Working Alliance, Treatment Satisfaction, and Patterns of Posttreatment Use Among Adolescent Substance Users.

This longitudinal study examined the relationships among the working alliance, treatment satisfaction, and posttreatment use among adolescents in treatment for substance abuse. Adolescents (N = 600) from the Cannabis Youth Treatment study (M. L. Dennis et al., 2002) completed measures of working alliance and treatment satisfaction as well as substance use and substance-related problems at intake and 3, 6, 9, 12, and 30 months' postintake. When controlling for initial substance use and substance-related problems, working alliance, but not treatment satisfaction, predicted use at 3 and 6 months' postintake. Neither working alliance nor treatment satisfaction were predictive of longitudinal patterns of posttreatment use. Implications for the assessment of working alliance and treatment satisfaction are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Distress Tolerance as a Predictor of Early Treatment Dropout in a Residential Substance Abuse Treatment Facility.

A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abstinence Self-Efficacy and Abstinence 1 Year After Substance Use Disorder Treatment.

To better understand the relationship between abstinence self-efficacy and treatment outcomes in substance use disorder patients, experts in the field need more information about the levels of abstinence self-efficacy most predictive of treatment outcomes. Participants (N = 2,967) from 15 residential substance use disorder treatment programs were assessed at treatment entry, discharge, and 1-year follow-up. A signal detection analysis compared the ability of different measures of self-efficacy to predict 1-year abstinence and identified the optimal cutoffs for significant predictors. The maximal level of abstinence self-efficacy (i.e., 100% confident) measured at discharge was the strongest predictor of 1-year abstinence. Treatment providers should focus on obtaining high levels of abstinence self-efficacy during treatment with the goal of achieving 100% confidence in abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spiritual Transcendence as a Predictor of Psychosocial Outcome From an Outpatient Substance Abuse Program.

Does the Spiritual Transcendence Scale (STS; R. L. Piedmont, 1999) predict psychosocial outcomes from an outpatient substance abuse program? Self-report data on symptoms, personality, and coping resources were obtained for 73 consecutive admissions (57 men and 16 women; ages 19-66 years) at intake and again from the 56 (47 men and 9 women) who completed treatment. Controlling for relevant demographic variables, pretreatment STS scores were significantly related to self-ratings at posttreatment. The STS predicted treatment outcomes over and above the contribution of the five-factor model of personality. Significant partial correlations between pretreatment STS scores and therapist ratings of treatment outcome were also obtained. Spiritual Transcendence, especially the facets of Universality and Connectedness, appears to play a significant role in substance abuse recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child Anxiety Treatment: Outcomes in Adolescence and Impact on Substance Use and Depression at 7.4-Year Follow-Up.

Research suggests that the sequelae of childhood anxiety disorders, if left untreated, can include chronic anxiety, depression, and substance abuse. The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders (generalized, separation, and social anxiety disorders) an average of 7.4 years earlier. The 86 participants (ages 15 to 22 years; 91% of the original sample) and their parents completed diagnostic interviews and self- and parent-report measures. According to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. The findings are discussed with regard to child anxiety and some of its sequelae. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent and Parent Alliance and Treatment Outcome in Multidimensional Family Therapy.

In this study, the authors examined the relation between adolescent and parent therapeutic alliances and treatment outcome among 65 substance-abusing adolescents receiving multidimensional family therapy. Observer ratings of parent alliance predicted premature termination from treatment. Observer ratings, but not self-report, of adolescent alliance predicted adolescents' substance abuse and dependency symptoms at posttreatment, as well as days of cannabis use at 3-month follow-up. The association between adolescent alliance and substance abuse and dependency symptoms at posttreatment was moderated by the strength of the parent alliance. Results reveal the unique and interactive effects of the 2 alliances on treatment outcome and emphasize the need for a systemic and well-articulated approach to developing and maintaining the multiple alliances inherent to family therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of Parent Support and Peer Support in Adolescent Substance Use: A Test of Mediated Effects.

This research tested comparative effects of parent and peer support on adolescent substance use (tobacco, alcohol, and marijuana) with data from 2 assessments of a multiethnic sample of 1,826 adolescents, mean age 12.3 years. Multiple regression analyses indicated that parental support was inversely related to substance use and that peer support was positively related to substance use, as a suppression effect. Structural modeling analyses indicated that effects of support were mediated through pathways involving good self-control, poor self-control, and risk-taking tendency; parent and peer support had different patterns of relations to these mediators. The mediators had pathways to substance use through positive and negative recent events and through peer affiliations. Effects for gender and ethnicity were also noted. Mechanisms of operation for parent and peer support are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Controlled Study of a Cigarette Smoking Cessation Intervention for Adolescents in Substance Abuse Treatment.

Tobacco use is prevalent among youth with alcohol and other drug problems, yet this issue has received limited research and clinical attention. This study reports on a controlled evaluation of a cigarette smoking intervention with 54 adolescents in treatment for substance abuse, ages 13-18 (22% female). Participants were assessed at 4 time points. A greater proportion of participants in the treatment condition (n = 26) reported cessation attempts and point abstinence than did control participants (n = 28) at all time points. However, significant differences were found only for point abstinence at a 3-month follow-up. These findings provide initial support for the efficacy of a smoking cessation intervention delivered in the context of adolescent substance abuse treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Alcohol and Other Drugs: Perspectives on Use, Abuse, Treatment and Prevention.

Reviews the book, Alcohol and Other Drugs: Perspectives on Use, Abuse, Treatment and Prevention by Whitehead, Grindstaff and Boydell (Eds.) (1973). According to the editors, the purpose of this collection of twenty three articles is "to provide readers with a somewhat advanced view of some of the major findings and issues in the use of alcohol and other drugs". Eleven of the articles (approximately one third of the book) are directed to alcohol topics and the remainder to other drugs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of the OCDS-Revised: A Measure of Alcohol and Drug Urges With Outpatient Substance Abuse Clients.

Urges to use substances is an important construct in understanding the maintenance of substance use as well as relapse. There is a need to evaluate single instruments measuring global urges to use substances (including alcohol). The Obsessive Compulsive Drinking Scale (OCDS; R. F. Anton, D. H. Moak, & P. Latham, 1995) was revised and tested as a single measure of urges to use substances. Participants were 252 adults entering outpatient substance abuse treatment. Results suggest that the revised scale (OCDS-R) primarily assesses 1 global factor for urges to use substances. In addition, strong support was found for the reliability and concurrent validity of the OCDS-R, although results for its predictive validity were mixed. The OCDS-R is a brief, psychometrically sound self-report instrument that has applicability within clinical and research settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying Shared Environmental Contributions to Early Substance Use: The Respective Roles of Peers and Parents.

Although behavior genetic studies have suggested that early substance use is primarily environmentally mediated, no study has sought to identify the specific sources of environmental variance. Using data obtained from multiple informants, this study assessed the contributions of peer deviance and parent-child relationship problems to substance use in 14-year-old male and female twins (N = 1,403) drawn from the Minnesota Twin Family Study (MTFS). All three phenotypes were influenced primarily by shared environmental variance (average c2 = .51), as was the overlap among them. Moreover, peer deviance and parent-child relationship problems accounted for approximately 77% of the variance in early substance use. Findings also indicated that peer deviance, but not parent-child relationship problems, accounted uniquely for variance in early substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial Mediators of Antiretroviral Nonadherence in HIV-Positive Adults With Substance Use and Mental Health Problems.

This study used data from 1,889 HIV-positive patients on antiretroviral (ARV) medications who participated in the HIV Cost and Services Utilization Study to investigate whether nonadherence to ARV medications among patients with mental health and substance use problems could be explained by difficulty getting and negative attitudes toward ARV medications, poor fit of the regimen with lifestyle, lack of instruction and cues for remembering the regimen from a health care provider, and poor support from others for taking ARV medications. Difficulty getting ARV medications and poor fit with lifestyle were significant mediators of nonadherence for patients with a probable psychiatric disorder. Difficulty getting medication was a mediator for heavy drinkers, and poor fit with lifestyle was a mediator for drug users who drank heavily. Further research is needed to identify and address the barriers to adherence in these populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood ADHD and Adolescent Substance Use: An Examination of Deviant Peer Group Affiliation as a Risk Factor.

Deviant peer group affiliation was evaluated as a risk factor for substance use in adolescents with childhood attention-deficit/hyperactivity disorder (ADHD). Results showed that deviant peer affiliation mediated the relationship between ADHD and substance use, suggesting that children with ADHD are more likely than children without ADHD to become involved with deviant peers and, as a result, more likely to use substances. Moreover, the relationship between deviant peer affiliation and substance use was stronger for adolescents with ADHD, suggesting that once they are immersed in a deviant peer group, adolescents with ADHD are more vulnerable to the negative social influences of that group. This study is the first step in identifying high-risk pathways from childhood ADHD to substance use in adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk and Protective Factors for Substance Use Among African American High School Dropouts.

Risk and protective factors that predict substance use were investigated with 318 African American high school dropout youths who completed the 1992 follow-up of the National Educational Longitudinal Study of 1988. A conceptual model linking positive family relationships and religious involvement to youths' substance use and conventional peer affiliations through a positive life orientation was examined with structural equation modeling. Positive life orientation, which included optimism and conventional goals for the future, fully mediated the influence of family relationships on conventional peer affiliations. Religious involvement directly predicted conventional peer affiliations and positive life orientation. Conventional peer affiliations mediated the other variables' influence on substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practice Makes Progress? Homework Assignments and Outcome in Treatment of Cocaine Dependence.

The relationship between treatment outcome and the extent to which participants completed homework assignments was evaluated among 60 cocaine-dependent individuals assigned to cognitive-behavioral therapy (CBT). Homework was assigned in 72% of all sessions and initiated by participants in 48% of the sessions in which it was assigned. Completion of homework was unrelated to participants' baseline characteristics and several indicators of treatment compliance. Participants who completed more homework assignments demonstrated significantly greater increases in the quantity and quality of their coping skills and used significantly less cocaine during treatment and through a 1-year follow-up. These data suggest that the extent to which participants are willing to complete extrasession assignments may be an important mediator of response to CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of continuing care adherence on environmental risks, substance use, and substance-related problems following adolescent residential treatment.

The effectiveness of adolescent treatment to reduce substance use has been demonstrated by a number of different literature reviews, yet longer term outcome studies have suggested that continued alcohol and other drug use is common. Participation in continuing care services and reductions in environmental risk factors (e.g., peer substance use or alcohol or drug use in the home) have both been found to be associated with improved posttreatment substance use. The authors conducted Path analysis to examine the experimental direct effect of the Assertive Continuing Care Protocol (S. H. Godley, M. D. Godley, & M. L. Dennis, 2001) on general continuing care adherence following residential treatment and the protocol's indirect effect (via general continuing care adherence) on social and environmental risk factors, as well as subsequent substance use and substance-related problems. Supporting previous findings, the final model indicates that greater adherence to continuing care is associated with reductions in environmental risk, which in turn is associated with reduced adolescent substance use and substance-related problems 9 months after discharge from residential treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trajectories of Alcohol and Drug Use and Dependence From Adolescence to Adulthood: The Effects of Familial Alcoholism and Personality.

This study describes trajectories of substance use and dependence from adolescence to adulthood. Identified consumption groups include heavy drinking/heavy drug use, moderate drinking/experimental drug use, and light drinking/rare drug use. Dependence groups include alcohol only, drug only, and comorbid groups. The heavy drinking/heavy drug use group was at risk for alcohol and drug dependence and persistent dependence and showed more familial alcoholism, negative emotionality, and low constraint. The moderate drinking/experimental drug use group was at risk for alcohol dependence but not comorbid or persistent dependence and showed less negative emotionality and higher constraint. Familial alcoholism raised risk for alcohol and drug use and dependence in part because children from alcoholic families were more impulsive and lower in agreeableness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of Community-Based Treatment for Substance-Abusing Adolescents: 12-Month Outcomes of Youths Entering Phoenix Academy or Alternative Probation Dispositions.

Whereas strong efficacy research has been conducted on novel treatment approaches for adolescent substance abusers, little is known about the effectiveness of the substance abuse treatment approaches most commonly available to youths, their families, and referring agencies. This report compares the 12-month outcomes of adolescent probationers (N = 449) who received either Phoenix Academy, a therapeutic community for adolescents that uses a treatment model that is widely implemented across the U.S., or an alternative probation disposition. Across many pretreatment risk factors for relapse and recidivism, groups were well matched after case-mix adjustment. Repeated measures analyses of substance use, psychological functioning, and crime outcomes collected 3, 6, and 12 months after the baseline interview demonstrated that Phoenix Academy treatment is associated with superior substance use and psychological functioning outcomes over the period of observation. As one of the most rigorous evaluations of the effectiveness of a traditional community-based adolescent drug treatment program, this study provides evidence that one such program is effective. Implications of this finding for the dissemination of efficacious novel treatment approaches are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of Forgiveness Therapy on Anger, Mood, and Vulnerability to Substance Use Among Inpatient Substance-Dependent Clients.

Anger and related emotions have been identified as triggers in substance use. Forgiveness therapy (FT) targets anger, anxiety, and depression as foci of treatment. Fourteen patients with substance dependence from a local residential treatment facility were randomly assigned to and completed either 12 approximately twice-weekly sessions of individual FT or 12 approximately twice-weekly sessions of an alternative individual treatment based on routine drug and alcohol therapy topics. Participants who completed FT had significantly more improvement in total and trait anger, depression, total and trait anxiety, self-esteem, forgiveness, and vulnerability to drug use than did the alternative treatment group. Most benefits of FT remained significant at 4-month follow-up. These results support FT as an efficacious newly developed model for residential drug rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)