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Knapp WP, Soares BGO, Farrel M, Lima MS. Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders. Cochrane Database Syst Rev 2007:CD003023. [PMID: 17636713 DOI: 10.1002/14651858.cd003023.pub2] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The consumption of psychostimulants for non-medical reasons probably occurs because of their euphoriant and psychomotor-stimulating properties. Chronic consumption of these agents results in development of stereotyped behaviour, paranoia, and possibly aggressive behaviour. Psychosocial treatments for psychostimulant use disorder are supposed to improve compliance, and to promote abstinence. Evidence from randomised controlled trials in this subject needs to be summarised. OBJECTIVES To conduct a systematic review of all RCTs on psychosocial interventions for treating psychostimulant use disorder. SEARCH STRATEGY Electronic searches of Cochrane Library, EMBASE, MEDLINE, and LILACS (to may 2006); reference searching; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of psychostimulants abuse/ dependence. SELECTION CRITERIA All randomised-controlled trials focusing on psychosocial interventions for treating psychostimulants abuse/ dependence. DATA COLLECTION AND ANALYSIS Three authors extracted the data independently and Relative Risks, weighted mean difference and number needed to treat were estimated, when possible. The reviewers assumed that people who died or dropped out had no improvement (intention to treat analysis) and tested the sensitivity of the final results to this assumption. MAIN RESULTS Twenty-seven randomised controlled studies (3663 participants) fulfilled inclusion criteria and had data that could be used for at least one of the main comparisons. There was a wide heterogeneity in the interventions evaluated: this did not allow to provide a summary estimate of effect and results cannot be summarised in a clear cut way. The comparisons between different type of Behavioural Interventions showed results in favour of treatments with some form of Contingency management in respect to both reducing drop outs and lowering cocaine use.. AUTHORS' CONCLUSIONS Overall this review reports little significant behavioural changes with reductions in rates of drug consumption following an intervention. Moreover, with the evidence currently available, there are no data supporting a single treatment approach that is able to comprise the multidimensional facets of addiction patterns and to significantly yield better outcomes to resolve the chronic, relapsing nature of addiction, with all its correlates and consequences.
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Affiliation(s)
- W P Knapp
- Universidade Federal do Rio Grande do Sul, Psychiatry, Avenue Paulo Gama 110, Porto Alegre, Brazil.
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French MT, Zavala SK, McCollister KE, Waldron HB, Turner CW, Ozechowski TJ. Cost-effectiveness analysis of four interventions for adolescents with a substance use disorder. J Subst Abuse Treat 2007; 34:272-81. [PMID: 17600651 PMCID: PMC2323204 DOI: 10.1016/j.jsat.2007.04.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 04/02/2007] [Accepted: 04/05/2007] [Indexed: 11/21/2022]
Abstract
Alcohol, tobacco, and illicit drug use among adolescents in the United States continues to be a serious public health challenge. A variety of outpatient treatments for adolescent substance use disorders have been developed and evaluated. Although no specific treatment modality is effective in all settings, a number of promising adolescent interventions have emerged. As policy makers try to prioritize which programs to fund with limited public resources, the need for systematic economic evaluations of these programs is critical. The present study attempted a cost-effectiveness analysis of four interventions, including family-based, individual, and group cognitive behavioral approaches, for adolescents with a substance use disorder. The results indicated that treatment costs varied substantially across the four interventions. Moreover, family therapy showed significantly better substance use outcome compared to group treatment at the 4-month assessment, but group treatment was similar to the other interventions for substance use outcome at the 7-month assessment and for delinquency outcome at both the 4- and 7-month assessments. These findings over a relatively short follow-up period suggest that the least expensive intervention (group) was the most cost-effective. However, this study encountered numerous data and methodological challenges in trying to supplement a completed clinical trial with an economic evaluation. These challenges are explained and recommendations are proposed to guide future economic evaluations in this area.
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Affiliation(s)
- Michael T French
- Health Economics Research Group, Department of Sociology, University of Miami, Coral Gables, FL 33124, USA.
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Bosch-Capblanch X, Abba K, Prictor M, Garner P. Contracts between patients and healthcare practitioners for improving patients' adherence to treatment, prevention and health promotion activities. Cochrane Database Syst Rev 2007; 2007:CD004808. [PMID: 17443556 PMCID: PMC6464838 DOI: 10.1002/14651858.cd004808.pub3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Contracts are a verbal or written agreement that a patient makes with themselves, with healthcare practitioners, or with carers, where participants commit to a set of behaviours related to the care of a patient. Contracts aim to improve the patients' adherence to treatment or health promotion programmes. OBJECTIVES To assess the effects of contracts between patients and healthcare practitioners on patients' adherence to treatment, prevention and health promotion activities, the stated health or behaviour aims in the contract, patient satisfaction or other relevant outcomes, including health practitioner behaviour and views, health status, reported harms, costs, or denial of treatment as a result of the contract. SEARCH STRATEGY We searched: the Cochrane Consumers and Communication Review Group's Specialised Register (in May 2004); the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library 2004, issue 1); MEDLINE 1966 to May 2004); EMBASE (1980 to May 2004); PsycINFO (1966 to May 2004); CINAHL (1982 to May 2004); Dissertation Abstracts. A: Humanities and Social Sciences (1966 to May 2004); Sociological Abstracts (1963 to May 2004); UK National Research Register (2000 to May 2004); and C2-SPECTR, Campbell Collaboration (1950 to May 2004). SELECTION CRITERIA We included randomised controlled trials comparing the effects of contracts between healthcare practitioners and patients or their carers on patient adherence, applied to diagnostic procedures, therapeutic regimens or any health promotion or illness prevention initiative for patients. Contracts had to specify at least one activity to be observed and a commitment of adherence to it. We included trials comparing contracts with routine care or any other intervention. DATA COLLECTION AND ANALYSIS Selection and quality assessment of trials were conducted independently by two review authors; single data extraction was checked by a statistician. We present the data as a narrative summary, given the wide range of interventions, participants, settings and outcomes, grouped by the health problem being addressed. MAIN RESULTS We included thirty trials, all conducted in high income countries, involving 4691 participants. Median sample size per group was 21. We examined the quality of each trial against eight standard criteria, and all trials were inadequate in relation to three or more of these standards. Trials evaluated contracts in addiction (10 trials), hypertension (4 trials), weight control (3 trials) and a variety of other areas (13 trials). Sixteen trials reported at least one outcome that showed statistically significant differences favouring the contracts group, five trials reported at least one outcome that showed differences favouring the control group and 26 trials reported at least one outcome without differences between groups. Effects on adherence were not detected when measured over longer periods. AUTHORS' CONCLUSIONS There is limited evidence that contracts can potentially contribute to improving adherence, but there is insufficient evidence from large, good quality studies to routinely recommend contracts for improving adherence to treatment or preventive health regimens.
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Affiliation(s)
- X Bosch-Capblanch
- International Health Research Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK L35QA.
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Prendergast M, Podus D, Finney J, Greenwell L, Roll J. Contingency management for treatment of substance use disorders: a meta-analysis. Addiction 2006; 101:1546-60. [PMID: 17034434 DOI: 10.1111/j.1360-0443.2006.01581.x] [Citation(s) in RCA: 533] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS To examine the effectiveness of contingency management (CM) techniques in treating substance use disorders (i.e. illicit drugs, alcohol, tobacco). DESIGN Meta-analysis was used to determine the average effect size and potential moderators in 47 comparisons of the effectiveness of CM from studies based on a treatment-control group design and published between 1970 and 2002. FINDINGS The mean effect size (ES) of CM was positive, with a magnitude of d = 0.42 using a fixed effects model. The magnitude of the ES declined over time, following treatment. CM was more effective in treating opiate use (d = 0.65) and cocaine use (d = 0.66), compared with tobacco (d = 0.31) or multiple drugs (d = 0.42). Larger effect sizes were associated with higher researcher involvement, earlier studies and shorter treatment duration. CONCLUSIONS Study findings suggest that CM is among the more effective approaches to promoting abstinence during the treatment of substance use disorders. CM improves the ability of clients to remain abstinent, thereby allowing them to take fuller advantage of other clinical treatment components.
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Affiliation(s)
- Michael Prendergast
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
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Godley MD, Kahn JH, Dennis ML, Godley SH, Funk RR. The stability and impact of environmental factors on substance use and problems after adolescent outpatient treatment for cannabis abuse or dependence. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2006; 19:62-70. [PMID: 15783279 DOI: 10.1037/0893-164x.19.1.62] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Because alcohol or other drug use following adolescent substance abuse treatment is common, understanding mediators of posttreatment outcome could help improve treatment interventions. The authors conducted path analyses based on data from 552 adolescents (aged 12-18; 82% male) with cannabis abuse or dependence who participated in outpatient treatment. The analysis used the Family Conflict and Cohesion subscales, from the Family Environment Scale, and several scales and indices from the Global Appraisal of Individual Needs. Family conflict, family cohesion, and social support indirectly predicted substance use and substance-related problems as mediated by recovery environment and social risk. This model replicated across 4 follow-up waves (3, 6, 9, and 12 months postintake). These results support the idea of targeting environmental factors during continuing care as a way to improve treatment outcomes for adolescents with cannabis disorders.
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Strada MJ, Donohue B, Lefforge NL. Examination of ethnicity in controlled treatment outcome studies involving adolescent substance abusers: a comprehensive literature review. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2006; 20:11-27. [PMID: 16536661 DOI: 10.1037/0893-164x.20.1.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The extent to which adolescent drug treatment outcome studies address ethnicity was systematically examined. Reliability coefficients were calculated for both the search methodology used to obtain these outcome studies and the extent to which ethnicity was addressed along several dimensions. The resulting coefficients were highly reliable. Findings indicated that although investigators of 94% of the outcome studies considered ethnicity to some extent, only 28% of these studies incorporated ethnicity into their design, and only 6% of studies involved statistical analyses to examine differential response to treatment or moderating effects of ethnicity with a sufficient number of ethnic minority participants. Overall, results indicated that there is much work to do regarding the examination of ethnicity in controlled treatment outcome studies involving adolescent substance abusers. Indeed, modifications were rarely made to the treatment components to accommodate ethnicity-related variables. Future recommendations are presented in light of these findings.
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Affiliation(s)
- Marilyn J Strada
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA
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The Adolescent Drug Abuse Prevention and Treatment (ADAPT) Program: A Mental Health-Law Enforcement Collaboration. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2006. [DOI: 10.1300/j029v15n02_05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Neuman MG, Monteiro M, Rehm J. Drug interactions between psychoactive substances and antiretroviral therapy in individuals infected with human immunodeficiency and hepatitis viruses. Subst Use Misuse 2006; 41:1395-463. [PMID: 17002989 DOI: 10.1080/10826080600846235] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The liver disease characteristic of alcohol dependence encompasses three main related entities: steatosis, alcoholic hepatitis, and cirrhosis. Alcoholic cirrhosis is a leading cause of global morbidity and mortality. Alcohol intake among injecting drug users is a major contributor to transmission of viral infections, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C viruses (HCV). HIV and HCV coinfected patients develop liver diseases earlier and more severely than the monoinfected individuals, including hepatocellular carcinoma. Interactions exist between the therapeutic drugs used to minimize and control the drug and alcohol dependence. Furthermore, drug-drug interactions occur between the highly active antiretroviral therapy (HAART) and alcohol, different HAART components and methadone, or each one of the therapies with the other, thus contributing to a higher toxicity level. With the evolution of effective antiretroviral therapy, survival of persons with HIV, and the syndrome it causes, acquired immunodeficiency syndrome (AIDS) has increased dramatically. Drug-drug interactions may appear between alcohol and anti-HBV or anti-HCV, therapy in the presence or absence of anti-HIV therapy. Several other medical-, social-, and drug-related factors of this population have to be considered when providing HAART. Because many coinfected patients also have problems with substance use, dealing with their drug dependence is an important first step in an attempt to improve adherence to and tolerance of antiviral therapy. It is necessary to minimize the risk of liver disease acceleration and/or reinfection with hepatitis viruses. Knowledge of potential drug interactions between methadone, antiretroviral therapy, psychoactive drugs, and antipsychotics and the role of coinfection with HBV or HCV and the drugs used in eradicating viral hepatitis permits suitable antiretroviral combinations.
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59
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Roozen HG, Van Beers SEC, Weevers HJA, Breteler MHM, Willemsen MC, Postmus PE, Kerkhof AJFM. Effects on smoking cessation: naltrexone combined with a cognitive behavioral treatment based on the community reinforcement approach. Subst Use Misuse 2006; 41:45-60. [PMID: 16393735 DOI: 10.1080/10826080500318665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A promising option in substance abuse treatment is the Community Reinforcement Approach (CRA). The opioid antagonist naltrexone (NTX) may work in combination with nicotine replacement therapy (NRT) to block the effects of smoking stimuli in abstinent smokers. Effects of lower doses than 50 mg/dd. have not been reported. A study was conducted in Amsterdam in 2000/2001 with the objective to explore the effects of the combination NTX (25/50-mg dd.), NRT, and CRA in terms of craving and abstinence. In a randomized open label, 2 x 2 between subjects design, 25 recovered spontaneous pneumothorax (SP) participants received 8 weeks of treatment. Due to side effects, only 3 participants were compliant in the 50-mg NTX condition. Craving significantly declined between each measurement and there was a significant interaction between decline in craving and craving measured at baseline. The abstinence rate in the CRA group was nearly double that in the non-psychosocial therapy group (46% vs. 25%; NS) at 3 months follow-up after treatment.
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Affiliation(s)
- Hendrik G Roozen
- Department of Clinical Psychology, Research Institute of Psychology and Health, Vrije Universiteit, Amsterdam, The Netherlands
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Abstract
Rigorous research has recently identified a range of behavioral therapies that have been shown to be effective across the most prevalent types of substance dependence. This review summarizes the roles of behavioral therapies as contrasted with those of pharmacotherapies for substance use disorders and then provides an overview of the major classes of behavioral therapies (clinical management, coping skills approaches, motivational interviewing, and family and interpersonal approaches), highlighting their effectiveness across cocaine, opioid, alcohol, and cannabis use disorders. Lastly, important areas of current research emphasis including combined treatments, strategies for effectively transporting empirically validated treatments into clinical practice, and increasing the efficiency of treatment are described.
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Affiliation(s)
- Kathleen M Carroll
- Yale University School of Medicine, Division of Substance Abuse, 950 Campbell Avenue (151D), West Haven, CT 06516, USA.
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Dennis M, Godley SH, Diamond G, Tims FM, Babor T, Donaldson J, Liddle H, Titus JC, Kaminer Y, Webb C, Hamilton N, Funk R. The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials. J Subst Abuse Treat 2005; 27:197-213. [PMID: 15501373 DOI: 10.1016/j.jsat.2003.09.005] [Citation(s) in RCA: 457] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2002] [Revised: 04/17/2003] [Accepted: 09/13/2003] [Indexed: 11/16/2022]
Abstract
This article presents the main outcome findings from two inter-related randomized trials conducted at four sites to evaluate the effectiveness and cost-effectiveness of five short-term outpatient interventions for adolescents with cannabis use disorders. Trial 1 compared five sessions of Motivational Enhancement Therapy plus Cognitive Behavioral Therapy (MET/CBT) with a 12-session regimen of MET and CBT (MET/CBT12) and another that included family education and therapy components (Family Support Network [FSN]). Trial II compared the five-session MET/CBT with the Adolescent Community Reinforcement Approach (ACRA) and Multidimensional Family Therapy (MDFT). The 600 cannabis users were predominately white males, aged 15-16. All five CYT interventions demonstrated significant pre-post treatment during the 12 months after random assignment to a treatment intervention in the two main outcomes: days of abstinence and the percent of adolescents in recovery (no use or abuse/dependence problems and living in the community). Overall, the clinical outcomes were very similar across sites and conditions; however, after controlling for initial severity, the most cost-effective interventions were MET/CBT5 and MET/CBT12 in Trial 1 and ACRA and MET/CBT5 in Trial 2. It is possible that the similar results occurred because outcomes were driven more by general factors beyond the treatment approaches tested in this study; or because of shared, general helping factors across therapies that help these teens attend to and decrease their connection to cannabis and alcohol.
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Kaminer Y, Slesnick N. Evidence-based cognitive-behavioral and family therapies for adolescent alcohol and other substance use disorders. RECENT DEVELOPMENTS IN ALCOHOLISM : AN OFFICIAL PUBLICATION OF THE AMERICAN MEDICAL SOCIETY ON ALCOHOLISM, THE RESEARCH SOCIETY ON ALCOHOLISM, AND THE NATIONAL COUNCIL ON ALCOHOLISM 2005; 17:383-405. [PMID: 15789877 DOI: 10.1007/0-306-48626-1_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Yifrah Kaminer
- University of Connecticut Health Center, Alcohol Research Center and Department of Psychiatry, Farmington, CT 06030-2103, USA
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Waldron HB, Kaminer Y. On the learning curve: the emerging evidence supporting cognitive-behavioral therapies for adolescent substance abuse. Addiction 2004; 99 Suppl 2:93-105. [PMID: 15488108 PMCID: PMC1781376 DOI: 10.1111/j.1360-0443.2004.00857.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Cognitive-behavioral therapy (CBT) approaches to intervention for adolescent substance use disorders has been limited and formal controlled clinical efficacy trials have been rare. Moreover, the early literature on the efficacy of CBT for adolescent substance abuse has been characterized by significant methodological limitations. Recent innovations in the treatment of adolescent substance abuse and the recent completion of several randomized clinical trials has brightened the picture with respect to establishing the empirical support for CBT. The aim of this review is to integrate the findings from controlled trials of CBT for adolescent substance abuse. METHOD Studies representing randomized clinical trials were reviewed using criteria provided by Lonigan et al. and Nathan & Gorman as a guide. FINDINGS AND CONCLUSIONS Despite some prominent differences in design and methodology, the studies reviewed provide consistent empirical evidence that group and individual CBT are associated with significant and clinically meaningful reductions in adolescent substance use. The evidence for the efficacy of group therapy is particularly important, countering the assertion that aggregating problem youths into group treatment settings is associated with iatrogenic effects. The findings from the randomized trials reviewed represent significant developments in treatment outcome research and lay the foundation for validating CBT for adolescent substance use disorders. Future research directions include improving short- and long-term outcomes, enhancing treatment motivation and engagement, and identifying mechanisms and processes associated with positive change, especially for youths with comorbid conditions.
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Godley SH, Jones N, Funk R, Ives M, Passetti LL. Comparing outcomes of best-practice and research-based outpatient treatment protocols for adolescents. J Psychoactive Drugs 2004; 36:35-48. [PMID: 15152708 DOI: 10.1080/02791072.2004.10399722] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Comparisons of well-developed practice-based interventions with research-based interventions are rare. This quasi-experimental study compares the outcomes of 274 adolescents (75% male; 63% weekly+ users; 54% dependent; 27% prior treatment; 73% with co-occurring problems) who received Chestnut Health System's best-practice Outpatient Treatment (CHS) or Cannabis Youth Treatment (CYT) research-based interventions. Ninety-five percent of participants completed follow-up interviews at three, six, nine, and 12 months after their intake GAIN interview. Initially, the CYT cohort scores indicated greater severity on several substance-related measures, while the CHS cohort scored higher on prior mental health treatment, victimization, and illegal activities measures. Adolescents in the CHS cohort were more likely to have longer lengths of stay and receive over three times as many hours of treatment. Mixed effects models revealed that CHS participants were significantly more likely to report a decrease in recovery environment risk, an increase in self-help attendance after treatment, and greater decreases in emotional problems, while CYT participants were significantly more likely to report decreases in their substance use. The results suggest that neither the best-practice nor the research-based interventions were clearly superior and call for a more rigorous randomized field experiment to better understand the differences in effectiveness between interventions.
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Affiliation(s)
- Susan H Godley
- Chestnut Health Systems, 720 West Chestnut, Bloomington, Illinois 61701, USA
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66
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Roozen HG, Boulogne JJ, van Tulder MW, van den Brink W, De Jong CAJ, Kerkhof AJFM. A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction. Drug Alcohol Depend 2004; 74:1-13. [PMID: 15072802 DOI: 10.1016/j.drugalcdep.2003.12.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Revised: 11/11/2003] [Accepted: 11/18/2003] [Indexed: 11/30/2022]
Abstract
The community reinforcement approach (CRA) has been applied in the treatment of disorders resulting from alcohol, cocaine and opioid use. The objectives were to review the effectiveness of (1) CRA compared with usual care, and (2) CRA versus CRA plus contingency management. Studies were selected through a literature search of RCTs focusing on substance abuse. The search yielded 11 studies of mainly high methodological quality. The results of CRA, when compared to usual care: there is strong evidence that CRA is more effective with regard to number of drinking days, and conflicting evidence with regard to continuous abstinence in the alcohol treatment. There is moderate evidence that CRA with disulfiram is more effective in terms of number of drinking days, and limited evidence that there is no difference in effect in terms of continuous abstinence. Furthermore, there is strong evidence that CRA with "incentives" is more effective with regard to cocaine abstinence. There is limited evidence that CRA with "incentives" is more effective in an opioid detoxification program. There is limited evidence that CRA is more effective in a methadone maintenance program. Finally, there is strong evidence that CRA with abstinence-contingent "incentives" is more effective than CRA (non-contingent incentives) treatment aimed at cocaine abstinence.
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Affiliation(s)
- Hendrik G Roozen
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
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Baskin TW, Tierney SC, Minami T, Wampold BE. Establishing specificity in psychotherapy: a meta-analysis of structural equivalence of placebo controls. J Consult Clin Psychol 2004; 71:973-9. [PMID: 14622072 DOI: 10.1037/0022-006x.71.6.973] [Citation(s) in RCA: 192] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Placebo treatments in psychotherapy cannot adequately control for all common factors, which thereby attenuates their effects vis-a-vis active treatments. In this study, the authors used meta-analytic procedures to test one possible factor contributing to the attenuation of effects: structural inequalities between placebo and active treatments. Structural aspects of the placebo included number and duration of sessions, training of therapist, format of therapy, and restriction of topics. Results indicate that comparisons between active treatments and structurally inequivalent placebos produced larger effects than comparisons between active treatments and structurally equivalent placebos: moreover, the latter comparison produced negligible effects, indicating that active treatments were not demonstrably superior to well-designed placebos.
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Affiliation(s)
- Thomas W Baskin
- Department of Counseling Psychology, University of Wisconsin-Madison, 53706, USA
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Kidorf M, Brooner RK. Special section: the most critical unresolved issues associated with contemporary vocational rehabilitation for substance users. The critical relationship between employment services and patient motivation. Subst Use Misuse 2004; 39:2611-4. [PMID: 15603016 DOI: 10.1081/ja-200034596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Several interventions and service delivery models now exist to help unemployed people in treatment for substance use disorder seek gainful employment (Platt, 1995). Some of these interventions can be conveniently offered within substance user treatment settings. One of the best known examples of these interventions is job seeking skills training and support services that help patients develop resumes, complete employment applications, learn effective networking strategies, and develop and practice effective responses to common issues and questions raised during employment interviews. A wide range of more comprehensive off-site employment programs that provide intensive vocational training and rehabilitation also exist in many communities. The growing availability of on-site services in substance user treatment programs also creates the
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kramer TL, Robbins JM, Phillips SD, Miller TL, Burns BJ. Detection and outcomes of substance use disorders in adolescents seeking mental health treatment. J Am Acad Child Adolesc Psychiatry 2003; 42:1318-26. [PMID: 14566169 DOI: 10.1097/01.chi.0000084833.67701.44] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare detection rates, service use, and outcomes of substance use disorder (SUD) in adolescents seeking mental health treatment. METHOD Adolescents (n = 237) and their parents or caregivers completed parallel, self-administered versions of the Adolescent Treatment Outcomes Module (ATOM) at intake and 6-month follow-up. SUD was assessed using the Diagnostic Interview Schedule for Children (DISC). RESULTS Although 42 (16.6%) adolescents seeking mental health treatment met DISC criteria for any SUD at baseline, clinicians detected only 19 of these (kappa = 0.51). Sensitivity and specificity were high for a screening tool for adolescent SUD (95.2 and 82.0, respectively). Adolescents with undetected SUD were less likely to receive SUD services and to have more legal problems at 6-month follow-up compared to adolescents with detected SUD. CONCLUSIONS SUD rates may be high in adolescents seeking mental health treatment, confirming the need for routine screening in this population. Results confirm that a large gap exists between the need for and access to SUD treatments, which may contribute to poorer outcomes for all adolescents with SUD.
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Affiliation(s)
- Teresa L Kramer
- Centers for Mental Healthcare Research, Dept. of Psychiatry, University of Arkansas for Medical Sciences, 5800 W. 10th Street Suite 605, Little Rock, AR 72205, USA.
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DeCato Murphy L, Donohue B, Azrin NH, Teichner GA, Crum T. Adolescents and their parents: a critical review of measures to assess their satisfaction with one another. Clin Psychol Rev 2003; 23:129-70. [PMID: 12560002 DOI: 10.1016/s0272-7358(03)00016-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The importance of assessing the parent-adolescent relationship has been stressed in the literature. However, an integration of studies that have been conducted to assess satisfaction in the parent-adolescent relationship is warranted, including evaluation of measures to assess their satisfaction with one another. Therefore, the purpose of this paper is to provide a critical examination of the clinical utility and psychometric properties of such measures. Suggestions for future research are also provided.
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Affiliation(s)
- Leah DeCato Murphy
- Columbia Presbyterian Medical Center/New York Presbyterian Hospital, New York, NY 10032, USA.
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71
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DeCato LA, Donohue B, Azrin NH, Teichner GA, Crum T. Adolescents and their parents: a critical review of measures to assess their satisfaction with one another. Clin Psychol Rev 2002; 22:833-74. [PMID: 12214328 DOI: 10.1016/s0272-7358(01)00097-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The importance of assessing the parent-adolescent relationship has been stressed in the literature. However, an integration of studies that have been conducted to assess satisfaction in the parent-adolescent relationship is warranted, including evaluation of measures to assess their satisfaction with one another. Therefore, the purpose of this paper is to provide a critical examination of the clinical utility and psychometric properties of such measures. Suggestions for future research are also provided.
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Affiliation(s)
- Leah A DeCato
- Center for Psychological Studies, Nova Southeastern University, 3301 College Avenue, Ft. Lauderdale, FL 33314-7721, USA.
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72
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Prendergast ML, Podus D, Chang E, Urada D. The effectiveness of drug abuse treatment: a meta-analysis of comparison group studies. Drug Alcohol Depend 2002; 67:53-72. [PMID: 12062779 DOI: 10.1016/s0376-8716(02)00014-5] [Citation(s) in RCA: 237] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A meta-analysis was conducted on 78 studies of drug treatment conducted between 1965 and 1996. Each study compared outcomes among clients who received drug treatment with outcomes among clients who received either minimal treatment or no treatment. Five methodological variables were significant predictors of effect size. Larger effect sizes were associated with studies with the following characteristics: smaller numbers of dependent variables, significant differences between groups at admission, low levels of attrition in the treatment group, a passive comparison group (no treatment, minimal treatment) as opposed to an active comparison group (standard treatment), and drug use determined by a drug test. Controlling for these methodological variables, further analyses indicated that drug abuse treatment has both a statistically significant and a clinically meaningful effect in reducing drug use and crime, and that these effects are unlikely to be due to publication bias. For substance abuse outcomes, larger effect sizes tended to be found in studies in which treatment implementation was rated high, the degree of theoretical development of the treatment was rated low, or researcher allegiance to the treatment was rated as favorable. For crime outcomes, only the average age of study participants was a significant predictor of effect size, with treatment reducing crime to a greater degree among studies with samples consisting of younger adults as opposed to older adults. Treatment modality and other variables were not related to effect sizes for either drug use or crime outcomes
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Affiliation(s)
- Michael L Prendergast
- Integrated Substance Abuse Programs, UCLA Drug Abuse Research Center, Neuropsychiatric Institute, University of California, 11050 Santa Monica Blvd, Suite 150, Los Angeles, CA 90025, USA.
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73
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Barrett H, Slesnick N, Brody JL, Turner CW, Peterson TR. Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments. J Consult Clin Psychol 2001. [DOI: 10.1037/0022-006x.69.5.802] [Citation(s) in RCA: 274] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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74
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Buelow G, Range LM. No-suicide contracts among college students. DEATH STUDIES 2001; 25:583-592. [PMID: 11813707 DOI: 10.1080/07481180126577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study evaluates the use of 3 no-suicide contracts that differed in length from 1 to 9 sentences, and in specificity from indicating that clients will talk to a friend or therapist to a clear outline of persons and interventions to be used if they feel suicidal. Of the sample of 112 college students, 40% admitted to suicidal ideation and 54% reported some form of previous counseling. Students read all 3 contracts and rated them on how well they helped stop suicidal thoughts, communicated that the therapist cared, strengthened resistance to suicide, lessened depression, gave hope, encouraged cooperation with therapy and empowered, and how much they were complicated, short, or unrealistic. Regardless of gender, ethnicity, history of counseling, or prior suicidal ideation, students rated the more detailed contract best overall. Although other groups may respond differently, for college students, a specific, detailed no-suicide contract is best.
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Affiliation(s)
- G Buelow
- University of Southern Mississippi, Hattiesburg, Mississippi.
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75
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Curry JF, Wells KC, Lochman JE, Craighead WE, Nagy PD. Group and family cognitive behavior therapy for adolescent depression and substance abuse: A case study. COGNITIVE AND BEHAVIORAL PRACTICE 2001. [DOI: 10.1016/s1077-7229(01)80010-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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76
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A Controlled Evaluation and Description of Individual-Cognitive Problem Solving and Family-Behavior Therapies in Dually-Diagnosed Conduct-Disordered and Substance-Dependent Youth. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2001. [DOI: 10.1300/j029v11n01_01] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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77
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Rivers SM, Greenbaum RL, Goldberg E. Hospital-based adolescent substance abuse treatment: comorbidity, outcomes, and gender. J Nerv Ment Dis 2001; 189:229-37. [PMID: 11339318 DOI: 10.1097/00005053-200104000-00004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Positive change was demonstrated on a number of self-report scales administered to 129 adolescents at a hospital-based substance abuse program, of whom 72 were posttested after 8 weeks. Female subjects showed change on more measures than male subjects, and a greater number of female subjects went from the clinical to subclinical range. Based on number of sessions attended, subjects were grouped by "dose" into either "hi-attenders" or "lo-attenders." A Trials (pretest/posttest) x Dose interaction revealed significant reduction in drug use at posttest for hi-attenders who were initially heavier users. Multiple regression analyses determined how well "comorbidity" predicted attendance and change in drug use. Although comorbidity failed to predict attendance consistently, male subjects who reported more internalizing symptomatology reduced their drug use to a greater extent than those low on this dimension, and female subjects who initially reported experiencing more family problems became more self-efficacious about future drug avoidance.
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Affiliation(s)
- S M Rivers
- Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Ontario, Canada
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78
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DeCato LA, Donohue B, Azrin NH, Teichner GA. Satisfaction of conduct-disordered and substance-abusing youth with their parents. Behav Modif 2001; 25:44-61. [PMID: 11151485 DOI: 10.1177/0145445501251003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Conduct-disordered and substance-abusing adolescents (N = 132) completed the Youth Happiness With Parent Scale (YHPS). The YHPS measures youth happiness with parental behaviors across 11 domains (e.g., communication, chores, and discipline) as well as a single item reflecting overall happiness. Results indicated that youth satisfaction did not vary as a function of parents' or youths' age, ethnic minority status, or gender. Although youth were relatively dissatisfied with their parents across behavioral domains (particularly illegal behaviors, drug use, school conduct, and alcohol use), they were fairly satisfied with their parents overall. Youth happiness with parental behaviors was negatively related to externalizing but not internalizing behavioral problems of the youth. Study implications and future directions are discussed in light of the results.
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79
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Donohue B, DeCato LA, Azrin NH, Teichner GA. Satisfaction of parents with their conduct-disordered and substance-abusing youth. Behav Modif 2001; 25:21-43. [PMID: 11151483 DOI: 10.1177/0145445501251002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined parental satisfaction (using the Parent Satisfaction With Youth Scale) in 132 parents of adolescents who were dually diagnosed with conduct disorder/oppositional defiant disorder and drug abuse/dependence. Results indicated parental satisfaction did not vary as a function of age, ethnic minority status, or gender. Parents of younger youth were generally more dissatisfied than parents of older adolescents although younger youth were no more delinquent than older youth. These results suggest that parents of delinquent youth become tolerant of their children's behavior problems with time. As expected, parents were most dissatisfied with their youth's use of drugs, illicit behavior, school performance, and response to discipline. Parents who endorsed lower levels of satisfaction reported their youth engaged in more pronounced levels of problem behavior and more drug use than did parents who were relatively more satisfied with their youth. Study implications and future directions are discussed.
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Affiliation(s)
- B Donohue
- University of Nevada, Las Vegas, USA
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80
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Piane G. Contingency contracting and systematic desensitization for heroin addicts in methadone maintenance programs. J Psychoactive Drugs 2000; 32:311-9. [PMID: 11061683 DOI: 10.1080/02791072.2000.10400455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The use and effectiveness of contingency contracting and systematic desensitization with heroin addicts being treated in methadone maintenance programs are discussed. Both behavior therapies can be practically implemented in methadone maintenance programs to supplement methadone pharmacotherapy. Contingency contracting has been effectively employed to reduce illicit drug use and to manage patients in the clinic. Systematic desensitization has less effect on actual heroin usage yet effectively reduces the fear of withdrawal and general anxiety, while improving self-image, assertiveness, and adjustment in the community. A clinic protocol that incorporates all three therapies-methadone maintenance, contingency contracting, and systematic desensitization-is proposed.
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Affiliation(s)
- G Piane
- Public and Community Health Programs, Northern Illinois University, Dekalb 60115, USA
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81
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Burgard JF, Donohue B, Azrin NH, Teichner G. Prevalence and treatment of substance abuse in the mentally retarded population: an empirical review. J Psychoactive Drugs 2000; 32:293-8. [PMID: 11061680 DOI: 10.1080/02791072.2000.10400452] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This article presents the first comprehensive review of studies of alcohol and illicit substance use in mentally retarded individuals, including prevalence, and recommendations for assessment and treatment. Mentally retarded persons appear to use/abuse alcohol at about the same rate as their noncognitively-impaired counterparts, and illicit drugs at moderately lower rates. However, little is known regarding which assessments and interventions are most effective in this population, given the absence of published treatment outcome studies and case examples. This is particularly disconcerting as detrimental consequences resulting from substance use have been identified in mentally retarded samples. Anecdotal data suggests that treatment for these individuals require modifications of existing empirically-derived substance abuse interventions to accommodate their unique needs.
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Affiliation(s)
- J F Burgard
- Chronic Pain Rehabilitation Program, James A. Haley Veterans Hospital, Tampa, Florida, USA
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82
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Abstract
Adolescent substance abuse is rising dramatically in the United States. This observation is especially troubling given the association between substance use and HIV, as well as other sexually transmitted diseases. Surprisingly, there have been few carefully constructed, controlled studies examining different treatment approaches with adolescent substance abusers. In our review of the literature, we note that family therapy and, to a lesser extent, cognitive behavioral therapy, received the most attention as intervention strategies with adolescents. Both approaches appear to have some success, although further research is necessary. In addition, developing and assessing strategies to improve family involvement in treatment requires additional investigation.
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Affiliation(s)
- R E Booth
- Campus Box C-251, Department of Psychiatry, University of Colorado Health Sciences Center, 1643 Boulder Street, Denver, CO 80211, USA
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83
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Graham K, Gillis K. The relationship between psychosocial well-being and alcohol and drug use following substance misuse treatment. Subst Use Misuse 1999; 34:1199-222. [PMID: 10419220 DOI: 10.3109/10826089909039405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The relationship between psychosocial status and alcohol and drug use at 12-month follow-up was evaluated for clients of two addictions treatment programs (90 treated for alcohol; 51 for drugs or drugs and alcohol). Psychosocial status at follow-up was mostly unrelated to alcohol use among clients who were not using drugs prior to treatment. Among drug users, returning to both alcohol and drug use was strongly associated with poorer psychosocial status, with partial correlational analyses indicating that (a) drug use was the main factor associated with poorer status and (b) poorer status was likely a consequence rather than a precursor of drug use. The implications of these findings are discussed.
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Affiliation(s)
- K Graham
- Addiction Research Foundation, London, Ontario, Canada.
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84
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Donohue B, Van Hasselt VB, Hersen M, Perrin S. Substance refusal skills in a population of adolescents diagnosed with conduct disorder and substance abuse. Addict Behav 1999; 24:37-46. [PMID: 10189971 DOI: 10.1016/s0306-4603(98)00035-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study examined substance refusal skills of 44 conduct-disordered male adolescents. Fifty percent of these adolescents were dually diagnosed with substance abuse/dependence. Substance refusal skills were assessed utilizing a role-play test that consisted of four interpersonal scenarios in which a confederate prompted youths to engage in illicit drug and alcohol activity. The test demonstrated adequate interrater agreement and validity. Overall skill in refusing alcohol was positively related to adolescents' perceptions of belonging and attention, and overall skill in refusing illicit drugs was positively related to school performance and social competence. Contrary to expectations, substance refusal skills of dually diagnosed adolescents were comparable to their non-substance-abusing counterparts. Clinical implications of this study are discussed.
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Affiliation(s)
- B Donohue
- Department of Psychology, University of Nevada, Las Vegas 89154, USA
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85
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Weinberg NZ, Rahdert E, Colliver JD, Glantz MD. Adolescent substance abuse: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1998; 37:252-61. [PMID: 9519629 DOI: 10.1097/00004583-199803000-00009] [Citation(s) in RCA: 297] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review and synthesize the recent scientific literature on adolescent substance abuse, covering natural history, epidemiology, etiology, comorbidity, assessment, treatment, and prevention, and to highlight areas for future research. METHOD Studies of adolescent substance abuse were reviewed with the focus on substance abuse and dependence rather than substance use. RESULTS There has been a sharp recent resurgence in adolescent drug use. Biological factors, including genetic and temperament characteristics, as well as family environment factors, are emerging as important etiological variables. Comorbidity with other psychiatric disorders, particularly with conduct disorder, is frequent and complicates treatment. New assessment instruments are available for clinical and research use. Among treatment modalities, family-based interventions have received the most study. CONCLUSIONS The past decade has seen growth in the volume and sophistication of research on adolescent substance abuse and in the conceptualization of this problem. Further research is needed, particularly on the significance of comorbid conditions and on individualized and effective treatment approaches.
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Affiliation(s)
- N Z Weinberg
- National Institute on Drug Abuse, National Institutes of Health, Rockville, MD, USA
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86
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Elk R, Mangus LG, LaSoya RJ, Rhoades HM, Andres RL, Grabowski J. Behavioral Interventions: Effective and Adaptable for the Treatment of Pregnant Cocaine-Dependent Women. JOURNAL OF DRUG ISSUES 1997. [DOI: 10.1177/002204269702700311] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined the effectiveness of behavioral interventions in the treatment of cocaine-dependent pregnant women. The study was carried out in four stages: (1) the unique needs of substance-abusing women were examined to identify effective treatment factors, (2) behavioral interventions found to be effective in other cocaine-dependent populations were identified, (3) strategies from these two elements were combined in an ongoing treatment-study of cocaine-dependent pregnant women (the Pregnancy Project), and (4) outcome data in a group of 35 women who participated in the Pregnancy Project were examined. The rate of retention in treatment was high, as was compliance with prenatal care for those women who remained in treatment. A high rate of compliance with prenatal care was associated with good perinatal outcome. There was a relatively high rate of cocaine abstinence during treatment, at birth, and in the early period following birth of the baby. Many of the patients especially appreciated the individually based, self-empowering aspects of the behavioral counseling interventions. We concluded that behavioral interventions, within a woman-friendly treatment program, are an important treatment option to consider.
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87
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Donohue B, Thevenin DM, Runyon MK. Behavioral treatment of conversion disorder in adolescence. A case example of Globus Hystericus. Behav Modif 1997; 21:231-51. [PMID: 9086868 DOI: 10.1177/01454455970212006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The present single case study evaluated the efficacy of a cognitive-behavioral intervention for the treatment of a patient diagnosed with globus hystericus, a conversion disorder characterized by a perceived lump in the throat. The patient was a non-mentally retarded 12-year-old female who refused to swallow solids because she thought that her throat muscles would involuntarily constrict and result in choking. She lost approximately .5 lbs. per week during the 6 months prior to treatment. Improvements in weight gain were demonstrated consequent to the implementation of behavior therapy, with weight gain being particularly pronounced after contingency contracting was added to therapy. Weight gain was maintained at 1, 6, and 10 months posttreatment.
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88
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Donohue B, Acierno R, Kogan E. Relationship of depression with measures of social functioning in adult drug abusers. Addict Behav 1996; 21:211-6. [PMID: 8730523 DOI: 10.1016/0306-4603(95)00051-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The present study describes the relationship between depression and several measures of social functioning--including employment, criminal activity, incarceration, marital functioning, and alcohol and drug use--in a population of adult drug abusers. Our investigation extends past work in this area by specifically investigating the effects of depression (as opposed to simple substance use) on social and interpersonal functioning. Predictably, elevated levels of depression were associated with increased use of hard drugs and alcohol, greater levels of institutionalization, reduced attendance at work or school, and lower overall rates of marital satisfaction. Consistent with previous reports, level of marijuana use was not related to severity of depression. It appears that depressed substance abusers experience significantly more social, vocational, and interpersonal dysfunction than their nondepressed counterparts. It is proposed that the efficacy of existing treatment programs for adult drug abusers will be enhanced through the addition of strategies to assess and ameliorate depression.
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Affiliation(s)
- B Donohue
- Center for Psychological Studies, Nova Southeastern University, Ft. Lauderdale, FL 33314, USA
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89
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Azrin NH, Acierno R, Kogan ES, Donohue B, Besalel VA, McMahon PT. Follow-up results of supportive versus behavioral therapy for illicit drug use. Behav Res Ther 1996; 34:41-6. [PMID: 8561763 DOI: 10.1016/0005-7967(95)00049-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Follow-up data (mean 9 months) were obtained for 74 subjects who had been treated for a mean of 8 months and 17 sessions in a controlled comparison of Behavioral vs Supportive Counselling for drug abuse. Based on urinalysis, self-report, and family report, all subjects (100%) were actively using drugs at pre-treatment. During the last month of treatment, 81% of the Supportive treatment subjects and 44% of the Behavioral treatment subjects were using drugs at least once. At the follow-up month, drugs were used at least once by 71% of the Supportive vs 42% of Behavioral subjects. When drug use was measured in terms of the number of days of use per month, Supportive counselled subjects did not decrease drug use either by the end of treatment or at follow-up; for Behavioral subjects, drug use decreased by 63% by the end of treatment and by 73% at follow-up. Alcohol use, and days worked/or in school showed a similar pattern of greater improvement for the Behavioral treatment being maintained at the follow-up. These results indicate a substantial treatment-specific reduction of drug usage that endures after treatment is discontinued. The present favorable results appear attributable to the inclusion of family/significant others in therapy and the use of reinforcement contingent on urinalysis results.
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Affiliation(s)
- N H Azrin
- Center for Psychological Studies, Nova-Southeastern University, Ft. Lauderdale, FL 33314, USA
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