Substance use treatment outcomes for youth: integrating personal and environmental predictors

Do adverse experiences predict unemployment and need of psychiatric help after treatment for drug use disorders?

Background: This study prospectively examined the association between adverse experiences (physical abuse, sexual abuse and parental substance use problems [SUPs]), not being employed, in education or training (NEET) and being in need of acute psychiatric help among patients receiving treatment for substance use disorders. Methods: A total of 580 adolescents and early adults aged 15-25 years enrolled in treatment for drug use disorders were included in the analyses. Treatment data were linked to participants' register data on employment, education and acute contact to psychiatric services for the following two years. Multivariable logistic regression models were used to examine associations between the three adverse experiences, NEET and need of acute psychiatric help, adjusting for confounders such as age, gender, ethnicity, treatment response and treatment condition. Results: More than half of the participants were NEET two years after treatment enrolment. After controlling for demographics and treatment conditions, NEET was predicted by parental substance use problems (odds ratio [OR] = 1.89, 95% confidence interval [CI] 1.31- 2.70), exposure to physical abuse (OR = 1.48, 95% CI 1.03-2.13) and non-abstinence (abstinence was negatively associated with NEET, OR = 0.53, 95% CI 0.37-0.76). Being exposed to two (OR = 3.17, 95% CI 1.93-5.21) and three types of adverse experiences (OR = 3.14, 95% CI = 1.47-6.70) predicted NEET more strongly than exposure to one type. One out of 10 participants sought acute care from psychiatric services at least once within two years after treatment. Only sex and ethnic minority status were associated with contacting psychiatric services acutely. Conclusion: The present study suggests that adverse experiences, such as being exposed to parental problematic substance use and physical abuse, may be important predictors for NEET after treatment for SUDs.

Housing and supportive services for substance use and self-efficacy among young mothers experiencing homelessness: A randomized controlled trial

AIMS

Homeless mothers with young children in their care contend with high rates of substance use and low self-efficacy. However, a limited number of studies have examined these outcomes associated with housing and supportive services.

DESIGN

Participants were randomly assigned to: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline.

SETTINGS

The study recruited a community-based sample from homeless service agencies and advertisements in a large Midwestern city.

PARTICIPANTS

The study recruited two hundred forty (N = 240) women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care.

MEASUREMENTS

We measured frequency of alcohol and drug use using the Form 90 semi-structured interview, and self-efficacy using Pearlin and Schooler's (1978) 7-item Mastery Scale.

FINDINGS

Overall, mothers showed significant improvement in substance use and self-efficacy over time in each condition. However, as expected, patterns of change differentiated intervention groups with more mothers showing better substance use and self-efficacy outcomes in housing + supportive services than in SAU. Unexpectedly, more mothers in SAU showed better outcomes than those in housing-only.

CONCLUSIONS

Substance use decreased and self-efficacy increased over time, but patterns of change characterized the intervention groups. In particular, findings suggest that when providing housing to this population, supportive services should also be offered.

Adolescents with substance abuse problems in outpatient treatment: A one-year prospective follow-up study

Aim:

There is a lack of knowledge about how adolescents with substance abuse problems manage after taking part in treatment. It is also difficult to perform traditional follow-up studies with this group. This article presents the outcome of a prospective study of 455 adolescents who underwent outpatient treatment, based on data taken from official registers. It aims to describe and analyse indications of continued use of substance (CUS) and how various risk and protective factors predict outcomes after initiated treatment at a Maria clinic in Sweden.

Design:

The study is based on structured interviews at intake, and the data that indicated CUS were taken from several different national registers. The analyses included descriptive data and bivariate associations, logistic regressions and a CHAID analysis.

Results:

Almost two thirds of the adolescents have no indication of CUS at one-year follow-up. The ten studied risk factors independently were weak predictors of CUS and it was instead the accumulation of risk factors that were linked to a negative outcome.

Conclusion:

The majority of adolescents who start outpatient treatment for substance abuse problems return to a lesser extent in registers that may indicate a continued problem with alcohol and drugs one year later. A concentration of more than five risk factors appears to be associated with a registration. The study also provides an example of an alternative method for following up adolescents with alcohol and drug abuse problems.

Until there's nothing left: Caregiver resource provision to youth with opioid use disorders

Background and Aims: Despite the considerable literature associating certain characteristics of caregivers and family structures with risks of adolescent/young adult (youth) substance use, there has been little study of the role of caregivers in opioid use disorder (OUD) treatment outcomes. This qualitative study sought to understand and contextualize the factors that influenced the resources caregivers provided their youth after residential treatment. Methods: In order to improve understandings of the role caregivers play both during and after residential OUD treatment, 31 caregivers of youth who were in a residential substance use disorder treatment center were interviewed at baseline, three-months, and six-months following their youth's discharge. Results: This analysis focused on the provision of caregiver resources and identified three key influences - OUD understandings and expectations, relationships with youth, and the emotional toll on caregivers. This has important implications as residential treatment success rates are relatively low among this population. Conclusions: These findings suggest that engagement of caregivers and families in outpatient care following residential treatment could offer an important opportunity for interventions that promote youth recovery.

A longitudinal evaluation of a survivor-mentor program for child survivors of sex trafficking in the United States

BACKGROUND

Commercial sexual exploitation (CSE) of children is a significant public health and criminal justice problem, but there are few evaluated models of CSE mentorship service.

OBJECTIVES

To assess whether youth who participated in a CSE survivor-mentor program evidenced changes in CSE victimization, dating abuse victimization, health, delinquency, social support, and coping during the year following their enrollment in the program.

PARTICIPANTS

41 youth who were CSE-experienced at baseline (72%) or determined very high risk, 11-18 years old, 95% female, 58% heterosexual, 29% White, 29% Hispanic, and 42% other races/ethnicities.

SETTING

An urban city in the Northeast United States.

METHODS

We used a one-group repeated measures design and a GEE analysis. Data were collected at baseline, six months after baseline (71% follow-up) and 12 months after baseline (68% follow-up).

RESULTS

At baseline 72% could be characterized as CSE-experienced, while at 6 months the percentage decreased to 24% (p < 0.001) and at 12 months to 14% (p < 0.001). After 6 months of receiving survivor-mentor services, youth were less likely to have experienced CSE, engaged in sexually explicit behavior (SEB), used illicit drugs, engaged in delinquent behavior, been arrested or detained by police, and they had better social support and coping skills. After 12 months, youth were less likely to have experienced CSE, to have engaged in delinquent behavior, be arrested or detained by police, and had improved coping skills.

CONCLUSION

Findings demonstrate that youth who received survivor-mentor services from MLMC experienced improved well-being and less drug use, delinquent behavior, and exploitation.

Testing mediational processes of substance use relapse among youth who participated in a mobile texting aftercare project

BACKGROUND

The goal of this paper is to advance the understanding of mechanisms of action involved in behavioral-driven aftercare interventions for substance use disorders (SUDs) among youth populations. This paper reports data from a study that measured the impact of an aftercare intervention on primary substance use relapse among youth who completed treatment in Los Angeles County for SUDs. The aftercare intervention, Project ESQYIR-Educating and Supporting inQuisitive Youth In Recovery, utilized text messaging to monitor relapse and recovery processes, provide feedback, reminders, support, and education among youth from SUD specialty settings during the initial 3-month period following treatment completion.

Method: Mediational modeling informed by Baron and Kenny was used to examine the extent to which select recovery processes including participation in extracurricular activities and self-help, were impacted by the texting intervention, and if such processes helped sustain recovery and prevent primary substance use relapse. The data come from a two-group randomized controlled pilot study testing the initial efficacy of a mobile health texting aftercare intervention among 80 youth (Mage= 20.7, SD = 3.5, range: 14-26 years) who volunteered to participate after completing SUD treatment between 2012 and 2013.

Results: Among the two recovery processes examined in the mediational modeling, only involvement in extracurricular activities mediated the effects of the texting aftercare intervention on reductions in primary substance use relapse; not self-help participation.

Conclusion: Findings from this pilot study offer greater understanding about potential recovery-related mechanisms of action of mobile aftercare interventions. Mobile texting was found to promote increased engagement in recovery-related behaviors such as participation in extracurricular activities, which mediated the effects of the mobile aftercare intervention on decreasing primary substance use relapse. Findings suggest mobile approaches may be effective for increasing adherence to a wide-array of recovery behavioral regiments among youth populations challenged by complex behavioral issues.

Treatment effectiveness of a mindfulness-based inpatient group psychotherapy in adolescent substance use disorder - study protocol for a randomized controlled trial

BACKGROUND

Current treatments for adolescents with substance use disorder (SUD) have had only limited success. In recent years, research has underlined the role of self-regulatory processes and impulsivity in the development and maintenance of SUD in adolescents. Mindfulness has gained much attention due to its capacity to influence self-regulatory processes, particularly in adult populations. Initial studies have shown the potential of mindfulness-based approaches in younger SUD patients. The aim of the present clinical trial is to evaluate the added treatment effect of a mindfulness-based group psychotherapy ("Mind it!") for adolescents with SUD in comparison to the current standard treatment. Moreover, we seek to explore the feasibility of the intervention and possible mediators of treatment effects.

METHODS/DESIGN

There will be N = 340 participants aged between 13 and 19 years who are receiving child or adolescent psychiatric or psychotherapeutic inpatient or day treatment targeting their SUD and who have reported substance use 30 days before detoxification and do not show acute psychotic or suicidal symptoms at baseline. The study is a prospective randomized controlled multi-center trial in which patients are assessed: (1) after completing a prior detoxification phase (t0), (2) at 4 weeks (t1), (3) at 8 weeks (t2), and (4) at 6 months after t2 (t3). Participants in the intervention group will receive mindfulness-based group psychotherapy in addition to their existing treatment regime. The primary outcome is substance use in the past 30 days at follow-up based on the Timeline Followback self-report. Secondary outcomes include craving, severity of dependence, and abstinence motivation. Mindfulness, impulsivity, and emotion regulation will be analyzed as possible mediators of treatment effects.

DISCUSSION

This trial is expected to provide evidence of the added effect of a novel, safe, and feasible treatment option for adolescents with SUD.

TRIAL REGISTRATION

German Register of Clinical Studies, DRKS00014041 . Registered on 17 April 2018.

"God put weed here for us to smoke": A mixed-methods study of religion and spirituality among adolescents with cannabis use disorders

BACKGROUND

A growing literature on adults with substance use disorders (SUDs) suggests that religious and spiritual processes can support recovery, such that higher levels of religiosity and/or spirituality predict better substance use outcomes. However, studies of the role of religion and spirituality in adolescent SUD treatment response have produced mixed findings, and religiosity and spirituality have rarely been examined separately.

METHODS

The present study examined religiosity and spirituality as predictors of outcomes in an outpatient treatment adolescent sample (N = 101) in which cannabis was the predominant drug of choice. Qualitative data were used to contextualize the quantitative findings.

RESULTS

Results showed that higher levels of spirituality at posttreatment predicted increased cannabis use at 6-month follow-up (β = .237, p = .043), whereas higher levels of baseline spirituality predicted a lower likelihood of heavy drinking at posttreatment (odds ratio [OR] = .316, P = .040). Religiosity did not predict substance use outcomes at later time points. When asked to describe the relation between their religious/spiritual views and their substance use, adolescents described believing that they had a choice about their substance use and were in control of it, feeling more spiritual when under the influence of cannabis, and being helped by substance use.

CONCLUSIONS

Together, findings suggest that for adolescents with SUDs, religion and spirituality may not counteract the use of cannabis, which may be explained by adolescents' views of their substance use as being consistent with their spirituality and under their control.

Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review

This Campbell systematic review examines the effects of recovery schools on student behavioral and academic outcomes, compared to the effects of non-recovery schools. The review summarizes evidence from one quasi-experimental study (with a total of 194 participants) that had potential serious risk of bias due to confounding. Sizable portions of youth are in recovery from substance use disorders, and many youth will return to use after receiving substance use treatment. Youth spend most of their waking hours at school, and thus schools are important social environments for youth in recovery from substance use disorders. Recovery schools have been identified as educational programs that may help support youth in recovery from substance use disorders. This review focused on two types of recovery schools: RHSs, which are schools that award secondary school diplomas and offer a range of therapeutic services in addition to standard educational curricula; and CRCs, which offer therapeutic and sober support services on college campuses. This review looked at whether recovery schools (RHSs or CRCs) affect academic success and substance use outcomes among students, compared to similar students who are not enrolled in recovery schools.

Plain language summary

There is insufficient evidence to know whether recovery high schools and collegiate recovery communities are effective: Evidence that recovery high schools (RHSs) may improve academic and substance use outcomes is based on the findings from a single study with a serious risk of bias.The review in brief: Very limited evidence addresses the effectiveness of recovery high schools (RHSs). There is no rigorous evidence on the effectiveness of collegiate recovery communities (CRCs).It is unclear whether CRCs are effective in promoting academic success and reducing substance use among college students.What is the aim of this review?: This Campbell systematic review examines the effects of recovery schools on student behavioral and academic outcomes, compared to the effects of non-recovery schools. The review summarizes evidence from one quasi-experimental study (with a total of 194 participants) that had potential serious risk of bias due to confounding.What are the main findings of this review?: Sizable portions of youth are in recovery from substance use disorders, and many youth will return to use after receiving substance use treatment. Youth spend most of their waking hours at school, and thus schools are important social environments for youth in recovery from substance use disorders. Recovery schools have been identified as educational programs that may help support youth in recovery from substance use disorders.This review focused on two types of recovery schools: RHSs, which are schools that award secondary school diplomas and offer a range of therapeutic services in addition to standard educational curricula; and CRCs, which offer therapeutic and sober support services on college campuses.This review looked at whether recovery schools (RHSs or CRCs) affect academic success and substance use outcomes among students, compared to similar students who are not enrolled in recovery schools.What studies are included?: The included study of recovery high schools used a controlled quasi-experimental pretest-posttest design and reported on the following outcomes: grade point average, truancy, school absenteeism, alcohol use, marijuana use, other drug use, and abstinence from alcohol/drugs. The included study focused on a sample of U.S. high school students. There were no eligible studies of CRCs.What do the findings of this review mean?: Findings from this review indicate insufficient evidence on the effects of recovery schools on student well-being. Although there is some indication RHSs may improve academic and substance use outcomes, this is based on the findings from a single study. There is no available evidence on the effects of CRCs.No strong conclusions can be drawn at this time, given the lack of available evidence on RHSs and CRCs, and the serious risk of bias in the one RHS study included in the review. The evidence from this review suggests there is a clear need for additional rigorous evaluations of recovery school effects prior to widespread implementation.How up-to-date is this review?: The review authors searched for studies until September 2018. This Campbell systematic review was published in 2018.

Executive Summary/Abstract

BACKGROUND: Substance use disorders (SUDs) among youth are a major public health problem. In the United States, for example, the incidence of SUDs increases steadily after age 12 and peaks among youth ages 18-23 (White, Evans, Ali, Achara-Abrahams, & King, 2009). Although not every youth who experiments with alcohol or illicit drugs is diagnosed with an SUD, approximately 7-9% of 12-24 year olds in the United States were admitted for public SUD treatment in 2013 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2016). Recovery from an SUD involves reduction or complete abstinence of use, defined broadly as "voluntarily sustained control over substance use, which maximises health and wellbeing and participation in the rights, roles and responsibilities of society" (UK Drug Policy Commission, 2008). However, SUDs are often experienced as chronic conditions; among youth who successfully complete substance use treatment, approximately 45-70% return to substance use within months of treatment discharge (Anderson, Ramo, Schulte, Cummins, & Brown, 2007; Brown, D'Amico, McCarthy, & Tapert, 2001; Ramo, Prince, Roesch, & Brown, 2012; White et al., 2004). Thus, multiple treatment episodes and ongoing recovery supports after treatment are often necessary to assist with the recovery process (Brown et al., 2001; Ramo et al., 2012; White et al., 2004).Success and engagement at school and in postsecondary education are critical to healthy youth development. For youth in recovery from SUDs, school attendance, engagement, and achievement build human capital by motivating personal growth, creating new opportunities and social networks, and increasing life satisfaction and meaning (Keane, 2011; Terrion, 2012; 2014). Upon discharge from formal substance use treatment settings, schools become one of the most important social environments in the lives of youth with SUDs. Healthy school peer environments can enable youth to replace substance use behaviors and norms with healthy activities and prosocial, sober peers. Conversely, many school environments may be risky for youth in recovery from SUDs due to perceived substance use among peers, availability of drugs or alcohol, and substance-approving norms on campus (Centers for Disease Control [CDC], 2011; Spear & Skala, 1995; Wambeam, Canen, Linkenbach, & Otto, 2014).Given the many social and environmental challenges faced by youth in recovery from substance use, recovery-specific institutional supports are increasingly being linked to educational settings. The two primary types of education-based continuing care supports for youth in recovery, defined under the umbrella term of "recovery schools" for this review, are recovery high schools (RHSs) and collegiate recovery communities (CRCs). RHSs are secondary schools that provide standard high school education and award secondary school diplomas, but also include therapeutic programming aimed at promoting recovery (e.g., group check-ins, community service, counseling sessions). CRCs also provide recovery oriented support services (e.g., self-help groups, counseling sessions, sober dorms) for students, but are embedded within larger college or university settings. The primary aims of RHSs and CRCs are to promote abstinence and prevent relapse among students, and thus ultimately improve students' academic success.OBJECTIVES: This review summarized and synthesized the available research evidence on the effects of recovery schools for improving academic success and behavioural outcomes among high school and college students who are in recovery from substance use. The specific research questions that guided the review are as follows: 1. What effect does recovery school attendance (versus attending a non-recovery or traditional school setting) have on academic outcomes for students in recovery from substance use? Specifically (by program type): a. For recovery high schools: what are the effects on measures of academic achievement, high school completion, and college enrolment?b. For collegiate recovery communities: what are the effects on measures of academic achievement and college completion?2. What effect does recovery school attendance have on substance use outcomes for students in recovery from substance use? Specifically, what are the effects on alcohol, marijuana, cocaine, or other substance use?3. Do the effects of recovery schools on students' outcomes vary according to the race/ethnicity, gender, or socioeconomic status of the students?4. Do the effects of recovery schools on students' outcomes vary according to existing mental health comorbidity status or juvenile justice involvement of the students? SEARCH METHODS: We aimed to identify all published and unpublished literature on recovery schools by using a comprehensive and systematic literature search. We searched multiple electronic databases, research registers, grey literature sources, and reference lists from prior reviews; and contacted experts in the field.SELECTION CRITERIA: Studies were included in the review if they met the following criteria:Types of studies: Randomized controlled trial (RCT), quasi-randomized controlled trial (QRCT), or controlled quasi-experimental design (QED).Types of participants: Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions.Types of interventions: Recovery schools broadly defined as educational institutions, or programs at educational institutions, developed specifically for students in recovery and that address recovery needs in addition to academic development.Types of comparisons: Traditional educational programs or services that did not explicitly have a substance use recovery focus.Types of outcome measures: The review focused on primary outcomes in the following two domains: academic performance (e.g., achievement test scores, grade-point average, high school completion, school attendance, college enrolment, college completion) and substance use (alcohol, marijuana, cocaine, heroin, stimulant, mixed drug use, or other illicit drug use). Studies that met all other eligibility criteria were considered eligible for the narrative review portion of this review even if they did not report outcomes in one of the primary outcome domains.Other criteria: Studies must have been reported between 1978 and 2016. The search was not restricted by geography, language, publication status, or any other study characteristic.DATA COLLECTION AND ANALYSIS: Two reviewers independently screened all titles and abstracts of records identified in the systematic search. Records that were clearly ineligible or irrelevant were excluded at the title/abstract phase; all other records were retrieved in full-text and screened for eligibility by two independent reviewers. Any discrepancies in eligibility assessments were discussed and resolved via consensus. Studies that met the inclusion criteria were coded by two independent reviewers using a structured data extraction form; any disagreements in coding were resolved via discussion and consensus. If members of the review team had conducted any of the primary studies eligible for the review, external and independent data collectors extracted data from those studies. Risk of bias was assessed using the ROBINS-I tool for non-randomized study designs (Sterne, Higgins, & Reeves, 2016).Inverse variance weighted random effects meta-analyses were planned to synthesize effect sizes across studies, as well as heterogeneity analysis, subgroup analysis, sensitivity analysis, and publication bias analysis. However, these synthesis methods were not used given that only one study met the inclusion criteria for the review. Instead, effect sizes (and their corresponding 95% confidence intervals) were reported for all eligible outcomes reported in the study.RESULTS: Only one study met criteria for inclusion in the review. This study used a QED to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified in the search.The results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (= 0.26, 95% CI [-0.04, 0.56]), truancy (= 0.01, 95% CI [-0.29, 0.31]), and alcohol use (= 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (= 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (= 0.51, 95% CI [0.20, 0.82]), and other drug use (= 0.45, 95% CI [0.14, 0.76]).Overall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.AUTHORS' CONCLUSIONS: There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. No identified studies examined the effectiveness of CRCs across the outcomes of interest in this review, so it is unclear what effects these programs may have on students' academic and behavioral outcomes.The paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in the review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools.

Research Review: The effectiveness of multidimensional family therapy in treating adolescents with multiple behavior problems - a meta-analysis

BACKGROUND

Multidimensional family therapy (MDFT) is a well-established treatment for adolescents showing both substance abuse and/or antisocial behavior.

METHOD

The effectiveness of MDFT in reducing adolescents' substance abuse, delinquency, externalizing and internalizing psychopathology, and family malfunctioning was examined by means of a (three-level) meta-analysis, summarizing 61 effect sizes from 19 manuscripts (N = 1,488 participants).

RESULTS

Compared with other therapies, the overall effect size of MDFT was significant, albeit small in magnitude (d = 0.24, p < .001), and similar across intervention outcome categories. Moderator analysis revealed that adolescents with high severity problems, including severe substance abuse and disruptive behavior disorder, benefited more from MDFT than adolescents with less severe conditions.

CONCLUSIONS

It can be concluded that MDFT is effective for adolescents with substance abuse, delinquency, and comorbid behavior problems. Subsequently, it is important to match specific characteristics of the adolescents, such as extent of impairment, with MDFT.

Time to relapse following treatment for methamphetamine use: a long-term perspective on patterns and predictors

INTRODUCTION

This paper describes methamphetamine (MA) use patterns, specifically the duration of continuing abstinence ("time to relapse") for periods averaging 5 years post-discharge from treatment for MA use, and the relationship with selected user and treatment characteristics.

METHODS

A sample of 350 treatment admissions from a large county substance use disorder (SUD) treatment system was randomly selected (within gender, race/ethnicity, treatment modality strata). Retrospective self-report data are from natural history interviews (NHI) conducted approximately 3 years after treatment and a follow-up of 2-3 years later. Relapse is defined as any use of MA with time as the number of months of continuous MA abstinence after treatment discharge until relapse. This outcome was constructed from a monthly MA use timeline using NHI data. A Cox model was used to examine time to relapse and predictors.

RESULTS

Sixty-one percent of the sample relapsed to MA use within 1 year after treatment discharge and 14% during years 2-5. Significant protective factors predicting longer time to relapse included having experienced serious MA-related psychiatric/behavioral problems (hazard ratio [HR]=0.75, p=0.027), longer duration of the index treatment episode (HR=0.93, p=0.001), and participating in self-help or other treatment during the post-treatment abstinence period (HR=0.29, p<0.001); risk factors for shorter time to relapse included having a parent with alcohol and/or drug use problems (HR=1.35, p=0.020) and involvement in MA sales (HR=1.48, p=0.002).

CONCLUSIONS

Results contribute a long-term perspective on patterns of MA use following treatment and support a need for early post-treatment and long-term continuing care and relapse-prevention services.

Psychopharmacological treatment of young people with substance dependence: a survey of prescribing practices in England

BACKROUND

Prescribing for substance-dependent youth requires expert knowledge of developmental and contextual issues and use of largely unlicensed medicines. This first national survey aimed to determine the nature of pharmacological treatments delivered in England including the extent of maintenance therapy, supervised consumption and specialties prescribing.

METHOD

Data were gathered regarding opiate substitutes & other medications prescribed for opiate, alcohol & benzodiazepine dependence, drug & alcohol relapse prevention and comorbidities. Evidence of distinct approaches to younger compared with older adolescents was sought.

RESULTS

The overall response rate was 73%. The majority treated were over 16 years. 85% treatments were opiate substitute therapies; many received longer term maintenance therapy. Prescribing for alcohol dependence & comorbidity was low; the largest prescribing group were General Practitioners.

CONCLUSIONS

Questions remain about the scale of youth dependence, the use of substitute agents in maintenance treatment and the number of adolescent addiction specialists in the treatment cadre.

Recovery Supports for Young People: What Do Existing Supports Reveal About the Recovery Environment?

This article seeks to address how our understanding of the recovery process and resulting supports can be made more comprehensive: how can links from treatment to home to school to communities be made so that there are fewer and fewer recovery gaps for adolescents? Using the ecology of recovery model developed by White (2009) as the impetus for such a review, the article discusses the challenges inherent within adolescent substance abuse recovery, factors impacting successful recovery, and programs addressing this issue that have been empirically studied. Studied programs can be categorized as (1) formalized aftercare recovery and (2) recovery communities, and both examples will be described using existing literature. From the review of existing recovery support research and resources, the discussion highlights gaps and future research areas in order to address the complexity of recovery among young people.

Therapeutic Engagement and Posttreatment Substance Use in Adolescent TC Clients

The problem of adolescent drug use places a huge toll on society and a heavy burden on the criminal justice system. Despite the ability of therapeutic communities (TCs) to lower drug relapse, a great deal remains unknown in terms of how the process of treatment actually works for adolescents. Using data collected as part of the Drug Abuse Treatment Outcomes Studies–Adolescents, this study examines the direct and indirect relationship between therapeutic engagement and posttreatment substance use. Though there are few direct effects of therapeutic engagement on substance use, findings suggest that those more engaged in treatment are more likely to complete treatment and, therefore, less likely to use substances. This suggests that instruments that evaluate therapeutic engagement are important in assessing involvement in treatment, and that programming designed to engage the adolescents in TC treatment should be utilized to reduce the risk of posttreatment relapse.

12-step participation and outcomes over 7 years among adolescent substance use patients with and without psychiatric comorbidity

This study examines the associations between 12-step participation and outcomes over 7 years among 419 adolescent substance use patients with and without psychiatric comorbidities. Although level of participation decreased over time for both groups, comorbid adolescents participated in 12-step groups at comparable or higher levels across time points. Results from mixed-effects logistic regression models indicated that for both groups, 12-step participation was associated with both alcohol and drug abstinence at follow-ups, increasing the likelihood of either by at least 3 times. Findings highlight the potential benefits of 12-step participation in maintaining long-term recovery for adolescents with and without psychiatric disorders.

Twelve-Step attendance trajectories over 7 years among adolescents entering substance use treatment in an integrated health plan

AIMS

This study examines 12-Step attendance trajectories over 7 years, factors associated with the trajectories, and relationships between the trajectories and long-term substance use outcomes among adolescents entering out-patient substance use treatment in a private, non-profit integrated managed-care health plan.

DESIGN

Longitudinal observational study.

SETTING

Four Kaiser Permanente Northern California substance use treatment programs.

PARTICIPANTS

A total of 391 adolescents entering treatment between 2000 and 2002 who completed at least one follow-up interview in year 1, and at least one during years 3-7, after treatment entry.

MEASUREMENTS

Alcohol and drug use, 12-Step meeting attendance and activity involvement and post-treatment medical service utilization.

FINDINGS

Semiparametric group-based modeling identified three distinct 12-Step attendance trajectory groups over 7 years: low/no attendance (60%), early but not continued (26%) and continued (14%). There were lower proportions of males and of adolescents with prior substance use treatment experience in the low/no attendance group (P = 0.019 and P = 0.003, respectively). In addition, those in the low/no attendance group had lower perception on circumstances, motivation and readiness for treatment at baseline (P = 0.023). Multivariate logistic generalized estimating equation analyses found that those in the continued group were more likely to be abstinent from both alcohol and drugs during follow-ups than those in the low/no attendance group [odds ratio (OR) = 2.40, P = 0.003 and OR = 1.96, P = 0.026, respectively]. However, no differences in long-term outcomes were found between those in the other two groups.

CONCLUSION

Robust connection with 12-Step groups appears to be associated with better long-term outcomes among adolescents with substance use disorders.

What Adolescents Need to Prevent Relapse after Treatment for Substance Abuse: A Comparison of Youth, Parent, and Staff Perspectives

OBJECTIVE

Little is known about what factors and supports youths identify as important for their sustained recovery after substance abuse treatment, and if their caregivers and treatment staff identify similar needs. The purpose of this study was to explore what youths, caregivers, and staff perceive as important to remain substance free after completing a residential treatment program.

METHODS

Semi-structured interviews were conducted with 28 adolescents, 30 parents, and 29 staff at 3 treatment agencies. Data were coded thematically and themes were organized by respondent type.

RESULTS

There was high frequency and concordance across respondents regarding the need for aftercare services, supportive relationships, and activities. Only one item, outpatient treatment, demonstrated significant differences across groups.

CONCLUSIONS

External supports and activities are important to recovery of adolescents from substances following treatment completion. Implications and potential areas of inquiry are discussed.

To drink or not to drink: motives and expectancies for use and nonuse in adolescence

Drinking motives have a prominent role in cognitive models of adolescent and adult alcohol decision-making (Cooper, Russell, Skinner, & Windle, 1992; Cooper, 1994). The complementary construct of motivation not to drink has received less attention (Epler, Sher & Piasecki, 2009). We examined how abstinence motives interacted with drinking motives and alcohol expectancies to predict alcohol consumption in samples of US high school students (N>2500). Nondrinking motives predicted lower rates of lifetime and current alcohol use. Motives not to drink interacted with specific drinking motives, like social and coping motives, and alcohol expectancies to predict certain aspects of drinking behavior. For example, motives not to drink had the greatest impact on youth with weaker social motivations. Findings highlight the distinction between motives not to drink and other alcohol-related cognitions in predicting adolescent alcohol consumption. This work not only supports the utility of this construct in developing models of youth alcohol-related decision-making but also has implications for prevention programming.

Advances in adolescent substance abuse treatment

Alcohol and other drug use among adolescents has been a public health problem for decades. Although some substance use may be developmentally routine, a concerning number of adolescents meet criteria for a substance use disorder and could greatly benefit from a quality treatment experience. However, parents and health care providers want evidence of the efficacy of adolescent-specific treatment programs. This review summarizes four factors surrounding the efficacy of current adolescent treatment programs: 1) adolescent-specific treatment services; 2) the variety of therapeutic modalities; 3) relapse and recovery rates; and 4) the need for evidence-based, quality assessments and research. Current adolescent treatment efforts are summarized, and the recent literature regarding the efficacy of adolescent treatment and recovery rates is discussed.

Alcohol consumption among adolescents in Kraljevo, Serbia

The aim of this study was to investigate the prevalence and predictors of alcohol consumption among adolescents in one town in Central Serbia. A questionnaire was used to obtain data from 191 Serbian students aged 18 years regarding personal experience with alcohol consumption and cigarette smoking, along with sociodemographics data. Alcohol consumption was reported by 97.4% subjects, with 34.9% having the first experience with alcohol at the age of 14 years or less. Binge drinking (the intake of five or more drinks at one sitting) was reported by 37.8% subjects. Significantly higher consumption of beer (p<0.0001) and spirits (p=0.03) was observed in boys. The most common reason for both initiation and continuation of drinking, regardless of gender, were celebrations (p≥0.12). Smokers were more likely than nonsmokers to consume all alcoholic beverages more frequently (p≤0.04) and in larger quantities (p≤0.004). More frequent or more extensive alcohol consumption, or both, was associated in boys with frequent going out and socializing (p≤0.01), close peer relationship (p=0.04), alcohol abuse within the immediate environment (p≤0.04), better financial status of family (p=0.04), and parental criticism (p≤0.02); in girls, it was associated with parental disapproval (p≤0.02), alcohol abuse within the immediate environment (p≤0.04), and general discontentedness (p=0.049). Regardless of gender, positive alcohol outcome expectancies increased alcohol consumption (p≤0.048), and negative expectancies decreased intake (p≤0.047).

Friends or foes: social anxiety, peer affiliation, and drinking in middle school

OBJECTIVE

The relation between social anxiety and alcohol consumption suggests aspects of both risk and protection, but most research has focused on late adolescents and emerging adults.

METHOD

We investigated the synergistic impact of social anxiety, a need for affiliation with others, and perceived peer alcohol use on drinking in a sample of more than 1,500 early adolescents from southern California (48% girls). Via school-wide surveys, middle school students completed the Social Anxiety Scale for Children-Revised, a modified version of the Interpersonal Orientation Scale, as well as measures of perceived peer drinking and self-reported lifetime and current drinking.

RESULTS

For socially anxious youths, high levels of perceived peer use in conjunction with high levels of affiliation need was associated with greater alcohol use on average and more frequent episodic drinking. Specific to heavy episodic drinking, the interaction of social anxiety and perceived peer drinking seemed to affect girls and boys differentially. Sex differences emerged for the moderation of social anxiety's influence on drinking initiation by perceived peer influence.

CONCLUSIONS

These findings suggest that alcohol-related risks associated with social anxiety might be gender specific and more important in earlier stages of alcohol use than previously believed.

Impact of Adolescent Alcohol and Drug Use on Neuropsychological Functioning in Young Adulthood: 10-Year Outcomes

BACKGROUND: Alcohol and other substance use disorders (AUD/SUD) are common among youth and often continue into adulthood; therefore, the neurocognitive effects of substance use are of great concern. Because neuromaturation continues into young adulthood, youth with AUD/SUD may be at risk for lasting cognitive decrements. This study prospectively examines neuropsychological functioning over 10 years as a function of AUD/SUD history and outcomes. METHODS: The 51 participants consisted of 18 youth with persisting AUD/SUD, 19 youth with remitted AUD/SUD, and 14 community youth with no AUD/SUD history followed over 10 years (ages 16 to 27 on average) with neuropsychological testing and substance use interviews on 8 occasions. Neuropsychological performance from baseline to 10-year follow-up was compared between the three groups. RESULTS: Despite scoring higher than controls at intake, both AUD/SUD groups showed a relative decline in visuospatial construction at 10-year follow-up (p=.001). Regressions showed that alcohol use (β=-.33, p < .01) and drug withdrawal symptoms (β=-.31, p<.05) over follow-up were predictive of year 10 visuospatial function. Alcohol use also predicted verbal learning and memory (β=-.28, p<.05), while stimulant use predicted visual learning and memory function (β=-.33, p=.01). More recent substance use was associated with poorer executive function (β=.28, p<.05). DISCUSSION: These findings confirm prior studies suggesting that heavy, chronic alcohol and other substance use persisting from adolescence to young adulthood may produce cognitive disadvantages, primarily in visuospatial and memory abilities. Youth who chronically consume heavy quantities of alcohol and/or experience drug withdrawal symptoms may be particularly at risk for cognitive deterioration by young adulthood.

Validation of a Targeted Peer Relations Scale for Adolescents Treated for Substance Use Disorder: An Application of Rasch Modeling

The objective of this research is to use item response theory (IRT) to validate a 14-item peer relations scale for use in the adolescent treatment population. Subjects are 509 adolescents discharged from substance abuse treatment from 2004–2009. The person reliability is 0.76 and the Cronbach’s alpha person raw score reliability is 0.93 both indicating the scale is a strong metric. The item reliability of 0.99 is high showing the model is reliable. The real separation (8.49) meaning items are placed on the Rasch “ruler” with about eight levels of importance identified. The mean-square statistics of the infit and outfit values were between 0.5 and 1.5 for the items indicating a low level of randomness and thus unidimensionality of the scale. Inspection of a Wright Item Map shows the hierarchical structure of the scale with a moderate degree of inter-item spread. The analysis shows the scale is a reliable unidimensional metric.

Middle School Drinking: Who, Where, and When

The goal of this research was to describe the most common drinking situations for young adolescents (N=1171; 46.6% girls), as well as determine predictors of their drinking in the seventh and eighth grades. Middle school students most frequently drank at parties with three to four teens, in their home or at a friend's home, and reported alcohol-related problems including conflicts with friends or parents, memory loss, nausea, and doing things they would not normally do. Differences emerged in predicting higher levels of drinking on the basis of sex, race, grade, positive alcohol expectancies, impulsivity, and peer drinking. These findings suggest both specific and general factors are implicated in drinking for middle school students. Contextual factors, including drinking alone, in public places, and at or near school, are characteristic of the most problematic alcohol involvement in middle school and may have utility in prevention and early intervention.

Alcohol and drug involvement after adolescent treatment and functioning during emerging adulthood

This study identified patterns of alcohol and other drug (AOD) involvement during the decade following adolescent AOD treatment and developmental outcomes in emerging adulthood. AOD and psychosocial variables were assessed at eight time points from adolescence into adulthood (n=153; 41.2% women) in an inpatient treatment sample of alcohol and other drug dependent teens. Latent class growth analysis identified six trajectories based on alcohol and substance use frequency which were consistent with developmental transitions and validated by measures of dependency symptoms. While few differences were evident at intake, the educational, occupational and interpersonal attainments were differentially associated with the alcohol/drug trajectories as youth transitioned into adulthood. High rates of high school graduation (71.1%), professional occupations (45.2%), marriage/cohabitation (48.5%), and financial responsibility for children (F[5,27]=2.75, p=.02) were evident for those with the least alcohol and drug involvement. More severe drug use trajectories were associated with higher rates of dependence, incarceration and more treatment at the final period of assessment. Outcomes of the trajectory of frequent alcohol involvement were distinct from combined alcohol and drug use. These findings highlight the long-term diversity of substance use outcomes following adolescent treatment and suggest that identification of these patterns of use following treatment can help clarify the developmental impact of youth alcohol and drug use on outcomes in young adulthood.

Addictive personality and problematic mobile phone use

Mobile phone use is banned or regulated in some circumstances. Despite recognized safety concerns and legal regulations, some people do not refrain from using mobile phones. Such problematic mobile phone use can be considered to be an addiction-like behavior. To find the potential predictors, we examined the correlation between problematic mobile phone use and personality traits reported in addiction literature, which indicated that problematic mobile phone use was a function of gender, self-monitoring, and approval motivation but not of loneliness. These findings suggest that the measurements of these addictive personality traits would be helpful in the screening and intervention of potential problematic users of mobile phones.

Three-year chemical dependency and mental health treatment outcomes among adolescents: the role of continuing care

BACKGROUND

Few studies have examined the effects of treatment factors, including the types of services [chemical dependency (CD), psychiatric, or both], on long-term outcomes among adolescents following CD treatment, and whether receiving continuing care may contribute to better outcomes. This study examines the effect of the index CD and ongoing CD and psychiatric treatment episodes, 12-step participation, and individual characteristics such as CD and mental health (MH) severity and gender, age, and ethnicity, on 3-year CD and MH outcomes.

METHODS

Participants were 296 adolescents aged 13 to 18 seeking treatment at 4 CD programs of a nonprofit, managed care, integrated health system. We surveyed participants at intake, 1 year, and 3 years, and examined survey and administrative data, and CD and psychiatric utilization.

RESULTS

At 3 years, 29.7% of the sample reported total abstinence from both alcohol and drugs (excluding tobacco). Compared with girls, boys had only half the odds of being abstinent (OR = 0.46, p = 0.0204). Gender also predicted Externalizing severity at 3 years (coefficients 18.42 vs. 14.77, p < 0.01). CD treatment readmission in the second and third follow-up years was related to abstinence at 3 years (OR = 0.24, p = 0.0066 and OR = 3.33, p = 0.0207, respectively). Abstinence at 1 year predicted abstinence at 3 years (OR = 4.11, p < 0.0001). Those who were abstinent at 1 year also had better MH outcomes (both lower Internalizing and Externalizing scores) than those who were not (11.75 vs. 15.55, p = 0.0012 and 15.13 vs. 18.06, p = 0.0179, respectively).

CONCLUSIONS

A CD treatment episode resulting in good 1-year CD outcomes may contribute significantly to both CD and MH outcomes 3 years later. The findings also point to the value of providing a continuing care model of treatment for adolescents.

Outpatient alcoholism treatment--24-month outcome and predictors of outcome

OBJECTIVES

To study the value of demographic and alcohol-related variables for predicting 24-month treatment outcome in an outpatient setting.

METHODS

Prospective observational study with 92 alcohol-dependent patients. Assessments were made by personal interviews at the beginning and end of therapy, and at the 24-month follow-up. Univariate and logistic regression analyses were performed.

RESULTS

The mean age was 46.0 (SD = 9.9) years. There were 58 males (65.2%) and 31 females (34.8%). Of the 67 patients interviewed at 2-year follow-up, 58% were abstinent and 79% improved. Differences between abstainers and non-abstainers were found for number of previous detoxifications, and number of patients attempted suicides. In addition, female gender and a higher number of prior treatments predicted negative treatment outcome.

CONCLUSION

Matching patients to different types of treatment by means of empirically based characteristics may help to improve outcome but research has failed to establish reliable predictors in that area. Data from this follow-up study confirm the role of certain clinical outcome predictors. Additionally, results give further evidence for outpatient treatment as an effective setting for alcohol-dependent patients as indicated by a favourable retention rate (84%) and outcome (minimum abstinence rate 44%).

Twelve-Step affiliation and 3-year substance use outcomes among adolescents: social support and religious service attendance as potential mediators

AIMS

Twelve-Step affiliation among adolescents is little understood. We examined 12-Step affiliation and its association with substance use outcomes 3 years post-treatment intake among adolescents seeking chemical dependency (CD) treatment in a private, managed-care health plan. We also examined the effects of social support and religious service attendance on the relationship.

DESIGN

We analyzed data for 357 adolescents, aged 13-18, who entered treatment at four Kaiser Permanente Northern California CD programs between March 2000 and May 2002 and completed both baseline and 3-year follow-up interviews.

MEASURES

Measures at follow-up included alcohol and drug use, 12-Step affiliation, social support and frequency of religious service attendance.

FINDINGS

At 3 years, 68 adolescents (19%) reported attending any 12-Step meetings, and 49 (14%) reported involvement in at least one of seven 12-Step activities, in the previous 6 months. Multivariate logistic regression analyses indicated that after controlling individual and treatment factors, 12-Step attendance at 1 year was marginally significant, while 12-Step attendance at 3 years was associated with both alcohol and drug abstinence at 3 years [odds ratio (OR) 2.58, P < 0.05 and OR 2.53, P < 0.05, respectively]. Similarly, 12-Step activity involvement was associated significantly with 30-day alcohol and drug abstinence. There are possible mediating effects of social support and religious service attendance on the relationship between post-treatment 12-Step affiliation and 3-year outcomes.

CONCLUSIONS

The findings suggest the importance of 12-Step affiliation in maintaining long-term recovery, and help to understand the mechanism through which it works among adolescents.

Impact of relapse predictors on psychosocial functioning of SUD youth one year after treatment

This investigation examined how personal, environmental and substance use factors predicted psychosocial functioning for youth with alcohol and drug problems. Four hundred twenty-four adolescents (M = 15.9, SD = 1.3) completed comprehensive assessments, including personal characteristics (e.g., Axis I diagnosis, motivation, self-esteem), environmental factors (e.g., family history, social supports) and substance use, at study intake and throughout the year following inpatient treatment. Treatment outcomes were assessed by measures of academic functioning, family relations, social functioning as well as health status and mental health treatment at one year. Aspects of the proposed model significantly predicted all treatment outcome domains, except family functioning, in the year following treatment. Psychosocial functioning at one year was predicted by age, gender, SES, comorbid psychopathology, family influence and nonusing social supports prior to treatment and relapse status after treatment. The utility of variables associated with substance use treatment outcomes in predicting psychosocial outcomes is considered.