Adolescent Substance Abuse Treatment Outcome Research Articles

Heart Rate Variability Biofeedback in Adolescent Substance Abuse Treatment

Strategies are needed to improve adolescent substance abuse treatment outcomes. For example, during outpatient substance abuse treatment, up to 80% of adolescents continue to use.1,2 Following residential substance abuse treatment, 88% of adolescents relapse within 6 months.3

Delay discounting predicts adolescent substance abuse treatment outcome.

The purpose of the current study was to identify predictors of delay discounting among adolescents receiving treatment for marijuana abuse or dependence, and to test delay discounting as a predictor of treatment outcome. Participants for this study were 165 adolescents (88% male) between the ages of 12 and 18 (mean age = 15.8 years; standard deviation = 1.3 years) who enrolled in a clinical trial comparing three behavioral treatments for adolescent marijuana abuse or dependence. Participants completed a delay discounting task at treatment onset for $100 and $1,000 of hypothetical money and marijuana. Overall, smaller magnitude rewards were discounted more than larger magnitude rewards. Delay discounting rates were concurrently related to demographic variables (socioeconomic status, race). Delay discounting of $1,000 of money predicted during treatment abstinence outcomes among adolescent marijuana abusers, over and above the effects of type of treatment received. Teens who show higher levels of discounting of the future may be an important subgroup to identify at treatment onset. Youth with a greater tendency to discount the future may require different intervention strategies that address their impulsivity (e.g., targeting executive function or inhibitory control) and/or different schedules of reinforcement to address their degree of preference for immediate rewards.

Parental consent in adolescent substance abuse treatment outcome studies

No systematic review has focused on parental consenting procedures used in adolescent substance abuse treatment outcomes research. To address this gap, we examined parental consenting procedures in adolescent outcome studies ( n = 34) published between 1980 and 2007. Although parental consent was required in 89% of adolescent treatment outcome studies we reviewed, consenting procedures were not routinely reported. We argue that parental consenting procedures should be routinely reported as a methodological feature of adolescent treatment outcome studies and, given concerns about sample bias in adolescent risk behavior research when parental consent is required, encourage outcomes researchers in this area to prospectively study the impact of consenting procedures on both the study participation rates and substance use reporting.

Adolescent tobacco use and substance abuse treatment outcomes

This study investigated the relationship between cigarette-smoking status and 12-month alcohol and marijuana treatment outcomes in a sample of 1,779 adolescents from the Drug Abuse Treatment Outcomes Study for Adolescents. Participants were classified into four groups based on change in cigarette-smoking status from intake to the 12-month follow-up: persistent smokers, nonsmokers, quitters, and smoking initiators. Logistic regression was used to predict likelihood of relapse to alcohol, marijuana, and other drugs after controlling for intake levels and demographic/treatment characteristics. Results found persistent smokers and smoking initiators to have significantly greater odds of alcohol and marijuana relapse compared with quitters. Furthermore, persistent smokers and smoking initiators were also found to have distinctively shorter periods to marijuana relapse at follow-up. Implications for the implementation of tobacco cessation treatment in the context of substance abuse treatment for adolescents are discussed.

Exposure to Adolescent Community Reinforcement Approach treatment procedures as a mediator of the relationship between adolescent substance abuse treatment retention and outcome

Data from 399 adolescents, who participated in one of four randomly controlled trials of the Adolescent Community Reinforcement Approach (A-CRA) intervention, were used to examine the extent to which exposure to A-CRA procedures mediated the relationship between treatment retention and outcomes. Although zero-order correlations indicated that retention in treatment was a significant predictor of alcohol and other drug (AOD) use ( r = −0.18, p < .001), this relationship was reduced to nonsignificance ( p = .39) when exposure to A-CRA procedures was included in the model. Overall, the final model evidenced a very good fit (root mean square error of approximation = .00; comparative fit index = 1.00) and explained 29% and 43% of the variance in adolescents' posttreatment AOD use and AOD-related problems, respectively. In addition, Chi-Squared Automatic Interaction Detection analysis was used to derive a target level of A-CRA exposure, which was found to be significantly related to being in recovery at follow-up. The current findings are useful, as little research to date has identified significant mediators of the relationship between retention and treatment outcomes or identified target thresholds of treatment exposure.

Nonresponse Bias in Adolescent Substance Abuse Treatment Outcomes Research: Implications for Evaluating Care

ABSTRACT Nonresponse bias was investigated in an outcomes study of adolescent substance abuse treatment. Treatment-related characteristics of respondents (n = 53) were compared with those of non respondents (n = 61). Statistical analysis showed that few differences were seen between respondents and nonrespondents. The results indicate that outcomes data can be collected in this treatment population that are relatively unaffected by nonresponse bias. Missing responses are shown to be very likely missing at random.

The Impact of Publicly Funded Managed Care on Adolescent Substance Abuse Treatment Outcomes

This study compares the 12-month changes in substance use following admission to substance abuse treatment in Massachusetts between adolescents enrolled in Medicaid managed care and other publicly funded adolescents. Two hundred and fifty-five adolescents were interviewed as they entered substance abuse treatment and at 6 and 12 month follow-ups. Medicaid enrollment data were used to determine the managed care enrollment status. One hundred forty two (56%) adolescents were in the managed care group and 113 (44%) comprise the comparison group. Substance use outcomes include a count of negative consequences of substance use, days of alcohol use, days of cannabis use, and days of any substance use in the previous 30 days. Repeated measures analysis of covariance (ANCOVA) was used to assess change with time of measurement and managed care status as main effects and the interaction of time and managed care included to measure differences between the groups over time. Although several changes across time were detected for all four outcomes, we found no evidence of an impact of managed care for any of the outcomes. The results of our study do not support the fears that behavioral managed care, by imposing limits on services provided, would substantially reduce the effectiveness of substance abuse treatment for adolescents. At the same time, the results do not support those who believe that the continuity of care and improved resource utilization claimed for managed care would improve outcomes.

Assessing Social Work's Contribution to Controlled Studies of Adolescent Substance Abuse Treatment

ABSTRACT Findings from a review of social work's contribution to the adolescent substance abuse treatment outcome literature between 1990 and 2001 are presented. Social work involvement in adolescent substance abuse treatment was evaluated through a computerized bibliographic search of medical and social science databases and by a manual search of 13 core social work journals. Results indicate that social work has contributed little to knowledge development in adolescent chemical dependency treatment. Investigators affiliated with a department or school of social work accounted for three of 15 controlled treatment outcome studies. Only one report was published in a core social work journal. Efforts to develop clinical guidelines in this important practice domain will founder until a sufficiently directive body of practice-relevant research accumulates to guide evidence-based substance abuse treatment for adolescents.

Assessing the Effectiveness of Community-Based Substance Abuse Treatment for Adolescents

The Adolescent Treatment Models initiative, a 10-site, multimodality, prospective study, was designed to evaluate adolescent substance abuse treatment outcomes and to assess the relative efficacy of different treatment models. Based upon longitudinal data gathered at multiple assessment points using a standardized instrument, treatment outcome trajectories were determined for a cohort of 1,057 adolescents from entry into substance abuse treatment until 12 months post-intake. Client outcomes on substance use and program effectiveness were explored across individual treatment programs and levels of care. Strong treatment effects, defined as a significant reduction in alcohol and other drug use at three months post-intake, were found. The reductions of greatest magnitude in relation to pretreatment use occurred among adolescents in residential treatment. Within level of care, few significant differences in treatment effects were found between programs. Relapse effects, defined as an increase in substance use at 12 months relative to three months, were observed across nearly all programs, but varied in relation to treatment modality. This is most evident among those entering residential treatment, with the highest rate of relapse occurring among adolescents in longterm residential treatment care. Despite strong evidence of treatment effectiveness, continuing care is vital to maintenance of treatment benefit.

Parental Substance Use, Family Support and Outcome Following Treatment for Adolescent Psychoactive Substance Use Disorders

ABSTRACT Families are found to play an important role in adolescent substance abuse. This study examined family variables that may influence adolescent substance use during the 6 months following inpatient treatment: (1) parental substance use; (2) family aftercare attendance; and, (3) adolescent ratings of family helpfulness. It was hypothesized that the effects of parental substance use on adolescent use would be mediated by family aftercare attendance and family helpfulness ratings. Adolescent inpatients (N = 103; M age = 16) were assessed during treatment and 6 months later. Results revealed no relationship between either parental substance use and family aftercare attendance or reports of family helpfulness. More frequent family aftercare attendance and higher ratings of helpfulness were associated with less adolescent use during follow-up. Findings highlight the importance of family behaviors on adolescent substance abuse treatment outcome.

Discharge Status as a Performance Indicator: Can It Predict Adolescent Substance Abuse Treatment Outcome?

ABSTRACT Several market forces including the federal government (Government Performance and Results Act of 1993), managed behavioral health care, and accreditation organizations such as JCAHO, NCQA, and CARF are placing increasing emphasis on substance abuse treatment programs to use performance indicators to monitor quality of outcomes. Discharge status is a frequently cited performance indicator with high intuitive appeal to serve as a low-cost proxy indicator of therapeutic outcome. Researchers are just beginning to address the relationship of discharge status to therapeutic outcomes for adolescents treated for substance abuse. The purpose of the present study was to assess the relationship between discharge status and therapeutic outcomes after discharge from a residential treatment program for adolescents. Eighty-six clients were categorized based on the discharge status assigned to them by the treatment program and interviewed using the Global Appraisal of Individual Needs (GAIN) questionnaire at intake and 90 days after discharge. Results of this study did not indicate superior outcomes for the planned discharge group. Both groups significantly decreased their days of use, heavy use, and problems related to alcohol and other drug use. Several issues are raised regarding the use of discharge status as a performance indicator and recommendations are made for further research in this area.

Adolescent substance abuse treatment outcome: The role of substance abuse problem severity, psychosocial, and treatment factors.

A structural equation model incorporating substance abuse problem severity, psychosocial risk and protection, and treatment variables examined adolescent drug abuse treatment outcome pathways across 6- and 12-month follow-up points. Findings on resiliency factors and an empirical method adapted from previous research were used to select and assign 10 psychosocial factors to either a multiple protective factor index or a risk factor index. Gender, substance abuse problem severity, treatment modality, treatment length, and aftercare participation were also examined as outcome predictors. The findings suggest that treatment intensity decisions may be better informed by pretreatment psychosocial risk level rather than by substance abuse problem severity. The present study also suggests that drug-abusing adolescents who receive sufficiently long treatment, participate in aftercare, and possess at least 1 individual or interpersonal protective factor during their recovery process have the best chance to maintain gains made during treatment.

Demographic, individual, and interpersonal predictors of adolescent alcohol and marijuana use following treatment.

A vulnerability model of adolescent substance abuse treatment outcome provided the basis for selection of demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of adolescents (N = 225) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 months posttreatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-month follow-up. Peer substance use at intake and 6-month posttreatment both predicted substance use frequency outcomes at 12-month follow-up. Alcohol and marijuana use frequencies at 6-month follow-up also predicted continued use for these substances throughout the remainder of the 1st posttreatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st posttreatment year. Elevated psychological substance dependence at 6-month follow-up was a unique risk factor for subsequent marijuana use. Findings support conceptual models that attempt to explain adolescent substance abuse treatment outcome in terms of relationships among demographic, individual, interpersonal, and treatment factors.

A Comprehensive and Comparative Review of Adolescent Substance Abuse Treatment Outcome

A Comprehensive and Comparative Review of Adolescent Substance Abuse Treatment Outcome

Demographic, individual, and interpersonal predictors of adolescent alcohol and marijuana use following treatment.

A vulnerability model of adolescent substance abuse treatment outcome provided the basis for selection of demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of adolescents (N = 225) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 months posttreatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-month follow-up. Peer substance use at intake and 6-month posttreatment both predicted substance use frequency outcomes at 12-month follow-up. Alcohol and marijuana use frequencies at 6-month follow-up also predicted continued use for these substances throughout the remainder of the 1st posttreatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st posttreatment year. Elevated psychological substance dependence at 6-month follow-up was a unique risk factor for subsequent marijuana use. Findings support conceptual models that attempt to explain adolescent substance abuse treatment outcome in terms of relationships among demographic, individual, interpersonal, and treatment factors.

A comprehensive and comparative review of adolescent substance abuse treatment outcome.

There are relatively few studies on adolescent substance abuse treatment. The ones that exist tend to be methodologically weak. Methodologically stronger studies have usually found most adolescents receiving treatment to have significant reductions in substance use and problems in other life areas in the year following treatment. Average rate of sustained abstinence after treatment is 38% (range, 30–55) at 6 months and 32% at 12 months (range, 14–47). Variables most consistently related to successful outcome are treatment completion, low pretreatment substance use, and peer/ parent social support/nonuse of substances. There is evidence that treatment is superior to no treatment, but insufficient evidence to compare the effectiveness of treatment types. The exception to this is that outpatient family therapy appears superior to other forms of outpatient treatment.

Adolescent substance abuse treatment outcome: The role of substance abuse problem severity, psychosocial, and treatment factors.

Adolescent substance abuse treatment outcome: The role of substance abuse problem severity, psychosocial, and treatment factors.

Follow-up contact bias in adolescent substance abuse treatment outcome research.

This study examined the problem of follow-up contact bias in adolescent substance abuse treatment outcome research. The sample consisted of 299 male and female adolescents at an AA-oriented hospital-based inpatient substance abuse treatment program. Six-month and 12-month follow-up data were collected from adolescents and their parents with a sequence of standard and supplementary follow-up data collection procedures. Standard efforts were implemented first and subjects contacted were assigned to the easy-to-contact group. Those subjects not contacted with the initial standard efforts were included in the supplementary effort. Subjects contacted with supplementary efforts constituted the difficult-to-contact group. The difficult-to-contact group exhibited consistently poorer outcomes compared to the easy-to-contact group across most outcome variables and for both follow-up periods. Outcome results from extant studies with a significant number of noncontacted subjects may represent overestimates of outcome and may not be generalizable to the noncontacted group.

Coping as a predictor of adolescent substance abuse treatment outcome.

The present study examines whether skills for coping with relapse-risk situations assessed during treatment can predict outcome in adolescents treated for drug and alcohol abuse. After the exclusion of individuals who evidenced low commitment to change, who were institutionalized following treatment, or for whom outcome data were unreliable, analyses were conducted on 57 adolescents. It was hypothesized that coping factors reflecting problem-focused, social-support, self-blame, and wishful-thinking strategies would predict 6-month outcome status. A multiple regression analysis found that the coping factors accounted for significant variance in the prediction of a composite measure of treatment outcome and also predicted variables reflecting total days using and initial length of abstinence. Examination of the influence of coping factors in relation to outcome revealed that wishful thinking and social support contributed significantly to the prediction of total days using and length of initial abstinence, respectively. These findings were interpreted to suggest that one's cognitive approach to coping may impact drug and alcohol relapse by reducing appraised stress in a relapse-risk situation and, thus, decreasing active coping efforts. Additionally, these results highlight the importance to successful outcome of utilizing social resources. The findings are interpreted to suggest that interventions aimed at cognitive aspects of coping and enhancing social support in substance abusing teens may be useful in preventing relapse.

The impact of social support and self-esteem on adolescent substance abuse treatment outcome

Although poor social resources and low self-esteem have been implicated in the development of teenage drug abuse, the role of these factors in the remission of adolescent addiction remains unclear. This study examines social support characteristics and self-esteem in relation to outcome following adolescent chemical dependency treatment. Adolescents and their parents completed self-report questionnaires and a research interview during treatment and at 6 and 12 months post-treatment. Two types of outcome were assessed at follow-up: (1) alcohol and drug use, and (2) functioning in major life domains (e.g., family, school/work, peers). Results indicate that the quality of social resources (i.e., drug-use patterns of supports) reported during treatment was related to alcohol- and drug-use status post-treatment, with abstainers reporting more nonusing supports than teens who returned to heavy drug use. Self-esteem and the degree of satisfaction with social support during treatment were negatively correlated with the number of major life problems during the 6 months following discharge. Altogether, inpatient measures of self-esteem, number of high-quality supports, and social support satisfaction accounted for 16% of the variance in 6-month substance use outcome and 25% of the variance in psychosocial functioning 6 months post-treatment. Six-month social support and self-esteem measures were similarly related to 1-year outcome. The implications of these findings for adolescent drug abuse treatment are discussed.