Drug Abuse Treatment

Research Findings from February, 2005 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.

Interpersonal Maladjustment as Predictor of Mother's Response to Relational Parenting Intervention

This research team previously demonstrated that a Relational Psychotherapy Mothers' Group (RPMG) was more effective in improving parenting than standard drug counseling (DC) for mothers enrolled in methadone maintenance. The research team recently examined whether mother's interpersonal maladjustment predicted a differential response to RPMG in a sample of 52 mothers and 24 children ages 7 and 16 who had completed baseline, post-treatment, and 6-month follow-up assessments. Results indicated an interaction effect; as maternal interpersonal maladjustment increased, parenting problems improved for mothers in the RPMG group, but remained the same or worsened for DC mothers. Mothers' and children's reports of child maltreatment risk were in or near the normal range for RPMG mothers but in or near clinical range for DC mothers at post-treatment and follow-up. RPMG mothers reported improved affective interactions and the DC group reported no such improvements, regardless of mothers' level of interpersonal maladjustment. These findings highlight the importance of including parenting interventions in substance abuse treatment and the value of interpersonally oriented interventions for substance-abusing mothers and their children. Suchman, N.E., McMahon, T.J., and Luthar, S.S. Journal of Substance Abuse Treatment, 27, pp. 135-143, 2004.

A Randomized Controlled Trial of Pemoline for Attention-Deficit/Hyperactivity Disorder in Substance-Abusing Adolescents

In adolescents with substance use disorder (SUD), comorbid attention-deficit/hyperactivity disorder (ADHD) is associated with greater severity of substance abuse, conduct problems, and worse treatment outcomes. Although many controlled trials have established the efficacy of psychostimulants, including pemoline, for ADHD in children and adolescents, none have been conducted in adolescents with SUD. This randomized, placebo-controlled trial, conducted between 1996 and 2000, evaluated the safety and efficacy of pemoline on substance abuse and conduct problems. Sixty-nine adolescents (aged 13-19) with conduct disorder (CD), SUD, and ADHD were recruited from the community and randomly assigned to a 12-week clinical trial of pemoline (n = 35) or placebo (n = 34), titrated over 4 weeks to a single morning dose of 75 to 112.5 mg as tolerated. Pemoline had greater efficacy than placebo for ADHD as determined by significantly more Clinician's Global Impression-Improvement (CGI-I) ratings of 1 (very much improved) or 2 (much improved) at the study endpoint (n = 69; p <.05). There was also greater reduction in ADHD severity on the parent-rated Conners Hyperactivity-Impulsivity scale in pemoline-treated study completers compared to placebo-treated completers (pemoline, n = 17; placebo, n = 16; p <.01), but no difference between groups in the intent-to-treat analysis (n = 68; p <.13). Substance use did not decline in either group, and there was no difference between groups in baseline to study endpoint change in substance use or CD symptoms. Overall, pemoline was well tolerated, demonstrating a good safety profile and no elevation in liver enzyme levels. Pemoline was efficacious for ADHD but did not have an impact on CD or substance abuse in the absence of specific treatment for SUD. Riggs, P.D., Hall, S.K., Mikulich-Gilbertson, S.K., Lohman, M. and Kayser, A. A Randomized Controlled Trial of Pemoline for Attention-Deficit/Hyperactivity Disorder in Substance-abusing Adolescents. J Am. Acad. Child Adolesc.Psychiatry, 43, pp. 420-429, 2004.

ADHD Status and Relapse In Adolescent Drug Abusers following Treatment

This study examined adolescent drug abusers in treatment (N = 220) to estimate the degree to which probable ADHD status increases the odds of post-treatment alcohol, marijuana, and other drug relapse during 6 months following discharge. Drug abusing youth with probable ADHD status exhibited 2.5 times the risk of post-treatment alcohol relapse when compared to youth without probable ADHD status while controlling for demographics, pretreatment conduct-disordered behavior, pretreatment alcohol use frequency, and treatment factors. A significant crude association between probable ADHD status and other drug relapse was not maintained when adjusted for pretreatment conduct-disordered behavior, pretreatment other drug use frequency, or treatment factors. The findings suggest that standard treatment approaches that do not directly address co-morbid disorders may result in elevated post-treatment relapse rates among recovering youth with ADHD. Latimer, W.W., Ernst, J., Hennessey, J., Stinchfield, R.D., and Winters, K.C. Relapse Among Adolescent Drug Abusers Following Treatment: The Role of Probable ADHD Status. Journal of Child and Adolescent Substance Abuse, 13(3), pp. 1-16, 2004.

Effectiveness of Commonly Available Substance Abuse Treatment

Strong efficacy research has been conducted on novel treatment approaches for adolescent substance abusers, yet, 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. Morral, A.R., McCaffrey, D.F. and Ridgeway, G. Effectiveness of Community-Based Treatment for Substance-Abusing Adolescents: 12-Month Outcomes of Youths Entering Phoenix Academy or Alternative Probation Dispositions. Psychology of Addictive Behaviors. 18(3), pp. 257-268, 2004.