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Wells M, Kelly PJ, Robson D, Haynes C, Hatton E, Larance B. Systematic review of treatment completion rates and correlates among young people accessing alcohol and other drug treatment. Drug Alcohol Depend 2024; 262:111376. [PMID: 38971027 DOI: 10.1016/j.drugalcdep.2024.111376] [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: 03/24/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND AND AIMS Treatment completion is associated with improved alcohol and other drug (AOD) treatment outcomes. Unfortunately, treatment disengagement is common, particularly among young people. We reviewed and synthesised research on AOD treatment completion and/or early disengagement among young people. METHODS We conducted a systematic review and meta-analysis of studies reporting on completion rates and/or early disengagement from psychosocial AOD treatment among adolescents and young adults. An overall estimated treatment completion rate was calculated using inverse-variance random effects meta-analysis, and random-effects meta-regression was used to identify between-study level moderators of completion rate. We completed a narrative review summarising literature on early treatment disengagement and within-study level correlates of treatment completion. Study quality was assessed using the EPHPP. RESULTS Of the 6158 studies screened, we retained 410 for full text review and included 98 studies in the review. Treatment completion rates were reported in 88 studies, and early disengagement rates were reported in 13. The estimated overall treatment completion rate was 59 % (95 % CI=57-61 %), with experimental studies reporting higher rates of completion than observational studies. There was limited evidence for demographic or substance-related correlates of treatment completion. Contingency management was associated with increased completion rates, as was family-based intervention. CONCLUSIONS Disengagement from AOD treatment among youth populations is common and contributes to poor treatment outcomes. Existing research has yielded little consensus on the factors associated with treatment completion. The use of contingency management strategies and involving family/social supports in treatment were identified as potential avenues for promoting ongoing treatment engagement.
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Affiliation(s)
- Megan Wells
- School of Psychology, University of Wollongong, Australia.
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Australia
| | - Davina Robson
- School of Psychology, University of Wollongong, Australia; School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Australia
| | - Chloe Haynes
- School of Psychology, University of Wollongong, Australia
| | - Emma Hatton
- School of Psychology, University of Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Australia
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Wells M, Kelly PJ, Mullaney L, Lee ML, Stirling R, Etter S, Larance B. Predictors of alcohol and other drug treatment completion among young people accessing residential and community-based treatment: A retrospective analysis of routinely collected service data. Addiction 2024. [PMID: 38946548 DOI: 10.1111/add.16602] [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: 11/06/2023] [Accepted: 05/24/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND AND AIMS Young people accessing alcohol and other drug (AOD) treatment experience high rates of treatment disengagement, contributing to poorer outcomes. To improve outcomes, it is important to identify factors associated with treatment retention. This study measured the relationships between client characteristics, treatment characteristics, clinical severity measures and completion of treatment among young people. DESIGN, SETTING AND PARTICIPANTS This study was a retrospective analysis of routinely collected data set in residential- and community-based AOD services in New South Wales, Australia. Routinely collected data from the Network of Alcohol and Other Drug Agencies' (NADA) database were used. Included individuals were aged 10-24 years and accessed treatment between 2012 and 2023 (n = 17 474). MEASUREMENTS Variables included client-related characteristics, service characteristics and baseline measures of clinical severity [Kessler-10 (K10), EUROHIS-QoL, severity of dependence scale (SDS)]. Multivariable binary logistic regression models assessed the relationships between these characteristics and treatment completion. FINDINGS Rates of treatment completion were highest among adolescents in community-based treatment (57%) and lowest among young adults in residential treatment (35%). Polysubstance use was negatively associated with treatment completion among adolescents [adjusted odds ratio (adjOR) = 0.71, P < 0.001] and adults (adjOR = 0.70, P < 0.001) in community-based treatment, and adolescents in residential treatment (adjOR = 0.62, P = 0.006), as was housing insecurity (adolescents in community treatment, adjOR = 0.61, P = 0.001; adults in community treatment, adjOR = 0.77, P = 0.002; adolescents in residential treatment, adjOR = 0.42, P = 0.005). Attending youth-specific services was associated with higher treatment completion rates among adults in community-based (adjOR = 1.81, P < 0.001) and residential treatment (adjOR = 1.72, P < 0.001). Varying correlates of treatment completion were identified throughout treatment groups, reflecting the differences in population and/or needs across contexts. CONCLUSIONS In New South Wales, Australia, fewer than half of young people accessing alcohol and other drug treatment between 2012 and 2023 completed treatment, and completion rates were lower among those facing barriers such as polysubstance use and housing insecurity.
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Affiliation(s)
- Megan Wells
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Mei Lin Lee
- School of Psychology, University of Wollongong, Wollongong, Australia
- Network of Alcohol and Other Drug Agencies, Sydney, Australia
| | - Robert Stirling
- Network of Alcohol and Other Drug Agencies, Sydney, Australia
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Sarah Etter
- Network of Alcohol and Other Drug Agencies, Sydney, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Erga AH, Ushakova A, Elstad M, Fodstad EC, Belfrage A. The Relationship Between Self-Reported Childhood Maltreatment and Mental Health in Substance Use Disorders: A 6-Year Retrospective Analysis. J Dual Diagn 2024; 20:210-222. [PMID: 38648609 DOI: 10.1080/15504263.2024.2338799] [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] [Indexed: 04/25/2024]
Abstract
OBJECTIVE This longitudinal cohort study aims to investigate the relationship between self-reported childhood maltreatment (CM) and the retrospective trajectory of substance use, mental health, and satisfaction with life in individuals with substance use disorders. METHODS One hundred eleven treatment-seeking individuals with substance use disorder were recruited from clinical settings and monitored prospectively for 6 years. The participants' substance use, mental health, and satisfaction with life were assessed using standardized measures. Cluster analysis divided the cohort into two groups-low CM and high CM-based on their scores on the Childhood Trauma Questionnaire Short Form at year 6. Mixed-effects linear models were fitted to assess the association between longitudinal scores on drug use, mental health, and satisfaction with life and CM group. RESULTS Most participants (92%) reported at least 1 CM. Out of all participants, 36% were categorized into the high-CM group, while 59% were categorized into the low-CM group. CM group was not associated with the amount of substance or alcohol use. CM group was significantly associated with the longitudinal course of mental health and life satisfaction. CONCLUSIONS This study underscores the association between self-reported CM and mental health and life satisfaction in patients with substance use disorder. Our results may imply an increased risk of adverse outcomes in patients with high levels of CM, while bearing in mind that both current and retrospective mental health and substance use problems can influence the accuracy of recalling CM.
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Affiliation(s)
- Aleksander H Erga
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Department of Social Studies, University of Stavanger, Stavanger, Norway
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Anastasia Ushakova
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Maria Elstad
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Elise Constance Fodstad
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Anna Belfrage
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
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Rosenkranz SE, Courtney D, Chen S, Ma C. Outcomes among youth attending inpatient treatment for co-occurring disorders. Early Interv Psychiatry 2024; 18:198-206. [PMID: 37455362 DOI: 10.1111/eip.13450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/30/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
AIM An emerging body of research is identifying effective outpatient integrated treatment approaches for youth with co-occurring psychiatric and substance use disorders, though few studies exist examining inpatient treatment. The current study aimed to address this gap by examining response to treatment during admission to, and in the year following discharge from, a specialized inpatient program for youth with co-occurring disorders. METHODS A single-cohort longitudinal design examined change in adaptive functioning, mental health symptoms, and substance use frequency among N = 142 youth (69.1% female) aged 14-21 (M = 16.9, SD = 1.5) attending the program. Participants completed self-report measures at admission, discharge, and 1-, 6- and 12-months post-discharge. RESULTS Analyses indicated significant improvements in adaptive functioning, internalizing and externalizing symptoms, and substance use frequency during admission. There was some loss of gains in adaptive functioning over the 12-months post-discharge. Improvements were maintained in internalizing symptoms and substance use frequency, and improvements in externalizing symptoms continued over the 12-months post-discharge. There was no significant interaction between change in functioning and internalizing symptoms at admission or type of substance use disorder diagnosis. There was a significant interaction with externalizing symptoms, such that those with clinically significant levels of externalizing symptoms at admission experienced greater improvement in functioning, though the groups ended treatment with comparable functioning scores. CONCLUSIONS The results provide preliminary support for integrated treatment for co-occurring disorders delivered in an inpatient setting. However, the results also reflect the significant needs of youth with co-occurring disorders and the importance of ongoing care post-discharge from intensive treatment settings.
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Affiliation(s)
- Susan E Rosenkranz
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Darren Courtney
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sheng Chen
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Clement Ma
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Seidel DH, Markes M, Grouven U, Messow CM, Sieben W, Knelangen M, Oelkers-Ax R, Grümer S, Kölsch H, Kromp M, von Pluto Prondzinski M. Systemic therapy in children and adolescents with mental disorders: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:125. [PMID: 38355466 PMCID: PMC10868021 DOI: 10.1186/s12888-024-05556-y] [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: 09/05/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Systemic therapy (ST) is a psychotherapeutic intervention in complex human systems (both psychological and interpersonal). Cognitive behavioural therapy (CBT) is an established treatment for children and adolescents with mental disorders. As methodologically rigorous systematic reviews on ST in this population are lacking, we conducted a systematic review and meta-analysis to compare the benefit and harm of ST (and ST as an add-on to CBT) with CBT in children and adolescents with mental disorders. METHODS We searched MEDLINE, Embase, PsycINFO and other sources for randomised controlled trials in 14 mental disorder classes for the above comparisons in respect of effects on patient-relevant outcomes (search date: 7/2022). Where possible, meta-analyses were performed and results were graded into 3 different evidence categories: "proof", "indication", or "hint" (or none of these categories). PRISMA standards were followed. RESULTS Fifteen studies in 5 mental disorder classes with usable data were identified. 2079 patients (mean age: 10 to 19 years) were analysed. 12/15 studies and 29/30 outcomes showed a high risk of bias. In 2 classes, statistically significant and clinically relevant effects in favour of ST were found, supporting the conclusion of a hint of greater benefit of ST for mental and behavioural disorders due to psychoactive substance use and of ST as an add-on to CBT for obsessive-compulsive disorders. In 2 other classes (eating disorders; hyperkinetic disorders), there was no evidence of greater benefit or harm of ST. For affective disorders, a statistically significant effect to the disadvantage of ST was found for 1 outcome, supporting the conclusion of a hint of lesser benefit of ST. CONCLUSIONS Our results show a hint of greater benefit of ST (or ST as an add-on to CBT) compared with CBT for 2 mental disorder classes in children and adolescents (mental and behavioural disorders due to psychoactive substance use, obsessive compulsive disorders). Given the importance of CBT as a control intervention, ST can therefore be considered a beneficial treatment option for children and adolescents with certain mental disorders. Limitations include an overall high risk of bias of studies and outcomes and a lack of data for several disorders.
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Affiliation(s)
- David Henry Seidel
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany.
| | - Martina Markes
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Ulrich Grouven
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Claudia-Martina Messow
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Wiebke Sieben
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Marco Knelangen
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Rieke Oelkers-Ax
- Family Therapy Centre (Familientherapeutisches Zentrum gGmbH, FaTZ), Hermann-Walker-Straße 16, 69151, Neckargemünd, Germany
| | - Sebastian Grümer
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Heike Kölsch
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Mandy Kromp
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
| | - Markus von Pluto Prondzinski
- Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany
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Geijer-Simpson E, Kaner E, Lingam R, McArdle P, McGovern R. Effectiveness of Family-Involved Interventions in Reducing Co-Occurring Alcohol Use and Mental Health Problems in Young People Aged 12-17: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6890. [PMID: 37835160 PMCID: PMC10572317 DOI: 10.3390/ijerph20196890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
There is a high prevalence rate of co-occurring alcohol use and mental health problems in young people. This is associated with adverse outcomes and poses a substantial public health concern. We identified and synthesized evidence on the effectiveness of family-involved interventions in reducing alcohol use and mental health problems in young people aged 12-17. Seven databases were searched from inception to January 2023. Data from 19 articles reporting on 14 trials were pooled through random-effects meta-analysis for each outcome using Review Manager 5.3. Pooled estimates resulted in non-significant findings for alcohol use (SMD -0.60; 95% CI -1.63 to 0.42; p = 0.25; 6 trials; 537 participants), internalizing symptoms (SMD -0.13; 95% CI -0.37 to 0.10; p = 0.27), externalizing symptoms (SMD -0.26; 95% CI -0.66 to 0.15; p = 0.22) and substance use (SMD -0.33; 95% CI -0.72 to 0.06; p = 0.10). In contrast, significant intervention effects were identified for the mechanism of change, family conflict (SMD -0.30; 95% CI -0.51 to -0.09; p = 0.005). Consequently, addressing family functioning may not be sufficient in reducing co-occurring alcohol use and mental health problems. Non-significant intervention effects could be due to a lack of content addressing the relationship between alcohol use and mental health problems. Future intervention development could explore whether to incorporate such content and how best to involve the family.
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Affiliation(s)
- Emma Geijer-Simpson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Raghu Lingam
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia
| | - Paul McArdle
- Northumberland, Tyne & Wear Foundation Trust, Newcastle upon Tyne NE3 3XT, UK
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
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Boson K, Anderberg M, Melander Hagborg J, Wennberg P, Dahlberg M. Adolescents with substance use problems in outpatient treatment: a one-year prospective follow-up study focusing on mental health and gender differences. Subst Abuse Treat Prev Policy 2022; 17:53. [PMID: 35840967 PMCID: PMC9284845 DOI: 10.1186/s13011-022-00482-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Although several studies have found a high incidence of coexisting mental health problems among adolescents with substance use problems, follow-up studies addressing how these conditions change over time are rare. The study will describe and analyze indications of mental health problems and how various risk factors predict outcomes 1 year after initial treatment contact. In addition, gender-specific risk factors are explored. Methods A clinical sample of 455 adolescents (29% girls, median age 17 years) answered a structural interview at baseline and were followed up using official records 1 year after initiated treatment. Bivariate associations and logistic regressions were conducted to analyse the links between risk factors at the individual, social, and structural levels as well as links between various mental illness symptoms at treatment start and indications of mental health problems 1 year later were analysed. Results The results show that mental health problems among adolescents largely persisted 1 year after start of outpatient care for substance use problems. Forty-two per cent of the sample displayed indications of mental health problems at follow-up, and registrations for both outpatient treatment and psychiatric medication were more common among the girls. Girls also reported more mental illness symptoms at treatment start than boys did, especially anxiety. Depression and suicidal thoughts had predictive values regarding indications of mental health problems and small cumulative effects were found for 6–10 co-occurring risk factors. Conclusions Adolescents with depression and suicidal thoughts at treatment start should yield attention among clinicians as these general risk factors could predict indication of mental health problems at 1 year follow-up effectively. Also, patients with more than six co-occurring risk factors seem more vulnerable for continued mental health problems. Generally, girls displayed a greater mental health and psychosocial burden at treatment initiation and were more likely to show indication of mental health problems at follow-up. These results suggests that girls are more likely to get psychiatric out-treatment parallel to, or after, substance abuse treatment. We recommend further investigation of gender differences and gender-specific needs in substance use treatment.
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Camenga DR, Hammer LD. Improving Substance Use Prevention, Assessment, and Treatment Financing to Enhance Equity and Improve Outcomes Among Children, Adolescents, and Young Adults. Pediatrics 2022; 150:188344. [PMID: 35757960 DOI: 10.1542/peds.2022-057992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Access to timely prevention and treatment services remains challenging for many children, adolescents, young adults, and families affected by substance use. The American Academy of Pediatrics recognizes the scope and urgency of this problem and has developed this policy statement for consideration by Congress, federal and state policy makers, and public and private payers. This policy statement updates the 2001 policy statement "Improving Substance Abuse Prevention, Assessment, and Treatment Financing for Children and Adolescents" and provides recommendations for financing substance use prevention, assessment, and treatment of children, adolescents, and young adults.
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Affiliation(s)
- Deepa R Camenga
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Lawrence D Hammer
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, California
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Scott K, Becker SJ, Helseth SA, Saldanha IJ, Balk EM, Adam GP, Konnyu KJ, Steele DW. Pharmacotherapy interventions for adolescent co-occurring substance use and mental health disorders: a systematic review. Fam Pract 2022; 39:301-310. [PMID: 34448853 PMCID: PMC9126201 DOI: 10.1093/fampra/cmab096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Co-occurring mental health and substance use (SU) disorders among adolescents are common, with two-thirds of adolescents who seek SU treatment also requiring support for mental health. Primary care physicians play a key role in the pharmacological treatment of mental health disorders among adolescents, however, little is known about the impact of these treatments on SU outcomes. OBJECTIVES This systematic review summarizes the evidence regarding commonly used pharmacotherapy interventions for mental health and their impact on adolescent SU. METHODS Literature searches were conducted across five databases as part of a larger systematic review of adolescent SU interventions. Studies were screened for eligibility by two researchers, and study data were extracted regarding study design, patient and treatment characteristics and results. Risk of bias analyses and qualitative syntheses were completed to evaluate the strength of the evidence and the impact of pharmacotherapy on SU outcomes. RESULTS Ten randomized controlled trials exploring seven pharmacotherapies met criteria for inclusion. All studies had low to moderate risk of bias. Four studies evaluated pharmacotherapy for co-occurring depression and SU, three evaluated attention deficit hyperactivity disorder and SU, and three evaluated bipolar disorder and SU. Five of the 10 studies also included a behavioural intervention. We found no evidence that pharmacotherapy for co-occurring mental health diagnoses impacted SU. CONCLUSION Family medicine clinicians prescribing pharmacotherapy for mental health should be aware that additional interventions will likely be needed to address co-occurring SU.
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Affiliation(s)
- Kelli Scott
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sara J Becker
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sarah A Helseth
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Ian J Saldanha
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Ethan M Balk
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Gaelen P Adam
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Kristin J Konnyu
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Dale W Steele
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
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Anderberg M, Dahlberg M, Wennberg P. Adolescents with substance abuse problems in outpatient treatment: A one-year prospective follow-up study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 38:466-479. [PMID: 35308818 PMCID: PMC8900184 DOI: 10.1177/1455072521995611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
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.
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Predictors and moderators of marijuana and heavy alcohol use outcomes in adolescents treated for co-occurring substance use and psychiatric disorders in a randomized controlled trial. J Subst Abuse Treat 2021; 131:108536. [PMID: 34238628 DOI: 10.1016/j.jsat.2021.108536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/15/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The current study identifies predictors and moderators of substance use outcomes for 111 adolescents with co-occurring substance use and psychiatric disorders who participated in a randomized controlled trial that compared the effectiveness of two home-based treatments: an integrated cognitive behavioral therapy (I-CBT) protocol, in which masters-level clinic staff received intensive training and ongoing supervision in the use of this protocol versus a treatment-as-usual (TAU) comparison condition in which therapists received a continuing education-style CBT workshop in the same protocol. METHOD The study conducted exploratory predictor and moderator analyses of marijuana and heavy alcohol use outcomes using candidate variables across four domains of psychological characteristics: adolescent substance use, adolescent psychiatric symptoms, parent, and family. RESULTS Regardless of treatment condition, low parental monitoring at baseline, as assessed by a videotaped interaction task, but not self-report, predicted greater percentage of marijuana use and heavy alcohol use days over the 6-month follow-up period. If parents entered treatment with low levels of parental monitoring, adolescents in the I-CBT condition reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU over the 6-month follow-up period. Greater adolescent aggression and parental emotion dysregulation at baseline also predicted greater percentage of marijuana use days over the 6-month follow-up period for the sample as a whole. Adolescents in the I-CBT condition who reported low positive urgency at baseline reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU care over the 6-month follow-up period. CONCLUSION The article discusses implications for clinical decision-making, improving treatment effectiveness, and tailoring interventions for adolescents with co-occurring substance use and psychiatric disorders.
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MacPherson HA, Wolff J, Nestor B, Frazier E, Massing-Schaffer M, Graves H, Esposito-Smythers C, Spirito A. Parental Monitoring Predicts Depressive Symptom and Suicidal Ideation Outcomes in Adolescents Being Treated for Co-Occurring Substance Use and Psychiatric Disorders. J Affect Disord 2021; 284:190-198. [PMID: 33607509 PMCID: PMC7926270 DOI: 10.1016/j.jad.2021.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Comorbidity of substance use disorders (SUDs) with mood disorders and other psychiatric conditions is common. Parenting processes and family functioning are impaired in adolescents with SUDs and mood disorders, and parent/family factors predict intervention response. However, limited research has examined the relationship between parent/family factors and mood symptom treatment response in adolescents with comorbid SUDs and psychiatric conditions. METHOD This study examined the predictive effects of parenting processes and family functioning on depressive symptoms and suicidal ideation (SI) in a randomized controlled trial of integrated cognitive-behavioral therapy vs. treatment as usual for 111 adolescents with comorbid SUDs and psychiatric disorders. Measures of parenting processes, family functioning, depressive symptoms, and SI were completed at baseline and 3-, 6-, and 12-month follow-ups. Exploratory analyses involved mixed-effects regression models. RESULTS Across treatment conditions, depressive symptoms and SI improved over 12 months. Family functioning domains of family roles (d=0.47) and affective involvement (d=0.39) significantly improved across treatment conditions over 12 months. Higher baseline parental monitoring predicted improved trajectory of depressive symptoms (d=0.44) and SI (d=0.46). There were no significant predictive effects for baseline family functioning or other parenting processes (listening, limit setting). LIMITATIONS Limitations include the modest sample, attrition over follow-up, and generalizability to samples with higher rates of mood disorders and/or uncomplicated mood disorders. CONCLUSIONS Parental monitoring may be an important prognostic indicator of depressive symptoms and SI in adolescents with co-occurring SUDs and psychiatric conditions, and therefore may be useful to assess and target in treatment, in addition to family functioning.
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Affiliation(s)
- Heather A. MacPherson
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA,Emma Pendleton Bradley Hospital, East Providence, RI,
USA,Corresponding Author: Heather A. MacPherson, 1011
Veterans Memorial Parkway, East Providence, RI 02915, Phone: (401) 432-1162,
Fax: (401) 432-1607,
| | - Jennifer Wolff
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA,Rhode Island Hospital, Providence, RI, USA
| | - Bridget Nestor
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
| | - Elisabeth Frazier
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA,Emma Pendleton Bradley Hospital, East Providence, RI,
USA
| | - Maya Massing-Schaffer
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
| | - Hannah Graves
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
| | | | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
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13
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Knapp AA, Allan NP, Cloutier R, Blumenthal H, Moradi S, Budney AJ, Lord SE. Effects of anxiety sensitivity on cannabis, alcohol, and nicotine use among adolescents: evaluating pathways through anxiety, withdrawal symptoms, and coping motives. J Behav Med 2021; 44:187-201. [PMID: 32980966 PMCID: PMC7965231 DOI: 10.1007/s10865-020-00182-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 09/05/2020] [Indexed: 12/14/2022]
Abstract
Anxiety sensitivity (AS) is a promising intervention target due to its relevance to negative health behaviors broadly, and substance use specifically. The aim of the current study was to evaluate the direct and indirect pathways through which elevated AS could relate to recent substance use among a national adolescent sample recruited via social-media. As predicted, AS was indirectly associated with greater likelihood of using alcohol, cigarettes, and electronic nicotine delivery systems in the past-month through anxiety symptoms. Regarding cannabis, AS was directly related to increased likelihood of past-month cannabis use; however, the indirect relation between AS and likelihood of past-month use via anxiety symptoms was not significant. Through chained indirect effects, AS was related positively to past-month alcohol and cannabis use via anxiety symptoms and coping-related motives, and through withdrawal symptoms and coping-related motives. Study findings can be used to generate hypotheses on potential pathways through which AS could prospectively relate to substance use among youth.
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Affiliation(s)
- Ashley A Knapp
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr. 10th Floor, Chicago, IL, 60611, USA.
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Lebanon, NH, 03766, USA.
| | - Nicholas P Allan
- Department of Psychology, Ohio University, Porter Hall 209, Athens, OH, 45701, USA
| | - Renee Cloutier
- Teen Stress and Alcohol Research Laboratory, Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Heidemarie Blumenthal
- Teen Stress and Alcohol Research Laboratory, Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203, USA
| | - Shahrzad Moradi
- Department of Psychology, Ohio University, Porter Hall 209, Athens, OH, 45701, USA
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Lebanon, NH, 03766, USA
| | - Sarah E Lord
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Lebanon, NH, 03766, USA
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14
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Villagrana M, Lee SY. Racial/Ethnic Disparities in Treatment Completion for Youths with and without a Psychiatric Comorbidity. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2020. [DOI: 10.1080/1067828x.2020.1843580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Kroll DS, Feldman DE, Wang SYA, Zhang R, Manza P, Wiers CE, Volkow ND, Wang GJ. The associations of comorbid substance use disorders and psychiatric conditions with adolescent brain structure and function: A review. J Neurol Sci 2020; 418:117099. [PMID: 32866814 PMCID: PMC9003866 DOI: 10.1016/j.jns.2020.117099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 07/15/2020] [Accepted: 08/14/2020] [Indexed: 12/30/2022]
Abstract
Adolescence is a period of rapid neural and behavioral development that often precipitates substance use, substance use disorders (SUDs), and other psychopathology. While externalizing disorders have been closely linked to SUD epidemiologically, the comorbidity of internalizing disorders and SUD is less well understood. Neuroimaging studies can be used to measure structural and functional developments in the brain that mediate the relationship between psychopathology and SUD in adolescence. Externalizing disorders and SUD are both associated with structural and functional changes in the basal ganglia and prefrontal cortex in adolescence. The neural mechanisms underlying internalizing disorders and SUD are less clear, but evidence points to involvement of the amygdala and prefrontal cortex. We also highlight independent contributions of SUD, which may vary in certain ways by the substances assessed. A deeper understanding of the neural basis of the relationship between psychopathology and SUD will allow for more informed interventions in this critical developmental stage.
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Affiliation(s)
- Danielle S Kroll
- National Institute on Alcohol Abuse and Alcoholism, 10 Center Dr, Rm B2L124, Bethesda, MD 20892-1013, USA
| | - Dana E Feldman
- National Institute on Alcohol Abuse and Alcoholism, 10 Center Dr, Rm B2L124, Bethesda, MD 20892-1013, USA
| | - Szu-Yung Ariel Wang
- National Institute on Alcohol Abuse and Alcoholism, 10 Center Dr, Rm B2L124, Bethesda, MD 20892-1013, USA
| | - Rui Zhang
- National Institute on Alcohol Abuse and Alcoholism, 10 Center Dr, Rm B2L124, Bethesda, MD 20892-1013, USA
| | - Peter Manza
- National Institute on Alcohol Abuse and Alcoholism, 10 Center Dr, Rm B2L124, Bethesda, MD 20892-1013, USA
| | - Corinde E Wiers
- National Institute on Alcohol Abuse and Alcoholism, 10 Center Dr, Rm B2L124, Bethesda, MD 20892-1013, USA
| | - Nora D Volkow
- National Institute on Alcohol Abuse and Alcoholism, 10 Center Dr, Rm B2L124, Bethesda, MD 20892-1013, USA; National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Suite 5274, Bethesda, MD 20892-9581, USA
| | - Gene-Jack Wang
- National Institute on Alcohol Abuse and Alcoholism, 10 Center Dr, Rm B2L124, Bethesda, MD 20892-1013, USA.
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16
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Griffin BA, Ayer L, Pane J, Vegetabile B, Burgette L, McCaffrey D, Coffman DL, Cefalu M, Funk R, Godley MD. Expanding outcomes when considering the relative effectiveness of two evidence-based outpatient treatment programs for adolescents. J Subst Abuse Treat 2020; 118:108075. [PMID: 32972649 PMCID: PMC7519172 DOI: 10.1016/j.jsat.2020.108075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/08/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
Abstract
The current study seeks to advance understanding about how to address substance use and co-occurring mental health problems in adolescents. Specifically, we compared the effectiveness of two evidence-based treatment programs (Motivational Enhancement Treatment/Cognitive Behavior Therapy, 5 Sessions [MET/CBT5] and Adolescent Community Reinforcement Approach [A-CRA]) for both substance use and mental health outcomes (i.e., crossover effects). We used statistical methods designed to approximate randomized controlled trials when comparing nonequivalent groups using observational study data. Our methods also included an assessment of the potential impact of omitted variables. We found that after applying balancing weighting to ensure similarity of the baseline samples (given the nonrandomized study design), both groups significantly improved on the two substance use outcomes (days abstinent and percent of youth in recovery) and on the two mental health outcomes (post-traumatic stress disorder (PTSD) symptoms and general emotional problems). Youth in A-CRA were significantly more likely to be in recovery at the 3-month follow-up compared to youth in MET/CBT5, but the size of this effect was very small. Youth receiving MET/CBT5 appeared to show significantly more improvement in the two mental health measures compared to youth in A-CRA, though these effect sizes were also very small. The findings indicate that adolescents with co-occurring substance use and mental health problems improve on both substance use and mental health outcomes with both treatments even though they are not specifically targeting mental health problems.
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Affiliation(s)
| | - Lynsay Ayer
- RAND Corporation, 1200 South Hayes Street, Arlington, VA, USA.
| | - Joseph Pane
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA.
| | | | - Lane Burgette
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA.
| | | | - Donna L Coffman
- Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th floor, Philadelphia, PA 19122, USA.
| | - Matthew Cefalu
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA.
| | - Rod Funk
- Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761, USA.
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761, USA.
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17
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Wolff J, Esposito-Smythers C, Frazier E, Stout R, Gomez J, Massing-Schaffer M, Nestor B, Cheek S, Graves H, Yen S, Hunt J, Spirito A. A randomized trial of an integrated cognitive behavioral treatment protocol for adolescents receiving home-based services for co-occurring disorders. J Subst Abuse Treat 2020; 116:108055. [PMID: 32741505 PMCID: PMC9106275 DOI: 10.1016/j.jsat.2020.108055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/17/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022]
Abstract
The current study conducted a preliminary test of whether community mental health clinic staff could implement a multicomponent cognitive behavioral treatment, developed for adolescents with substance misuse (alcohol and/or marijuana) and comorbid psychiatric symptoms. We randomized a total of 111 families, with an adolescent 12-18 years old, referred to a home-based services program for youth with co-occurring substance use and mental health problems, to receive treatment from either masters-level therapists who received intensive cognitive behavioral therapy (I-CBT) training or from masters-level therapists who took part in a typical brief continuing education-style CBT workshop (treatment as usual, or TAU). Each family's therapist and insurance company determined the frequency and intensity of treatment. We administered follow-up assessments at 3, 6, and 12 months. There was a small, but not statistically significant, reduction in the percent days of heavy drinking and marijuana use over time for both conditions, with the overall effect across the three follow-up points favoring the I-CBT condition. There were no differences on alcohol use days or other drug use. There was also a small, but nonsignificant, positive effect over time on externalizing symptoms, depressed mood, and anxiety, favoring the I-CBT condition. Youth in the I-CBT condition relative to TAU had significantly fewer juvenile justice contacts, while the pattern of costly service use varied, with higher rates at 6-month and lower rates at 12-month follow-ups. If therapists pay greater attention to parent training and provide more parent-adolescent communication sessions, outcomes may improve above standard community care. Training enhancements, to better meet the needs of community therapists and their clinic settings, may also produce better overall results for parents and adolescents.
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Affiliation(s)
- Jennifer Wolff
- Brown University, Department of Psychiatry and Human Behavior, United States of America; Rhode Island Hospital, Providence, RI, United States of America.
| | | | - Elisabeth Frazier
- Brown University, Department of Psychiatry and Human Behavior, United States of America; Emma Pendleton Bradley Hospital, Riverside, RI, United States of America
| | - Robert Stout
- Brown University, Department of Psychiatry and Human Behavior, United States of America; Decision Sciences Institute, United States of America
| | - Judy Gomez
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Maya Massing-Schaffer
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Bridget Nestor
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Shayna Cheek
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Hannah Graves
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Shirley Yen
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Jeffrey Hunt
- Brown University, Department of Psychiatry and Human Behavior, United States of America; Emma Pendleton Bradley Hospital, Riverside, RI, United States of America
| | - Anthony Spirito
- Brown University, Department of Psychiatry and Human Behavior, United States of America
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18
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Susukida R, Mojtabai R, Amin-Esmaeili M. Validation of Addiction Severity Index (ASI) for Assessment of Psychiatric Comorbidity in Multi-Site Randomized Controlled Trials. J Dual Diagn 2020; 16:312-321. [PMID: 32254003 DOI: 10.1080/15504263.2020.1741755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: This study aimed to assess the validity of the psychiatric problems subscale of the Addiction Severity Index (ASI-psych) to ascertain psychiatric comorbidity among individuals participating in randomized controlled trials (RCTs) of substance use disorder (SUD) treatments.Methods: The ASI-psych score among 1,660 RCT participants of National Institute of Drug Abuse Clinical Trials Network studies was compared against diagnosis of any serious mental disorder based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (SCID) or Mini-International Neuropsychiatric Interview (MINI). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for detecting any serious mental disorders were estimated by the receiver operating characteristic (ROC) analysis.Results: Based on the overall sample, the AUC score for any serious mental disorder was 0.72 (95% confidence interval [CI], [0.69, 0.75]) with the optimal ASI-psych score of 24.6. There was no statistically significant difference in AUCs based on the SCID and MINI (χ2 = 0.05, p = .82) or by target drugs of RCTs (χ2 =1.33, p = .72).Conclusions: Results support the utility of the ASI in screening for psychiatric comorbidity among patients receiving SUD treatments in RCT settings.
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Affiliation(s)
- Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
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19
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Richert T, Anderberg M, Dahlberg M. Mental health problems among young people in substance abuse treatment in Sweden. Subst Abuse Treat Prev Policy 2020; 15:43. [PMID: 32580732 PMCID: PMC7315521 DOI: 10.1186/s13011-020-00282-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/06/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Young people with substance use problems face a high risk of co-occurring mental health problems, something that may involve a more difficult life situation, social problems as well as worse treatment outcomes. The aim of this study is to analyse self-reported mental health problems among young people receiving outpatient treatment for substance use problems in Sweden. We explore what types of mental health problems are more or less predominant, and whether there are significant differences between boys and girls. In addition, we analyse how various mental health problems covary with indicators of substance abuse severity. METHODS The study is based on structured interviews with 1970 young people enrolled at outpatient clinics in 11 Swedish cities. The data was analysed through frequency- and averages-calculations, Chi-square tests and multivariate logistic regression analyses. RESULTS Self-reported mental health problems were common among the young people in the study. A relatively large percentage of the total group (34-54%) reported problems such as concentration difficulties, sleeping difficulties, anxiety and depression. At the same time, many of the young people did not report any symptoms and only a small group, about 20%, reported diagnosed mental health disorders. The results show substantial gender differences, with girls reporting significantly higher levels of mental health problems. Multivariate logistic regression analyses demonstrated significant associations between severity of drug use problems and anxiety, concentration difficulties, aggression, hallucinations and mental stress caused by experiences of trauma. CONCLUSIONS Treatment needs are diverse within this group of young people who use drugs. Since girls report higher levels of all mental health problems, and a larger burden of psychosocial risk factors than boys, they are likely to require more comprehensive treatment interventions. The link between more severe drug problems and mental health problems points to the importance of exploring this relationship in treatment. A multidisciplinary approach, in which co-occurring problems can be addressed simultaneously, may be the best treatment form for many young people with drug problems.
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Affiliation(s)
- Torkel Richert
- Department of Social Work, Malmö University, Citadellsvägen 7, 211 18 Malmö, Sweden
| | - Mats Anderberg
- Department of Pedagogy and Learning, Linnaeus University, Växjö, Sweden
| | - Mikael Dahlberg
- Department of Pedagogy and Learning, Linnaeus University, Växjö, Sweden
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20
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Squeglia LM, Fadus MC, McClure EA, Tomko RL, Gray KM. Pharmacological Treatment of Youth Substance Use Disorders. J Child Adolesc Psychopharmacol 2019; 29:559-572. [PMID: 31009234 PMCID: PMC6727439 DOI: 10.1089/cap.2019.0009] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
While the majority of youth who experiment with alcohol and drugs do not develop problematic levels of use, 5% of adolescents and 15% of young adults meet criteria for a substance use disorder (SUD). Pharmacotherapy, in combination with behavioral interventions, has the potential to increase the likelihood of successful treatment for youth struggling with SUD; however, the literature in this area is limited. To date, there are no Food and Drug Administration (FDA)-approved medications for adolescent SUD, other than buprenorphine, which has been approved down to 16 years of age for opioid use disorder. Despite alcohol and cannabis being the most commonly used substances during adolescence, only three medications have been tested among this demographic, and only two have warranted further study (i.e., naltrexone for alcohol and N-acetylcysteine for cannabis use disorder). Although less common in adolescents and young adults, the most promising pharmacological findings for this age group are for opioid (buprenorphine) and tobacco (bupropion and varenicline) use disorders. In addition, despite the recent marked increases in electronic nicotine delivery systems (i.e., vaping) among youth, treatment strategies are still in their infancy and no recommendation exists for how to promote cessation for youth vaping. Current findings are limited by: small, demographically homogeneous samples; few trials, including a substantial number of youth younger than 18; low retention; medication adherence rates; and minimal information on effective dosing levels and long-term outcomes. Overall, pharmacotherapy may be a potentially effective strategy to increase treatment effects; however, more rigorous research trials are warranted before FDA approval would be granted for any of the potential adjunctive medications in this age group.
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Affiliation(s)
- Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Address correspondence to: Lindsay M. Squeglia, PhD, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425
| | - Matthew C. Fadus
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Rachel L. Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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21
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Bouvier BA, Kinnard EN, Yedinak JL, Li Y, Elston B, Green TC, Hadland SE, Marshall BDL. Prevalence and Correlates of Depressive Symptomology among Young Adults Who Use Prescription Opioids Non-medically. J Psychoactive Drugs 2019; 51:441-452. [PMID: 31411548 DOI: 10.1080/02791072.2019.1654151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Non-medical prescription opioid (NMPO) use and depression frequently co-occur and are mutually reinforcing in adults, yet NMPO use and depression in younger populations has been under-studied. We examined the prevalence and correlates of depressive symptomology among NMPO-using young adults. The Rhode Island Young Adult Prescription Drug Study (RAPiDS) recruited young adults in Rhode Island who reported past 30-day NMPO use. We administered the Center for Epidemiologic Studies Short Depression Scale (CES-D 10), and used modified Poisson regression to identify the independent correlates of depressive symptomology (CES-D 10 score ≥10). Over half (59.8%, n = 119) screened positive for depressive symptomology. In modified Poisson regression analysis, diagnostic history of depressive disorder and childhood verbal abuse were associated with depressive symptomology. Participants with depressive symptomology were more likely to report using prescription opioids non-medically to feel less depressed or anxious, to avoid withdrawal symptoms, and as a substitute when other drugs are not available. Among young adult NMPO users, depressive symptomology is prevalent and associated with distinct motivations for engaging in NMPO use and represents a potential subgroup for intervention. Improving guidelines with tools such as screening for depressive symptomology among young adult NMPO users may help prevent NMPO-related harms.
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Affiliation(s)
- Benjamin A Bouvier
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Elizabeth N Kinnard
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA, USA
| | - Jesse L Yedinak
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Beth Elston
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Traci C Green
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,Department of Emergency Medicine, Boston Medical Center Injury Prevention Center and Boston University School of Medicine, Boston, MA, USA.,Department of Emergency Medicine, The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Scott E Hadland
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA.,Department of Pediatrics, Division of General Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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22
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Hinckley JD, Riggs P. Integrated Treatment of Adolescents with Co-occurring Depression and Substance Use Disorder. Child Adolesc Psychiatr Clin N Am 2019; 28:461-472. [PMID: 31076120 DOI: 10.1016/j.chc.2019.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Substance use disorders (SUDs) are commonly co-occurring among adolescents with depression. Integrated treatment is important given treatment implications and increased rates of suicidality. All adolescents should be screened for SUD using Screening, Brief Intervention, and Referral to Treatment. Review of randomized controlled trials in adolescents reveals motivational enhancement therapy/cognitive behavioral therapy is an evidence-based intervention and should be considered first-line treatment. If depression does not improve, fluoxetine should be considered, as it is well-tolerated in substance-involved adolescents with depression. Adolescents who do not show improvement in SUD or who have severe SUD should be referred to evidence-based SUD treatment.
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Affiliation(s)
- Jesse D Hinckley
- Division of Substance Dependence, Department of Psychiatry, University of Colorado School of Medicine, 13001 East 17th Place, MS F570, Aurora, CO 80045, USA.
| | - Paula Riggs
- Division of Substance Dependence, Department of Psychiatry, University of Colorado School of Medicine, 13001 East 17th Place, MS F570, Aurora, CO 80045, USA
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23
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Rose EJ, Picci G, Fishbein DH. Neurocognitive Precursors of Substance Misuse Corresponding to Risk, Resistance, and Resilience Pathways: Implications for Prevention Science. Front Psychiatry 2019; 10:399. [PMID: 31258493 PMCID: PMC6586742 DOI: 10.3389/fpsyt.2019.00399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022] Open
Abstract
Studies of substance misuse prevention generally focus on characteristics that typify risk, with the assumption that the prevalence of the problem will be optimally reduced by identifying, targeting, and reducing or eliminating risk factors. However, this risk-centered approach neglects variations in individual-level and environmental characteristics that portend differential pathways that are distinguishable by timing of substance use initiation (e.g., early versus delayed), the likelihood of use escalation versus eventual desistance, and enduring abstinence, despite exposure to significant risk factors. Considering the various underpinnings of these distinct substance use trajectories is critical to a more nuanced understanding of the effects, potency, and malleability of factors that are known to increase risk or confer protection. Here, we discuss three pathways relative to substance use patterns and predictors in the context of adversity, a well-known, highly significant influence on propensity for substance misuse. The first pathway is designated as "high risk" based on early onset of substance use, rapid escalation, and proneness to substance use disorders. Individuals who defy all odds and eventually exhibit adaptive developmental outcomes despite an initial maladaptive reaction to adversity, are referred to as "resilient." However, another categorization that has not been adequately characterized is "resistant." Resistant individuals include those who do not exhibit problematic substance use behaviors (e.g., early onset and escalation) and do not develop substance use disorders or other forms of psychopathology, despite significant exposure to factors that normally increase the propensity for such outcomes (e.g. trauma and/or adversity). In this paper, we apply this conceptualization of risk, resistance, and resilience for substance misuse to a more fine-grained analysis of substance use pathways and their corresponding patterns (e.g., non-use, initiation, escalation, desistance). The significance of the progression of neurocognitive functioning over the course of development is discussed as well as how this knowledge may be translated to make a science-based determination of intervention targets. This more encompassing theoretical model has direct implications for primary prevention and clinical approaches to disrupt risk pathways and to optimize long-term outcomes.
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Affiliation(s)
- Emma Jane Rose
- Program for Translational Research on Adversity and Neurodevelopment (P-TRAN), The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Giorgia Picci
- Program for Translational Research on Adversity and Neurodevelopment (P-TRAN), The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Diana H Fishbein
- Program for Translational Research on Adversity and Neurodevelopment (P-TRAN), The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA.,Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
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Multidimensional Family Therapy as a community-based alternative to residential treatment for adolescents with substance use and co-occurring mental health disorders. J Subst Abuse Treat 2018; 90:47-56. [DOI: 10.1016/j.jsat.2018.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/27/2018] [Accepted: 04/23/2018] [Indexed: 11/17/2022]
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Bagot KS, Kaminer Y. Harm Reduction for Youth in Treatment for Substance Use Disorders: One Size Does Not Fit All. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0217-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Feder KA, McCart MR, Kahn G, Mauro PM, Sheidow AJ, Letourneau EJ. Association of Mental Health Symptoms and Peer Behaviors with Risk for Substance Use and Condomless Sex among Youth in Juvenile Drug Court. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2018; 27:133-145. [PMID: 33867782 DOI: 10.1080/1067828x.2018.1430642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Juvenile drug courts are a growing response to adolescent substance use, but a better understanding of modifiable risk factors is needed to improve program outcomes. Youth's mental health symptoms and peers' activities may impede the effectiveness of these "therapeutic" courts. In a unique longitudinal sample of 105 adolescents involved in juvenile drug court, we find elevated internalizing symptoms and deviant behavior of peers were each associated with increased risk of alcohol and marijuana use. Similar effects were seen on risk for condomless sex. Mental health and peer behaviors should be intervention targets for evidence-based juvenile drug court programming.
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Affiliation(s)
- Kenneth A Feder
- Predoctoral Student, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 415 N Washington St., Baltimore, MD 21231
| | - Michael R McCart
- Senior Research Scientist, Oregon Social Learning Center, 10 Shelton McMurphey Blvd., Eugene, Oregon 97401
| | - Geoffrey Kahn
- Predoctoral Student, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 415 N Washington St., Baltimore, MD 21231
| | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, USA
| | - Ashli J Sheidow
- Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Road, Suite 104, Charleston, South Carolina 29407; United States
| | - Elizabeth J Letourneau
- Associate Professor, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 415 N Washington St., Baltimore, MD 21231
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Gattamorta KA, Mena MP, Ainsley JB, Santisteban DA. The Comorbidity of Psychiatric and Substance Use Disorders Among Hispanic Adolescents. J Dual Diagn 2017; 13:254-263. [PMID: 28661822 PMCID: PMC6103297 DOI: 10.1080/15504263.2017.1343965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The comorbidity of psychiatric disorders and substance abuse disorders among adolescents and adults is well-documented in the literature. The current study investigates the relationship between psychiatric and substance use disorders in a sample of treatment-seeking Hispanic adolescents. METHODS The study uses baseline data (N = 190) from a randomized control trial testing the effectiveness of a family-based treatment for Hispanic adolescents with substance abuse disorder to examine the relationship between psychiatric disorders and substance use patterns at baseline, including types of substances used (both lifetime use and past-month use) and age at onset of substance use, controlling for age and gender. RESULTS Linear regression models were used to examine predictors of age at onset, while logistic regression models examined predictors of lifetime substance use. Significant findings predicting age at onset for marijuana and alcohol are discussed. In addition, psychiatric profiles were differentially associated with lifetime use of sedatives, stimulants, and hallucinogens, but not alcohol or marijuana. CONCLUSIONS Findings from this study can be used to help inform the treatment of adolescents seeking mental health and substance use services.
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Affiliation(s)
- Karina A Gattamorta
- a School of Nursing and Health Studies , University of Miami , Coral Gables , Florida , USA
| | - Maite P Mena
- b Department of Educational and Psychological Studies, School of Education and Health Development , University of Miami , Coral Gables , Florida , USA
| | - Jordan B Ainsley
- b Department of Educational and Psychological Studies, School of Education and Health Development , University of Miami , Coral Gables , Florida , USA
| | - Daniel A Santisteban
- b Department of Educational and Psychological Studies, School of Education and Health Development , University of Miami , Coral Gables , Florida , USA
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Kadam M, Sinha A, Nimkar S, Matcheswalla Y, De Sousa A. A Comparative Study of Factors Associated with Relapse in Alcohol Dependence and Opioid Dependence. Indian J Psychol Med 2017; 39:627-633. [PMID: 29200559 PMCID: PMC5688890 DOI: 10.4103/ijpsym.ijpsym_356_17] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Alcohol and opiates are among the most addictive substances posing significant public health problems due to the biopsychosocial impact that they have on individuals. Research shows that majority of abstinent alcohol and/or opioid dependence subjects relapse within 1 year. It has also been estimated that 26-36 million people worldwide abuse opiates, with exceptionally high-relapse rates. The purpose of this study was to compare the sociodemographic factors and correlates relapse in alcohol dependence and opioid dependence. METHODOLOGY This research uses a cross-sectional comparative study design with a sample size of 60 drawn from a population of clinically diagnosed patients of alcohol dependence (n = 30) or opioid dependence (n = 30) and seeking treatment for relapse. In addition to collecting sociodemographic data, other factors such as craving, affect, self-efficacy, and expressed emotions were measured using standardized instruments including brief substance craving scale, Bradburn affect balance scale, drug avoidance and self-efficacy scale and family emotional involvement, and conflict scale. The data were statistically analyzed. RESULTS Disparity in sociodemographic factors was seen in both the groups with opioid group being more likely to be single, unemployed, belonging to lower socioeconomic status, and having a criminal record (P = 0.025). Among factors associated with relapse, the opioid group scored significantly higher on craving, perceived criticism (P = 0.0001), and lower on self-efficacy (P = 0.016). Most common reason cited for relapse in both the groups was desire for positive mood. CONCLUSION This study highlights the role of social determinants in drug dependence and relapse. Relapse was found to be a complex multifactorial phenomenon. Despite differences in presentation, somewhat similar relapse mechanisms were seen in both groups.
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Affiliation(s)
- Maithili Kadam
- Department of Psychiatry, Grant Government Medical College, J.J. Hospital, Mumbai, Maharashtra, India
| | - Ankita Sinha
- Department of Psychiatry, Grant Government Medical College, J.J. Hospital, Mumbai, Maharashtra, India
| | - Swateja Nimkar
- Department of Health Services, University of Southern Indiana, Evansville, USA
| | - Yusuf Matcheswalla
- Department of Psychiatry, Grant Government Medical College, J.J. Hospital, Mumbai, Maharashtra, India
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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Squeglia LM, Cservenka A. Adolescence and Drug Use Vulnerability: Findings from Neuroimaging. Curr Opin Behav Sci 2017; 13:164-170. [PMID: 28111629 DOI: 10.1016/j.cobeha.2016.12.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Adolescence is a period of vulnerability for developing substance use disorder. Recent neuropsychological and neuroimaging studies have elucidated underlying neural vulnerabilities that contribute to initiation of substance use during adolescence. Findings suggest poorer performance on tasks of inhibition and working memory, smaller brain volumes in reward and cognitive control regions, less brain activation during executive functioning tasks, and heightened reward responsivity are predictive of youth initiating substance use during adolescence. In youth who are family history positive (FHP) for substance use disorder, poorer executive functioning, smaller volume of limbic brain regions (e.g., amygdala), sex-specific patterns of hippocampal volume, and a positive association between nucleus accumbens volume and family history density have been reported. Further, reduced white matter integrity, altered brain response during inhibitory control, including both greater and less frontal lobe response, blunted emotional processing, and weaker neural connectivity have also been found in FHP youth. Thus, there is significant overlap among the neural precursors shown to be predictive of alcohol and substance use initiation during adolescence and those that distinguish FHP from youth without a family history of substance use disorder, suggesting common targets for prevention and intervention. Understanding these predictive factors helps identify at-risk youth for prevention efforts, as well as create interventions targeting cognitive weaknesses or brain regions involved in substance use initiation.
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Affiliation(s)
- Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA
| | - Anita Cservenka
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA
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Abstract
Specific treatments targeting adolescents with substance use disorders (SUDs) have been developed over the last couple of decades. Despite these developmentally tailored treatments, long-term abstinence rates remain relatively low among adolescents receiving care. Research over the last decade has increasingly focused on adolescents with comorbid substance use and psychiatric disorders, in recognition of the barriers caused by inadequate treatment of co-occurring psychiatric disorders. Treatments targeting dually diagnosed youth are now regarded as essential to improving SUD treatment outcomes, but remain underutilized. A variety of treatment modalities such as behavioral therapy, family therapy, 12-step groups, motivational interviewing, contingency management, and combinations of these interventions have been modified for adolescents. In this article, we review the research on these treatments, as they apply to dually diagnosed youth. Furthermore, we explore the evidence for various treatments targeting comorbid SUD, specific to the presence of externalizing or internalizing disorders. The current evidence base supports the importance of integrated treatment targeting both SUD and psychiatric disorders simultaneously. High-quality treatment programs offering combinations of behavioral and family therapy, particularly with motivational interviewing and contingency management, are particularly well supported. In addition, we review various psychotropic medication treatments that have also been studied in conjunction with adolescent SUD treatment. Finally, we review research on post-treatment, supportive care that has been shown to improve long-term SUD outcomes. Recently conceptualized modular treatments, which offer personalized combinations of evidence-based treatments for specific disorders, have been proposed as a means of improving outcomes. Future research on modular programs must test the efficacy of individualized treatments when applied to combinations of psychiatric and SUDs in adolescents.
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Marijuana use and service utilization among adolescents 7 years post substance use treatment. Drug Alcohol Depend 2016; 168:1-7. [PMID: 27606492 PMCID: PMC5297892 DOI: 10.1016/j.drugalcdep.2016.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/29/2016] [Accepted: 08/05/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND In an environment of increasingly liberal attitudes towards marijuana use and legalization, little is known about long-term trajectories of marijuana use among clinical samples of adolescents, and how these trajectories relate to health services utilization over time. METHODS Latent growth curve analysis was used to identify distinct trajectories of marijuana use in a clinical sample of adolescents (N=391) over 7 years post substance use treatment in an integrated health system. We examined psychiatric problems and polysubstance use associated with the identified trajectory groups using general linear models. Nonlinear mixed-effects logistic regressions were used to examine associations between health services use and the trajectory groups. RESULTS We identified three marijuana use trajectory groups: (1) Abstinent (n=117); (2) Low/Stable use (n=174); and (3) Increasing use (n=100). Average externalizing and anxiety/depression scores were significantly lower over time for the Abstinent group compared to the Increasing and Low/Stable groups. The Low Stable and the Increasing group had fewer psychiatric visits over time (p<0.05) and the Low/Stable group used more substance use treatment services over time compared with the Abstinent group (p<0.001). CONCLUSIONS Treated adolescents showed distinct marijuana use patterns, one of which indicated a group of adolescents at risk of increased use over time. These individuals have greater psychiatric and polysubstance use over time, but may not be accessing needed services.
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Babbin SF, Stanger C, Scherer EA, Budney AJ. Identifying treatment response subgroups for adolescent cannabis use. Addict Behav 2016; 59:72-9. [PMID: 27082747 PMCID: PMC4846516 DOI: 10.1016/j.addbeh.2016.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 02/23/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Outpatient treatments for adolescent substance use demonstrate clinically meaningful reductions in substance use, but effect sizes are often low, relapse rates are high, and response to treatment is heterogeneous across participants. The present study utilized cluster analysis to identify subgroups of treatment response among adolescents from three randomized clinical trials evaluating behavioral treatments for substance use. METHODS Analyses were performed on a sample of 194 adolescents (average age=15.8, 81.4% male) who reported cannabis use during the past 30days or had a cannabis-positive urine test. Clustering was based on percent days cannabis use at 5 time periods (intake, end of treatment, 3, 6, and 9months post-treatment). Participants in the identified subgroups were then compared across a number of variables not involved in the clustering (e.g., substance use, demographics, and psychopathology) to test for predictors of cluster membership. RESULTS Four clusters were identified based on statistical indices and visual inspection of the resulting cluster profiles: Low Use Responders (n=109, low baseline level, sustained decrease); High Use Responders (n=45, high baseline level, sustained decrease); Relapsers (n=25, medium baseline level, decrease, rapid increase post-treatment); and Non-Responders (n=15; consistently high level of use). Cannabis dependence, mean cannabis uses per day, and socioeconomic status were predictive of cluster membership. CONCLUSIONS Cluster analysis empirically identified different patterns of treatment response over time for adolescent outpatients. Investigating homogenous subgroups of participants provides insight into study outcomes, and variables associated with clusters have potential utility to identify participants that may benefit from more intensive treatment.
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Affiliation(s)
- Steven F Babbin
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Catherine Stanger
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Emily A Scherer
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alan J Budney
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Schuler MS, Vasilenko SA, Lanza ST. Age-varying associations between substance use behaviors and depressive symptoms during adolescence and young adulthood. Drug Alcohol Depend 2015; 157:75-82. [PMID: 26483358 PMCID: PMC4663168 DOI: 10.1016/j.drugalcdep.2015.10.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 09/29/2015] [Accepted: 10/02/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Substance use and depression often co-occur, complicating treatment of both substance use and depression. Despite research documenting age-related trends in both substance use and depression, little research has examined how the associations between substance use behaviors and depression changes across the lifespan. METHODS This study examines how the associations between substance use behaviors (daily smoking, regular heavy episodic drinking (HED), and marijuana use) and depressive symptoms vary from adolescence into young adulthood (ages 12-31), and how these associations differ by gender. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we implemented time-varying effect models (TVEM), an analytic approach that estimates how the associations between predictors (e.g., substance use measures) and an outcome (e.g., depressive symptoms) vary across age. RESULTS Marijuana use and daily smoking were significantly associated with depressive symptoms at most ages from 12 to 31. Regular HED was significantly associated with depressive symptoms during adolescence only. In bivariate analyses, the association with depressive symptoms for each substance use behavior was significantly stronger for females at certain ages; when adjusting for concurrent substance use in a multivariate analysis, no gender differences were observed. CONCLUSIONS While the associations between depressive symptoms and both marijuana and daily smoking were relatively stable across ages 12-31, regular HED was only significantly associated with depressive symptoms during adolescence. Understanding age and gender trends in these associations can help tailor prevention efforts and joint treatment methods in order to maximize public health benefit.
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Affiliation(s)
- Megan S Schuler
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02215, United States.
| | - Sara A Vasilenko
- The Methodology Center, The Pennsylvania State University, State College, PA 16801, United States.
| | - Stephanie T Lanza
- The Methodology Center, Department of Biobehavioral Health, The Pennsylvania State University, State College, PA 16801, United States.
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Hersh J, Curry JF, Kaminer Y. What is the impact of comorbid depression on adolescent substance abuse treatment? Subst Abus 2015; 35:364-75. [PMID: 25157785 DOI: 10.1080/08897077.2014.956164] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) are among the most common psychiatric diagnoses in adolescents. Some research suggests that comorbid depression in adolescents with SUD is associated with increased likelihood of alcohol dependence, poorer social competence, and greater risk for suicide attempts. However, little is known about how depression influences adolescent substance abuse treatment retention and outcomes. METHODS This review aimed to summarize the effects of comorbid depression on treatment retention and outcomes across 13 adolescent SUD treatment studies. RESULTS RESULTS indicated that depression has a mixed relationship with treatment retention and outcomes, exerting a negative, positive, or nonsignificant effect depending on aspects of the study. CONCLUSIONS More research needs to be done, particularly addressing the potential mediators and moderators of the relationship between depression and SUD outcomes. Importantly, recognizing that the studies varied widely in hypotheses and research methods, the field needs to develop more standardized methods to allow for a clearer understanding of the role of comorbid depression.
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Affiliation(s)
- Jacqueline Hersh
- a Department of Psychology & Neuroscience , Duke University , Durham , North Carolina , USA
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Wagner B, Riggs P, Mikulich-Gilbertson S. The importance of distribution-choice in modeling substance use data: a comparison of negative binomial, beta binomial, and zero-inflated distributions. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:489-97. [PMID: 26154448 DOI: 10.3109/00952990.2015.1056447] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND It is important to correctly understand the associations among addiction to multiple drugs and between co-occurring substance use and psychiatric disorders. Substance-specific outcomes (e.g. number of days used cannabis) have distributional characteristics which range widely depending on the substance and the sample being evaluated. OBJECTIVES We recommend a four-part strategy for determining the appropriate distribution for modeling substance use data. We demonstrate this strategy by comparing the model fit and resulting inferences from applying four different distributions to model use of substances that range greatly in the prevalence and frequency of their use. METHODS Using Timeline Followback (TLFB) data from a previously-published study, we used negative binomial, beta-binomial and their zero-inflated counterparts to model proportion of days during treatment of cannabis, cigarettes, alcohol, and opioid use. The fit for each distribution was evaluated with statistical model selection criteria, visual plots and a comparison of the resulting inferences. RESULTS We demonstrate the feasibility and utility of modeling each substance individually and show that no single distribution provides the best fit for all substances. Inferences regarding use of each substance and associations with important clinical variables were not consistent across models and differed by substance. CONCLUSION Thus, the distribution chosen for modeling substance use must be carefully selected and evaluated because it may impact the resulting conclusions. Furthermore, the common procedure of aggregating use across different substances may not be ideal.
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Affiliation(s)
| | - Paula Riggs
- b Department of Psychiatry , University of Colorado , Aurora , CO , USA
| | - Susan Mikulich-Gilbertson
- a Department of Biostatistics and Informatics , and.,b Department of Psychiatry , University of Colorado , Aurora , CO , USA
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Brown RA, Abrantes AM, Minami H, Prince MA, Bloom EL, Apodaca TR, Strong DR, Picotte DM, Monti PM, MacPherson L, Matsko SV, Hunt JI. Motivational Interviewing to Reduce Substance Use in Adolescents with Psychiatric Comorbidity. J Subst Abuse Treat 2015; 59:20-9. [PMID: 26362000 DOI: 10.1016/j.jsat.2015.06.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/28/2015] [Accepted: 06/29/2015] [Indexed: 11/16/2022]
Abstract
Substance use among adolescents with one or more psychiatric disorders is a significant public health concern. In this study, 151 psychiatrically hospitalized adolescents, ages 13-17 with comorbid psychiatric and substance use disorders, were randomized to a two-session Motivational Interviewing intervention to reduce substance use plus treatment as usual (MI) vs. treatment as usual only (TAU). Results indicated that the MI group had a longer latency to first use of any substance following hospital discharge relative to TAU (36 days versus 11 days). Adolescents who received MI also reported less total use of substances and less use of marijuana during the first 6 months post-discharge, although this effect was not significant across 12 months. Finally, MI was associated with a significant reduction in rule-breaking behaviors at 6-month follow-up. Future directions are discussed, including means of extending effects beyond 6 months and dissemination of the intervention to community-based settings.
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Affiliation(s)
- Richard A Brown
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI.
| | - Ana M Abrantes
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | - Haruka Minami
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | - Mark A Prince
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | - Erika Litvin Bloom
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | | | | | - Dawn M Picotte
- Butler Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI
| | - Peter M Monti
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | | | | | - Jeffrey I Hunt
- Alpert Medical School of Brown University, Providence, RI; Bradley Hospital, East Providence, RI
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Abstract
Schools provide an ideal setting for screening, brief interventions, and outpatient treatment for substance use disorders (SUD). Individual treatment for SUD is effective at decreasing substance use as well as substance-related harm. In some contexts, rather than being helpful, group interventions can result in harm to participants; therefore, individual treatment may be preferred. Early interventions for adolescents who are using alcohol and other drugs (AOD) are generally effective in decreasing frequency and quantity of AOD use as well as decreasing risky behaviors.
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Elkington KS, Teplin LA, Abram KM, Jakubowski JA, Dulcan MK, Welty LJ. Psychiatric disorders and violence: a study of delinquent youth after detention. J Am Acad Child Adolesc Psychiatry 2015; 54:302-12.e5. [PMID: 25791147 PMCID: PMC4369770 DOI: 10.1016/j.jaac.2015.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 12/18/2014] [Accepted: 01/08/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the relationship between psychiatric disorders and violence in delinquent youth after detention. METHOD The Northwestern Juvenile Project is a longitudinal study of youth from the Cook County Juvenile Temporary Detention Center (Chicago, Illinois). Violence and psychiatric disorders were assessed via self-report in 1,659 youth (56% African American, 28% Hispanic, 36% female, aged 13-25 years) interviewed up to 4 times between 3 and 5 years after detention. Using generalized estimating equations and logistic regression, we examined the following: the prevalence of violence 3 and 5 years after detention; the contemporaneous relationships between psychiatric disorders and violence as youth age; and whether the presence of a psychiatric disorder predicts subsequent violence. RESULTS Rates of any violence decreased between 3 and 5 years after detention, from 35% to 21% (males), and from 20% to 17% (females). There was a contemporaneous relationship between disorder and violence. Compared to the group with no disorder, males and females with any disorder had greater odds of any violence (adjusted odds ratio [AOR] = 3.0, 95% CI = 1.9-4.7, and AOR = 4.4, 95% CI = 3.0-6.3, respectively). All specific disorders were associated contemporaneously with violence, except for major depressive disorder/dysthymia among males. Substance use disorders predicted subsequent violence. Males with other drug use disorder and females with marijuana use disorder 3 years after detention had greater odds of any violence 2 years later (AOR = 3.4, 95% CI = 1.4-8.2, and AOR = 2.0, 95% CI = 1.1-3.8, respectively). CONCLUSION Aside from substance use disorders, the psychiatric disorders studied may not be useful markers of subsequent violence. Violence assessment and reduction must be key components of ongoing psychiatric services for high-risk youth.
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Affiliation(s)
- Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, and Columbia University, New York
| | - Linda A Teplin
- Northwestern University, Feinberg School of Medicine, Chicago.
| | - Karen M Abram
- Northwestern University, Feinberg School of Medicine, Chicago
| | | | - Mina K Dulcan
- Northwestern University, Feinberg School of Medicine, Chicago; Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Leah J Welty
- Northwestern University, Feinberg School of Medicine, Chicago
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Curtis SV, Wodarski JS. The East tennessee assertive adolescent family treatment program: a three-year evaluation. SOCIAL WORK IN PUBLIC HEALTH 2015; 30:225-235. [PMID: 25757693 DOI: 10.1080/19371918.2014.992713] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Assertive Adolescent Family Treatment Program targeted adolescents defined as age 12 to 17 years and transition age youth (age 18-24) who were served by the Helen Ross McNabb Center Regional Mental Health System. Most of the participating individuals met the Diagnostic and Statistical Manual of Mental Disorders(IV-TR) criteria for substance abuse or substance dependence and co-occurring mental health disorder. Significant findings in the study included a decrease in illegal drug use, decrease in alcohol consumption, decrease in criminal activity, decrease in violent behaviors, and an increase in cognitive ability. Other findings indicated a decrease in risky sexual behaviors and an increase in participant interaction with supportive friends and family. This study indicates success of the Assertive Adolescent Family Treatment Program and the intervention models used. More research is needed in East Tennessee to generalize the findings and establish a stronger evidence base.
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Affiliation(s)
- Sarah V Curtis
- a The University of Tennessee , Knoxville , Tennessee , USA
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Santisteban DA, Mena MP, Muir J, McCabe BE, Abalo C, Cummings AM. The efficacy of two adolescent substance abuse treatments and the impact of comorbid depression: results of a small randomized controlled trial. Psychiatr Rehabil J 2015; 38:55-64. [PMID: 25799306 PMCID: PMC5021542 DOI: 10.1037/prj0000106] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this randomized trial was to investigate the efficacy of 2 behavioral treatments focusing on different change mechanisms in ameliorating a borderline personality disorder constellation of behaviors and substance use in adolescents referred by juvenile diversion programs. METHODS Forty adolescents 14-17 years of age and meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for borderline personality disorder and substance use disorders were randomized to integrative borderline personality disorder-oriented adolescent family therapy (I-BAFT) or individual drug counseling. This design allowed a comparison of 2 manualized interventions, 1 family based and 1 individually oriented. Profiles of clinical change were used to detect impact and estimate treatment effect sizes. RESULTS Primary analyses showed that both interventions had a clinically significant impact on borderline personality disorder behaviors 12 months after baseline but with no differential treatment effects. The impact on substance use was more complex. Subgroup analyses revealed that adolescents with depression had significantly more severe profiles of borderline personality disorder and substance use. These youths were the only group to show reductions in substance use, but they only did so if they received the I-BAFT intervention. Study data also documented the high dosage of intensive residential treatment needed by this population. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Results highlight the intensive treatment needs of juvenile justice-involved youths with co-occurring substance use and borderline personality disorder including depression, the hybrid outpatient and residential treatment often required by this population, and the promise of a family-oriented approach, particularly for youths with severe symptoms and co-occurring depression. (PsycINFO Database Record
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Affiliation(s)
- Daniel A Santisteban
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami
| | - Maite P Mena
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami
| | - Joan Muir
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami
| | - Brian E McCabe
- School of Nursing and Health Studies, University of Miami
| | - Clara Abalo
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami
| | - Amanda M Cummings
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami
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Hollen V, Ortiz G. Mental Health and Substance Use Comorbidity Among Adolescents in Psychiatric Inpatient Hospitals: Prevalence and Covariates. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2015. [DOI: 10.1080/1067828x.2013.768575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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42
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Godley SH, Smith JE, Passetti LL, Subramaniam G. The Adolescent Community Reinforcement Approach (A-CRA) as a Model Paradigm for the Management of Adolescents With Substance Use Disorders and Co-Occurring Psychiatric Disorders. Subst Abus 2014; 35:352-63. [DOI: 10.1080/08897077.2014.936993] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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King S, McChargue D. Adolescent substance use treatment: the moderating effects of psychopathology on treatment outcomes. J Addict Dis 2014; 33:366-75. [PMID: 25299955 DOI: 10.1080/10550887.2014.969599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study tested the influence of co-occurring mental health diagnoses on the relationship between length of stay and treatment outcome among adolescents residing in an inpatient substance abuse treatment facility. Data were collected via record review. Follow-up information was obtained at 7 days and 3 months post-discharge. Treatment outcome was defined as abstinence and engagement in recovery activities. Hierarchical linear regression demonstrated that comorbidities differentially moderated the relationship between length of stay and treatment outcome. Results suggest that these adolescents attempt to engage in recovery activities independent of abstinence and may need supplemental aftercare assistance to maintain their efforts.
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Affiliation(s)
- Sarah King
- a Department of Psychology , University of Nebraska , Lincoln , Nebraska , USA
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44
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Hersh J, Curry JF, Becker SJ. The Influence of Comorbid Depression and Conduct Disorder on MET/CBT Treatment Outcome for Adolescent Substance Use Disorders. Int J Cogn Ther 2013; 6:325-341. [PMID: 25197427 PMCID: PMC4155521 DOI: 10.1521/ijct.2013.6.4.325] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although depression and conduct disorder frequently co-occur with substance use disorders (SUDs), few studies have investigated the individual and interactive effects of these conditions on SUD treatment outcome. Data were collected from 90 adolescents aged 13-21 (M = 17.1, SD = 2.07) who received a brief evidence-based intervention for SUD. Hierarchical regressions assessed the relationship among demographic variables, depression, conduct disorder, and two substance use outcomes (frequency and problems) at two intervals (three months, six months). Results revealed that higher baseline substance use and lower socioeconomic status significantly predicted higher substance problems and frequency at three-months. At six months, higher three month substance problems and lower depressive symptoms predicted substance problems. In addition, an interaction indicated that the effect of conduct disorder on substance problems was greatest at lower levels of depression. Results are discussed in the context of previous research indicating mixed effects of depression on SUD treatment outcome.
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Affiliation(s)
| | - John F Curry
- Department of Psychology & Neuroscience, Duke University ; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Sara J Becker
- Department of Psychiatry and Human Behavior, Brown University Medical School
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45
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von Sydow K, Retzlaff R, Beher S, Haun MW, Schweitzer J. The efficacy of systemic therapy for childhood and adolescent externalizing disorders: a systematic review of 47 RCT. FAMILY PROCESS 2013; 52:576-618. [PMID: 24102196 DOI: 10.1111/famp.12047] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Systemic (family) therapy is a widely used psychotherapy approach. However, most systematic efficacy reviews have focused solely on "family-based treatment" rather than on the theoretic orientation "systemic therapy." We systematically review trials on the efficacy of systemic therapy for the treatment of childhood and adolescent externalizing disorders. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems-oriented therapy in various forms (family, individual, group, multi-family group therapy) with child or adolescent index patients (0-17 years) suffering from mental disorders were identified by data base searches and cross-references. Inclusion criteria were as follows: index patient diagnosed with a DSM- or ICD-listed mental disorder, and trial published in any language up to the end of 2011. The RCTs were analyzed for their research methodology, interventions applied, and results (postintervention; follow-up). A total of 47 trials from the United States, Europe, and China, published in English, German, and Mandarin, were identified. A total of 42 of them showed systemic therapy to be efficacious for the treatment of attention deficit hyperactivity disorders, conduct disorders, and substance use disorders. Results were stable across follow-up periods of up to 14 years. There is a sound evidence base for the efficacy of systemic therapy for children and adolescents (and their families) diagnosed with externalizing disorders.
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Affiliation(s)
- Kirsten von Sydow
- Berlin School of Psychology/Psychologische Hochschule Berlin (PHB), Berlin, Germany
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46
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Godley SH, Hunter BD, Fernández-Artamendi S, Smith JE, Meyers RJ, Godley MD. A comparison of treatment outcomes for adolescent community reinforcement approach participants with and without co-occurring problems. J Subst Abuse Treat 2013; 46:463-71. [PMID: 24462478 DOI: 10.1016/j.jsat.2013.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/16/2013] [Accepted: 10/29/2013] [Indexed: 11/28/2022]
Abstract
This study examined the relationship between Adolescent Community Reinforcement Approach (A-CRA) participation with treatment engagement, retention, and satisfaction, and with substance use and emotional problem outcomes. Participants had substance use disorders (SUD) only or co-occurring substance use and psychiatric problems. Those with co-occurring problems reported more days of substance use and emotional problems at intake to treatment than those with SUD only. All groups received equivalent exposure to A-CRA during treatment implementation. At the 12-month follow-up, adolescents classified as externalizers (n = 468) or those with both externalizing and internalizing problems (n = 674) had significantly greater improvement in their days of abstinence and substance problems relative to adolescents with substance use disorders only (n = 666). Additionally, adolescents reporting symptoms of internalizing (n = 154), externalizing, or both externalizing and internalizing disorders had significantly greater improvements in days of emotional problems relative to adolescents with SUD only.
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Affiliation(s)
- Susan H Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761.
| | | | | | | | | | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761
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Casanueva C, Stambaugh L, Urato M, Fraser JG, Williams J. Illicit Drug Use From Adolescence to Young Adulthood Among Child Welfare-Involved Youths. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2013. [DOI: 10.1080/1067828x.2012.735514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Matthew Urato
- a RTI International , Research Triangle Park , NC , USA
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48
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Drug trajectories among youth undergoing treatment: The influence of psychological problems and delinquency. J Adolesc 2013; 36:705-16. [DOI: 10.1016/j.adolescence.2013.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 05/22/2013] [Accepted: 05/27/2013] [Indexed: 11/22/2022]
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Skala K, Walter H. Adolescence and Alcohol: a review of the literature. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2013; 27:202-11. [PMID: 23839238 DOI: 10.1007/s40211-013-0066-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/20/2013] [Indexed: 01/01/2023]
Abstract
Up to two thirds of adolescents consume alcohol and about a quarter engage in abusive behavior at some point. Many users begin alcohol use at young ages, and binge drinking is a dominant pattern for a proportion of youth. Because neurogenesis is inhibited by ethanol, consequences of adolescent alcohol abuse include changes in brain development and impairment of neurocognitive performance. A variety of mental and psychosocial problems are also often witnessed in alcohol abusing youth. Apart from the influence exerted by genetic and psychosocial factors, the chance of developing problematic alcohol consumption is increased by consumption in a binge drinking manner and by first contact with alcohol at a young age. Discrimination of alcohol consumption within the frames of normal adolescent behavior from problematic use is still a challenging issue. Different prevention programs provide treatment either directly to the adolescent, in the context of the school, or within the frame of the adolescent's family. Although some of these efforts have been shown to be effective in reducing alcohol misuse in youth, hardly any intervention reveals satisfactory outcomes in a long-term prospect. Successful prevention strategies would need to comprise treatment of current neuropsychological impairment as well as of comorbid mental health problems and concurrent other substance misuse.
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Affiliation(s)
- Katrin Skala
- Department of Child- and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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50
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Horigian VE, Weems CF, Robbins MS, Feaster DJ, Ucha J, Miller M, Werstlein R. Reductions in anxiety and depression symptoms in youth receiving substance use treatment. Am J Addict 2013; 22:329-37. [PMID: 23795871 PMCID: PMC4103979 DOI: 10.1111/j.1521-0391.2013.12031.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/26/2011] [Accepted: 10/26/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Research shows that interventions for substance use disorders may be helpful in reducing internalizing disorders in adolescents. This paper examines the prevalence and reductions of anxiety and depression symptoms among youth receiving substance use treatment. METHODS Four hundred eighty adolescents ages 12-17 who received treatment for substance abuse as part of the Brief Strategic Family Therapy effectiveness trial were screened for anxiety and depression using the Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS). Twelve-month post-randomization assessments were completed by 327 parents and 315 youth. Sixty-five percent of the sample was found to have probability of at least one anxiety disorder or depression diagnosis. RESULTS Significant reduction of anxiety and depressive symptoms and significant reductions in probable anxiety and depression diagnoses were observed at follow-up. Few differences by treatment type and by ethnic group were noticed. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Findings indicate that substance use interventions might help reduce the prevalence of anxiety and depressive symptoms and the probability of these disorders.
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Affiliation(s)
- Viviana E Horigian
- Department of Epidemiology and Public Health, Center for Family Studies, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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