Drug Abuse Treatment

Research Findings from February, 2001 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the child and adolescent drug abuse treatment. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Toward a Developmental Family Therapy: The Clinical Utility of Research on Adolescence

Dr. Howard Liddle and colleagues at the University of Miami focus on selected determinants of adolescent growth and development and discuss how this knowledge can have a direct and clinically useful impact on the design of treatment. The authors describe how an understanding of normative processes and developmental psychopathology in adolescent-parent relationships (e.g., attachment; conflict), biological maturation (e.g., puberty; sexuality) and cognitive development (concrete versus abstract thinking) informed the development of multidimensional family therapy for drug abusing youth. Liddle, H. A., Rowe, C., Diamond, G., Sessa, F.M., Schmidt, S. and Ettinger, D. Journal of Marital and Family Therapy, 26 (4), pp. 485-500, 2000.

A Multivariate Process Model of Adolescent 12-Step Attendance and Substance Use Outcome Following Inpatient Treatment

Dr. Mark Myers and colleagues at the University of California, San Diego, examined (1) the relationship between attendance at community-based 12-step meetings and substance use outcome after discharge from an inpatient drug treatment program and (2) a process model of how 12-step attendance affects motivation, coping and self-efficacy which, in turn, affects substance use outcome. Adolescents (N=99; 14-18 years; 60% female) were assessed at 3 and 6 months post-treatment. Results indicate modest beneficial effects of 12-step attendance that were mediated by motivation-for-abstinence but not by abstinence-focused coping or by feelings of self-efficacy. Although average attendance dropped considerably during the second 3-month period, abstainers attended approximately twice as many 12-step meetings during the first 3 months as did adolescents who relapsed. Myers, M.G., Brown, S.A. and Kelly, J.F. Psychology of Additive Behaviors, 14(4), pp. 376-389, 2000.

The Role of Problem Severity, Psychosocial, and Treatment Factors in Adolescent Substance Abuse Treatment Outcome

Dr. Michael Newcomb collaborated with investigators from the University of Minnesota in developing a structural equation model looking at substance abuse problem severity, psychosocial risk and protection, and treatment variables as factors in adolescent drug abuse treatment outcome pathways across 6- and 12-month follow-up points. Findings on resiliency factors and an empirical method adapted from previous research were used to select and assign 10 psychosocial factors to either a multiple protective factor index or a risk factor index. Gender, substance abuse problem severity, treatment modality, treatment length, and aftercare participation were also examined as outcome predictors. The findings suggest that treatment intensity decisions may be better informed by pretreatment psychosocial risk level rather than by substance abuse problem severity. The present study also suggests that drug-abusing adolescents who receive sufficiently long treatment, participate in aftercare, and possess at least 1 individual or interpersonal protective factor during their recovery process have the best chance to maintain gains made during treatment. Latimer, W.W., Newcomb, M., Winters, K.C., and Stinchfield, R.D. Adolescent Substance Abuse Treatment Outcome: the Role of Substance Abuse Problem Severity, Psychosocial, and Treatment Factors. Journal of Consulting and Clinical Psychology, 68(4), pp. 684-696, 2000.

Ethnicity and Gender in Polydrug Use

The purpose of this study was to determine if ethnic and gender differences in polydrug use exist among a cohort of inner-city adolescents during the three-year middle school period. Students in 22 urban schools completed self-report questionnaires with measures of drug use (smoking, drinking, and marijuana use) at three annual assessments. For participating students, (N=2354), analyses of variance were conducted to test for ethnic group (Asian, Black, Hispanic, and White) and gender differences in polydrug use. Ethnic differences were found for polydrug use measures at each assessment point. Asian and Black adolescents generally reported less polydrug use than White and Hispanic youth. When gender differences were evident, boys engaged in more use than girls. The relatively high rates of polydrug use indicate that prevention intervention programs that target multiple substances may be more efficient in reducing overall risk than prevention programs that focus on a single substance (e.g., smoking prevention only). Epstein, J.A., Botvin, G.J., Griffin, K.W., and Diaz, T. Role of Ethnicity and Gender in Polydrug Use Among a Longitudinal Sample of Inner-City Adolescents. Journal of Alcohol and Drug Education, 45, pp. 1- 12, Fall 2000.

Monthly Bursts in Adolescent Drug Use

The goal of this study was to determine the extent to which monthly bursts in substance use (i.e., tobacco, marijuana, alcohol) were related to family and peer relations. Using a structured protocol, monthly interviews were conducted with 181 young adolescents, ages 11-14 yrs old, and their parents. Scores derived from monthly telephone reports described variation in parent involvement, exposure to deviant peers, peer conflicts, and level of family stress. Consistent with an ecological framework of development, environmental factors varied by gender and family membership. Across gender in both 1- and 2-parent families, exposure to peer problem behavior co-varied with increased substance use in the same month. Other monthly predictors varied by gender. Findings suggest that intervention programs for high-risk youth targeting adolescent problem behavior need to focus on managing the peer environment. Dishion, T.J. and Medici Skaggs, N. An Ecological Analysis of Monthly "Bursts" in Early Adolescent Substance Use. Applied Developmental Science, 4(2), pp. 89-97, 2000.

Skill Training Appears to Reduce Recidivism in Juvenile Offenders

This study compared juvenile offenders' recidivism following nonrandom assignment to juvenile diversion, juvenile diversion plus skill training, or juvenile diversion plus mentoring. Juvenile diversion with skill training was shown to be most effective, with a re-arrest rate of 37% two or more years after intake compared to 51% in the mentoring program and 46% in the diversion only program. Skills training was also most cost-effective, achieving a 14% relative reduction in recidivism at a savings of $33,600. Blechman, E.A., Maurice, A., Buecker, B. and Helberg, C. Can Mentoring or Skill Training Reduce Recidivism? Observational Study with Propensity Analysis. Prevention Science 1(3), pp. 139-156, 2000.

Trauma, Drugs and Violence Among Juvenile Offenders

Trauma typically occurs when one experiences a situation where life has been threatened or lost. If the trauma is not resolved, negative residual effects may result in alcohol and drug use, involvement in violent activities as well as the development of mental health problems such as posttraumatic stress disorder (PTSD). Findings from a study examining the link between trauma, drug use and violence among youth are presented. Results from interviews with 414 juveniles remanded to the Office of Children and Family Services (formerly New York State Division For Youth) for assault, sexual assault, robbery or homicide, document the trauma experienced by these youth, as well as how it correlated with their drug usage and participation in violent, illegal activities. Discussion of these findings, their implications for understanding and intervening, and recommendations for future research are highlighted. Crimmins, S.M., Cleary, S.D., Brownstein, H.H., Spunt, B.J., Warley, R.M. Trauma, Drugs and Violence among Juvenile Offenders. J Psychoactive Drugs, 32, pp. 43-54, 2000.

Development of Marijuana Use From Childhood to Young Adulthood

The present study was designed to examine the relationship between unconventionality and marijuana use over time. The sample for this paper consisted of 532 male and female participants interviewed during early adolescence, late adolescence, their early twenties, and their late twenties. Latent growth modeling was used. The findings indicated that (1) the influence of initial unconventionality (T2) on initial marijuana use (T2) was stronger for males, (2) unconventionality at T2 was not significantly related to overall rate of growth in marijuana use, and (3) change in unconventionality was related to overall growth rate of marijuana use. The implications of the findings for prevention and treatment are discussed. Brook, J.S., Whiteman, M., Finch, S.J., Morojele, N.K. and Cohen, P. Individual Latent Growth Curves in the Development of Marijuana Use from Childhood to Young Adulthood. J Behav Med 23(5), pp. 451-464, 2000.