Outpatient interventions for adolescent substance abuse: A quality of evidence review.

Previous reviews of outpatient interventions for adolescent substance abuse have been limited in the extent to which they considered the methodological quality of individual studies. The authors assessed 31 randomized trials of outpatient interventions for adolescent substance abuse on 14 attributes of trial quality. A quality of evidence score was calculated for each study and used to compare the evidence in support of different outpatient interventions. Across studies, frequently reported methodological attributes included presence of an active comparison condition, reporting of baseline data, use of treatment manuals, and verification of self-reported outcomes. Infrequently reported attributes included power and determination of sample size, techniques to randomize participants to condition, specification of hypotheses and primary outcomes, use of treatment adherence ratings, blind assessment, and inclusion of dropouts in the analysis. Treatment models with evidence of immediate superiority in 2 or more methodologically stronger studies included ecological family therapy, brief motivational interventions, and cognitive-behavioral therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing substance abuse with children and adolescents.

Reviews research, from 1977 to 1984, on the prevention of tobacco, alcohol, and drug abuse with children and adolescents. The review is organized according to an intervention focus on the agent, environment, and host. A study, involving 193 6th graders and skills and attention-placebo interventions, examined methods and results of host-oriented skills intervention to prevent cigarette smoking. Results suggest that attention-placebo interventions (e.g., oral quizzes, games, debates) were insufficient to prevent smoking. Based on the review, conceptual and methodological progress in substance abuse prevention research is noted. Suggestions for future research include technological improvements necessary to implement preventive interventions on a wide scale. Highlighted are the importance of careful designs: manipulation checks on independent variables; process data collection; multimodal measures of self-report, behavioral, and physiological variables; and multivariate statistical analyses in studies on interventions to prevent tobacco, alcohol, and drug abuse with children and adolescents. (75 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing substance abuse among American-Indian adolescents: A bicultural competence skills approach.

Tobacco, alcohol, and drug use are problems for American-Indian people. We reviewed these problems and the explanations for them and described a bicultural competence skills approach for preventing substance abuse with American-Indian adolescents. Data from a study of that approach suggest its efficacy with American-Indian youth. At posttest and a 6-month follow-up, American-Indian subjects who received preventive intervention based on bicultural competence skills concepts improved more than did American-Indian subjects in a no-intervention control condition on measures of substance-use knowledge, attitudes, and interactive skills, and on self-reported rates of tobacco, alcohol, and drug use. Our findings have implications for future substance-abuse prevention research with American-Indian people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Classes of substance abuse relapse situations: A comparison of adolescents and adults.

Research in the process of relapse has uncovered important developmental differences in the situations that make adolescents and adults most vulnerable to relapse after substance abuse treatment. This study takes a developmental, person-centered approach to relapse by examining the latent class structure of relapse precursors in adolescents and adults. Adults (N = 160) and adolescents (N = 188) in substance abuse and psychiatric treatment were followed up to 18 months after discharge to gather detailed information about their first relapse after treatment. Both adolescents and adults exhibited a 2-class structure of relapse precursors. Adult classes were labeled social and urges situations (primary precursors: social pressure and urges; 67%) and negative and urges situations (primary precursors: negative affect and urges; 33%), while teen classes were labeled social and positive situations (primary precursors: enhancing a positive emotional state and social pressure; 69%) and complex situations (primary precursors: negative affect, negative interpersonal situations, social pressure, and urges; 31%). Findings are discussed in relation to developmental and clinical considerations in treating clients with substance use disorders and comorbid psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceptability and availability of harm-reduction interventions for drug abuse in American substance abuse treatment agencies.

[Correction Notice: An erratum for this article was reported in Vol 18(1) of Psychology of Addictive Behaviors (see record 2007-16711-001). On page 208, the first sentence in the note of Table 4 incorrectly reads as follows: "Numbers in parentheses are ns of respondents who provided an 'other' reason for this specific intervention." The sentence should read as follows: "Numbers in parentheses are ns of respondents whose agencies do not offer this intervention."] This study assessed acceptability, availability, and reasons for nonavailability of interventions designed to prevent drug use related harm by substituting pharmaceuticals for illicit drugs; facilitating detoxification; and reducing the occurrence of HIV transmission, relapse, and opiate overdose. A survey was mailed to a sample of 500 randomly selected American substance abuse treatment agencies. Of 435 potentially eligible respondents, 222 (51%) returned usable data. A subset of interventions--including harm reduction education, cue exposure therapy, needle exchange, substitute opiate prescribing, various detoxification regimes, and complementary therapies--were rated as somewhat or completely acceptable by 50% or more of the respondents. Regardless of their acceptability, listed interventions were generally not available from responding agencies; respondents typically attributed unavailability to lack of resources and inconsistency of an intervention with agency philosophy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing substance abuse treatment engagement in incarcerated adolescents.

The purpose of this study was to determine whether motivational interviewing (MI), compared with an attention control condition (relaxation training [RT]) enhances substance abuse treatment engagement in incarcerated adolescents. At the start of incarceration, adolescents were randomly assigned to individually administered MI or RT. Subsequently, therapists and adolescents (N = 130) rated degree of adolescent participation in the facility's standard care group-based treatments targeting crime and substance use. All adolescents received the facility standard care treatment after their individual MI or RT session. MI statistically significantly mitigated negative substance abuse treatment engagement. Other indicators of treatment engagement were in the expected direction; however, effect sizes were small and nonsignificant. These findings are significant, given concerns regarding the deleterious effects of treating delinquent adolescents in groups and the potential for adolescents to reinforce each other's negative behavior, which in turn may lead to escalated substance use and other delinquent behaviors after release. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Network therapy for substance abuse: A clinical trial.

Describes an effective treatment for addicted patients in office practice. In network therapy, the therapist draws on family and peer support in the office setting to secure abstinence and aid in relapse prevention. This approach complements individual therapy and can draw on self-help groups and other modalities as well. Assessment of a series of 60 patients treated for alcohol and drug dependence demonstrates the mode of operation and the outcome of this approach. 46 experienced major or full improvement, and those using disulfiram under observation of a network member showed the best outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance-building interventions with adolescents in family therapy: A process study.

Identified, articulated, and measured therapist behaviors associated with improving initially poor therapist–adolescent alliances in multidimensional family therapy (MDFT). A list of preliminary alliance-building interventions was generated from MDFT theory and adolescent development research. This list was then refined through the observation of videotaped MDFT sessions. A sample of 5 improved and 5 unimproved alliance cases was then drawn from a larger treatment study. Ss (mean age 15 yrs) were primarily African American, male, adolescent substance abusers and their families. Coders rated the 1st 3 sessions of each case (30 sessions) to determine the extent to which each alliance-building intervention was employed. Measures of alliance features included the Vanderbilt Alliance Scale (D. E. Hartley and H. H. Strupp, 1983), the Alliance Building Behavior Scale (G. M. Diamond, et al, 1996), and the Self-Perception Profile for Adolescents (S. Harter, 1988). By session 3, therapists were attending to the adolescent's experience, formulating personally meaningful goals, and presenting as the adolescent's ally more extensively in the improved alliance cases than in the unimproved alliance cases. Using these data, proposed stages of alliance building with adolescents are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Victimization and substance abuse among women: Contributing factors, interventions, and implications.

Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have been identified as contributing to victimization and substance abuse and on interventions designed to address these contributing factors. The purposes of this article are to (a) review the literature on factors related to victimization and substance abuse, (b) review interventions and outcomes, and (c) discuss clinical implications for interventions and research. Results suggest that there is a high rate of co-occurrence of victimization and substance abuse among women, that the factors contributing to victimization and substance abuse are complex, and that there is a lack of treatment models addressing victimization and substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and substance abuse relapse among women: A pilot study.

The authors compared substance-dependent women with and without a comorbid diagnosis of posttraumatic stress disorder (PTSD) on their alcohol and drug use after inpatient substance abuse treatment. Participants were 31 women with a diagnosed substance dependence disorder. Forty-two percent of the entire sample (n?=?13) met DSM-III—R criteria for current PTSD. Follow-up interviews revealed that approximately 70% of the women relapsed during the 3 months posttreatment. Although rates of relapse did not significantly differ by PTSD status, PTSD women were found to relapse more quickly than non-PTSD women. Although preliminary, study findings suggest that the presence of PTSD among substance-dependent women may have prognostic significance as well as important treatment implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Clinical management of substance abuse programs.

Reviews the book, Clinical management of substance abuse programs by Robert J. Craig (see record 1987-97819-000). Clinical management of substance abuse programs is a significant contribution to substance abuse program management. The author provides the program director with specific information about increasing program effectiveness. His thesis is that broad program activities have greater impact on total patient care than does any individual activity with a particular patient. The book is divided into three parts. Part I is devoted to the following sections: (a) an introduction and review of the book's contents, (b) diagnostic interviewing, and (c) psychological testing. The three chapters in Part II review general models of treatment, including multimodal, combined alcohol and drug, and treatment matching. Part III, which contains four chapters, details clinical program management activities. In this section the author offers the nuts and bolts for designing a substance abuse program based on effective evaluation and quality control. The author is successful in providing a basic text to assist clinician/managers in designing more effective treatment programs for substance abusers. I recommend this book to any professional responsible for program development in substance abuse treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A social stress model of substance abuse.

The social stress model provides a framework for detecting protective factors that may contribute to adolescents" resiliency when confronted with compelling influences to engage in substance abuse. Parameters of the model were tested in 2 urban high school samples (N?=?124) of Black (78%), White (16%), and Hispanic (6%) adolescents aged 12–14 years. Pretest and posttest measures, designed to detect the relative influence of stress, social networks, social competencies, and community resources on levels of students" usage, were completed at the beginning and end of the school year. The parameters of the model, estimated using LISREL7, indicated that the pathway from family characteristics to usage and from assertion to usage were significant. The paths from the remaining hypothesized variables were not significant. Implications for the design of prevention programs that facilitate youths" resiliency are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of substance abuse in psychotherapy clients: The effectiveness of the MMPI-2 substance abuse scales.

The Minnesota Multiphasic Personality Inventory—2 (MMPI—2) contains 3 scales, the MacAndrew Alcoholism Scale—Revised (MAC—R), the Addiction Potential Scale (APS), and the Addiction Acknowledgement Scale (AAS), that were developed to identify alcohol and drug abusing individuals. The current study was designed to measure the effectiveness of these scales at detecting substance abuse problems in a community-based mental health sample. MAC—R, APS, and AAS scores were obtained from 64 therapists who identified 68 substance abusing and 392 nonabusing psychotherapy clients. The results indicated that mean scores on all 3 scales were higher for the substance abusers than for nonabusers. Furthermore, discriminant analysis found all 3 scales to be effective screening tools. The AAS was the best single predictor, and a combination of the AAS and MAC—R provided the best overall discrimination. The implications of early substance abuse detection on treatment effectiveness are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of substance abuse testing in patient care facilities

Drug testing, once practically ignored as a health care management strategy in curbing legal liability potential, is now the norm rather than exception. Most hospitals today conduct drug tests involving employment considerations and "for cause" (e.g., accidents) involving most employees but excluding physicians. Random drug testing is recommended for health care institutions to consider as a strategy designed to reduce illicit drug abuse in such facilities. This recommendation is based on the nature and sensitivity of the health care institution's mission and purpose relative to patient care and safety.     

Neurocognitive aspects of substance abuse treatment: A psychotherapist's primer.

Reviews research indicating that neuropsychological dysfunction and psychosocial markers are essential predictors of substance abuse treatment outcome. In particular, evidence reveals that the prefrontal cortex plays a significant role in moderating behavior patterns. Clinical research also shows that the prefrontal/frontal region of the brain is often impaired among substance abusers. Left unrecognized and untreated, problems with prefrontal executive functions (e.g., reduced attention, impulsivity, disinhibition) may prevent some substance abusers from fully benefiting from contemporary treatment approaches. A guide for substance abuse clinicians to use during the assessment and treatment of neurocognitive functions is presented. The guide outlines the development of a neurocognitive profile and discusses how deficits can be explained to patients and treated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Twelve-step and cognitive-behavioral treatment for substance abuse: A comparison of treatment effectiveness.

The comparative effectiveness of 12-step and cognitive-behavioral (C-B) models of substance abuse treatment was examined among 3,018 patients from 15 programs at the US Department of Veterans Affairs Medical Centers. Across program types, participants showed significant improvements in functioning from treatment admission to a 1-year follow-up. Although 12-step patients were somewhat more likely to be abstinent at the 1-year follow-up, 12-step, C-B, and combined 12-Step–C-B treatment programs were equally effective in reducing substance use and improving most other areas of functioning. The finding of equal effectiveness was consistency over several treatment subgroups: Patients attending the "purest" 12-step and C-B treatment programs, and patients who had received the "full dose" of treatment. Also, patients with only substance abuse diagnoses, those with concomitant psychiatric diagnoses, and patients who were mandated to treatment showed similar improvement at the 1-year follow-up, regardless of type of treatment received. These data provide important new evidence supporting the effectiveness of 12-step treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social skill deficit interventions for substance abusers.

Because substance abusers demonstrate significant cognitive and behavioral skill deficits, 2 social competency models of habilitation are proposed to increase abusers' life management skills and coping abilities. Social problem-solving training programs focus on generic cognitive problem-solving deficits, while social skills training programs address specific behavioral deficiencies. Social problem solving is a cognitive-behavioral approach that teaches people how to think, emphasizing thinking that is alternative, consequential, means-end, perspective taking, and social-causal. Social skills training may be taught using modeling, role playing, rehearsal, coaching, and feedback. Both approaches have been successful for increasing social adjustment and diminishing psychopathology among high-risk substance abusers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women and substance abuse: Research directions for the 1990s.

Explores directions in which current research being conducted on women and substance abuse should go in the 1990s. In the area of definition and measurement, focus should be on (1) substance-specific vs polysubstance abuse research and (2) gender-specific consumption measures. Regarding antecedents and consequences, genetic and environmental influences, companionate drinking and drug use, and female sexuality and alcohol/drug use should be explored. Attention should also be given to the early identification and intervention of drug use. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbidity of schizophrenia and substance abuse: Implications for treatment.

The problem of substance abuse disorders in schizophrenia patients is reviewed, including the prevalence of comorbid disorders, assessment, hypothesized mechanisms underlying abuse, and the clinical effects of abuse on the course of illness and cognitive functioning. The principles of treatment for dual-diagnosis schizophrenia patients are outlined, and the limitations of existing interventions are noted. Gaps in current knowledge about the impact of substance abuse on schizophrenia and its treatment are identified, and suggestions are made regarding promising avenues of research in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pilot study of a cognitive restructuring program for treating posttraumatic disorders in adolescents.

The study explored the feasibility and efficacy of a manualized cognitive restructuring program for treating adolescents suffering from posttraumatic stress disorder (PTSD). Nine girls and 3 boys (mean age 16 years; range = 14–18), with PTSD, were recruited from a community mental health center and a tertiary health care center and enrolled in a pilot study. The adolescents were seen weekly for 12–16 weeks of individual treatment. Variables assessed included: trauma history, PTSD diagnosis and severity, depression, substance abuse, and client satisfaction. Twelve adolescents consented to treatment; 9 completed the program. The number of types of traumas reported averaged 6.5 (range = 1–13). Paired t tests were used to test prepost change for PTSD symptoms and depression, in completers. From baseline to posttreatment, there were statistically significant improvements in PTSD and depression. Treatment gains were maintained at 3 month follow-up. Preliminary results suggest the feasibility of implementing a manualized cognitive restructuring program to treat PTSD in adolescents. Completers rated themselves as improved and satisfied at posttreatment and 3-month follow-up. Feedback from referring clinicians also indicated high satisfaction. (PsycINFO Database Record (c) 2011 APA, all rights reserved)