Drug Abuse Treatment

Research Findings from September, 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.

Study Links Recalled Adolescent Peer Norms About Drug Use With Current Drug Use

Drug use among adolescents is a significant social and public health problem in the U.S. and in many other countries. This study explored the relationship between the drug use norms of young adult peers (recalled from age 15) and subjects' current drug use in the past 12 months. Subjects included two samples of 18-24 year olds from a low income, minority neighborhood in New York City, a probabilistically selected household sample, and a targeted sample of users of cocaine, heroin, crack or injected drugs. Norms varied by drug, and were least for marijuana, and increasingly negative for cocaine, heroin, crack, and injected drugs. There was a strong relationship between recalled norms and current use for both individual drugs and a hierarchically defined level of drug use; this relationship remained significant after controlling for socio-demographics and parental and sibling drug use. Intervention programs for young teens that influence peer selection and norms of groups of adolescents should be developed and tested. Research is also needed on the social, economic, political, and other determinants of norms in the neighborhood and community context. Flom, P.L., Friedman, S.R., Kottiri, B.J., Neaigus, A., and Curtis, R. Recalled Adolescent Peer Norms Towards Drug Use in Young Adulthood in a Low-Income, Minority Urban Neighborhood. Journal of Drug Issues, pp. 425-444, Spring 2001.

Project EX - Outcomes of a Teen Smoking Cessation Program

Project EX is an eight-session teen school-based clinic tobacco use cessation program that involves the inclusion of enjoyable motivating activities (games, talk show, and alternative medicine-type) to try to enhance quit rates among youth. This clinic program was tested in a three-group experimental design: clinic-only, clinic plus a school-as-community (SAC) component, and standard care control. Eighteen schools were assigned to the three conditions using a randomized block design. A total of 335 smokers participated in the study, making this the largest controlled teen smoking cessation field trial conducted to date. Seventeen percent of the smokers enrolled in the clinics had reports of having quit smoking for at least the last 30 days at 3-month follow-up (5 months after the program quit day), compared to only 8% of the control condition smokers over the same time period. The Project EX clinic component appears to be an effective means of tobacco use cessation among teens. Sussman, S., Dent. C.W., and Lichtman, K.L. Project EX - Outcomes of a Teen Smoking Cessation Program. Addictive Behaviors, 26 (3), pp. 425-438, 2001.

School-based Tobacco Use Prevention and Cessation: Where are We Going?

The objective of this article is to discuss the past, present, and future directions of school-based tobacco use prevention and cessation research. It discusses the origins of tobacco use prevention research; how prevention research advanced with empirical etiologic work; the genesis of comprehensive social influences programming and its contents; multiple modalities of programming beyond the school setting; and the rebirth of teen cessation programming and the issue of dissemination. Results indicate there are many avenues of teen tobacco use prevention and cessation research and practice that need continued exploration, particularly regarding effects on mediation and teen cessation. This discussion provides background to assist health behavior researchers and practitioners to move forward in this area. Sussman, S. School-based Tobacco Use Prevention and Cessation: Where are We Going? American Journal of Health Behavior 20, 25(3), pp. 191-199, 2001.

Predictors of Smoking Cessation from Adolescence into Young Adulthood

Although smoking cigarettes is hazardous to health and cessation has positive health benefits, few smokers are able to successfully quit. The purpose of this study was to examine the predictors of smoking cessation in a non-clinical 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. Predictors of Smoking Cessation from Adolescence into Young Adulthood. Addict Behav, 26(4), pp. 517-529 2001.

Influence of Parental Child-rearing Practices and Environment on Adolescent Drug Use

This study examined the relationship between the domains of environmental factors, family illegal drug use, parental child-rearing practices, maternal and adolescent personality attributes, and adolescent illegal drug use. A nonclinical sample of 2,837 Colombian youths and their mothers were interviewed about intrapersonal, interpersonal, and environmental factors in their lives. Results indicated that certain environmental factors (e.g., violence, drug availability, and machismo), family drug use, a distant parent-child relationship, and unconventional behaviors are risk factors for adolescent illegal drug use. As hypothesized, results showed that the adverse effects of family illegal drug use on adolescent drug use can be buffered by protective parental child-rearing practices and environmental factors, leading to less adolescent illegal drug use. Prevention and treatment efforts should incorporate protective environmental, familial, and intrapersonal components in order to reduce adolescent illegal drug use. Brook, J.S., Brook, D.W., De La Rosa, M., Whiteman, M., Johnson, E., and Montoya, I. J. Behav Med, April 24(2), pp. 183-203, 2001.

An Evaluation of Drug Treatments for Adolescents in 4 US Cities

Little is known about outcomes of community-based treatment programs for adolescents with drug problems. This study evaluated the treatment outcomes of 1,167 adolescents (age range, 11-18 years; 368 females, 799 males) from 4 US cities (Pittsburgh, Pa; Minneapolis, Minn; Chicago, Ill; and Portland, Ore) using a naturalistic, non- experimental evaluation design. These adolescents were consecutive admissions between 1993 and 1995 in one of 23 community-based treatment programs in the Drug Abuse Treatment Outcome Studies for Adolescents. Included were 418 admissions to 8 residential programs, 292 admissions to 9 outpatient drug-free programs, and 457 admissions to 6 short-terminpatient programs. Adolescents in treatment typically had multiple problems (e.g., 58.4% of them were involved in the legal system, and 63.0% met diagnostic criteria for a mental disorder). Nevertheless, less than half (43.8%) of all patients reported weekly marijuana use in the year following treatment (dropping from 80.4% in the year before admission). Similarly, there were decreases in heavy drinking (dropping from 33.8% to 20.3%), use of other illicit drugs (dropping from 48.0% to 42.2%), and criminal involvement (dropping from 75.6% to 52.8%). Additionally, patients reported better psychological adjustment and school performance after treatment. Longer stays in treatment were positively associated with several favorable outcomes, although length of time in treatment was generally short. These findings suggest that substance abuse treatment for adolescents is effective in achieving many important behavioral and psychological improvements. Strategies specific to adolescents to improve their treatment retention and completion are needed to maximize the therapeutic benefits of drug treatment. Hser, Y.I., Grella, C.E., Hubbard, R.L., Hsieh, S-C., Fletcher, B.W., Brown, B.S., and Anglin, M.D. An Evaluation of Drug Treatments for Adolescents in 4 US Cities. Arch Gen Psychiatry. 58, pp. 689-695, 2001.

Drug Treatment Outcomes for Adolescents with Comorbid Mental and Substance Use Disorders

This study compared the pretreatment characteristics and post treatment outcomes of substance-abusing adolescents with and without comorbid mental disorders in the Drug Abuse Treatment Outcome Studies for Adolescents. Subjects (N = 992) were sampled from 23 adolescent drug treatment programs across three modalities (residential, short-term inpatient, outpatient drug-free). Nearly two thirds (64%) of the sample had at least one comorbid mental disorder, most often conduct disorder. Comorbid youth were more likely to be drug or alcohol dependent and had more problems with family, school, and criminal involvement. Although comorbid youth reduced their drug use and other problem behaviors after treatment, they were more likely to use marijuana and hallucinogens, and to engage in illegal acts in the 12 months after treatment, as compared with the noncomorbid adolescents. Integrated treatment protocols need to be implemented within drug treatment programs in order to improve the outcomes of adolescents with comorbid substance use and mental disorders. Grella, C.E., Hser, Y.I., Joshi, V, and Rounds-Bryant, J. Drug Treatment Outcomes for Adolescents with Comorbid Mental and Substance Use Disorders. J Nerv Ment Dis.,189(6), pp. 384-392, June 2001.