Adolescent Substance Abuse: Research and Clinical Advances

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 10
Foreword 1......Page 14
Foreword 2......Page 16
Acknowledgements......Page 18
Abbreviations......Page 19
1 Treating adolescent substance abuse: state of the science......Page 21
A brief history of adolescent substance abuse treatment research......Page 23
Practice and policy trends in treatment for adolescent substance abuse......Page 27
Comprehensive assessment and integrative treatment planning with adolescent substance abusers......Page 28
Empirically based interventions for adolescent substance abuse: research and practice implications......Page 29
Culturally based treatment development for adolescent substance abusers......Page 32
Next steps in adolescent substance abuse treatment research......Page 33
References......Page 34
Part I Theoretical, empirical, and methodological foundations for research into treatment of adolescent substance abuse......Page 43
2 The developmental context for adolescent substance abuse intervention......Page 45
The developmental model......Page 46
The adolescent personality domain......Page 48
Parental discipline......Page 49
The marital relationship domain......Page 50
The larger context......Page 51
Ethnicity......Page 52
The biological domain......Page 53
Interactions of individual, family, peer, and environmental factors......Page 54
Individual characteristics as buffers......Page 55
Familial factors as buffers......Page 56
Ethnic identity as an enhancer of protective factors......Page 57
Peer factors as enhancers of protective factors......Page 58
Implications for prevention and treatment......Page 59
Individual treatment......Page 60
Family treatment......Page 61
Group treatments......Page 62
Conclusions......Page 64
References......Page 65
3 Recent methodological and statistical advances: a latent variable growth modeling framework......Page 72
A latent variable approach to growth curve modeling......Page 73
Typical approaches to studying change......Page 74
Toward an integrated developmental model......Page 75
Slope......Page 76
Representing the shape of growth over time......Page 77
Including predictors and sequelae of change......Page 78
Multivariate and higher-order extensions......Page 79
Analyzing treatment effectiveness: modeling between-subjects effects......Page 80
Alternative approaches to analyzing treatment effects: interrupted time series models......Page 81
Incorporating effects of the social context: hierarchical or multilevel designs......Page 84
Full information maximum likelihood......Page 85
Limited information multilevel latent growth modeling......Page 87
Modeling unobserved heterogeneity: treatment audience profiling......Page 89
Growth mixture modeling......Page 90
Advantages of the latent variable growth model......Page 92
Design issues: sample size selection and power estimation......Page 93
Summary......Page 94
References......Page 95
4 Clinical course of youth following treatment for alcohol and drug problems......Page 99
Adolescent relapse patterns following drug and alcohol treatment: treatment outcome studies......Page 100
The process of relapse for adolescents......Page 107
Personal/environmental characteristics......Page 110
Alternative pathways to success......Page 111
Comorbidity......Page 113
Neurocognitive factors......Page 114
Conclusions......Page 116
References......Page 118
5 Cannabis Youth Treatment intervention: preliminary findings and implications......Page 124
Motivational enhancement treatment/cognitive-behavior therapy 5 sessions......Page 125
Motivational enhancement treatment/cognitive-behavior therapy 12 sessions......Page 126
Family Support Network......Page 127
The adolescent community reinforcement approach (ACRA)......Page 128
Multidimensional family therapy......Page 129
Overview of field trials......Page 130
Co-occurring problems are the norm......Page 131
Treatment participation was high......Page 132
Trial 1......Page 133
Treatments are affordable......Page 134
Implications and next steps......Page 135
Why were the clinical outcomes so similar?......Page 136
Would therapists in the community accept and/or use manual-guided therapies?......Page 137
Would the level of therapist supervision utilized in the program be realistic or even necessary in a community setting?......Page 138
What is happening with the manuals?......Page 139
References......Page 140
Part II Practice and policy trends in treatment for adolescent substance abuse......Page 147
6 Epidemiological trends and clinical implications of adolescent substance abuse in Europe......Page 149
European Schools Project on Alcohol and other Drugs......Page 150
European Monitoring Centre for Drugs and Drug Addiction......Page 151
United Kingdom......Page 152
Austria......Page 153
Finland......Page 154
The Netherlands and Spain......Page 155
Finland......Page 156
Comorbidity and temporal sequences of disorders......Page 157
Intrapersonal factors......Page 158
Political implications of adolescent substance abuse: a response from the European Union......Page 159
Clinical implications of adolescent substance abuse: response from Germany......Page 161
Conclusions......Page 162
References......Page 165
7 The Drug Abuse Treatment Outcomes Studies: outcomes with adolescent substance abusers......Page 168
Characteristics of the youth admissions......Page 170
Treatment retention and posttreatment outcomes......Page 171
Youth characteristics......Page 172
Treatment retention and post-treatment outcomes......Page 173
The Drug Abuse Treatment Outcome Studies......Page 175
Residential treatment programs......Page 176
Demographic characteristics......Page 177
Mental disorders......Page 178
Changes in characteristics of adolescents in TOPS & DATOS-A......Page 179
Changes in treatment service profiles......Page 180
Treatment processes......Page 181
Services received......Page 182
Treatment outcomes among patients in the Drug Abuse Treatment Outcome Studies for Adolescents......Page 183
Outcomes for youth with comorbid mental disorders......Page 184
Differences by ethnicity......Page 185
Conclusions......Page 186
References......Page 189
8 Adolescent treatment services: the context of care......Page 194
Background......Page 195
Systems of care: the existing system......Page 196
The optimal system......Page 197
Providers of care......Page 199
Financing mechanisms and funding streams......Page 201
Technology transfer and treatment quality......Page 204
Conclusions and recommendations......Page 205
References......Page 206
The legal framework in England......Page 209
Recent policy initiatives......Page 210
The Health Advisory Service......Page 213
A Strategic Framework......Page 214
Tier 1......Page 215
Tier 2......Page 216
Tier 3......Page 217
Links between tiers......Page 218
Links of the framework with evidence......Page 219
Achievements......Page 221
References......Page 222
10 Health services with drug-abusing adolescents: the next frontier of research......Page 224
Effective......Page 226
Patient Centered......Page 228
Efficient......Page 229
Equitable......Page 233
Redesign......Page 234
References......Page 235
Part III Comprehensive assessment and integrative treatment planning with adolescent substance abusers......Page 241
Assessment model......Page 243
Print resources......Page 244
Developmental considerations......Page 245
Diagnostic interviews......Page 246
Validity of self-report......Page 247
Clinical implications of data sources......Page 248
Peers......Page 249
Drug use history......Page 250
Abuse and dependence diagnostic symptoms......Page 251
Peer drug involvement......Page 252
Coexisting psychopathology......Page 253
Clinical implications of content factors......Page 254
Bridging assessment and referral decisions......Page 255
Conclusions and future directions......Page 256
References......Page 257
Current status of pharmacotherapy......Page 261
Lessons from the adult literature......Page 262
Pharmacological treatment studies in adolescents......Page 265
Substitution therapy......Page 266
Aversive therapy......Page 267
Importance of comorbidity in adolescents......Page 268
Mood disorders......Page 270
Attention-deficit hyperactivity disorder......Page 271
Future directions in research......Page 273
The use of common, salient variables among studies......Page 274
Multimodal studies using a combination of pharmacotherapy and psychosocial intervention modalities......Page 275
References......Page 276
13 Developmentally informed diagnostic and treatment considerations in comorbid conditions......Page 284
Developmental context and bidirectional impact of substance use and comorbid psychiatric disorders......Page 285
The role of psychiatric comorbidity......Page 286
Disruptive behavior disorders......Page 287
Internalizing disorders......Page 288
Integrated clinical assessment of adolescent substance abuse and comorbidity......Page 290
A clinical approach to integrating treatment of substance abuse and comorbidity......Page 291
1. Initiating treatment......Page 292
2. Assessing suitability for pharmacotherapy......Page 293
4. Choosing specific medications for comorbidity......Page 294
6. Dealing with relapse......Page 295
Conclusions......Page 296
References......Page 298
14 Prevention of infection with human immunodeficiency virus in adolescent substance abusers......Page 304
Structure and message of the chapter......Page 306
Co-occurring patterns of HIV risk and substance use in adolescents......Page 307
Levels of intervention......Page 308
Individual-level interventions: prevention counseling......Page 309
Prevention case management......Page 310
Small-group interventions......Page 311
Accounting for the effectiveness of group interventions......Page 312
Limitations of group interventions......Page 314
Intervening at the family level......Page 315
Community-level interventions......Page 316
Future as context: research to advance prevention of HIV infection and substance abuse in adolescents......Page 318
References......Page 323
Part IV Empirically based interventions for adolescent substance abuse: research and practical implications......Page 331
Background and history......Page 333
The empirical basis for the therapeutic community approach......Page 335
Outcome studies......Page 336
The prototypical adolescent therapeutic community......Page 338
Treatment protocol......Page 339
The role of family......Page 340
Adolescent therapeutic communities in the twenty-first century......Page 341
Clinical issues......Page 343
Client issues......Page 344
Treatment issues......Page 345
Policy issues......Page 346
Conclusions......Page 348
References......Page 349
16 School-based group treatment for adolescent substance abuse......Page 353
Why use schools for delivery of substance abuse treatment......Page 354
What is known about effective school-based treatments?......Page 356
The student assistance program......Page 357
Development of a standardized Westchester model student assistance program......Page 360
Study design and preliminary results......Page 363
Mechanisms of change in group counseling......Page 366
Conclusions and future directions......Page 367
References......Page 370
17 Profiles of change in behavioral and family interventions for adolescent substance abuse and dependence......Page 377
Classifying patterns of change......Page 379
An examination of differences in individual outcomes......Page 380
Cluster analysis procedures......Page 382
Individual profiles of change......Page 384
Predictors of profiles......Page 385
Profiles of change associated with family therapy......Page 386
Implications for treatment......Page 388
Conclusions......Page 389
References......Page 390
Behavior analysis......Page 395
Principles of contingency management for the treatment of substance abuse......Page 399
Contingency management for the treatment of adolescent substance abuse......Page 401
Implementation issues......Page 405
Concerns......Page 407
Conclusions......Page 408
Acknowledgements......Page 409
References......Page 410
Theoretical models underlying cognitive–behavioral intervention approaches......Page 416
Randomized clinical trials for adolescent substance abuse treatment......Page 418
Cognitive–behavioral therapy for common comorbid psychiatric disorders......Page 422
Depression......Page 423
Post-traumatic stress disorder......Page 424
Conduct disorders/antisocial behavior......Page 425
Client–treatment matching......Page 426
Treatment modality: group or individual intervention......Page 427
Mechanisms of change in cognitive–behavioral therapy for substance abuse disorders......Page 428
Clinical implications and future research directions......Page 431
References......Page 432
Part V Culturally based treatment development for adolescent substance abusers......Page 441
20 Family-centered treatment for American Indian adolescent substance abuse: toward a culturally and historically informed strategy......Page 443
American Indian communities......Page 446
Toward a family-centered inpatient treatment......Page 449
Pilot research......Page 451
Evaluation model......Page 452
The enhancement condition......Page 453
Analysis of outcomes......Page 454
Conclusions......Page 457
References......Page 463
Empirically supported treatments and Hispanics......Page 469
Shortcomings of current efforts to ensure ‘‘cultural competence’’......Page 470
Utilizing basic research and treatment development mechanisms to enhance a family treatment......Page 472
Development of an integrative family therapy for Hispanic adolescents......Page 473
Adolescent developmental literature......Page 474
Acculturation and externalizing behavior......Page 476
Immigration-related experiences and parent-adolescent attachment......Page 477
Hispanic values and family processes......Page 478
Designing interventions to integrate the relevant literature......Page 479
Creating thematic modules......Page 480
Integration of individual treatment......Page 481
Pilot cases to refine the interventions......Page 482
A basic research study to investigate empirically the links between culture-related factors and family process......Page 483
A small randomized trial to test the efficacy of the intervention......Page 484
Conclusions and implications for blending research and practice......Page 485
References......Page 486
Part VI Building the future......Page 491
22 The road ahead: achievements and challenges for research into the treatment of adolescent substance abuse......Page 493
Remaining gaps and future directions......Page 496
Policy: learning how to use science to improve practice......Page 498
A call to action: policy development to address the research–practice gap......Page 499
Doing our homework......Page 500
Creating a policy plan......Page 501
The advocacy vacuum......Page 503
Action items: recommendations to conceptualize and launch policy work......Page 507
Fact-finding......Page 510
Political strategy 101: build coalitions......Page 511
Link to other initiatives......Page 512
Train the next generation......Page 513
The road ahead: policy as the missing link between research and practice......Page 514
References......Page 515
Index......Page 521