Adolescent Substance Abuse Treatment Research Articles

La comunidad terapéutica para los trastornos por uso de sustancias en adolescentes

El campo del tratamiento residencial del abuso de drogas entre adolescentes es un terreno por explorar en profundidad. Los pocos estudios con que se cuenta hasta la fecha provienen de muestras con unas características muy concretas, y que no permiten la generalización de resultados. Se pretende actualizar el conocimiento sobre el tratamiento en comunidad terapéutica y su efectividad, teniendo en cuenta el perfil de los jóvenes que acceden al mismo. Para ello se ha realizado una búsqueda en las bases de datos Medline, Psycinfo y Cochrane, incorporando, en una segunda fase, las referencias más relevantes. A pesar de las limitaciones metodológicas de los estudios, la comunidad terapéutica resulta eficaz en el tratamiento de adolescentes con problemas moderados o severos de consumo, que requieren una intervención intensiva, integral y prolongada. Para mantener los efectos beneficiosos al alta, y prevenir futuras recaídas, la continuidad asistencial resulta fundamental. The residential treatment of adolescent substance abuse is a growing interest area to explore in depth. Most of the few studies conducted to date have used very specific samples, so that the generalization of results is not possible. The aim of this study is to update knowledge about therapeutic communities and its effectiveness, taking into account the profile of young people admitted to treatment. A systematic review was conducted using Medline, PsycINFO and Cochrane Library databases. Additional references from the bibliographies of selected articles were also included to review. Despite the methodological limitations of the studies, the therapeutic community is effective in treating adolescents with moderate/severe drug consumption, who need an intensive, comprehensive and time-sustained intervention. To preserve the post-treatment benefits, and so as to prevent future relapses in drug use, continuity of care in community services is crucial.

Can Pay for Performance Improve the Quality of Adolescent Substance Abuse Treatment?

Can Pay for Performance Improve the Quality of Adolescent Substance Abuse Treatment?

Clinical Manual of Adolescent Substance Abuse Treatment edited by Yifrah Kaminer, Ken C. Winters

Clinical Manual of Adolescent Substance Abuse Treatment edited by Yifrah Kaminer, Ken C. Winters

The comparative effectiveness of outpatient treatment for adolescent substance abuse: A meta-analysis

Meta-analysis was used to synthesize research on the effects of outpatient treatment on substance use outcomes for adolescents with substance use disorders. An extensive literature search located 45 eligible experimental or quasi-experimental studies reporting 73 treatment–comparison group pairs, with many of the comparison groups also receiving some treatment. The first analysis examined 250 effect sizes for the substance use outcomes of adolescents receiving different types of treatment relative to the respective comparison groups. As a category, family therapy programs were found to be more effective than their comparison conditions, whereas no treatment programs were less effective. However, not all treatment types were compared with each other in the available research, making it difficult to assess the comparative effectiveness of the different treatments. To provide a more differentiated picture of the relative improvement in substance use outcomes for different treatments, a second analysis examined 311 pre–post effect sizes measuring changes in substance use for adolescents in the separate treatment and comparison arms of the studies. The adolescents in almost all types of treatment showed reductions in substance use. The greatest improvements were found for family therapy and mixed and group counseling. Longer treatment duration was associated with smaller improvements, but other treatment characteristics and participant characteristics had little relationship to the pre–post changes in substance use. Based on these findings family therapy is the treatment with the strongest evidence of comparative effectiveness, although most types of treatment appear to be beneficial in helping adolescents reduce their substance use.

Assessing the sensitivity of treatment effect estimates to differential follow-up rates: implications for translational research

We develop a new tool for assessing the sensitivity of findings on treatment effectiveness to differential follow-up rates in the two treatment conditions being compared. The method censors the group with the higher response rate to create a synthetic respondent group that is then compared with the observed cases in the other condition to estimate a treatment effect. Censoring is done under various assumptions about the strength of the relationship between follow-up and outcomes to determine how informative differential dropout can alter inferences relative to estimates from models that assume the data are missing at random. The method provides an intuitive measure for understanding the strength of the association between outcomes and dropout that would be required to alter inferences about treatment effects. Our approach is motivated by translational research in which treatments found to be effective under experimental conditions are tested in standard treatment conditions. In such applications, follow-up rates in the experimental setting are likely to be substantially higher than in the standard setting, especially when observational data are used in the evaluation. We test the method on a case study evaluation of the effectiveness of an evidence-supported adolescent substance abuse treatment program (Motivational Enhancement Therapy/Cognitive Behavioral Therapy-5 [MET/CBT-5]) delivered by community-based treatment providers relative to its performance in a controlled research trial. In this case study, follow-up rates in the community based settings were extremely low (54%) compared to the experimental setting (95%) giving raise to concerns about non-ignorable drop-out.

Medical Marijuana Use Among Adolescents in Substance Abuse Treatment

To assess the prevalence and frequency of medical marijuana diversion and use among adolescents in substance abuse treatment and to identify factors related to their medical marijuana use. This study calculated the prevalence and frequency of diverted medical marijuana use among adolescents (n = 164), ages 14-18 years (mean age = 16.09, SD = 1.12), in substance abuse treatment in the Denver metropolitan area. Bivariate and multivariate analyses were completed to determine factors related to adolescents' use of medical marijuana. Approximately 74% of the adolescents had used someone else's medical marijuana, and they reported using diverted medical marijuana a median of 50 times. After adjusting for gender and race/ethnicity, adolescents who used medical marijuana had an earlier age of regular marijuana use, more marijuana abuse and dependence symptoms, and more conduct disorder symptoms compared with those who did not use medical marijuana. Medical marijuana use among adolescent patients in substance abuse treatment is very common, implying substantial diversion from registered users. These results support the need for policy changes that protect against diversion of medical marijuana and reduce adolescent access to diverted medical marijuana. Future studies should examine patterns of medical marijuana diversion and use in general population adolescents.

Matching adolescents with a cannabis use disorder to multidimensional family therapy or cognitive behavioral therapy: Treatment effect moderators in a randomized controlled trial

BackgroundIn a recent randomized controlled trial (Hendriks et al., 2011), multidimensional family therapy (MDFT) and cognitive behavioral therapy (CBT) were equally effective in reducing cannabis use in adolescents (13–18 years old) with a cannabis use disorder (n=109). In a secondary analysis of the trial data, we investigated which pretreatment patient characteristics differentially predicted treatment effect in MDFT and CBT, in order to generate hypotheses for future patient-treatment matching. MethodsThe predictive value of twenty patient characteristics, in the area of demographic background, substance use, substance-related problems, delinquency, treatment history, psychopathology, family functioning and school or work related problems, was investigated in bivariate and subsequent multivariate linear regression analyses, with baseline to month 12 reductions in cannabis use days and smoked joints as dependent variables. ResultsOlder adolescents (17–18 years old) benefited considerably more from CBT, and younger adolescents considerably more from MDFT (p<0.01). Similarly, adolescents with a past year conduct or oppositional defiant disorder, and those with internalizing problems achieved considerably better results in MDFT, while those without these coexisting psychiatric problems benefited much more from CBT (p<0.01, and p=0.02, respectively). ConclusionsThe current study strongly suggests that age, disruptive behavior disorders and internalizing problems are important treatment effect moderators of MDFT and CBT in adolescents with a cannabis use disorder. If replicated, this finding suggests directions for future patient-treatment matching in adolescent substance abuse treatment.

Test of association between 10 single nucleotide polymorphisms in the oxytocin receptor gene and conduct disorder

Animal and human studies have implicated oxytocin in affiliative and prosocial behaviors. We tested whether genetic variation in the oxytocin receptor (OXTR) gene is associated with conduct disorder (CD). Utilizing a family-based sample of adolescent probands recruited from an adolescent substance abuse treatment program, control probands and their families (total sample, n=1750), we conducted three tests of association with CD and 10 single nucleotide polymorphisms (SNPs) in the OXTR gene: (a) family-based comparison utilizing the entire sample; (b) within-Whites, case-control comparison of adolescent patients with CD and controls without CD; and (c) within-Whites case-control comparison of parents of patients and parents of controls. Family-based association tests failed to show significant results (no results P<0.05). While strictly correcting for the number of tests (α=0.002), adolescent patients with CD did not differ significantly from adolescent controls in genotype frequency for the OXTR SNPs tested; similarly, comparison of OXTR genotype frequencies for parents failed to differentiate patient and control family type, except a trend association for rs237889 (P=0.004). We concluded that in this sample, 10 SNPs in the OXTR gene were not significantly associated with CD.

The use of the Risky Sex Scale among adolescents receiving treatment services for substance use problems: Factor structure and predictive validity

This study evaluated the use of the Risky Sex Scale (RSS; T. O'Hare, 2001) among youth in outpatient treatment for substance use problems. An ethnically diverse sample of 394 adolescents (280 males; Mage = 16.33 years, SDage = 1.15) was recruited from 2 treatment sites. The study was guided by two aims. First, a confirmatory factor analysis was conducted on RSS item responses. Findings replicated the factor structure identified in previous studies of undergraduate students cited for campus alcohol violations. Second, structural equation modeling was used to document associations between RSS subscales and self-reported substance use and sexual risk behaviors. The risky sex expectancies subscale was significantly associated with co-occurring alcohol use and sex, alcohol use at last intercourse, and alcohol use during the prior 30 days. The risky sexual behaviors subscale was significantly associated with co-occurring drug use and sex, condom use at last intercourse, and unprotected intercourse during the prior 30 days. The factor structure of the RSS was consistent across age group (12–16 and 16–18 years) and across gender, and the links between the RSS subscales and health risk behaviors varied somewhat by gender but not by age group. These findings suggest that the RSS is an appropriate brief screening tool for predicting health risk behaviors among adolescents in substance abuse treatment.

Contingency Management in Community Programs Treating Adolescent Substance Abuse: A Feasibility Study

Adolescent substance abuse remains a public health problem, and more effective treatment approaches are needed. The study aims to determine the feasibility and preliminary effectiveness of implementing a cost-effective contingency management (CM) intervention in community substance abuse treatment for adolescents with marijuana use disorders. Thirty-one adolescents with primary marijuana use disorder enrolled in a community treatment were randomized into either a prize-based CM intervention contingent when submitting negative urine drug screens (UDS) or a noncontingent control group. There were no significant group differences in percent negative UDS, sustained negative UDS, or retention in treatment. CM was difficult to integrate into community treatment programs and did not seem to be an effective adjunct to standard community substance abuse treatment for adolescents with marijuana use disorders. Modifying the CM procedure for adolescents, changing staff attitudes toward CM, and/or combining CM with other evidence-based psychosocial treatment may improve outcomes.

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.

Tobacco use and psychiatric comorbidity among adolescents in substance abuse treatment

Adolescents in substance abuse treatment have approximately four times higher rates of tobacco use compared with adolescents in the general population, yet many substance abuse treatment programs do not provide tobacco cessation interventions. This study examined change in tobacco use among 151 adolescents in state-funded substance abuse treatment from intake to 12-month follow-up in relation to psychiatric comorbidity and substance use. Most adolescents (67.5%) used tobacco at intake and follow-up. Having a diagnosis of a mood, anxiety, or behavioral disorder was significantly associated with change in tobacco use. Individuals with a psychiatric disorder were less likely to be nonusers of tobacco than to be individuals who continued tobacco use (adjusted odds ratio [OR] = 0.153, 95% confidence interval [CI] = 0.040–0.587, p < .01), and they were less likely to have initiated tobacco use at follow-up than individuals who continued tobacco use (adjusted OR = 0.320, 95% CI = 0.105–0.970, p < .05). Contrary to the hypothesis, alcohol use and drug use during the 12-month follow-up was not significantly related to change in tobacco use. Adolescents in substance abuse treatment with comorbid psychiatric disorders may be particularly vulnerable to continuing tobacco use.

System-level effects of integrating a promising treatment into juvenile drug courts

This study examined the system-level effects of implementing a promising treatment for adolescent substance abuse in juvenile drug courts (JDCs). Six JDCs were randomized to receive training in the experimental intervention (contingency management–family engagement [CM-FAM]) or to continue their usual services (US). Participants were 104 families served by the courts, 51 therapists, and 74 JDC stakeholders (e.g., judges, prosecutors, defense attorneys). Assessments included repeated measurements of CM-FAM implementation by therapists and therapist and stakeholder perceptions of incentive-based interventions and organizational characteristics. Results revealed greater use of CM and family engagement techniques among CM-FAM relative to US therapists. In addition, therapists and stakeholders in the CM-FAM condition reported more favorable attitudes toward the use of incentives and greater improvement on several domains of organizational functioning relative to US counterparts. Taken together, these findings suggest that JDC professionals are amenable to the adoption and implementation of a treatment model that holds promise for improving youth outcomes.

Technology in Treatment: Are Adolescents and Counselors Interested in Online Relapse Prevention?

Approximately 75% of adolescents who receive substance abuse treatment relapse within one year; therefore, it is important to have effective, easily accessible aftercare resources to support them while they are in recovery. The goal of this study was twofold: 1) to find out from adolescents and counselors if an online relapse prevention program was feasible and of interest and 2) to solicit ideas for content for this program regarding peer relationships during early recovery. Sixteen counselors were interviewed about peer relationship-related content and features this program should include then asked to sort and rate the responses using an online concept mapping program. The development of an interactive prototype of the proposed program was informed by these results. This prototype was shown to the 16 counselors and 24 adolescents in substance abuse treatment (M age=15.8 years) for feedback. Then the adolescents participated in focus groups in which they discussed their use of technology and peer relationship-related challenges in recovery. The concepts that were rated highest by counselors were Setting Boundaries in Peer Relationships (M = 4.38), How to Follow Through with Decisions (M = 4.23), and Figuring Out What You Really Want (M = 4.18). Pre-established criteria for satisfaction were exceeded with both adolescents (M = 84%) and counselors (M = 86%). In the focus groups, adolescents said that they would be interested in using technology to meet challenges in recovery. The online relapse prevention program concept has feasibility according to these key stakeholders.

Waiting for What? An Inquiry into the Fundamental Questions of How to Fix Adolescent Mental Healthcare

Improving the effectiveness of mental health and substance abuse care for young Canadians is a complex and pressing issue. Currently, there is a focus on reducing wait times and facilitating "system integration" as proposed solutions to the crisis in mental health care. As resources are being allocated toward pursuing those two solutions, the authors argue that the more fundamental challenge to addressing the crisis in mental health care for Canadian adolescents is to urge treatment providers and agencies to clearly define the goals and mechanisms of treatment while evaluating program impacts in order to generate knowledge about effective approaches to treatment. In essence, the authors suggest asking two fundamental questions: What are we treating? And what works? Drawing from insights gained through the creation of a mental health treatment centre at Pine River Institute and the development of subsequent collaborations with various clinical and research communities, the authors outline the importance of clarifying the goals and mechanisms of mental health treatment and creating better definitions and measures of treatment success as a strong foundation for moving toward decreasing wait times and increasing system integration. More specifically, they suggest that the government's most effective role is to increase system capacity by setting standards for excellence. The government can increase system capacity by requiring accountability through accreditation and outcome evaluation; increasing resources for program evaluation; and encouraging innovation by funding research into potentially effective treatment that can contribute evidence to the field of adolescent mental health and substance abuse treatment.

The Effects of Family Therapies for Adolescent Delinquency and Substance Abuse: A Meta‐analysis

This meta-analysis summarizes results from k = 24 studies comparing either Brief Strategic Family Therapy, Functional Family Therapy, Multidimensional Family Therapy, or Multisystemic Therapy to either treatment-as-usual, an alternative therapy, or a control group in the treatment of adolescent substance abuse and delinquency. Additionally, the authors reviewed and applied three advanced meta-analysis methods including influence analysis, multivariate meta-analysis, and publication bias analyses. The results suggested that as a group the four family therapies had statistically significant, but modest effects as compared to treatment-as-usual (d = 0.21; k = 11) and as compared to alternative therapies (d = 0.26; k = 11). The effect of family therapy compared to control was larger (d = 0.70; k = 4) but was not statistically significant probably because of low power. There was insufficient evidence to determine whether the various models differed in their effectiveness relative to each other. Influence analyses suggested that three studies had a large effect on aggregate effect sizes and heterogeneity statistics. Moderator and multivariate analyses were largely underpowered but will be useful as this literature grows.

Evidence-Based Substance Abuse Treatment for Adolescents: Engagement and Outcomes

Over the past decade the empirical foundation which supports the use of evidence-based practices in adolescent substance abuse treatment has increased significantly. However, there remains a gap in the literature regarding the effectiveness of utilising assertive methods for re-engaging adolescents that leave treatment early or providing continuing care following treatment. This paper helps to fill this gap by (1) describing the Assertive Adolescent Family Treatment (AAFT) initiative funded to replicate the implementation of the Adolescent Community Reinforcement Approach (A-CRA) followed by Assertive Continuing Care (ACC); (2) discussing the primary components of A-CRA and ACC (e.g., number of sessions, therapeutic content) and the implementation strategies employed in an adolescent outpatient treatment setting in the Southwestern United States (e.g., personnel, training, fidelity monitoring); (3) describing a sample of 144 adolescent participants between the ages of 12 and 17 years old that received A-CRA and/or ACC; and (4) examining differential effects of A-CRA and ACC on key outcomes. The article concludes with a discussion of the practical implications and applications for social work practice.

Clinical Manual of Adolescent Substance Abuse Treatment

Clinical Manual of Adolescent Substance Abuse Treatment

The therapeutic alliance in adolescent substance abuse treatment: A one-with-many analysis.

Studies of the therapeutic alliance typically use a one-with-many (OWM) design in which each therapist (the one) treats multiple clients (the many). This study used Kenny, Kashy, and Cook's (2006) OWM method to examine the composition of the therapeutic alliance and to analyze the association between alliance and outcome in a sample of 398 adolescents treated for substance abuse by 14 therapists. Both the client and therapist alliance ratings yielded large relationship variances, with limited consensus among clients treated by the same therapist about the quality of the alliance. If a client reported an especially strong alliance with his or her therapist, the therapist was likely to also report an especially strong alliance with that client (dyadic reciprocity). The association between the components of the alliance and treatment outcome was complicated, with different levels of measurement and different components of the alliance (perceiver, partner, or relationship) derived from different informants (therapist or client) relating to different outcomes.

Cultural Accommodation of Substance Abuse Treatment for Latino Adolescents

Collaboration with community stakeholders is an often suggested step when integrating cultural variables into psychological treatments for members of ethnic minority groups. However, there is a dearth of literature describing how to accomplish this process within the context of substance abuse treatment studies. This article describes a qualitative study conducted through a series of focus groups with stakeholders in the Latino community. Data from focus groups were used by the researchers to guide the integration of cultural variables into an empirically supported substance abuse treatment for Latino adolescents currently being evaluated for efficacy. A model for culturally accommodating empirically supported treatments for ethnic minority participants is also described.