-Step meetings, contact with a sponsor, and participation in prayer and or meditation. (Table 21) 

Table 21. 12-Step Participation Registration to 6 Months
Indicator	Level Of Confidence
Attended Meetings	p < .01
Contact with Sponsor	p < .01
Spouse Participation	ns
Prayer/Meditation	p < .01

Current year 6-month follow-up did not demonstrate significant differences in DWI arrests or other legal problems. (Table 22) These findings were different from those reported last year where significant reductions in incarcerations were reported. Also of note was the lack of non-zero responses for the number of times guests were arrested for possession of drugs or any other crimes (at enrollment and follow-up). These two indicators are commonly high in Alcohol and Drug using populations when compared to the general public.

Table 22. Legal Problems Registration to 6 Months
Indicator	Level Of Confidence
Arrested for DWI	ns
Arrested for A&D Related Offense	ns
Arrested for Possession	ns
Other Arrests	ns
Incarcerations	ns

One possible explanation for this finding is guests were working. Current year data revealed no significant changes in employment issues from enrollment to the 6-month follow- up. (Table 23)

Table 23. Employment Issues Registration to 6 Months
Indicator	Level Of Confidence
Filed Worker’s Compensation Claim	ns
Been Fired	ns
On the Job Accidents	ns
Filed Grievances	ns
Received Formal Disciplinary	ns
Action	ns
Been Promoted	ns
Started a new job	ns

It is common for there to be a tendency for individuals to be slightly less positive about an experience the more time has elapsed since that experience. Nonetheless, a very strong 97.9% of the participants at 6-month follow-up reported they would very likely or likely recommend The Retreat to others. (Chart 14) This finding was consistent with the across year sample. Similarly, over 83% of both samples indicated that the problems that had originally brought them to The Retreat had improved (60.0% very great extent and 23.8% great extent). (Chart 15)

Findings at Twelve-Month Follow-Up

At twelve-month follow-up for previous years, 50.2% of the respondents indicated that they had not used substances since departing The Retreat, while 36.6% indicated that although they used, they used to a lesser degree than before enrolling. Approximately 9.4% reported their level of use as about the same as before enrolling, and 3.8% reported their use had increased. Current year use (n=179) saw some shifting in the distribution with 55.6% reporting no use, 29% reporting less use, 10.1% reporting about the same level of use, and 5.3% reporting more use than before enrollment. (Chart 16)

Overall, of those who used, 25.7% indicated they had used once, stopped, and then remained abstinent and another 10.8% reported they had used two or more times, but had been abstinent for the past 30 days prior to completing the survey. Thirty-five percent indicated they had used two or more times and had been abstinent for the past 60 days, and 28.4% reported they had used “more or less continuously” since departure from The Retreat approximately 12 months prior (again, this is only for those who reported using). (Table 24)

Table 24. Pattern of Use (Those Who Used) 12-Month Follow-up (In Percent)
	All Years	Current Year
Use Once and Stopped	22.2	25.7
Used ≥ 2 With Abstinence > 30 Days	23.1	10.8
Used ≥ 2 With Abstinence > 60 Days	31.0	35.1
Used More or Less Continuously	23.6	28.4

With current guests, alcohol was reported as the most frequently used substance (35.2%) followed by other substances (4.5%), illegally obtained prescription drugs (2.2%), cocaine/crack (1.7%), and amphetamines (1.1%). Data from previous years showed a slight shifting of the substances reported used, but these differences were not significant with the exception of cocaine/crack which saw a significant decrease in use (p<.05). (Table 25)

Table 25. Most Frequently Used Substances 12-Month Follow-up (In Percent)
	All Years	Current Year
Alcohol	33.0	35.2
Illegal Prescription drugs	0.9	2.2
Cocaine/Crack	6.0	1.7
Amphetamines	1.1	1.1
Marijuana/Hash	1.3	0.6
Other	2.6	4.5
No one substance	39.9	48.0

Satisfaction with life in general remained high at 12-month follow-up across previous years with nearly 91% responding positively to the question. Current year data saw a slight, but statistically insignificant, decrease in overall satisfaction of quality of life with 49.7% responding satisfaction to a very great extent and 38.5% responding to a great extent. (Chart 17) 

For both current year, and previous years, guests continue to report a significant ⁸improvement in their overall level of satisfaction with the quality of life compared to the time of enrollment. The quality of life indicator at 12 months has been demonstrated to be statistically stable with that reported at six months.

Similar to the findings reported for the 6-month follow-up, at 12-month follow-up 73% to 84% of current guests reported improvement in their relationships with key persons in their lives including spouse/SO, children, friends, other family, Higher Power, and their relationship with a 12-Step fellowship. These findings were consistent between both samples. (Chart 18)

⁸ ANOVA p < .01

Other improvements were also reported in self-image, health, problem solving ability, job in general, job performance and satisfaction with their job. (Chart 19)

Thirty-nine percent reported attending AA/Self Help meetings more than 3 times per week across all previous years. Current year data indicated that 37.1% reported comparable attendance. Only 8.2% of the previous year sample reported not attending AA/Self-Help, while 8.6% of current year participants reported no attendance. The all year sample showed 29.5% made contact with a sponsor 3 or more times per week, while 22.9% reported no contact. Only 26% of the current year sample reported contact with a sponsor 3 or more times per week, while 24.6% reported no contact.

Approximately 19% reported active involvement in self-help service work more than 3 times per week, 15.0% two to three times a week, 16.8% weekly, 11.0% monthly, 11.6% less than monthly, and 27.2% reported no involvement in service work. This level of self- help activity remained relatively stable with the all year sample though the number of clients involved in service work 3 or more times a week did significantly increase (p<.01).

At the 12-month follow-up for previous years, 40 guests reported having lived in a half-way house and 151 reported living in a sober living house. Average lengths of stay were 159 and 196 days respectively. In the current year sample there were 13 who reported living in a half-way house and 46 in sober houses reflecting the increased availability of sober houses (see impact of sober housing for more details).

It was interesting to find that there was no detoxification episodes reported from registration to the 12 months following the stay at The Retreat. Nearly all other service utilization indicators had insufficient values for analysis. The only marker with a sufficient sample size to evaluate was visits to a counselor or therapist which saw a significant increase 12 months after enrollment at The Retreat (Table 26) Previous years’ guests have reported significant decreases in detoxification episodes, A & D related hospitalizations, and emergency room visits.

Table 26. Treatment Utilization Registration to 12 Months
Indicator	Level Of Confidence
Detoxification	***
Outpatient A&D Treatment	ns
Residential A& D Treatment	ns
Medical Hospitalizations Related to A&D	ns
Visits with Counselor or Therapist	p <.01
Medical Hospitalizations Other	ns
Emergency Room Care	ns
Hospitalization for Emotional/Mental	ns
*** F/U had all zero values

Participation with 12-step fellowship activities increased significantly following the stay at The Retreat as did contact with a sponsor. The level of spouse participation in self-help activities saw no significant changes. (Table 27)

Table 27. 12-Step Participation Registration to 12 Months
Indicator	Level Of Confidence
Attended Meetings	p <.01
Contact with Sponsor	p <.05
Spouse Participation	ns

None of the legal system indicators were reported in sufficient for analysis, however this may not be an indicator of decreased legal problems. (Table 28) That being said, there was a decrease, albeit non- significant, in the number of times Retreat clients reported being jailed. The same reporting issues were observed with previous guests’ samples.

Table 28. Legal Problems Registration to 12 Months
Indicator	Level Of Confidence
Arrested for DWI	***
Arrested for A&D Related Offense	***
Arrested for Possession	***
Other Arrests	***
Incarcerations	***

As with legal issues, employment problems were not frequently reported by many guests. Consequently, statistically significant changes would be difficult to realize. Nonetheless, the number of guests reporting receiving formal disciplinary actions the past 12 months decreased; on the positive side, guests starting new jobs increased significantly, though again, small sample sizes may be distorting true trends. (Table 29)

Table 29. Employment Issues Registration to 12 Months
Indicator	Level Of Confidence
Filed Workers’ Compensation Claim	***
Been Fired	ns
On the Job Accidents	***
Filed Grievances	***
Received Formal Disciplinary Action	ns
Been Promoted	ns
Started a new job	p < .01 §
§ small sample size

Current guests’ level of satisfaction remained high at 12-month follow-up as has been previously reported. Guests’ willingness to recommend The Retreat to others, even at twelve-month follow-up, remained extremely positive. Approximately 84% percent of the respondents indicated agreement to a very great extent with the question regarding referring others in need of help to The Retreat. An additional 10.5% indicated agreement to a great extent, 4.1% indicated agreement with the statement to some extent, 0.0% little extent, and 1.8% very little extent. (Chart 20)

The Impact of Sober Housing

This section of the report is devoted to an updated analysis of the findings comparing those guests who accessed Retreat sober housing following their stay at The Retreat. These findings closely mirror findings previously reported over the few of years. For the baseline, data from a sample of 1640 individuals was used. Of these, 391 were reported as utilizing Retreat sober housing (SH) following their stay. A total of 567 prior guests have participated in the 12-month outcomes evaluation follow-up interviews to date; of these, 127 had utilized SH.

Baseline Characteristics

There were statistically significant differences in several demographic characteristics between guests who have accessed SH and those who have not (NSH). SH participants were more likely to be younger ⁹ overall than NSH guests (36.2 years compared to 39.1 years), though ages among SH vs. NSH females was not significantly different. ⁸ SH participants were also more likely to be male, single, not working full-time, and not have an income over $30,000 than the NSH cohort. Education was no different than the NSH cohort. ¹⁰

Guests who went on to utilize SH were significantly ¹¹ more likely to report illegal drug use as their primary choice than NSH guests prior to registration. Conversely, NSH guests were more likely ¹² to report alcohol use. SH guests reported that the use of alcohol and/or drugs negatively affected their lives to a significantly ¹³ greater degree than NSH guests. SH guests reported no difference in the overall quality of life than NSH guests at registration.

Findings at 12-Month Follow-Up

At 12-month follow-up SH and NSH cohorts tended to be indistinguishable in respect to full- time employment and their pattern of substance use.

⁹ t. test p < .01
¹⁰ chi square p < .05
¹¹ chi square p < .01
¹² chi square p < .01
¹³ chi square p < .01

It also appears, as would be expected, that those in the SH 12-month sample tended to be more like the NSH (also in the 12-month follow-up) at enrollment. Nonetheless, a statistical comparison of the key demographic characteristics at registration of those SH in the follow-up with those who were reported to have accessed sober housing, but who were either not yet in the follow-up window, or unable to contact for follow-up, showed no significant difference. Importantly, there continues to be no significant differences between the SH and NSH groups at follow-up in regards to the affect of drug and/or alcohol use on the daily lives of guests with both groups reporting significant improvement. Individuals in both the SH and NSH groups reported a significant ¹⁴ decrease in the degree to which drugs and/or alcohol negatively impacted their daily lives. Individuals in both groups also reported a significant ¹⁵ decrease in frequency of substance use at follow-up.

As previously reported, the quality of life for individuals in both groups significantly ¹⁶ increased at follow-up. This improvement was so substantial that there was no longer a difference between groups at 12-month follow-up.

¹⁴ t test p < .01
¹⁵ t test p < .01 for both groups
¹⁶ t test p < .01 for both groups

Summary & Conclusions

As has been consistently reported, outcomes from The Retreat remain very strong. At 12 months post departure, 55.6% reported no substance use and another 29.0% reported less use than prior to enrollment across previous years. With nearly 85% reporting improvement in the single most important indicator of substance use, there is little question regarding the strength of the experience at The Retreat. Statistically significant improvement in all the expected wellness indicators has been confirmed.

The Retreat data continues to be some of the strongest, compelling data the evaluator has worked with. It is clear the benefits garnered by participating in The Retreat’s recovery activities is having a very positive benefit for guests. Significant changes realized by the time guests are departing The Retreat are remaining at six and twelve months post departure. Some areas have emerged that could benefit from closer scrutiny.

As with all interim reports of on-going program evaluations of this type there are two caveats. First, due to necessary and appropriate funding restrictions, it should be assumed that some of the individuals who could not be contacted for follow-up were not doing as well as those who were contacted. Second, as this is an on-going effort, some changes in the findings should be expected. Nonetheless, monthly reporting of key satisfaction and out come data continue to be provided and monitored for trends.