Adolescent Substance Abuse Treatment Research Articles

Smoking Cessation Services in Adolescent Substance Abuse Treatment: Opportunities Missed?

The majority of adolescents receiving substance abuse treatment also use tobacco, yet there are few data regarding the adoption of tobacco use assessment and smoking cessation services by adolescent treatment programs. Using data from a national sample of adolescent-only treatment programs (n = 154), this research measures the adoption of aspects of assessment and treatment from the Public Health Service's (2000) guideline, Treating Tobacco Use and Dependence. When adoption of four intake/assessment practices was measured, adoption appeared high, but only 45% of programs had adopted all four practices. About 43% of programs offered some type of smoking cessation services. However, there was no association between adoption of intake procedures and the odds of availability of smoking cessation services, suggesting a lack of connection between the identification of treatment needs and the availability of services. The lack of smoking cessation services may represent a missed opportunity for early intervention with this population.

Brief Substance Abuse Treatment with Urban Adolescents: A Translational Research Study

The purpose of this translational research study was to test a brief, manualized adolescent substance abuse treatment protocol's effects in an urban community setting compared to a sample in an experimental study from which the treatment was first employed. One hundred two adolescents who were treated with a manualized protocol of five sessions of Motivational Enhancement Therapy/Cognitive Behavioral Therapy (MET/CBT-5) were followed for six months and outcomes were analyzed against a comparison sample (n = 102). Both groups were treated with (MET/CBT-5). The community setting group showed reduced alcohol use relative to the comparison group at six months using unadjusted measures and at three and six months using propensity score analyses to adjust for the differences in baseline characteristics of the two groups. These findings support using brief, manualized treatments for diverse, urban adolescents in outpatient community settings.

Multidimensional Family Therapy HIV/STD Risk‐Reduction Intervention: An Integrative Family‐Based Model for Drug‐Involved Juvenile Offenders

Drug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/ STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies (www.cjdats.org). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/ STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.

Decision-Making Authority and Substance Abuse Treatment for Adolescents: A Survey of State Laws

Purpose State laws concerning decision-making authority for voluntary inpatient substance abuse (SA) treatment of minors may be a potential barrier to appropriate treatment. We sought to identify and classify relevant laws related to the provision of voluntary inpatient SA treatment to adolescents 12 to 17 years (minors) as an exploratory assessment to improve understanding of how these laws might affect treatment decisions. Methods In summer 2006, we conducted a survey of statutes, regulations, and legal cases in the 50 states and the District of Columbia regarding the authority of parents (or guardians) and minors to make treatment decisions for voluntary inpatient SA treatment. Results All 50 states have laws applicable to voluntary inpatient SA treatment for adolescents, and the laws vary significantly throughout the nation. If a minor and parent disagree about SA treatment, some states defer to the decision-making authority of the minor, whereas other states defer to the parent. Most significantly, the majority of states fail to specify whether the minor's or the parent's decision will control in the event of a conflict. Conclusions The lack of clarity in state laws regarding decision-making authority for voluntary inpatient SA treatment of minors may create a potential barrier to treatment for adolescents, especially those with more serious SA problems. This lack of clarity could lead to confusion among parents, adolescents, healthcare professionals, and treatment facilities, and ultimately could result in a failure to treat adolescents in need of medical attention. Policymakers should ensure that state laws clearly specify procedures to enable treatment if a conflict arises between adolescents and parents, including procedures to ensure that the due process rights of adolescents are protected.

Racial/ethnic disparities in the patterns of co-occurring mental health problems in adolescents in substance abuse treatment

This study examines disparities in co-occurring mental health and substance use problems by race/ethnicity to inform the development of culturally appropriate treatment approaches. Using pooled clinical data collected with the Global Assessment of Individual Needs, we identified racial/ethnic and other factors associated with co-occurring internalizing problems, externalizing problems, and the combination thereof in adolescents in federally funded treatment facilities. Results show that after controlling for demographic and socioenvironmental factors, African Americans, Hispanics, and mixed-race adolescents were more likely than Whites to have co-occurring internalizing problems. African Americans and Native Americans were less likely than Whites to have externalizing problems and to have combined internalizing and externalizing problems. Presence of co-occurring problems was also associated with victimization, homelessness, and family substance abuse. These results indicate that co-occurring mental health problems vary by race/ethnicity, and therefore, refined approaches are needed for culturally appropriate care of patients.

Outcome evaluation findings of a Hawaiian culture-based adolescent substance abuse treatment program.

Outcome evaluation findings of a Hawaiian culture-based adolescent substance abuse treatment program.

Creating a Geospatial Database of Risks and Resources to Explore Urban Adolescent Substance Use

This article illustrates the methodology of creating a comprehensive geospatial database in order to systematically understand the social ecology of risk and protection for urban youth. The challenges and future opportunities involved with this complex work were reviewed, and specific examples were provided to guide researchers. Data were collected from a Washington, DC adolescent substance abuse treatment sample to construct a geospatial database to evaluate urban youths' social environmental risk and resources. A geographic information systems (GIS) approach was adopted to integrate a large array of variables at different levels of geography. For example, risk factors included proximity to crime hotspots, and other known potential establishments with negative influence (such as liquor stores). We also used GIS to assess the subjects' accessibility to protective resources such as public libraries, recreational, parks, and police stations. Unique to our method was the collecting and mapping of each teen's activity locations (places they typically frequent). These data form “risk and protection exposure” estimates for each teen. Finally, we illustrated the specific methods for creating a dynamic geospatial database for urban youth and present future analytical approaches and challenges with these type of data.

Eating Disorder Symptoms and Alcohol Use among Adolescents in Substance Abuse Treatment

To examine the relationship of eating disorder (ED) symptoms with the severity of alcohol use among adolescents in treatment for alcohol and other substance use disorders (AOSUDs). A sample consisted of 177 adolescents who participated in outpatient AOSUD treatment programs in Connecticut. Chi square tests, one-way ANOVAs and Pearson's correlation coefficients were used to describe the prevalence and correlates of any eating disorders, and the related symptoms. Multivariate regression was used to test the associations between ED symptoms and alcohol consumption. 26.4% of the participants had at least one ED symptom, with the highest number of symptoms occurring in females. The number of ED symptoms was associated with increases in the number of times that they became intoxicated in the year before entering treatment, the number of alcohol-related social problems, and the number of alcohol-related physical symptoms after taking into consideration the effects of age and gender. The prevalence of symptoms of EDs is high in adolescents with AOSUDs, with the number of ED symptoms correlating with increased alcohol consumption. Further studies on the course and treatment of adolescents with AOSUDs and symptoms of EDs are warranted.

Urban adolescents’ reflections on brief substance use treatment, social networks, and self-narratives

The purpose of this study was to examine urban adolescents’ experiences of completing a brief, substance use treatment protocol. Semi-structured interviews were conducted in 2006 with 23 patients to better understand their treatment experience, the subsequent impact on their social networks and self-narrative reflections. Results suggest common themes of new awareness of self in relation to substance use, utility of social networks in providing ongoing support, and hopeful future self-narratives. Participants named and evaluated all the substances that they could think of, with marijuana most frequently named and rated as good (65% of patients), indicating a positive attitude toward this drug. In general, we conclude that these qualitative data provide evidence of the effectiveness of brief substance abuse treatment for urban adolescents.

Clinical characteristics of treatment-seeking prescription opioid vs. heroin-using adolescents with opioid use disorder

Objectives To compare the clinical characteristics of treatment-seeking prescription opioid-using adolescents with DSM-IV opioid use disorder (OUD) to those with heroin-using OUD adolescents. Method We analyzed the data on OUD adolescents (94, ages 14–18 years) extracted from the parent study dataset comparing clinical characteristics of treatment-seeking OUD to non-OUD adolescents from a adolescent substance abuse treatment program in Baltimore, MD. The sample consisted of 41 non-heroin prescription opioid-using and 53 heroin-using OUD adolescents who were assessed cross-sectionally using standardized interviews and self-reports. Chi-square and t-tests were performed to determine group differences on demographic, substance use, psychiatric and HIV-risk behaviors. Results Both groups were older (mean 17 years), predominantly Caucasian, and had a suburban residence; they had high rates of co-occurring psychiatric disorders (83%) and they reported moderately high depression symptoms. The heroin-using sample was more likely to have dropped out of school, be dependent on opioids and inject drugs using needles. The prescription opioid-using OUD youth were more likely to meet criteria for multiple SUDs (including prescription sedatives and psychostimulants), current ADHD and report selling drugs; and more likely to be court ordered to current treatment and report prior psychiatric treatment. Conclusions Both groups of treatment-seeking OUD adolescents had multiple comorbidities but there were substantial differences between prescription opioid-users and heroin-users. These differences may suggest different prognoses and treatment implications. Future research may shed light on the factors leading to differences in choice of opioids and their impact on treatment outcomes; and assess the role of agonist assisted treatments and integrated psychiatric care.

Disparities in the Patterns and Determinants of HIV Risk Behaviors among Adolescents Entering Substance Abuse Treatment Programs

Black youth are disproportionately affected by the HIV/AIDS epidemic. This study examined disparities in patterns and determinants of sexual risk behaviors among black and white adolescents in substance abuse treatment programs. We used pooled clinical data collected from 4,565 sexually active 12-17-year-old black (29.7%) and white (70.3%) adolescents entering outpatient and residential substance abuse treatment programs nationally. Multivariate logistic regression analyses were used to examine racial differences in patterns of sexual risk behaviors and the associations of these behaviors with demographic, socioenvironmental and psychosocial risk factors, including substance use and abuse, symptoms of mental disorders and criminal behaviors. Blacks were significantly more likely than whites to have had sex with multiple partners, purchased or traded sex and used substances to enhance their sexual experiences, even after adjusting for demographic, socioenvironmental and psychosocial risk factors. Substance use and abuse, internalizing symptoms and drug-related crimes were significantly associated with engaging in > or =2 sexual risk behaviors in both groups. Disparities in determinants of HIV risk were also found. For instance, male gender, single-parent custody and history of criminal justice involvement were associated with having had sex with multiple partners among blacks but not among whites. Demographic, socioenvironmental and psychosocial risk factors accounted for up to 30% of the variance in sexual risk in both groups. Black adolescents with substance use problems are at greater risk for HIV infection than their white peers because of their higher rates of sexual risk behaviors. Differences in co-occurring psychosocial problems did not fully explain racial disparities in sexual risk behaviors. HIV prevention programs for black adolescents in treatment should consider both individual and broader contextual factors that co-occur with sexual risk behaviors.

A prospective investigation of suicide ideation, attempts, and use of mental health service among adolescents in substance abuse treatment.

This study examined suicide ideation, attempts, and subsequent mental health service among a sample of 948 youth from substance abuse treatment facilities across the United States. Youth were surveyed at intake and every 3 months for a 1-year period. Thirty percent of youth reported ideating in at least one interview, and 12% reported attempting suicide; almost half of all youth reported receiving outpatient mental health treatment at least once, and close to one-third of all youth reported being on prescription drugs for an emotional or behavioral problem. Higher levels of conduct disorder symptoms were associated with both ideation and attempts, while higher levels of depressive symptoms and being female were associated with ideation only. Among all youth, older youth were less likely to receive outpatient and prescription drug treatment, and Black and Hispanic youth were less likely to receive prescription drug treatment than White youth. Among youth who reported ideating, those with conduct disorder were less likely to receive prescription drug treatment 3 months later. These findings emphasize a high prevalence of suicide risk behavior in substance abuse treatment programs and provide insight into the specialized treatment youth in substance abuse treatment at risk for suicide currently receive.

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.

Assertive outreach strategies for narrowing the adolescent substance abuse treatment gap: implications for research, practice, and policy.

In any given year, only about 10% of the nearly two million adolescents exhibiting substance abuse or dependence in the United States receive substance abuse treatment. Given this state of affairs, it is unlikely that the massive effort and expenditure of resources over the past decade on developing, testing, and disseminating effective treatments for adolescent substance abuse will have an appreciable impact on the prevalence of substance use disorders among the adolescent population. In order to substantially diminish the pervasive gap between levels of need for and utilization of adolescent substance abuse treatment, specialized assertive outreach strategies may be needed. This paper outlines a framework for assertive outreach for adolescents with substance use disorders and proposes specific types of strategies for identifying and enrolling such adolescents into treatment. Implications for practice and policy pertaining to adolescent substance abuse treatment service delivery are considered.

New Initiatives in Improving Youth and Family Outcomes by Importing Evidence-Based Practices

ABSTRACT This article describes three community-based research projects that are designed to enhance the effectiveness of real-world adolescent substance abuse treatment and prevention, and presents preliminary study results from each. The first project is examining statewide public sector practitioner interest in and implementation of contingency management in treating adolescent substance abuse. The second project is integrating the Community Reinforcement Approach for adults into Multisystemic Therapy (MST) programs for use with substance-abusing caregivers. The third project is integrating Reinforcement-Based Therapy for adults with MST for child abuse and neglect in the treatment of families with co-occurring child maltreatment and caregiver substance abuse. Each project highlights the complexity of using the evidence base in the treatment of substance abuse, and the potential to improve outcomes for challenging clinical populations in real world practice settings.

Evidence-Based Psychosocial Treatments for Adolescent Substance Abuse

This review synthesized findings from 17 studies since 1998 regarding evaluation of outpatient treatments for adolescent substance abuse. These studies represented systematic design advances in adolescent clinical trial science. The research examined 46 different intervention conditions with a total sample of 2,307 adolescents. The sample included 7 individual cognitive behavior therapy (CBT) replications (n = 367), 13 group CBT replications (n = 771), 17 family therapy replications (n = 850) and 9 minimal treatment control conditions (n = 319). The total sample was composed of approximately 75% males, and the ethnic/racial distribution was approximately 45% White, 25% Hispanic, 25% African American, and 5% other groups. Meta-analysis was used to evaluate within-group effect sizes as well as differences between active treatment conditions and the minimal treatment control conditions. Methodological rigor of studies was classified using Nathan and Gorman (2002) criteria, and treatments were classified using criteria for well-established and probably efficacious interventions based on Chambless et al. (1996). Three treatment approaches, multidimensional family therapy, functional family therapy, and group CBT emerged as well-established models for substance abuse treatment. However, a number of other models are probably efficacious, and none of the treatment approaches appeared to be clearly superior to any others in terms of treatment effectiveness for adolescent substance abuse.

Clinical Outcomes of Traumatized Youth in Adolescent Substance Abuse Treatment: A Longitudinal Multisite Study

The purpose of this study was to evaluate the effectiveness of outpatient substance abuse treatment for youth with high traumatic stress compared to youth without high traumatic stress in substance abuse treatment centers across the United States. The data for this study were gathered using a longitudinal survey design with purposive sampling from nine drug treatment delivery systems across the United States participating in the cooperative grant Strengthening Communities for Youth (SCY) awarded by SAMHSA's Center for Substance Abuse Treatment (CSAT) between September 2002 and June 2006. Follow-up assessments were conducted with the youth at three, six, and 12 months following intake. Traumatized youth responded to outpatient treatment in a similar pattern when compared to nontraumatized youth, although the traumatized youth had consistently higher scores on substance use frequency and substance problems scales than nontraumatized youth throughout the study. Current empirically validated treatments for adolescent substance abuse do not prepare the practitioner for trauma-informed practice or specifically address trauma-informed recovery. Based on our results, we advocate for the development and integration of trauma-informed practice within substance abuse treatment for adolescents to help them recover from trauma and substance abuse issues.

Predictors of Early Therapeutic Alliance Among Adolescents in Substance Abuse Treatment

Given the importance of the therapeutic alliance in achieving positive treatment outcomes, research is needed to illuminate the factors that contribute to the development of this important relationship. The aim of the current study was to expand upon the existing literature by examining predictors of the early therapeutic alliance among adolescents treated in two outpatient programs. Use of multilevel modeling techniques revealed that the majority of the variance in adolescents' ratings of the therapeutic alliance was due to adolescent factors (91%), while the variance in therapist ratings of alliance were nearly equally divided between adolescent and therapist factors (52% vs. 48%). Participant age was found to be the only significant predictor of therapist-rated alliance, with therapists reporting higher alliances with older adolescents. Adolescents reporting higher levels of social support, greater problem recognition, and more reasons for quitting also reported higher therapeutic alliance ratings. Future research is needed to examine if early identification of adolescents with low social support and problem recognition combined with brief treatment readiness interventions can be a promising approach to help improve therapeutic engagement and post-treatment substance use outcomes.

Victimization Among African-American Adolescents in Substance Abuse Treatment

Victimization is regarded as a significant public health issue, especially among adolescents in urban areas. Although victimization is linked to substance use, the research on victimization among adolescents in treatment is underdeveloped. Given the high rate of victimization among African-American adolescents, further research on the prevalence and correlates of victimization for this population is needed. This knowledge can guide the development of effective treatment and prevention strategies. This study contributed to the research by examining the rate and different types of victimization among a sample of African-American adolescents in an urban substance abuse treatment program, testing whether victimization is associated with increased levels of psychopathology and high-risk behaviors; and comparing the rates and associations with existing studies of adolescent victimization. It reports on a sample of 259 African-American adolescents receiving substance abuse treatment in an inner-city program. Fifty-four percent of the subjects reported lifetime victimization. Severity of victimization was associated with depression, generalized anxiety disorder, traumatic stress disorder, and conduct disorder, although the effect sizes were relatively small. Lifetime victimization exhibited a relationship of small to moderate strength with high-risk behaviors (i.e., illegal activity, gang membership, multiple sex partners and unprotected sex). Service implications and recommendations for future research are provided.