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)     

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

As part of efforts to identify effective culturally appropriate treatment for Hawaiian and Asian and Pacific Islander adolescents with substance abuse and co-occurring disorders, this evaluation research sought to assess the efficacy of the I Mua Mau Ohana program. This long-term residential program combined culturally based experiential learning/therapy, education, spirituality, counseling, and family involvement. Participants were interviewed at intake and followed up at 3, 6, and 12 months using the Government Performance and Results Act (GPRA) Tool and the Global Appraisal of Individual Needs (GAIN) instruments. Results showed long-term improvement in substance use and related problems, decreased criminal justice involvement, and improved mental health and social functioning, while showing positive trends in education and employment. However, unexpected findings were revealed in family functioning. Although promising, further research is needed to substantiate the program's effectiveness and possibility of being considered an evidence-based program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment techniques and outcomes in multidimensional family therapy for adolescent behavior problems.

The link between treatment techniques and long-term treatment outcome was examined in an empirically supported family-based treatment for adolescent drug abuse. Observational ratings of therapist interventions were used to predict outcomes at 6 and 12 months posttreatment for 63 families receiving multidimensional family therapy. Greater use of in-session family-focused techniques predicted reduction in internalizing symptoms and improvement in family cohesion. Greater use of family-focused techniques also predicted reduced externalizing symptoms and family conflict, but only when adolescent focus was also high. In addition, greater use of adolescent-focused techniques predicted improvement in family cohesion and family conflict. Results suggest that both individual and multiperson interventions can exert an influential role in family-based therapy for clinically referred adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems.

The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive- behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and outcome (drug use, externalizing, and internalizing symptoms in both conditions) at post and 6-month follow-up. There were no alliance effects in CBT. In family therapy, stronger parent alliance predicted declines in drug use and externalizing. Adolescents with weak early alliances that subsequently improved by midtreatment showed significantly greater reductions in externalizing than adolescents whose alliances declined. Results underscore the need for ongoing developmental calibration of intervention theory and practice for adolescent clinical populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in tobacco use among adolescent smokers in substance abuse treatment.

Adolescents with substance use disorders (SUDs) smoke cigarettes more than youth in the general population. Little is known about changes in smoking patterns during and after outpatient SUD treatment. We examined whether receiving SUD treatment had a differential impact on cigarette smoking behaviors of mild (     

Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use.

This study investigated the efficacy of brief strategic family therapy (BSFT) with Hispanic behavior problem and drug using youth, an underrepresented population in the family therapy research literature. One hundred twenty-six Hispanic families with a behavior problem adolescent were randomly assigned to 1 of 2 conditions: BSFT or group treatment control (GC). Results showed that, compared to GC cases, BSFT cases showed significantly greater pre- to post-intervention improvement in parent reports of adolescent conduct problems and delinquency, adolescent reports of marijuana use, and observer ratings and self reports of family functioning. These results extend prior findings on the efficacy of family interventions to a difficult to treat Hispanic adolescent sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trajectories of change in adolescent substance use and symptomatology: Impact of paternal and maternal substance use disorders.

The effects of paternal and maternal substance use disorders (SUDs) on trajectories of change in adolescent offspring nicotine, alcohol, and drug use and symptomatology were investigated in a population-based sample of adolescent twins (N = 1,514). Adolescent and parental substance phenotypes were assessed when most adolescents were 11 years old, with 2 assessments of adolescents approximately every 3 years thereafter. Growth curves were fit using hierarchical linear modeling. Results indicated acceleration of substance involvement during adolescence, particularly for boys. Paternal and maternal SUD were each associated with more extreme trajectories. There was evidence for an additive, rather than interactive, combined parental effect. Findings help clarify the impact of paternal and maternal SUD on the development of substance involvement during adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examination of ethnicity in controlled treatment outcome studies involving adolescent substance abusers: A comprehensive literature review.

The extent to which adolescent drug treatment outcome studies address ethnicity was systematically examined. Reliability coefficients were calculated for both the search methodology used to obtain these outcome studies and the extent to which ethnicity was addressed along several dimensions. The resulting coefficients were highly reliable. Findings indicated that although investigators of 94% of the outcome studies considered ethnicity to some extent, only 28% of these studies incorporated ethnicity into their design, and only 6% of studies involved statistical analyses to examine differential response to treatment or moderating effects of ethnicity with a sufficient number of ethnic minority participants. Overall, results indicated that there is much work to do regarding the examination of ethnicity in controlled treatment outcome studies involving adolescent substance abusers. Indeed, modifications were rarely made to the treatment components to accommodate ethnicity-related variables. Future recommendations are presented in light of these findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Preventing substance abuse among children and adolescents.

Reviews the book, Preventing substance abuse among children and adolescents by Jean E. Rhodes and Leonard Jason (see record 1988-98428-000). This text is a recent volume in Pergamon Press's Psychology Practitioner Guidebooks series. The volumes in the series are reflective of the current trend to "manualize" various intervention approaches to specific behavior problems. The present volume is potentially valuable in that the content and implementation of various school-based prevention programs carried out in recent years (primarily in the context of research protocols) have not been disseminated widely to psychologists through the traditional means of professional texts. When the results of these investigations are presented in scholarly journal articles and chapters, the focus is usually on research aspects (e.g., methodological issues and outcome) and not the "nuts-and-bolts" of actually developing and implementing interventions. Furthermore, the need for materials of this type appears to be increasing. Many local organizations are actively attempting to develop substance abuse prevention programs and recently there have been major increases in federal funding for these activities. Thus, the publication of the text is clearly timely. Despite the shortcomings, the present text certainly fills an existing need. For the professional interested in educating him or herself in substance abuse prevention in adolescence, it is a good place to start. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of brief family interventions for general populations: Adolescent substance use outcomes 4 years following baseline.

This study examined the long-term substance use outcomes of 2 brief interventions designed for general population families of young adolescents. Thirty-three public schools were randomly assigned to 3 conditions: the 5-session Preparing for the Drug Free Years Program, the 7-session Iowa Strengthening Families Program, and a minimal contact control condition. The pretest involved 667 6th graders and their families. Assessments included multiple measures of initiation and current use of alcohol, tobacco, and marijuana. Pretest data were collected in the 6th grade and the reported follow-up data were collected in the 10th grade. Significant intervention-control differences in initiation and current use were found for both interventions. It is concluded that brief family skills-training interventions designed for general populations have the potential to reduce adolescent substance use and thus have important public health implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family therapy, substance abuse, and adolescents: Moving from isolated cultures to related components.

Reviews the books The family context of adolescent drug abuse, by R. H. Coombs (1988); Practical approaches in treating adolescent chemical dependency: A guide to clinical intervention and assessment, by P. B. Henry (1989); Consequences of adolescent drug abuse, by M. D. Newcomb and P. M. Bentler (1989); Adolescent drug abuse: Analyses of treatment research, by E. R. Rahdert and J. Grabowski (1988); Breakthroughs in family therapy with drug-abusing and problem youth, by J. I. Szapocznik and W. M. Kurtines (see record 1989-98115-000); and Family therapy approaches with adolescent substance abusers, by T. C. Todd and M. Selekman (in press). This spate of books includes representatives of three "cultures" interested in family therapy with substance-abusing adolescents: developmentally oriented research on substance abuse (Combs; Newcomb & Bentler; Rahdert & Grabowski), family therapy applied to substance abuse (Szapocznik et al.; Todd & Selekman), and the addiction/self-help approach (Henry). The coincidental publication of this large number of writings on families and adolescent substance abuse is encouraging. It suggests that all three cultures are vital and contributing. There are important well-written contributions in volumes from each culture. The disjointed status of the field may be a prelude to a significant integrative shift from the isolated cultures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational enhancement therapy for adolescent marijuana users: A preliminary randomized controlled trial.

This study's aims were (a) to investigate the feasibility of a school-based motivational enhancement therapy (MET) intervention in voluntarily attracting adolescents who smoke marijuana regularly but who are not seeking formal treatment and (b) to evaluate the efficacy of the intervention in reducing marijuana use. Ninety-seven adolescents who had used marijuana at least 9 times in the past month were randomly assigned to either an immediate 2-session MET intervention or to a 3-month delay condition. Two thirds of the sample characterized themselves as in the precontemplation or contemplation stages of change regarding marijuana use. Participants' marijuana use and associated negative consequences were assessed at baseline and at a 3-month follow-up. Analyses revealed that both groups significantly reduced marijuana use at the 3-month follow-up ( p = .001); however, no between-group differences were observed. Despite the absence of a clear effect of MET, this study demonstrated that adolescents could be attracted to participate in a voluntary marijuana intervention that holds promise for reducing problematic levels of marijuana use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multisystemic therapy for child abuse and neglect: A randomized effectiveness trial.

The primary purpose of this study was to conduct a randomized effectiveness trial of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) for physically abused youth (mean age = 13.88 years, 55.8% female, 68.6% Black) and their families. Eighty-six families being followed by Child Protective Services due to physical abuse were randomly assigned to MST-CAN or Enhanced Outpatient Treatment (EOT), with both interventions delivered by therapists employed at a community mental health center. Across five assessments extending 16 months post baseline, intent-to-treat analyses showed that MST-CAN was significantly more effective than EOT in reducing youth mental health symptoms, parent psychiatric distress, parenting behaviors associated with maltreatment, youth out-of-home placements, and changes in youth placement. Also, MST-CAN was significantly more effective at improving natural social support for parents. Effect sizes were in the medium to large range for most outcomes examined. Although fewer children in the MST-CAN condition experienced an incident of reabuse than did counterparts in the EOT condition, base rates were low and this difference was not statistically significant. The findings of this study demonstrate the potential for broad-based treatments of child physical abuse to be effectively transported and implemented in community treatment settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity.

A literature review on community studies of adolescent substance use, abuse, or dependence (SU/A/D) and psychiatric comorbidity yielded 22 articles from 15 studies with information on rates, specificity, timing, and differential patterns of comorbidity by gender, race/ethnicity, and other factors. Results revealed that 60% of youths with SU/A/D had a comorbid diagnosis, and conduct disorder (CD) and oppositional defiant disorder (not attention-deficit/hyperactivity disorder) were most commonly associated with SU/A/D, followed by depression. Child psychopathology (particularly CD) was associated with early onset of substance use and abuse in later adolescence. The authors suggest that available data relevant to SU/A/D and psychiatric comorbidity can be used to better address such questions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Site matters: Multisite randomized trial of motivational enhancement therapy in community drug abuse clinics.

[Correction Notice: An erratum for this article was reported in Vol 77(2) of Journal of Consulting and Clinical Psychology (see record 2009-03774-013). There are two errors in the means and standard deviations reported in Table 1 (p. 561). The mean (and standard deviation) for the Total sample % positive urine drug tests (28 days) in the motivational enhancement therapy (MET) column is not 0.21 (SD = 0.35) as reported, but rather 0.28 (SD = 0.40). The mean (and standard deviation) for the Total sample % positive urine drug tests (28 days) in the counseling as usual (CAU) column is not 0.28 (SD = 0.40) as reported, but rather 0.31 (SD = 0.41). These corrections do not change any of the values reported for the d, F, or p statistics in this table.] The effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use was evaluated in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation.

In this article, the authors examine whether delayed substance initiation during adolescence, achieved through universal family-focused interventions conducted in middle school, can reduce problematic substance use during young adulthood. Sixth-grade students enrolled in 33 rural midwestern schools and their families were randomly assigned to 3 experimental conditions. Self-report questionnaires provided data at 7 time points for the Iowa Strengthening Families Program (ISFP), Preparing for the Drug Free Years (PDFY), and control groups through young adulthood. Five young adult substance frequency measures (drunkenness, alcohol-related problems, cigarettes, illicit drugs, and polysubstance use) were modeled as distal outcomes affected by the average level and rate of increase in substance initiation across the adolescent years in latent growth curve analyses. Results show that the models fit the data and that they were robust across outcomes and interventions, with more robust effects found for ISFP. The addition of direct intervention effects on young adult outcomes was not supported, suggesting long-term effects were primarily indirect. Relative reduction rates were calculated to quantify intervention-control differences on the estimated proportion of young adults indicating problematic substance use; they ranged from 19% to 31% for ISFP and from 9% to 16% for PDFY. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reciprocal relations between adolescent substance use and delinquency: A longitudinal latent variable analysis.

Reciprocal relations between self-reported substance use and delinquency were examined through the analysis of 4-wave panel data collected from 1,218 high school students. A longitudinal, latent-variable framework was used to investigate interrelationships between changing patterns of generalized involvement in these 2 problem behaviors, while simultaneously accounting for specificity in drug use (e.g., marijuana use) and delinquency (e.g., theft). Analyses revealed that a model of bidirectional effects between polysubstance use and general delinquency was plausible for boys but not for girls. For boys, the effect of delinquency on substance use was small but consistent over time, whereas the effect of substance use on delinquency was larger but restricted to the earlier waves of the study. Implications for the question of whether or not substance use and delinquency have causal connections are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Buffering effect of religiosity for adolescent substance use.

This research examined the hypothesis that religiosity buffers the impact of life stress on adolescent substance use. Data were from a sample of 1,182 participants surveyed on 4 occasions between 7th grade (mean age = 12.4 years) and 10th grade. Religiosity was indexed by Jessor's Value on Religion Scale (R. Jessor & S. L. Jessor, 1977). Zero-order correlations showed religiosity inversely related to alcohol, tobacco, and marijuana use. Significant Life Events×Religiosity buffer interactions were found in cross-sectional analyses for tobacco, alcohol, and marijuana use. A latent growth analysis showed that religiosity reduced the impact of life stress on initial level of substance use and on rate of growth in substance use over time. Implications for further research on religiosity and substance use are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of early menarche to depression, eating disorders, substance abuse, and comorbid psychopathology among adolescent girls.

This prospective study tested whether early menarche partially accounts for the increases in depression, eating pathology, substance abuse, and comorbid psychopathology that occur among adolescent girls, with structured interview data from a community sample (N?=?496). Early menarche (prior to 11.6 years) was associated with elevated depression, substance abuse, and "any" disorder but did not confer increased risk for anorexia nervosa, bulimia nervosa, or binge eating disorder. Although there was significant comorbidity across all three classes of pathology, early menarche was associated only with comorbid depression and substance abuse. Results provide partial support for the assertion that early menarche is a general risk factor for psychopathology among adolescent girls but suggest that this risk may not apply to certain disorders and that the effects are modest in size. (PsycINFO Database Record (c) 2010 APA, all rights reserved)