Drug Abuse Treatment

Research Findings from May, 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.

Gender Differences in Juvenile Arrestees' Drug Use, Self-Reported Dependence, and Perceived Need for Treatment

The authors examined gender differences in drug use, self-reported dependence, and perceived need for treatment in a national sample of juvenile arrestees and detainees between the ages of nine and 18 years. A sample of 4,644 boys and girls, drawn from the Juvenile Drug Use Forecasting Survey from 1992 to 1995, was matched by sex within each of seven sites by survey year. In anonymous interviews, respondents were asked about their living arrangements, drug use, and need for drug treatment. Questions about drug use covered marijuana, cocaine, crack, heroin, crystal methamphetamine, amphetamines, and phencyclidine (PCP). Logistic regression was used to identify significant predictors of drug dependence and perceived need for treatment. Results showed that girls were significantly more likely than boys to report dependence but were no more likely to report a need for treatment. Among those who reported current, frequent drug use, girls were significantly less likely than boys to report a need for treatment. Girls who reported having more severe drug problems were more likely than their male counterparts to report dependence and a need for treatment. The authors conclude that clinicians should assess and reduce barriers to treatment perceived by girls in particular to engage them in services before their drug use escalates. Kim, J.Y., and Fendrich, M. Psychiatr Serv, 53(1), pp. 70-75, January 2002.

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. 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., and 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

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. Researchers found 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

The authors 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. 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 among adolescents who had engaged in criminal activity during the 12 months prior to entering DATOS-A treatment. 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,.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

The author attempted 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. Rounds-Bryant, J.L., and Staab, J. Journal of Adolescent Research, 16(6), pp. 624-641, 2001.