Drug Abuse Treatment

Research Findings from September, 2000 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 Adolescent Drug Abuse: Issues of Comorbidity and Family Functioning

Dr. Gayle Dakof, University of Miami, investigated gender differences in patterns of co-morbidity and family functioning among a sample of 95 youths (42 girls) referred by juvenile justice (80%), education (10%) and social welfare (10%) for substance abuse treatment. Findings indicate that male and female adolescent substance users (13-17 years) entering treatment do differ. The girls not only used drugs and engaged in externalizing behaviors as extensively as did their male counterparts but they also were distinguished by their higher levels of internalizing symptoms and family dysfunction. Dakof, G. Journal of Psychoactive Drugs, 32(1), pp. 25-32, 2000.

Post-Treatment Outcomes of Adolescent Females Referred for Conduct Disorder and Substance Use Disorders

Dr. Elizabeth Whitmore and colleagues, University of Colorado, investigated whether symptoms associated with substance abuse/dependence, conduct disorder and other psychiatric disorders were reduced in adolescents (13-19 years) admitted to a multi-component outpatient drug treatment program. Although the results indicate improvement in three areas (i.e., delinquency and conduct disorder [CD]; attention deficit hyperactivity disorder [ADHD]; educational/vocational status), substance involvement and level of depression did not improve. Unlike results from a concomitant study with boys, no pre-treatment variables predicted post-treatment drug use or conduct outcomes among the girls. And only two post-treatment factors (peer problems and number of ADHD symptoms) were found related to CD and the substance use disorders outcomes. Whitmore, E.A., Mikulich, S.K., Ehlers, K.M. and Crowley, T.J. Drug and Alcohol Dependence, 59, pp. 131-141, 2000.

Effectiveness of the Minnesota Model Approach in the Treatment of Adolescent Drug Abusers

Dr. Ken Winters and colleagues at the University of Minnesota assessed adolescents with substance use disorders eligible to enroll in a 12-step drug treatment program. Youths were evaluated 6- and 12-month post-treatment in terms of their drug use outcomes. Three groups of adolescents participated in the study: those (n=101) who completed treatment, those (n=39) who did not, and those (n=66) on a waiting list. Among treatment completers, residential and outpatient samples were also compared. Results indicate completing treatment was associated with far superior outcomes compared to those who did not complete treatment or receive any at all. Percentage of treatment completers reporting abstinence one-year post treatment was 23% compared to 2.6% for non-completers and 3.0% for those on the wait-list. No differences were found between residential and outpatient groups or was gender or age a factor. Winters, K.C., Stinchfield, R.D., Opland, E., Weller, C. and Latimer, W.W. Addiction, 95(4), pp. 601-612, 2000.

Cross-national Comparisons of the Prevalences and Correlates of Mental and Substance Use Disorders

Researchers at Harvard University, other U.S. and foreign research institutions and the World Health Organization (WHO) have formed an International Consortium in Psychiatric Epidemiology (ICPE) in order to carry out cross-national comparative studies of the prevalences and correlates of mental disorders. This article describes the findings of surveys in seven countries in North America (Canada and USA), Latin America Brazil and Mexico), and Europe (Germany, Netherlands, and Turkey), using a version of the WHO Composite International Diagnostic Interview (CIDI) to generate diagnoses. The results are reported using DSM-III-R and DSM-IV criteria without diagnostic hierarchy rules for mental disorders and with hierarchy rules for substance-use disorders. Prevalence estimates varied widely--from >40% lifetime prevalence of any mental disorder in Netherlands and the USA to levels of 12% in Turkey and 20% in Mexico. Comparisons of lifetime versus recent prevalence estimates show that mental disorders were often chronic, although chronicity was consistently higher for anxiety disorders than for mood or substance-use disorders. Retrospective reports suggest that mental disorders typically had early ages of onset, with estimated medians of 15 years for anxiety disorders, 26 years for mood disorders, and 21 years for substance-use disorders. All three classes of disorders were positively related to a number of socioeconomic measures of disadvantage (such as low income and education, unemployed, unmarried). Analysis of retrospective age-of-onset reports suggest that lifetime prevalences had increased in recent cohorts, but the increase was less for anxiety disorders than for mood or substance-use disorders. Delays in seeking professional treatment were widespread, especially among early- onset cases, and only a minority of people with prevailing disorders received any treatment. The authors conclude that there is a need for demonstration projects of early outreach and intervention programs for people with early-onset mental disorders, as well as quality assurance programs to look into the widespread problem of inadequate treatment. Andrade, L., Caraveo-Anduaga, J.J., Berglund, P., Bijl, R., Kessler, R.C., Demler, O., Walters, E., Kylyc, C., Offord, D., Ustun, T.B., and Wittchen, H.U. Cross-national Comparisons of the Prevalences and Correlates of Mental Disorders. Bulletin of the World Health Organization, 78(4), pp. 413-426, 2000.

Outcomes of a Secondary Preventive Intervention with Aggressive Children

Teacher-identified aggressive children were randomly assigned to one of two treatment conditions, both of which involved college student mentors. The experimental condition (PrimeTime) combined therapeutic mentoring, training in problem-solving skills, and consultation with parents and teachers. The comparison treatment (Standard Mentoring) relied solely on the skills of minimally trained, unsupervised mentors. Both interventions lasted 16 months. The goal was to examine the efficacy of the PrimeTime intervention and the soundness of the model of change. Outcome assessments (at posttreatment and at one-year follow-up) were based on parent-, teacher-, and peer-reports of children's aggression and others' acceptance, as well as on children's self-rated competence and acceptance by others. Outcome analyses revealed small gains for both treatments and provided only partial support for the efficacy of the PrimeTime intervention. Analyses of change processes supported the conceptual model but also identified iatrogenic effects that may have attenuated the therapeutic impact of PrimeTime. The discussion highlights the importance of testing both intervention efficacy and putative mechanisms of change when evaluating newly developed treatment models. Cavell, T.A., and Hughes, J.N. Secondary Prevention as Context for Assessing Change Processes in Aggressive Children. Journal of School Psychology, 38 (3), pp. 199-235, 2000.

A Manualized Preventive Intervention for Juvenile Offenders

Multi-problem families are often unprepared to provide support for recovering juvenile offenders that can prevent recidivism and associated negative outcomes, including substance abuse. Despite this, juvenile courts often return juvenile offenders to their families during parole, probation, and as an alternative to prosecution. This article provides information on a manual that describes Prosocial Family Therapy (PFT), a method of multisystemic care for juvenile offenders based on theories of risk and protective factors and therapy process. PFT integrates specific parent training techniques and nonspecific family therapy strategies. It includes techniques for reinforcing positive behaviors, skills training in communication, and strategies for motivating behavior change. Additionally, the manual describes how courts, schools, community agencies, and residential treatment centers can provide comprehensive care to juvenile offenders, ensure protocol adherence, and assess clinical significance of results. Blechman, E.A. and Vryan, K.D. Prosocial Family Therapy: A Manualized Preventive Intervention for Juvenile Offenders. Aggression and Violent Behavior 5(4), pp. 343-378, 2000.

Demographic, Individual, and Interpersonal Predictors of Adolescent Alcohol and Marijuana Use Following Treatment

A vulnerability model of adolescent substance abuse treatment outcome provided the basis for investigating demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of adolescents (N = 225) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 months posttreatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-month follow-up. Peer substance use at intake and 6-month posttreatment both predicted substance use frequency outcomes at 12-month follow-up. Alcohol and marijuana use frequencies at 6-month follow-up also predicted continued use for these substances throughout the remainder of the 1st posttreatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st posttreatment year. Elevated psychological substance dependence at 6-month follow-up was a unique risk factor for subsequent marijuana use. Latimer, W.W., Winters, K.C., Stinchfield, R., and Traver, R.E. Psychol Addict Behav, 14(2), 162-173, 2000.

The Effectiveness of the Minnesota Model Approach in the Treatment of Adolescent Drug Abusers

Outcomes of drug-abusing adolescents treated with a 12-Step "Minnesota Model" approach (inpatient and outpatient) were examined at 6 and 12 months post-treatment among three groups of adolescents: those who completed treatment, those who did not, and those on a waiting list. Subjects were 245 clinic-referred adolescents (12-18 years old) who met at least one DSM-III-R substance dependence disorder. Analyzed from both relative and absolute perspectives, it was found that completing treatment was associated with far superior outcome compared to either not completing or not receiving treatment. In the year after treatment, 53% of treatment completers reported either abstinence or a minor lapse, compared to 15% for the non-completers and 28% for the waiting list group. Favorable drug abuse treatment outcomes were about two to three times more likely if treatment was completed. There were no outcome differences between residential and outpatient groups. Alcohol was the most common drug used during the follow-up period, despite cannabis being the preferred drug at intake. Winters, K.C., Stinchfield, R.D., Opland, E., Weller, C., and Latimer, W.W. Addiction, 95(4), pp. 601-612, 2000.

Adolescent Amphetamine Users in Treatment, Client Profiles and Treatment Outcomes

The characteristics of adolescent amphetamine users admitted to residential therapeutic community treatment across the eastern United States and Canada 1992-1994 were examined. Amphetamine using adolescents were likely to be white, older, and have parents with higher education and occupational levels than nonusers. However, they also had more psychopathology, more extensive drug use and criminal histories, and engaged in more HIV-risk behaviors than nonusers. Additionally, amphetamine users tend to come from homes where one or both parents used illicit drugs, drank regularly, or had a mental illness, and they often reported histories of childhood maltreatment. At one-year follow-up, being an amphetamine user did not predict differences in treatment outcome after the client's demographic characteristics, overall drug use severity, and treatment completion were taken into account. Hawke, J.M., Jainchill, N., and De Leon, G. J Psychoactive Drugs, 32(1), pp. 95-105, 2000.

Adolescents in Therapeutic Communities, One-Year Posttreatment Outcomes

One-year post-treatment status was examined for 485 adolescents who had been in residential therapeutic communities (TCs). The majority of the sample had been mandated to treatment by the criminal or juvenile justice system. Most reported marijuana as the main drug of abuse. One year after treatment, there were significant reductions in drug use and criminal activity. The most consistent predictors of positive outcomes were completion of treatment and not associating with deviant peers post-treatment. Jainchill, N., Hawke, J., De Leon, G., Yagelka, J. J Psychoactive Drugs, 32(1), pp. 81-94, 2000.

Tobacco Smoking in Adolescents

This review summarizes what is currently known about tobacco use in children and adolescents. Throughout the tobacco epidemic, long-term nicotine dependence has resulted primarily from the initiation of tobacco use during adolescence, and many adolescents try to quit and fail. Strategies to prevent the onset and treat adolescent tobacco dependence have had limited success. In addition, adolescents do not benefit from the same level of societal support for cessation attempts as adults, and they may be less motivated to quit despite the negative health consequences. Overall, the impact of adolescent smoking cessation clinics has been disappointing due to low participation, high attrition, and low quit rates. This review considers the therapeutic reduction of smoking rates (exposure reduction) as an intermediate therapeutic goal for adolescent individuals who are dependent or dependence-prone, but for whom initial treatment interventions do not yield complete cessation. Moolchan, E.T., Ernst, M., and Henningfield, J.E. Journal of American Academy of Child and Adolescent Psychiatry, 39, pp. 682-693, 2000.

Pictorial Instrument for Child and Adolescent Psychiatry

The pictorial instrument for child and adolescent psychiatry (PICA-III-R) is presented as part of a comprehensive review of the tools used to diagnose psychiatric disorders in children and adolescents. The development of the PICA-III-R, its content, its initial psychometric properties, and directions for its use are described. The PICA-III-R assesses all DSM-III-R Axis-I psychiatric disorders in children aged 6 to 16 years, categorically (diagnosis present or absent) and dimensionally (range of severity). It comprises 137 pictures organized in modules that cover five diagnostic categories, including disorders of anxiety, mood, psychosis, disruptive behavior, and substance abuse. Its initial psychometric properties are promising with good internal consistency, significant discriminative power for diagnoses, and sensitivity to changes. Despite a large interest expressed by child psychiatrists, further testing has not been possible for practical reasons unrelated to the scientific importance of this work. Although it needs to be modified to follow DSM-IV criteria, the PICA-III-R can be of significant help to child psychiatrists, for clinical as well as research diagnostic purposes. Additionally, it can be used for the assessment of non-English speaking, or hearing/speech impaired children. Ernst, M., Cookus, B.A., and Moravec, B.C. Journal of American Academy of Child and Adolescent Psychiatry, 39, pp. 94-99, 2000.