1
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Liu C, Filbey FM. Unlocking the age-old secrets of reward and substance use. Pharmacol Biochem Behav 2024; 239:173766. [PMID: 38604456 DOI: 10.1016/j.pbb.2024.173766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
Although substance use is widespread across the lifespan from early adolescence to older adulthood, the prevalence of substance use disorder (SUD) differs between age groups. These age differences in SUD rates necessitate an investigation into how age moderates reward sensitivity, and consequently influences the risks and consequences related to substance use. This theoretical review integrates evidence from the literature to address the dynamic interplay between age and reward in the context of substance use. Overall, increasing evidence demonstrates that age moderates reward sensitivity and underlying reward system neurobiology. Reward sensitivity undergoes a non-linear trajectory across the lifespan. Low levels of reward sensitivity are associated with childhood and late adulthood. In contrast, high levels are associated with early to late adolescence, followed by a decline in the twenties. These fluctuations in reward sensitivity across the lifespan contribute to complex associations with substance use. This lends support to adolescence and young adulthood as vulnerable periods for the risk of subsequent SUD. More empirical research is needed to investigate reward sensitivity during SUD maintenance and recovery. Future research should also involve larger sample sizes and encompass a broader range of age groups, including older adults.
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Affiliation(s)
- Che Liu
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX 75235, United States of America.
| | - Francesca M Filbey
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX 75235, United States of America
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2
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Welsh JW, Dopp AR, Durham RM, Sitar SI, Passetti LL, Hunter SB, Godley MD, Winters KC. Narrative review: Revised Principles and Practice Recommendations for Adolescent Substance Use Treatment and Policy. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00140-0. [PMID: 38537736 DOI: 10.1016/j.jaac.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/24/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE In 2014, the U.S. National Institute on Drug Abuse released the "Principles of Adolescent Substance Use Disorder Treatment," summarizing previously established evidence and outlining principles of effective assessment, treatment, and aftercare for substance use disorders (SUD). Winters et al. (2018) updated these principles to be developmentally appropriate for adolescents. This review builds on that formative work and recommends updated adolescent assessment, treatment, and aftercare principles and practices. METHOD The Cochrane, MEDLINE-PubMed, and PsychInfo databases were searched for relevant studies with new data about adolescent substance use services. This article updates the 13 original principles; condenses the 8 original modalities into 5 practices; and highlights implications for public policy approaches, future funding, and research. RESULTS Key recommendations from the principles include integrating care for co-occurring mental health disorders and SUDs, improving service accessibility including through the educational system, maintaining engagement, and addressing tension between agencies when collaborating with other youth service systems. Updates to the treatment practices include adoption of Screening, Brief Intervention and Referral to Treatment (SBIRT), investment in social programs and family involvement in treatment, expanding access to behavioral therapies and medications, increasing funding to harm reduction services, supporting reimbursement for continuing care services, and increasing investment in research. CONCLUSION These revised principles of adolescent assessment, treatment, and aftercare approaches and practices aim to establish guidance and evidence-based practices for treatment providers, while encouraging necessary support from policymakers and funding agencies to improve the standard of care for adolescent SUD services.
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3
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Ryan-Pettes SR, Morrison M, Randall J, Halliday C, Ledgerwood DM, Cunningham PB. Juvenile Probation Officer Perception of Contingency Management to Target Caregiver Engagement and Training Outcomes. JOURNAL OF OFFENDER REHABILITATION 2023; 62:315-335. [PMID: 38046203 PMCID: PMC10688515 DOI: 10.1080/10509674.2023.2213692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Few community-based substance use treatment programs are available or skilled in treating justice-involved youth, highlighting the need to equip juvenile probation officers with the skills to deliver evidence-based substance use treatment. Contingency management (CM) is evidence-based for treating substance use and shows promise for juvenile probation officers' successful uptake (positive opinions and trainability). However, research has not examined whether probation officers' positive beliefs and trainability generalize to target behaviors beyond those displayed by youth, but that nevertheless affect youth outcomes. This study examined probation officers' perceptions of using CM to engage caregivers and assessed probation officers' CM knowledge and CM delivery after training in a protocol-specific CM program for caregivers of substance-using youth on probation. Results showed probation officers were ambivalent about CM for caregivers. Results also showed that age, training format and how competency is assessed may be essential to consider. Implications for the dissemination of CM and future research are discussed.
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Affiliation(s)
- Stacy R. Ryan-Pettes
- Baylor University, Department of Psychology and Neuroscience, One Bear Place 97334, Waco, Texas 76798
| | - Meghan Morrison
- Baylor University, Department of Psychology and Neuroscience, One Bear Place 97334, Waco, Texas 76798
| | - Jeff Randall
- Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Family Services Research Center, Medical University of South Carolina, 176 Croghan Spur Rd., Ste 104, Charleston, SC 29407
| | - Colleen Halliday
- Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Family Services Research Center, Medical University of South Carolina, 176 Croghan Spur Rd., Ste 104, Charleston, SC 29407
| | - David M. Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Tolan Park, Detroit, MI 48201
| | - Phillippe B. Cunningham
- Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Family Services Research Center, Medical University of South Carolina, 176 Croghan Spur Rd., Ste 104, Charleston, SC 29407
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4
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Winer JM, Yule AM, Hadland SE, Bagley SM. Addressing adolescent substance use with a public health prevention framework: the case for harm reduction. Ann Med 2022; 54:2123-2136. [PMID: 35900132 PMCID: PMC9341337 DOI: 10.1080/07853890.2022.2104922] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Adolescence is a developmental stage defined in part by risk-taking. Risk-taking is critical to normal development and has important benefits including trying new activities and exploring new relationships. Risk-taking is also associated with the initiation of substance use. Because substance use often begins in adolescence, much focus has been on primary prevention with the goal of preventing initial substance use. Secondary or tertiary prevention approaches, such as counselling to eliminate substance use or offering treatment, are common approaches for adolescents with problematic substance use or a substance use disorder. While this is important, for some adolescents, treatment or cessation of use may not be desired. In these cases, Healthcare Practitioners (HCPs) can offer clear advice that incorporates harm reduction. Harm reduction, which is often applied for adults who use substances, reduces the negative impacts associated with drug use without requiring abstinence. Harm reduction is crucial to keeping adolescents safe and healthy and can offer opportunities for future engagement in treatment. The objective of this review is to describe strategies for integrating harm reduction principles in clinical settings that are developmentally appropriate. A patient-centered, harm reduction approach can validate perceived benefits of substance use, offer strategies to minimise harm, and advise reduction of use and abstinence.KEY MESSAGES:Substance use often begins in adolescence and traditional approaches are often rooted in prevention framework.Harm reduction should be incorporated for adolescents with problematic substance use or a substance use disorder.This review offers strategies for integration of harm reduction principles tailored towards adolescents.
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Affiliation(s)
- James Michael Winer
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Amy M. Yule
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Scott E. Hadland
- Division of Adolescent and Young Adult Medicine, MassGeneral Hospital for Children, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sarah M. Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
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5
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Kenyon CC, Flaherty C, Floyd GC, Jenssen BP, Miller VA. Promoting Healthy Childhood Behaviors With Financial Incentives: A Narrative Review of Key Considerations and Design Features for Future Research. Acad Pediatr 2022; 22:203-209. [PMID: 34403802 PMCID: PMC8844312 DOI: 10.1016/j.acap.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/15/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022]
Abstract
In the last decade, there has been a robust increase in research using financial incentives to promote healthy behaviors as behavioral economics and new monitoring technologies have been applied to health behaviors. Most studies of financial incentives on health behaviors have focused on adults, yet many unhealthy adult behaviors have roots in childhood and adolescence. The use of financial incentives is an attractive but controversial strategy in childhood. In this review, we first propose 5 general considerations in designing and applying incentive interventions to children. These include: 1) the potential impact of incentives on intrinsic motivation, 2) ethical concerns about incentives promoting undue influence, 3) the importance of child neurodevelopmental stage, 4) how incentive interventions may influence health disparities, and 5) how to finance effective programs. We then highlight empirical findings from randomized trials investigating key design features of financial incentive interventions, including framing (loss vs gain), timing (immediate vs delayed), and magnitude (incentive size) effects on a range of childhood behaviors from healthy eating to adherence to glycemic control in type 1 diabetes. Though the current research base on these subjects in children is limited, we found no evidence suggesting that loss-framed incentives perform better than gain-framed incentives in children and isolated studies from healthy food choice experiments support the use of immediate, small incentives versus delayed, larger incentives. Future research on childhood incentives should compare the effectiveness of gain versus loss-framing and focus on which intervention characteristics lead to sustained behavior change and habit formation.
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Affiliation(s)
- Chén C. Kenyon
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia,Division of General Pediatrics, Children’s Hospital of Philadelphia,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Carina Flaherty
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
| | - G. Chandler Floyd
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
| | - Brian P. Jenssen
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia,Division of General Pediatrics, Children’s Hospital of Philadelphia,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Victoria A. Miller
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
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6
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Crum KI, Hulvershorn L. Editorial: Heavy Adolescent Alcohol Use: An Accelerant of Impulsivity? J Am Acad Child Adolesc Psychiatry 2021; 60:575-576. [PMID: 33359028 DOI: 10.1016/j.jaac.2020.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
It has been difficult to disentangle factors conferring vulnerability to substance use disorders (SUDs) from the consequences of substance use. Reward sensitivity and impulsivity have been identified as adolescent risk factors that confer vulnerability for later problematic substance use.1,2 Studies also suggest, however, that substance use itself affects brain development and behavior and that some of the same risk factors that predispose youth to SUD (eg, reward sensitivity and impulsivity) may be brought on or worsened by the neurotoxicity of drugs of abuse.3,4 Studies examining neural and behavioral correlates of SUDs commonly include youth with varying degrees of substance exposure; thus development of vulnerabilities to substance abuse are difficult to separate from the effects of substance use. In this issue of JACC, Ivanov et al.5 advance our field's knowledge in this area by leveraging longitudinal data from the European IMAGEN dataset (n = 2,200)6 in order to characterize predictors of alcohol use at age 16 as well as trajectories of impulsivity. This design allows investigation into whether alcohol drinking in adolescence may actually be related to worsening impulsivity. The authors followed a subset of the IMAGEN sample, 304 substance-naïve 14-year-olds over 2 years. Reward system function in the brain was assessed at baseline by collecting functional magnetic resonance imaging scans during a Monetary Incentive Delay (MID)7 task which assessed neural response to reward anticipation and outcome. Impulsivity and delay discounting, the propensity to select smaller immediate rewards versus larger, delayed rewards, were also assessed at baseline and follow-up. Linear regression was used to evaluate longitudinal associations among the frequency of alcohol use at age 16 and impulsivity, delay discounting, and reward system function at age 14. Reward system function was measured by activation in medial orbitofrontal cortex (mOFC) and ventral striatum regions of interest during the highest versus the lowest reward levels on the MID task. These regions are involved in key aspects of reward processing, including valuation of rewarding stimuli and outcomes.8,9.
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Affiliation(s)
- Kathleen I Crum
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, Indiana
| | - Leslie Hulvershorn
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, Indiana.
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7
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Winters KC, Mader J, Budney AJ, Stanger C, Knapp AA, Walker DD. Interventions for cannabis use disorder. Curr Opin Psychol 2020; 38:67-74. [PMID: 33338844 DOI: 10.1016/j.copsyc.2020.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Abstract
How to treat adults and adolescents with a Cannabis Use Disorder is a burgeoning research area. This article reviews the empirical literature pertaining to several psychosocial approaches (cognitive-behavior therapy, motivational enhancement, and contingency management), all of which are associated with favorable outcomes. We also review the emerging research on the use of pharmacotherapy, brief interventions and technology-delivered interventions, and conclude with an overview of future research needs.
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8
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Hogue A, Bobek M, MacLean A. Core Elements of CBT for Adolescent Conduct and Substance Use Problems: Comorbidity, Clinical Techniques, and Case Examples. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:426-441. [PMID: 34103883 PMCID: PMC8184115 DOI: 10.1016/j.cbpra.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescent externalizing problems (AEPs), including serious conduct problems, delinquency, and substance misuse, are the most common adolescent behavioral issues in specialty care. High rates of comorbidity between conduct and substance use problems necessitate multidomain treatment strategies that can effectively address the AEP spectrum. One strategy to increase delivery of evidence-based interventions for multiproblem youth in usual care is to focus on core elements of empirically supported treatments that can be judiciously applied to clients presenting with diverse clinical profiles. This article describes six core practice elements of the cognitive-behavioral treatment (CBT) approach for AEPs: (1) Functional Analysis of Behavior Problems; (2) Prosocial Activity Sampling; (3) Cognitive Monitoring and Restructuring; (4) Emotion Regulation Training; (5) Problem-solving Training; (6) Communication Training. Integrated delivery of these core CBT elements is illustrated in two case examples, and implications for treatment planning for youth with AEPs are discussed.
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Affiliation(s)
- Aaron Hogue
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Molly Bobek
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Alexandra MacLean
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
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9
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Stanger C, Budney AJ. Contingency Management: Using Incentives to Improve Outcomes for Adolescent Substance Use Disorders. Pediatr Clin North Am 2019; 66:1183-1192. [PMID: 31679606 PMCID: PMC6834344 DOI: 10.1016/j.pcl.2019.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Multiple interventions for treating adolescents with substance use disorders have demonstrated efficacy, but most teens do not show an enduring positive response to these treatments. Contingency management (CM)-based strategies provide a promising alternative, and clinical research focused on the development and testing of innovative CM models continues to grow. This article provides information on the principles that underlie CM interventions, key metrics that define their development and implementation, a brief review of studies that have tested these approaches, and some clinical CM tools. As with other interventions to help youth with substance use problems, there is much to learn about CM approaches.
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Affiliation(s)
- Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Dartmouth College, 46 Centerra Parkway, EverGreen Center Suite 300, HB 7255, Lebanon, NH 03766, USA.
| | - Alan J. Budney
- Professor, Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
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10
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Abstract
Cocaine use by adolescents and young adults continues to be a significant public health issue and the cause of medical and psychological morbidity and mortality. Although use rates are lower than those seen with alcohol, tobacco, and other illicit substances such as marijuana, cocaine is highly addictive and presents significant acute and long-term medical and psychological effects. This article reviews the epidemiology of cocaine use among adolescents and young adults, discusses the pharmacology and neurobiology of cocaine use and dependence, provides information regarding acute intoxication and systemic effects seen with more chronic use, and describes current assessment and treatment approaches.
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Affiliation(s)
- Sheryl A Ryan
- Division of Adolescent Medicine, Department of Pediatrics, Milton S. Hershey Medical Center, Penn State Hershey Children's Hospital, Hershey, PA 17033, USA.
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11
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Fadus MC, Squeglia LM, Valadez EA, Tomko RL, Bryant BE, Gray KM. Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies. Curr Psychiatry Rep 2019; 21:96. [PMID: 31522280 PMCID: PMC7241222 DOI: 10.1007/s11920-019-1086-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW To examine the most recent published evidence (2016-2019) regarding the treatment of adolescent substance use disorders and to provide an update on evidence-based strategies, adjunctive interventions, and methods to improve currently established treatment approaches. RECENT FINDINGS Recent evidence suggests that psychosocial treatments such as family-based therapy, cognitive behavioral therapy, and multicomponent approaches remain the most effective methods of treatment; however, innovative ways of improving these treatment strategies may include digital and culturally based interventions. New advances in adjunctive treatments such as pharmacotherapy, exercise, mindfulness, and recovery-oriented educational centers may have some clinical utility. Well-established psychosocial interventions remain the primary modality of treatment. Promising new adjunctive treatments and improvements in our currently established treatments may yield significant improvements.
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Affiliation(s)
- Matthew C Fadus
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA.
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Emilio A Valadez
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Brittany E Bryant
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
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12
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Stanger C, Scherer EA, Vo HT, Babbin SF, Knapp AA, McKay JR, Budney AJ. Working memory training and high magnitude incentives for youth cannabis use: A SMART pilot trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:31-39. [PMID: 31246068 DOI: 10.1037/adb0000480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this sequential multiple-assignment randomization treatment pilot study was to examine if (a) adding working memory training to contingency management (CM) for youth with cannabis use disorder (CUD) and (b) switching nonresponding youth to higher magnitude CM incentives boosts outcomes. In Phase 1, youth with CUD (n = 59, M age = 16, male = 71%) attending an intensive outpatient program were randomly assigned to 14 weeks of CM only or CM plus working memory training (WMT). In Week 4, a Phase 2 treatment was assigned. Those with negative urine drug tests (responders) continued in their Phase 1 treatment. Those who were drug positive (nonresponders) were randomly assigned to remain in their Phase 1 treatment or to higher magnitude CM. Zero-inflated negative binomial models comparing those assigned to CM versus CM + WMT indicated no differences in the likelihood of having ≥ 1 week of continuous abstinence or longer abstinence duration. Those assigned to WMT showed greater but nonsignificant improvements in working memory (n = 35; β = .69, p = .06). Working memory improvements were associated with achieving any abstinence (odds ratio = 3.50, 95% CI [1.01, 12.10], p = .05). Phase 2 randomization to higher magnitude CM did not boost outcomes. Overall results suggest that WMT appears promising, but the sample size was small, attrition was high, and replication is important. Alternative strategies should continue to be explored to improve outcomes for adolescent substance use disorders, such as different approaches for nonresponders, tailoring to other baseline or response characteristics, or more robust first-line interventions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Budney AJ, Sofis MJ, Borodovsky JT. An update on cannabis use disorder with comment on the impact of policy related to therapeutic and recreational cannabis use. Eur Arch Psychiatry Clin Neurosci 2019; 269:73-86. [PMID: 30604051 PMCID: PMC6397057 DOI: 10.1007/s00406-018-0976-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 12/19/2018] [Indexed: 12/17/2022]
Abstract
Confusion and controversy related to the potential for cannabis use to cause harm, or alternatively to provide benefit, continues globally. This issue has grown in intensity and importance with the increased recognition of the public health implications related to the escalation of the legalization of cannabis and cannabinoid products. This selective overview and commentary attempt to succinctly convey what is known about one potential consequence of cannabis use, the development of cannabis use disorder (CUD). Such knowledge may help guide a reasonable and objective public health perspective on the potential impact of cannabis use and CUD. Current scientific data and clinical observation strongly support the contention that cannabis use, like the use of other substances such as alcohol, opioids, stimulants, and tobacco, can develop into a use disorder (addiction) with important clinical consequences. Epidemiological data indicate that the majority of those who use cannabis do not have problems related to their use, but a substantial subset (10-30%) do report experiencing symptoms and consequences consistent with a CUD. Treatment seeking for CUD comprises a substantial proportion of all substance use treatment admissions, yet treatment response rates show much room for improvement. Changing cannabis policies related to its therapeutic and recreational use are likely to impact the development of CUD and its course; however, definitive data on such effects are not yet available. Clearly, the development of more effective prevention and treatment strategies is needed for those vulnerable to developing a CUD and for those with a CUD.
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Affiliation(s)
- Alan J. Budney
- Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, NH, USA
| | - Michael J. Sofis
- Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 315, Lebanon, NH, USA
| | - Jacob T. Borodovsky
- Department of Psychiatry, Washington University School of Medicine, St. Louis, USA
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14
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Chadi N, Bagley SM, Hadland SE. Addressing Adolescents' and Young Adults' Substance Use Disorders. Med Clin North Am 2018; 102:603-620. [PMID: 29933818 DOI: 10.1016/j.mcna.2018.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adolescents and young adults (AYAs) have unique needs and important biopsychosocial differences when compared with older adults who use substances. As their brains continue to develop, youth are especially susceptible to the reinforcing effects of substances in the context of a still-developing capacity for executive control and decision making. In this article, the authors highlight key differences in the neurobiologic, epidemiologic, and relational aspects of substance use found in AYA. They also discuss how best to engage with youth who use substances and how prevention and intervention can be adapted for optimal effectiveness for this distinct and high-risk population.
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Affiliation(s)
- Nicholas Chadi
- Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sarah M Bagley
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall Room 322, Boston, MA 02118, USA; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA; Department of Pediatrics, Boston Medical Center, Grayken Center for Addiction, 850 Harrison Avenue, Boston, MA 02118, USA; Department of Medicine, Boston Medical Center, Grayken Center for Addiction, 850 Harrison Avenue, Boston, MA 02118, USA
| | - Scott E Hadland
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall Room 322, Boston, MA 02118, USA; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
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15
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Hogue A, Henderson CE, Becker SJ, Knight DK. Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014-2017: Outcomes, Treatment Delivery, and Promising Horizons. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2018; 47:499-526. [PMID: 29893607 PMCID: PMC7192024 DOI: 10.1080/15374416.2018.1466307] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This article updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Hogue, Henderson, Ozechowski, and Robbins (2014). It first summarizes the Hogue et al. findings along with those from recent literature reviews and meta-analytic studies of ASU treatments. It then presents study design and methods criteria used to select 11 comparative studies subjected to Journal of Clinical Child and Adolescent Psychology level of support evaluation. These 11 studies are detailed in terms of their sample characteristics, methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach. These cumulative designations are virtually identical to those of the previous review: ecological family-based treatment, individual cognitive-behavioral therapy, and group cognitive-behavioral therapy remain well-established; behavioral family-based treatment and motivational interviewing remain probably efficacious; drug counseling remains possibly efficacious; and an updated total of 5 multicomponent treatments combining more than 1 approach (3 of which include contingency management) are deemed well-established or probably efficacious. Treatment delivery issues associated with evidence-based approaches are then reviewed, focusing on client engagement, fidelity and mediator, and predictor and moderator effects. Finally, to help accelerate innovation in ASU treatment science and practice, the article outlines promising horizons in improving youth identification and access, specifying and implementing pragmatic treatment in community settings, and leveraging emerging lessons from implementation science.
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Affiliation(s)
| | | | - Sara J Becker
- c Center for Alcohol and Addictions Studies , Brown University School of Public Health
| | - Danica K Knight
- d Institute of Behavioral Research , Texas Christian University
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Gray KM, Squeglia LM. Research Review: What have we learned about adolescent substance use? J Child Psychol Psychiatry 2018; 59:618-627. [PMID: 28714184 PMCID: PMC5771977 DOI: 10.1111/jcpp.12783] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adolescence is a critical biological, psychological, and social developmental stage involving heightened risk for substance use and associated adverse consequences. This review, synthesizing emerging findings on this complex topic, is intended to inform research and clinical care focused on adolescents. METHODS Literature searches were conducted using PubMed, yielding a cross-section of observational and interventional studies focused on adolescent substance use. Findings were organized and categorized to cover key areas of epidemiology, neurobiology, prevention, and treatment. FINDINGS Adolescent substance-related attitudes and use patterns have evolved over time, informed by adult and peer behaviors, public policy, media messaging, substance availability, and other variables. A number of risk and resiliency factors contribute to individual differences in substance use and related consequences. Advances in observational techniques have provided enhanced understanding of adolescent brain development and its implications for substance use. Prevention efforts have yielded mixed results, and while a number of adolescent-targeted evidence-based treatments for substance use disorders have been developed, effect sizes are generally modest, indicating the need for further research to enhance prevention and treatment outcomes. CONCLUSIONS Substance use in adolescence is heterogeneous, ranging from normative to pathological, and can lead to significant acute and long-term morbidity and mortality. Understanding risk and resiliency factors, underlying neurobiology, and optimal developmentally sensitive interventions is critical in addressing substance-associated problems in adolescence.
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Affiliation(s)
- Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina; Charleston SC USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina; Charleston SC USA
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Ziser K, Resmark G, Giel KE, Becker S, Stuber F, Zipfel S, Junne F. The effectiveness of contingency management in the treatment of patients with anorexia nervosa: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2018; 26:379-393. [PMID: 29577487 DOI: 10.1002/erv.2590] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 11/08/2022]
Abstract
Contingency management in stipulating weight gain is routinely used in the treatment of anorexia nervosa, however, empirical investigations concerning its effectiveness have been scarce. This systematic review was conducted according to the PRISMA statement. Of N = 973 hits, 42 full-texts were included in the qualitative synthesis (11 theoretical texts, 19 case reports, 12 descriptive, cohort, and controlled trials). A central topic in the included publications concerns the enhancement of patients' autonomy through participation in the contingency management process. This heightened autonomy is achieved by using contingency contracts. Positive short-term effects on weight gain were shown, whereas follow-up results were heterogeneous. Although contingency contracts are widely used in clinical practice, our systematic review shows that empirical evidence on underlying mechanisms and efficacy is still scarce. Using an explicit treatment contract can enhance patients' motivation, compliance, and autonomy. Clinical practice should see further development including innovative motivation enhancing and conflict dissolving techniques in addressing the pronounced ambivalence often shown by patients with anorexia nervosa.
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Affiliation(s)
- Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Sandra Becker
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Felicitas Stuber
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
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Petry NM, Alessi SM, Olmstead TA, Rash CJ, Zajac K. Contingency management treatment for substance use disorders: How far has it come, and where does it need to go? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:897-906. [PMID: 28639812 PMCID: PMC5714694 DOI: 10.1037/adb0000287] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Contingency management (CM) interventions consistently improve substance abuse treatment outcomes, yet CM remains a highly controversial intervention and is rarely implemented in practice settings. This article briefly outlines the evidence base of CM and then describes 4 of the most often-cited concerns about it: philosophical, motivational, durability, and economic. Data supporting and refuting each of these issues are reviewed. The article concludes with suggestions to address these matters and other important areas for CM research and implementation, with the aims of improving uptake of this efficacious intervention in practice settings and outcomes of patients with substance use disorders. (PsycINFO Database Record
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Affiliation(s)
- Nancy M Petry
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Sheila M Alessi
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | | | - Carla J Rash
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Kristyn Zajac
- Calhoun Cardiology Center, University of Connecticut School of Medicine
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Walker DD. Legalization of cannabis: Considerations for intervening with adolescent consumers. Prev Med 2017; 104:37-39. [PMID: 28729196 DOI: 10.1016/j.ypmed.2017.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/23/2017] [Accepted: 07/12/2017] [Indexed: 11/29/2022]
Abstract
Eight states and the District of Columbia have legalized the recreational use of cannabis for adults and more are expected to follow suit. After alcohol, cannabis is the most commonly used drug by adolescents. Consumption of this drug during this developmental period poses unique risks. Therefore, attention must be paid both to how legalization affects adolescents and how tailored interventions can effectively address their needs for assistance. This commentary offers considerations for how legalization might be crafted so as to benefit adolescents. It additionally focuses on how services might be designed to reach and intervene with teens who are questioning their use or are experiencing a cannabis use disorder and desire assistance in quitting.
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Affiliation(s)
- Denise D Walker
- Innovative Programs Research Group, School of Social Work, University of Washington, 909 NE 43rd St, Suite #304, Seattle, WA 98105, United States.
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Adolescents with cannabis use disorders: Adaptive treatment for poor responders. Addict Behav 2017; 70:102-106. [PMID: 28232290 DOI: 10.1016/j.addbeh.2017.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/02/2017] [Accepted: 02/08/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Treatment response as measured by both retention and abstinence attainment rates for adolescents with cannabis use disorders (CUD) has been unsatisfactory. This study tested the hypothesis that adaptive treatment (AT) will improve outcomes for poor responders (PR) to evidence-based practice interventions. METHOD A total of 161 adolescents, 13-18years of age, diagnosed with DSM-IV CUD, enrolled in this outpatient, randomized, AT study. Following a 7-session weekly motivational enhancement and cognitive behavioral therapy intervention (MET/CBT-7) only poor responders (defined as failing to achieve abstinence at week seven for any reason) were randomized into a 10-week AT phase of either an individualized enhanced CBT or an Adolescent Community Reinforcement Approach (ACRA) intervention. Good responders (GR) enrolled only in follow-up assessments starting at the completion of the AT phase (week 17). RESULTS Eighty adolescents (50%) met the criterion for poor response to treatment. Thirty seven percent of poor responders completed the AT phase and 27% of them achieved abstinence. There was no significant difference in retention and abstinence rates between the AT conditions. Although the majority of GR relapsed by week 17, they significantly differed from PR both for drug use (71% vs. 91%, respectively; p<0.05) and reporting to scheduled assessment on that week (78% vs. 54%, respectively; p<0.01). CONCLUSION Continuity of care to achieve abstinence among poor responders remains a therapeutic necessity and a research challenge. Examining innovative AT designed interventions including potential integrative approaches should be further studied in order to improve treatment outcomes.
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