Adolescent Substance Abuse Treatment Research Articles

The Association between Trauma History, Trauma-Related Psychopathology and Treatment Completion at an Adolescent Inpatient Substance Abuse Treatment Center in Turkey

Some adolescents are at great risk for early attrition from inpatient substance abuse treatment. We aimed to examine the effect of sociodemographic features, substance use patterns, childhood traumas and trauma-related psychopathology on the completion of an adolescent substance abuse inpatient treatment program in order to acquire information about adapting treatment strategies to enhance patient retention. Our study included 105 adolescents who were referred with a diagnosis of substance use disorder to our Child and Adolescent Substance Abuse Treatment Center's inpatient treatment program in Istanbul, Turkey from February to December 2017. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, the Hamilton Depression Rating Scale, the Conners-Wells Adolescent Self Report Scale, the Childhood Trauma Questionnaire, the Childhood Abuse and Neglect Question List, the Dependency Profile Index-Practitioner Form and the Adolescent Dissociative Experiences Scale were administered to the study group. The treatment completion rate was 26.7%. The patients who did not complete the inpatient treatment program had more history of childhood emotional neglect and/or abuse. The most common type of psychosocial trauma was emotional neglect (34%). Early attrition from the inpatient treatment program was related to dissociative amnesia, more severe attention deficit hyperactivity disorder, depression and synthetic cannabinoids use (p < 0.05). Our findings indicate that childhood psychosocial trauma and related clinical characteristics were associated with attrition from the adolescent inpatient substance abuse treatment program. Substance abuse treatment programs should adopt early assessment tools to identify those at risk for early attrition from treatment and provide targeted interventions for them.

Predictors of Topiramate Tolerability in Heavy Cannabis-Using Adolescents and Young Adults: A Secondary Analysis of a Randomized, Double-Blind, Placebo-Controlled Trial.

Cannabis is the most commonly abused illicit drug and accounts for the greatest number of adolescent substance abuse treatment admissions. Despite urgent need for effective interventions, the best available psychosocial treatment options yield only modest effects. Topiramate showed promise as an adjunctive pharmacotherapy to a psychosocial intervention for cannabis misuse among adolescents and young adults in a recent clinical trial, but it was not well tolerated. This study investigated associations between clinical characteristics and side effects and dropout among adolescents and young adults randomized to topiramate. This study involved secondary data analysis of a randomized placebo-controlled trial of topiramate for treating cannabis misuse (ages, 15-24 years; 50% female). We explored the interaction effects of baseline characteristics and medication condition (topiramate vs placebo) on treatment dropout. We also explored the relationship between side effects and dropout. Higher cannabis problems were significantly associated with reduced hazard of dropout in the topiramate group (P = 0.048) and were nonsignificantly associated with increased hazard of dropout in the placebo group (P = 0.062). Results also showed that memory difficulties were an overwhelming predictor of dropout in the topiramate condition; 42% of participants who dropped out experienced memory difficulties, whereas none of those who remained in the study experienced these effects. By identifying who may most benefit from and tolerate this medication, treatment for substance use disorders can become more individualized and positive outcomes may be enhanced.

The Double Bind of Siblings in Adolescent Substance Abuse Treatment

Siblings have been found to be perhaps the greatest source of social risk for adolescent substance abuse, particularly when the relationship is close. But, close sibling relationships are also linked to an array of important developmental and lifelong protective benefits. Sibling closeness simultaneously poses considerable risks and benefits. These conflicting findings suggest opposite treatment directions, or a “double bind” for practice. That sibling closeness risks contagion suggests treatment that aims to decrease sibling closeness. On the other hand, the many lifelong and protective benefits of close sibling relationships suggests increasing sibling closeness when possible. Family-based treatment is recommended for adolescent substance abuse, but offers little explicit direction for involving siblings in general, and none for this double bind. This paper untangles and translates the extant literature into preliminary practice guidelines; the Sibling Substance Abuse Treatment Matrix. Important variations related to gender, and age-spacing are considered. Implications for future research and practice are discussed.

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OBJECTIVES/SPECIFIC AIMS: This study sought to determine the accessibility, utilization, and preference for mobile phone use among a marginalized population of teens enrolled in an adolescent substance abuse treatment program and their parents. Specific study aims were to: (1) characterize mobile phone use, (2) assess the accessibility and reliability of mobile phone usage, (3) determine specific barriers to mobile phone use, and (4) examine parent and teen perceptions of the utility of integrating communication technology in substance use treatment. METHODS/STUDY POPULATION: In total, 103 (78.6% female; 75.7% Hispanic) parents of teens participating in an outpatient substance abuse treatment program with an average age of 42.60 (SD=9.28) participated in our study. Upon enrollment in a substance abuse treatment program between October 2014 and July 2016, parents completed a technology use survey as part of program development and a chart review of clinic outbound calls to parent mobile phones was completed to evaluate reliability of parent mobile phone access throughout treatment. Survey collection among teens is ongoing. Study population information for teens will be presented at the conference. RESULTS/ANTICIPATED RESULTS: The vast majority of parents owned a cell phone and used it as their primary phone (97.1%); 83% of parents owned smart phones in particular, with the majority being Android phones (68.7%). Parents were more likely to have pay-as-you-go (41.4%) and yearly (32.3%) contracts, and only 15% of the sample endorsed changing their phone number more than once in the past year (64%=never; 21%=once). Parents reported using several of the phone features: text (97%), email (76%), pictures (93%), and accessing the internet (92%); 92% reported they did not have a texting limit; and the most popular use of the mobile phone was to send and receive text messages (58.6%), followed by accessing the internet (19.2%). During the course of a 10-week treatment program, the clinic made 2776 confirmation phone calls to parents who completed surveys. Report of accessibility matched the clinic’s ability to reach parents. Of the 2776 calls, 97.2% were made to the original number provided, which was in service. Only 2.7% were determined to be disconnected, with the median number of days for disconnected service being 2 days with no voice and no texting capabilities (range=14) and 2 days with no voice, but with texting capabilities (range=28). In terms of parent perceptions of the utility of integrating communication technology in substance use treatment, 91% of parents reported they would be receptive to receiving text messages with parenting tips as aftercare support. Preferred content areas included: strategies for monitoring teen substance use (56%), strategies for using consequences (62%), suggestions for encouraging positive activities (62%), and ways to improve parent-child communication (63%). Accessibility, utilization, and preference for mobile phone use in a treatment program among teen respondents will be presented at the conference. DISCUSSION/SIGNIFICANCE OF IMPACT: This study characterized both subjective and objective mobile phone accessibility and usability among teens participating in an adolescent substance abuse treatment program and their parents. This study also provides information on teen and parent perceptions of using mobile phones during the aftercare period and ratings of acceptable messages following treatment. This data will help researchers design mobile-based interventions both during and after treatment, which is the future direction of our research group.

Interpersonal pathoplasticity and trajectories of change in routine adolescent and young adult residential substance abuse treatment.

Partnerships between mental health care stakeholders provide a context for generalizable clinical research with implications for quality improvement. In the context of a partnership between an adolescent residential substance abuse disorder (SUD) treatment center and clinical researchers, stakeholders identified knowledge gaps (internal and the field broadly) with regard to patient interpersonal factors that influence working alliance and acute SUD residential treatment outcome trajectories. To (a) examine interpersonal pathoplasticity and identify interpersonal subtypes in a naturalistic sample of adolescent and young-adult patients presenting for routine residential SUD treatment and (b) investigate the association between identified interpersonal subtypes and working alliance and acute treatment outcome trajectories. N = 100 patients (Mage = 17.39 years, 68% male, 84% White) completed self-reports of symptom and functioning outcomes, interpersonal problems, and the working alliance on multiple occasions between admission and discharge. Multiple methods were used to identify interpersonal subtypes and test pathoplasticity. Interpersonal subtype was entered as a predictor in respective multilevel models of working alliance and symptom outcome. Interpersonal subtypes of vindictive and exploitable patients demonstrated pathoplasticity. Subtype did not predict working alliance trajectories; however, a significant interaction between interpersonal subtype and a quadratic effect for time demonstrated that exploitable patients with longer than average treatment lengths experienced attenuated symptom change over the course of treatment whereas vindictive patients appeared to demonstrate steady progress. Interpersonal assessments should be integrated into residential SUD treatment to identify patients with an exploitable interpersonal style who might require additional attention or alternative interventions. (PsycINFO Database Record

Adolescent Frequent Heavy Drinking From 1991-2015.

* Abbreviations: MTF — : Monitoring the Future SES — : socioeconomic status Alcohol use during adolescence carries an increased risk of negative psychosocial and health outcomes. Adolescents who drink heavily have a higher likelihood of unprotected sex, physical altercations, poor school or work performance, and problems with parents.1 Earlier age of initiation is also a strong predictor of heavy alcohol consumption by adulthood and potential progression to an alcohol use disorder.2 Fortunately, since its peak in the late 1990s, the prevalence of binge drinking (defined as ≥5 drinks in the past 2 weeks) has declined to historic lows of 3.4%, 9.7%, and 15.5% among eighth, 10th, and 12th graders, respectively, according to Monitoring the Future (MTF) data.3 Despite this critical public health occurrence, the underlying reasons for this change are unclear. In this month’s issue of Pediatrics, Jang et al4 explore this decline, using 1991–2015 MTF data to delineate age, period, and cohort effects on frequent heavy drinking. Frequent heavy drinking was defined as ≥2 occasions of ≥5 drinks in a row during the past 2 weeks. “Age effects” describe the familiar phenomenon whereby adolescents become more likely to drink heavily … Address correspondence to Justine Wittenauer Welsh, MD, Emory Adolescent Substance Abuse Treatment Services, Emory University School of Medicine, 12 Executive Park Dr NE, Atlanta, GA 30329. E-mail: justine.welsh{at}emory.edu

The ABCD study of neurodevelopment: Identifying neurocircuit targets for prevention and treatment of adolescent substance abuse.

Substance use disorders (SUD) can be considered developmental disorders in light of their frequent origins in substance initiation during adolescence. Cross-sectional functional magnetic resonance imaging (fMRI) studies of adolescent substance users or adolescents with SUD have indicated aberrations in brain structures or circuits implicated in motivation, self-control, and mood-regulation. However, attributing these differences to the neurotoxicological effects of chronic substance use has been problematic in that these circuits are also aberrant in at-risk children, such as those with prenatal substance exposure, externalizing disorders (such as conduct disorder), or prodromal internalizing disorders such as depression. To better isolate the effects of substance exposure on the adolescent brain, the newly-launched Adolescent Brain Cognitive Development (ABCD) study, funded by the National Institutes of Health, will follow the neurodevelopmental trajectories of over 11,000 American 9/10-year-olds for 10 years, into emerging adulthood. This study will provide a rich open-access dataset on longitudinal interactions of neurodevelopment, environmental exposures, and childhood psychopathology that confer addiction risk. The ABCD twin study will further clarify genetic versus experiential influences (e.g., substance use) on neurodevelopmental and psychosocial outcomes. Neurocircuitry thought to regulate mood and behavior has been directly normalized by administration of psychoactive medications and by cognitive therapies in adults. Because of this, we contend that ABCD project data will be a crucial resource for prevention and treatment of SUD in adolescence because its cutting-edge neuroimaging and childhood assessments hold potential for discovery of additional targetable brain differences earlier in development that are prognostic of (or aberrant in) SUD. The ABCD sample size will also have the power to illuminate how sex differences, environmental interactions and other individual differences interact with neurodevelopment to inform treatment in different groups of adolescents.

Delivering HIV-prevention services to criminally-involved adolescents in substance abuse treatment

Delivering HIV-prevention services to criminally-involved adolescents in substance abuse treatment

Socioeconomic differences in adolescent substance abuse treatment participation and long-term outcomes

Socioeconomic status (SES) has been consistently linked to poorer access, utilization and outcomes of health care services, but this relationship has been understudied in adolescent substance abuse treatment research. This study examined SES differences in adolescent's treatment participation and long-term outcomes of abstinence and 12-step attendance over five years after treatment. Data are from 358 adolescents (ages 13–18) who were recruited at intake to substance abuse treatment between 2000 and 2002 at four Kaiser Permanente Northern California outpatient treatment programs. Follow-up interviews of adolescents and their parents were conducted at 1, 3, and 5years, with over 80% response rates across time points. Using parent SES as a proxy for adolescent SES, no socioeconomic differences were found in treatment initiation, treatment retention, or long-term abstinence from alcohol or drugs. Parent education, but not parent income, was significantly associated with 12-step attendance post-treatment such that adolescents with higher parent education were more likely to attend than those with lower parent education. Findings suggest a lack of socioeconomic disparities in substance abuse treatment participation in adolescence, but potential disparities in post-treatment 12-step attendance during the transition from adolescence to young adulthood.

A Randomized Controlled Trial of an Online Relapse Prevention Program for Adolescents in Substance Abuse Treatment

An Internet-based relapse prevention supplement to adolescent substance abuse treatment programming is a promising modality to reinforce treatment gains and enhance recovery; however, an evidence base is lacking. To assess the efficacy of the online Navigating my Journey (NmJ) program. 129 adolescent-aged participants (ages 13–23) receiving substance abuse treatment participated in a randomized parallel group study comparing two conditions: experimental (NmJ) versus attention control (viewed wellness articles from the Nemours Foundation at their discretion). Participants in the experimental condition were asked to complete 12 core lessons over 3 months. Lesson content was developed to teach evidence-based relapse prevention skills. Data were collected at four time points: baseline, 1-month follow up, 3-month follow up, and 6-month follow up. We used a linear mixed modeling approach to test for differences between conditions on each outcome. Participants in the experimental condition reported a significantly greater increase in motivation to reduce or not misuse drugs from baseline to 3-month follow up and from baseline to 6-month follow up, compared to the control participants. Participants in the experimental condition also reported a greater decrease in drug use score from baseline to 3-month follow up, compared to the control participants. An analysis of age as a potential moderator suggested that the intervention may be more effective for older adolescents. Greater use of the program was associated with greater self-efficacy and lower self-reported substance use over time. Relapse prevention treatment with adolescents may be facilitated by theory-based online interventions. NCT02125539.

An Overview of Youth Substance Abuse Recovery Strategies in Norway

ABSTRACTThere are a number of available adolescent substance abuse treatment centers and services in Norway. The overall responsibility to help youth that need alcohol and/or drug treatment lies in the municipalities. Treatments take place either in institutions (e.g., child welfare institutions or inpatient settings) or at outpatient clinics (e.g., opioid maintained treatment, psychiatric youth team). If the adolescent needs detoxification services, they typically receive this in a hospital or residential treatment setting. This article will describe available opportunities and barriers for youth treatment and aftercare in Norway.

Mindfulness-Based Substance Abuse Treatment for Adolescents.

Mindfulness-Based Substance Abuse Treatment for Adolescents.

“It was Bad to See My [Child] Doing this”: Mothers’ Experiences of Living with Adolescents with Substance Abuse Problems

This paper explores mothers’ experiences of living with an adolescent with substance use problems; an underresearched topic of inquiry worldwide. Specifically, we were interested in the stressors that mothers face and how these stressors influenced their subjective wellbeing. A qualitative, phenomenological approach was adopted where five mother-adolescent pairs were recruited from two adolescent substance abuse treatment centres to participate in 1:1 in-depth interviews using a lifegrid tool. Interpretative phenomenological analysis revealed that adolescent’s substance abuse produced several stressful life events, such as adolescent misconduct, family conflict and financial burdens that provoked feelings of hopelessness, guilt, self-blame, worry, shame, anger, and signs of depression. Understanding mothers’ experiences is essential to the development of informed support interventions for mothers of adolescents troubled by substance abuse. We conclude this paper by discussing the research and practice implications of our findings.

Predictors of Physical Altercation among Adolescents in Residential Substance Abuse Treatment

This study tested the hypothesis that basic social information-processing components represented by family conflict, peer aggression, and pro-aggression cognitive scripts are related to aggression and social problems among adolescents in substance abuse treatment. The sample consisted of 547 adolescents in two community-based residential facilities. Correlation results indicated that more peer aggression is related to more pro-aggression scripts; scripts, peer aggression, and family conflict are associated with social problems; and in-treatment physical altercation involvement is predicted by higher peer aggression. Findings suggest that social information-processing components are valuable for treatment research.

Organizational Predictors and Use of Evidence-Based Practices in Adolescent Substance Abuse Treatment

ABSTRACTBackground: Adolescent substance abuse remains a significant problem in the United States, yet treatment centers do not always admit adolescent clients. In this paper, we first determine the extent to which treatment is available for adolescents in general and whether or not adolescent-specific (segregated) tracks are offered. Second, we examine the organizational characteristics associated with adolescent treatment. Third, we illuminate how the adolescent caseload in a treatment center is related to offering evidence-based practices (EBPs). Methods: Drawing upon a nationally representative sample of US treatment programs, we use logistic regression to assess how organizational characteristics are associated with the provision of adolescent treatment. Using ordinal logistic regression, we analyze how the treatment center's adolescent caseload and organizational characteristics affect the extent to which a treatment center offers medication-assisted treatment (MAT) and psychosocial treatment. Results: Half (49.5%) of treatment programs admitted adolescents, and 41.8% offered an adolescent-specific track. Findings from the logistic regression suggested several organizational characteristics that were significantly associated with treating adolescents and/or having an adolescent-only track. Our findings from the ordinal models indicated a negative relationship between the percent of adolescents in a treatment center and the extent of MAT, and a positive relationship between the percent of adolescent clients and the extent of psychosocial treatment offered. Conclusions: This paper highlights organizational barriers to treatment entry for adolescents, who remain a small proportion of clients in treatment centers. When treatment centers serve adolescents, however, those adolescents are likely to receive care in adolescent-only tracks and/or services and in programs that offer several psychosocial EBPs. Finally, adolescents are less likely to receive treatment in centers that offer a variety of MAT.

Cultural accommodation of group substance abuse treatment for Latino adolescents: Results of an RCT.

Comparative studies examining the difference between empirically supported substance abuse treatments versus their culturally accommodated counterparts with participants from a single ethnic minority group are frequently called for in the literature but infrequently conducted in practice. This randomized clinical trial was conducted to compare the efficacy of an empirically supported standard version of a group-based cognitive-behavioral treatment (S-CBT) to a culturally accommodated version (A-CBT) with a sample of Latino adolescents primarily recruited from the juvenile justice system. Development of the culturally accommodated treatment and testing was guided by the Cultural Accommodation Model for Substance Abuse Treatment (CAM-SAT). Seventy Latino adolescents (mean age = 15.2; 90% male) were randomly assigned to 1 of 2 group-based treatment conditions (S-CBT = 36; A-CBT = 34) with assessments conducted at pretreatment, posttreatment, and 3-month follow-up. Longitudinal Poisson mixed models for count data were used to conduct the major analyses. The primary outcome variable in the analytic models was the number of days any substance was used (including alcohol, except tobacco) in the past 90 days. In addition, the variables ethnic identity, familism, and acculturation were included as cultural moderators in the analysis. Although both conditions produced significant decreases in substance use, the results did not support a time by treatment condition interaction; however, outcomes were moderated by ethnic identity and familism. The findings are discussed with implications for research and practice within the context of providing culturally relevant treatment for Latino adolescents with substance use disorders.

Integrating adolescent substance abuse screening, brief intervention and treatment in health professions education

Background Substance abuse remains one of the largest public health issues facing our society. Early alcohol and drug use is linked to a range of immediate and long-term consequences (e.g., academic, brain development, and later dependence). Although studies such as the Youth Risk Behavior Survey and National Survey on Drug Use and Health have recently shown stable or slight decline in the use of alcohol and certain drugs, alcohol remains the drug of choice, marijuana use has increased, and perceptions of harm has decreased. [1,2] Opportunities to address substance use exist in a range of settings where nurses, social workers and other health professionals work with youth yet training and adoption of adolescent screening and brief intervention has been slow. The cost of substance use disorders, in both adults and adolescents, could be reduced through the SAMHSA-backed prevention and early identification procedure of Screening, Brief Intervention, and Referral to Treatment (SBIRT), a cost-effective and widely-supported prevention framework. Research has shown SBIRT to be effective for the early identification of problematic alcohol use, with growing but inconsistent evidence for its effectiveness with other risky drug use. However, there is little substance use training in social work and nursing programs. SBIRT education is often optional or specialized, rather than being required coursework.

To Stay or Not to Stay: Adolescent Client, Parent, and Counselor Perspectives on Leaving Substance Abuse Treatment Early

Increasing motivation and raising retention rates are considerable challenges for providers of adolescent substance abuse treatment. Research has shown that motivation for treatment, social influences (peers, family, counselors), and for some clients external pressure from the juvenile justice system, can serve as key factors in successful retention. To further understand influences on motivation and retention, focus groups were conducted in two residential treatment facilities. Adolescent clients, parents, and treatment staff were asked to describe their experiences with the treatment process focusing specifically on factors related to treatment attrition and retention. Qualitative data analysis revealed five themes affecting retention either positively or negatively. Themes included relationships (with family, peers, and counselors), responsibility (degree to which clients embrace jobs, roles, and rules), emotional regulation (ability to express feelings appropriately), thinking (identifying behavior patterns and recognizing consequences), and self-efficacy (feelings of empowerment). Implications for future research and for developing strategies aimed at increasing motivation and retention are discussed.

What Can Parents Do? A Review of State Laws Regarding Decision Making for Adolescent Drug Abuse and Mental Health Treatment

This study examined U.S. state laws regarding parental and adolescent decision making for substance use and mental health inpatient and outpatient treatment. State statutes for requiring parental consent favored mental health over drug abuse treatment and inpatient over outpatient modalities. Parental consent was sufficient in 53% to 61% of the states for inpatient treatment, but only for 39% to 46% of the states for outpatient treatment. State laws favored the rights of minors to access drug treatment without parental consent, and to do so at a younger age than for mental health treatment. Implications for how these laws may impact parents seeking help for their children are discussed.

Assessing Adolescent Substance Abuse Programs With Updated Quality Indicators: The Development of a Consumer Guide for Adolescent Treatment

When adolescent substance abuse requires treatment, few parents know which treatment features are important and which treatment programs are effective. There are few resources to help them select appropriate care. We describe early work on an evaluation method and comparative treatment guide for parents based upon the premise that the quality of a program and its potential effectiveness is a function of the number and frequency of evidence-based treatment practices (EBPs) delivered. Thus, we describe the development of and measurement approach for a set of EBPs toward the goal of developing a Consumer Guide to Adolescent Substance Abuse Treatment.