Drug Abuse Treatment

Research Findings from February, 2002 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.

Enhanced Cognitive-Behavioral HIV Prevention Intervention for Adolescents Abusing Alcohol and Other Drugs

Dr. Robert Malow and colleagues at the University of Miami have designed an intervention to reduce HIV risk behaviors among adolescents in inpatient substance abuse treatment. An initial efficacy study showed that, compared to a Health-Promotion group intervention, an enhanced cognitive-behavioral intervention produced significantly better condom use skills and more favorable attitudes toward condoms. Malow, Deviux, and Rosenberg, Addictions Newsletter, 8, pp. 2 –14, 2001.

Buprenorphine Treatment of Pregnant Opioid-dependent Women: Maternal and Neonatal Outcomes

Researchers at the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine reported an open-label prospective study that examined maternal and neonatal safety and efficacy outcome measures during and following prenatal buprenorphine exposure. Three opioid-dependent pregnant women received 8 or 12 mg sublingual buprenorphine tablets daily for 15-16 weeks prior to delivery. Results showed that buprenorphine in combination with comprehensive prenatal care was safe and effective in these women. Prenatal exposure to buprenorphine resulted in normal birth outcomes, a mean of 4.33 days (minimum possible=4) hospitalization, and a 'relatively mild' neonatal abstinence syndrome comprised primarily of tremors (disturbed), hyperactive moro and shortened sleep after feeding. The infants required no pharmacological treatment. Onset of neonatal abstinence signs occurred within the first 12 h after birth, peaked by 72 h and returned to below pre-12 h levels by 120 h. It is concluded that buprenorphine has potential utility for the treatment of pregnant opioid-dependent women. Johnson, R.E., Jones, H.E., Jasinski, D.R., Svikis, D.S., Haug, N.A., Jansson, L.M., Kissin, W.B., Alpan, G., Lantz, M.E., Cone, E.J., Wilkins, D.G., Golden, A.S., Huggins, G.R., and Lester, B.M. Buprenorphine Treatment of Pregnant Opioid--Dependent Women: Maternal and Neonatal Outcomes. Drug Alcohol Depend, 63(1), pp. 97-103, 2001.

Sex-related HIV Risk Reduction Behavior Among Adolescents in DATOS-A

This study examines changes in levels of HIV-related risky sexual behaviors pre- and post- treatment in relation both to patient characteristics and treatment services, received among 796 adolescents entering drug treatment programs in four cities in the United States. More than half of the adolescents (54%) reported reductions in risky sex behavior after treatment or sustained low levels of risk. Conduct-disordered adolescents with abuse history, unmet physical and emotional needs, and low commitment to school were associated with lack of improvement. Furthermore, conduct-disordered adolescents who perceived treatment to be effective were more likely to show posttreatment improvement, with the exceptions that those who scored high on hostility or low in self-perception were not likely to improve. Among adolescents without conduct disorder, receipt of mental health services was associated with improvements in their risky sex behavior The effect of drug treatment on HIV risk reduction can be increased when attention is focused on adolescents' pretreatment risk factors, service needs, in treatment responses, and key personality characteristics. Joshi, V., Hser, Y.I., Grella, C.E., and Houlton, R. Journal of Adolescent Research, 16(6), pp. 642-660, 2001.

Social Learning Processes and Smoking Cessation

Maturing out and social learning are the two predominant hypotheses to explain cessation from various psychoactive drugs. This study examined the predictors of smoking cessation in a nonclinical sample of 134 male and 190 female, young adult, regular (daily) smokers within a social learning and maturing-out framework. Four waves of prospective, longitudinal data from a community sample followed from adolescence into young adulthood were analyzed. Logistic regression analyses were used to test the effects of differential associations, definitions, differential reinforcement, and changes in adult role status on smoking cessation in young adulthood. Becoming married to a nonsmoker and decreases in the proportion of friends who smoked were significant predictors of cessation. Current smokers and stoppers did not differ significantly in terms of prior intensity of cigarette use or alcohol abuse/dependence. They also did not differ in terms of psychological characteristics, including depression and prior coping use of cigarettes. Social networks were more important than social roles for predicting cessation in young adulthood. Thus, smoking cessation programs should focus on social learning processes. Chen, P.H., White, H.R., and Pandina, R.J. Addict Behav, 26(4), pp. 517-529, 2001.

Engagement Models for Adolescents in DATOS-A

Considerable research conducted with adults in drug treatment has demonstrated that engaging patients is essential for maximizing treatment retention, completion, and posttreatment outcome. This study applies a model of treatment engagement previously developed and tested with adults. Based on the importance of during-treatment activities for improving outcomes, relationships between patient background, treatment readiness, and therapeutic engagement were examined in a national sample of adolescents admitted to 20 treatment programs representing three modalities. Adolescent patients with higher readiness for treatment at intake subsequently became more therapeutically involved, replicating previous findings on relationships between motivation and engagement in adult samples. One of the most influential background factors associated with higher treatment readiness was patient relationships with family and friends. Interventions that focus on treatment readiness appear to be appropriate strategies for improving treatment engagement. Broome, K.M., Joe, G.W., Simpson, D.D. Journal of Adolescent Research, 16(6), pp. 608-623, 2001.

Treatment Service Patterns and Organizational Structures: An Analysis of Programs in DATOS-A

Findings from earlier studies have suggested that like adults, adolescent patient profiles differ by modality. As a first step in examining drug abuse treatment typologies for adolescents, the researchers investigated the relationship between patient needs and program characteristics. They hypothesized that there may be systematic differences in the types of services provided that are a function of program characteristics as well as the needs of patients entering treatment. The availability of a variety of treatment services was examined within a national sample of programs treating adolescent drug abuse patients. Treatment service delivery profiles were created and examined in the context of organizational variables such as program modality program directors' academic credentials, program capacity staff composition, accreditation, and patient problems. Results suggested that distinct profiles of services existed within residential and outpatient modalities and that these service profiles were related both to organizational factors and to patient problem profiles. Delany, P.J., Broome, K.M., Flynn, P.M., and Fletcher, B.W. Journal of Adolescent Research, 16(6), pp. 590-607, 2001.

Drug Abuse Treatment and Comprehensive Services for Adolescents

Data from two national studies of treatment spanning two decades-Treatment Outcome Prospective Study (TOPS), 1979 to 1981, and Drug Abuse Treatment Outcome Studies for Adolescents (DATOS-A), 1993 to 1995-provided a comparison of treatment and services provided to 261 TOPS and 1.519 DATOS-A in treatment adolescent patients in a cross-modality sample of 24 TOPS and 31 DATOS-A programs. The authors used patient self-reports of treatment needs and services received to compare unmet needs for six services. Findings showed a general decline over treatment eras in services received that was only partially offset by significant decreases in some self-reported service needs in DATOS-A. Unmet needs increased significantly over treatment eras for specific services, including psychological, family, employment, and financial services. The highest need in both studies was for family services. The DATOS-A appeared to be addressing family needs better than the TOPS program much of which was more adult focused. Across all DATOS modalities, from 40% to 50% patients reported unmet need for psychological services, considerably higher than the 7% to 10% of TOPS patients. Potential explanations for the increases in unmet needs include changes in treatment access and decreases in program resources for services. Etheridge, R.M., Smith, J.C., Rounds-Bryant, J.L., and Hubbard, R.L. Journal of Adolescent Research, 16(6), pp. 563-589, 2001.

The Effect of Drug Treatment on Criminal Behavior among Adolescents in DATOS-A

This study examined the effects on criminal behavior among 1,167 adolescents who participated in a community-based substance abuse treatment study (Drug Abuse Treatment Outcome Studies for Adolescents) (DATOS-A). The primary goals of this study were to assess the effect of substance abuse treatment on adolescent crime and to identify the patient characteristics that were most closely associated with reductions in crime during the posttreatment period. Results confirmed that among adolescents who had engaged in criminal activity during the 12 months prior to entering DATOS-A treatment, reductions in alcohol or marijuana use were independently associated with significant reductions in the likelihood of committing crimes during the 12-month follow-up period. The present study also provides further support for emphasizing dynamic rather than static patient characteristics to predict the likelihood of continued drug-related offending among substance-abusing adolescents. Farabee, D., Shen, H.K., Hser, Y.I., Grella, C.E., and Anglin, M.D. Journal of Adolescent Research, 16(6), pp. 679-696, 2001.

Prospective Risk Factors and Treatment Outcomes Among Adolescents in DATOS-A

The researchers applied a problem behavior approach to examining the relationship between pretreatment risk factors and posttreatment outcomes among 292 admissions to nine outpatient drug-free (ODF) and 418 admissions to eight residential (RES) adolescent programs. Assessments were administered at intake into treatment and 12 months following discharge. Using a structural modeling approach, the researchers found stability over time for alcohol use, criminal involvement, and psychological maladjustment. For adolescents treated in outpatient programs, (a) severity of drug use predicted lower rates of treatment retention, and (b) family drug involvement was related to higher posttreatment rates of alcohol use. Among those treated in residential programs, (a) family drug involvement and criminal involvement predicted lower rates of treatment retention, and (b) conduct disorders were related to more marijuana use at follow-up. The findings underscore the need for intervention strategies that address the intrapsychic and interpersonal functioning of drug-abusing adolescents to improve their behavioral outcomes. Galaif, E.R., Hser, Y.I., Grella, C.E., and Joshi, V. Journal of Adolescent Research, 16(6), pp. 661-678, 2001.

Patient Characteristics and Treatment Outcomes for African American, Hispanic, and White Adolescents in DATOS-A

This study attempts to extend what is known about adolescent substance abusers in adolescent-oriented substance abuse treatment by describing and comparing background and pretreatment characteristics and posttreatment outcomes of African American (n = 213), Hispanic (n = 108), and White adolescent (n = 773) substance abusers who participated in the Drug Abuse Treatment Outcome Studies for Adolescents (DATOS-A). The pretreatment data indicated that patients in each group were similar only with respect to basic demographics (gender, age and primary drug use) but differed in terms of referral source, involvement with the criminal justice system and prevalence of mental disorders. Posttreatment comparisons revealed significant racial/ethnic differences in serious posttreatment criminal behavior, only. Logistic regression results indicated that African American adolescents had a lower likelihood of engaging in serious illegal activity as compared to White adolescents during the posttreatment period. The results of this study provide at mechanism for more comprehensive understanding of adolescent substance abusers, their treatment needs, and their treatment outcomes. Rounds-Bryant, J.L., and Staab, J. Journal of Adolescent Research, 16(6), pp. 624-641, 2001.