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Cance JD, Adams ET, D'Amico EJ, Palimaru A, Fernandes CSF, Fiellin LE, Bonar EE, Walton MA, Komro KA, Knight D, Knight K, Rao V, Youn S, Saavedra L, Ridenour TA, Deeds B. Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:30-39. [PMID: 37261635 PMCID: PMC10689575 DOI: 10.1007/s11121-023-01545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/02/2023]
Abstract
Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.
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Affiliation(s)
- J D Cance
- RTI International, Research Triangle Park, Durham, NC, USA.
| | - E T Adams
- RTI International, Research Triangle Park, Durham, NC, USA
| | | | | | | | - L E Fiellin
- Yale University School of Medicine, New Haven, CT, USA
| | - E E Bonar
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - M A Walton
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - K A Komro
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - D Knight
- Texas Christian University, Fort Worth, TX, USA
| | - K Knight
- Texas Christian University, Fort Worth, TX, USA
| | - V Rao
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S Youn
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - L Saavedra
- RTI International, Research Triangle Park, Durham, NC, USA
| | - T A Ridenour
- RTI International, Research Triangle Park, Durham, NC, USA
| | - B Deeds
- National Institute on Drug Abuse, MD, Bethesda, USA
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Ridenour TA, Saavedra LM, Fernandes CSF, Cance JD, Graham PW, Oudekerk BA. Introduction to Helping to End Addiction Long-Term Prevention Cooperative: Overview and Strategies. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1-7. [PMID: 36870020 PMCID: PMC9985075 DOI: 10.1007/s11121-023-01503-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 03/05/2023]
Abstract
This supplemental issue describes the individual studies and collaborative efforts of the Helping to End Addiction Long-term Prevention Cooperative's (HPC's) innovative approaches to rapidly develop evidence-based prevention programs for widespread dissemination. This introduction succinctly reviews (1) the context that demands the rapid development of efficacious prevention programs and their scale-ups, (2) the unique objectives of the individual HPC research projects, and (3) collective efforts to harmonize research across studies to advance the prevention of opioid misuse and gain insight into opioid misuse etiology to inform improvements in preventive interventions. At the conclusion of HPC studies, we anticipate the availability of multiple evidence-based programs to prevent opioid misuse and use disorder for persons who experience particular sources of risk and for delivery in settings where prevention has traditionally been lacking. By harmonizing and coordinating efforts across 10 distinct outcomes studies of prevention programs and making data available for analysis by non-HPC researchers, the HPC's efficacy and etiology evidence will far surpass the additive contributions of 10 individual research projects.
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Affiliation(s)
- Ty A Ridenour
- RTI International, 3040, E. Cornwallis Rd., PO Box 12194, 326 Cox Bldg., Research Triangle Park, NC, 27709-2194, USA.
| | - Lissette M Saavedra
- RTI International, 3040, E. Cornwallis Rd., PO Box 12194, 326 Cox Bldg., Research Triangle Park, NC, 27709-2194, USA
| | | | - Jessica Duncan Cance
- RTI International, 3040, E. Cornwallis Rd., PO Box 12194, 326 Cox Bldg., Research Triangle Park, NC, 27709-2194, USA
| | - Phillip W Graham
- RTI International, 3040, E. Cornwallis Rd., PO Box 12194, 326 Cox Bldg., Research Triangle Park, NC, 27709-2194, USA
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Irfan SD, Sarwar G, Emran J, Khan SI. An uncharted territory of sexualized drug use: exploring the dynamics of chemsex among young and adolescent MSM including self-identified gay men in urban Dhaka, Bangladesh. Front Psychol 2023; 14:1124971. [PMID: 37425169 PMCID: PMC10324373 DOI: 10.3389/fpsyg.2023.1124971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Global and local literature depicted the pervasiveness of chemsex among men who have sex with men (MSM), yet there is limited evidence on adolescents and youth. Though literature showed their engagement in chemsex, further exploration is warranted about their socio-sexual contexts and implications. Therefore, this article explored the contexts and implications of chemsex on young and adolescent MSM. This article is extracted from qualitative research evidence, and research data are triangulated by programmatic evidence on adolescent and young MSM from two ongoing pilot interventions. The key motivational factors for engaging in chemsex were primarily rooted in the dynamics of their peer networks. Specifically, the onset of drug use is predominantly attributed to curiosity toward experimentation with methamphetamine, peer influence, propensity to lose weight, and increasing courage to approach potential sexual partners. Moreover, they continued taking drugs as it enhanced their sexual performance, thus perpetuating chemsex. Additionally, the findings revealed several sexual implications of methamphetamine, e.g., bolstering their sexual "stamina," increasing their propensity toward sexual violence, and reducing their decision-making abilities and judgment, thus collectively decreasing condom use. In essence, chemsex is considerably driven by their socio-sexual contexts, thus perpetuating sexual risk behaviors and compromising sexual health outcomes. Therefore, harm reduction interventions targeted need to be designed keeping in mind their socio-sexual dynamics and age.
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Levy S, Deister D, Fantegrossi J, Green L, Lunstead J, Martinez T, Riccardelli W, Schizer M, Schram J, Schram P, Weitzman E. Virtual Care in an Outpatient Subspecialty Substance Use Disorder Treatment Program. J Addict Med 2022; 16:e112-e117. [PMID: 34128485 DOI: 10.1097/adm.0000000000000871] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This article reports on the experience of an outpatient adolescent substance use disorder treatment program transitioning to virtual care during the COVID-19 pandemic. We describe the processes used to make the transition, including development of a safety protocol for patients seen virtually, present clinical volume data before and after the transition, and we describe a range of patient experiences through 3 clinical vignettes. METHODS Using data from the electronic health record, we generated counts of the total number of scheduled and completed appointments between December 2019 and June 2020. We used simple proportions to calculate the completed visit rate. RESULTS Both the absolute number of scheduled appointment and the percent of appointments completed increased with the initiation of virtual care, supporting the acceptability of this modality. Several patients experienced clinical improvements in conjunction with greater engagement, though challenges were also noted. CONCLUSIONS Virtual visits are a practical mode of treatment for adolescent substance use disorders, and more evidence is needed to understand the risks and benefits of this treatment modality.
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Affiliation(s)
- Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, MA (SL, JF, LG, JL, TM, WR, MS, JS, PS); Division of Developmental Medicine, Boston Children's Hospital, Boston, MA (SL, JF, LG, JL, TM, WR, MS, JS, PS); Department of Pediatrics, Harvard Medical School, Boston, MA (DD, EW); Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA (EW)
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Cumulative Exposure to Neighborhood Conditions and Substance Use Initiation among Low-Income Latinx and African American Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010831. [PMID: 34682576 PMCID: PMC8535668 DOI: 10.3390/ijerph182010831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE While previous research underscores the important role that neighborhood contexts play for child and adolescent health and well-being, how these neighborhood contexts influence substance use initiation among adolescents from low-income and ethnic minority families has been understudied. METHODS This study is a secondary analysis of data from the Denver Child Study a retrospective survey that uses a natural experiment aimed at assessing neighborhood effects on developmental outcomes of Latinx and African American adolescents (N = 736). Cox cause-specific hazards models were estimated to test: (1) the effects of cumulative exposure to neighborhood social disorder, neighborhood violent and property crime rates, and neighborhood social capital during preadolescence (ages 8-11) on the likelihood of initiating alcohol, cigarette, and marijuana use during adolescence (ages 12-18), after controlling for youth, caregiver, and household factors; and (2) whether the effects of these cumulative neighborhood factors vary by Latinx and African American ethnicity. RESULTS 5.6% of adolescents in this study initiated cigarette use, 5.4% initiated alcohol use and 5.2% used marijuana for the first time during adolescence. The results indicate that exposure to neighborhood social disorder during preadolescence is a significant risk factor, especially for the initiation of cigarette use (HR = 1.36, 95% CI = 1.062-1.745, p = 0.015) particularly among Latinx adolescents (HR = 1.42, 95% CI = 1.031-1.966, p = 0.032). CONCLUSIONS The findings suggest the need for further research on the relationship between exposure to neighborhood social disorder and adolescent substance use initiation in order to develop and implement community-based prevention and intervention programs to reduce substance use initiation and facilitate healthy adolescent development.
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Burrow-Sánchez JJ, Totsky J, Ratcliff BR, Corrales C. Generalizing treatment outcomes to externalizing behaviors for Latino/a adolescents with substance use disorders: A secondary analysis. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:797-802. [PMID: 33734782 DOI: 10.1037/adb0000713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Substance use treatment for adolescents may decrease not only substance use, but also other related outcomes such as externalizing behaviors. Although positively correlated to substance use in youth, externalizing behaviors are not commonly measured as outcomes in the context of substance use treatment. This study seeks to generalize the outcomes of substance use treatment to externalizing behaviors in a sample of Latino/a adolescents who participated in a randomized clinical trial. METHOD Secondary data analysis was conducted using a longitudinal mixed model to test the outcomes of two versions of a cognitive-behavioral substance use treatment (i.e., standard and culturally accommodated) on externalizing behaviors. Participants were Latino/a adolescents (N = 70) diagnosed with a substance use disorder randomized into one of the two study conditions. RESULTS The results indicated that Latino/a adolescents in both treatment conditions significantly decreased in self-reported externalizing behaviors from pretreatment to 12-months posttreatment. CONCLUSIONS Implications from this study suggest that participation in substance use treatment for Latino/a adolescents may also generalize to other outcomes such as externalizing behaviors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Hogue A, Henderson CE, Ozechowski TJ, Becker SJ, Coatsworth JD. Can the group harm the individual? Reviewing potential iatrogenic effects of group treatment for adolescent substance use. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2021. [DOI: 10.1111/cpsp.12307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hamersma S, Maclean JC. Do expansions in adolescent access to public insurance affect the decisions of substance use disorder treatment providers? JOURNAL OF HEALTH ECONOMICS 2021; 76:102434. [PMID: 33578327 DOI: 10.1016/j.jhealeco.2021.102434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
We apply a mixed-payer economy model to study the effects of changes in the generosity of children's public health insurance programs - measured by Medicaid and Children's Health Insurance Program income thresholds - on substance use disorder (SUD) treatment provider behavior. Using government data on specialty SUD treatment providers over the period 1997-2011 combined with a two-way fixed-effects model and local event study, we show that increases in the generosity of children's public health insurance induce providers to participate in some, but not all, public markets. Our effects appear to be driven by non-profit and government providers. Non-profit providers also appear to increase treatment quantity slightly in response to coverage expansions.
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Affiliation(s)
- Sarah Hamersma
- Department of Public Administration and International Affairs, Syracuse University, Senior Research Associate, Center for Policy Research, Syracuse, NY, USA.
| | - Johanna Catherine Maclean
- National Bureau of Economic Research, Cambridge, MA, USA; Institute for the Study of Labor, Bonn, Germany.
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Bennett ST, Babbage DR. Cultural Adaptation of CBT for Aboriginal Australians. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Duncan R Babbage
- Person Centred Research Centre, Health and Rehabilitation Research Institute, Auckland University of Technology,
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Hogue A, Bobek M, MacLean A. Core Elements of CBT for Adolescent Conduct and Substance Use Problems: Comorbidity, Clinical Techniques, and Case Examples. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:426-441. [PMID: 34103883 PMCID: PMC8184115 DOI: 10.1016/j.cbpra.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescent externalizing problems (AEPs), including serious conduct problems, delinquency, and substance misuse, are the most common adolescent behavioral issues in specialty care. High rates of comorbidity between conduct and substance use problems necessitate multidomain treatment strategies that can effectively address the AEP spectrum. One strategy to increase delivery of evidence-based interventions for multiproblem youth in usual care is to focus on core elements of empirically supported treatments that can be judiciously applied to clients presenting with diverse clinical profiles. This article describes six core practice elements of the cognitive-behavioral treatment (CBT) approach for AEPs: (1) Functional Analysis of Behavior Problems; (2) Prosocial Activity Sampling; (3) Cognitive Monitoring and Restructuring; (4) Emotion Regulation Training; (5) Problem-solving Training; (6) Communication Training. Integrated delivery of these core CBT elements is illustrated in two case examples, and implications for treatment planning for youth with AEPs are discussed.
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Affiliation(s)
- Aaron Hogue
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Molly Bobek
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Alexandra MacLean
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
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Christie GIG, Cheetham A, Lubman DI. Interventions for Alcohol and Drug Use Disorders in Young People: 10 Key Evidence-Based Approaches to Inform Service Delivery. CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00336-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Short term effects of the REAL media e-learning media literacy substance prevention curriculum: An RCT of adolescents disseminated through a community organization. Drug Alcohol Depend 2020; 214:108170. [PMID: 32693198 DOI: 10.1016/j.drugalcdep.2020.108170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The primary aim of this study was to evaluate the short-term effects of testing an e-learning program to reduce adolescent substance use and abuse. Early initiation of substance use is linked to a variety of negative outcomes, thus effective intervention programs are needed. One approach is to use media literacy to capitalize on adolescents' immersion with media in a variety of forms. We developed, implemented, and tested an engaging substance use prevention program by collaborating with a youth-oriented community partner (4-H). METHODS 639 middle adolescents from nine U.S. states participated in an RCT of REAL media. Participants completed a series of online surveys and were randomized to use an online substance prevention program (REAL media) or serve as control (delayed program use). Self-report surveys were administered at three points in time. This short-term evaluation uses data from the pretest (Time 1) and short-term posttest three-month surveys, which measured demographics, self-efficacy to counterargue, and injunctive and descriptive substance use norms. RESULTS Participants who completed the REAL media program reported increased self-efficacy to counterargue and decreased positive injunctive norms compared to control participants who did not complete the program. No significant differences were observed for descriptive norms. CONCLUSIONS We found support for the REAL media program in changing key predictors of youth substance use demonstrating (1) the efficacy of media literacy interventions targeting adolescents and (2) that e-learning substance use prevention efforts can be adapted for and implemented through community organizations.
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Liu F, Cui J, Liu X, Chen KW, Chen X, Li R. The effect of tai chi and Qigong exercise on depression and anxiety of individuals with substance use disorders: a systematic review and meta-analysis. BMC Complement Med Ther 2020; 20:161. [PMID: 32471415 PMCID: PMC7260819 DOI: 10.1186/s12906-020-02967-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Background Previous studies have acknowledged Tai Chi and Qigong exercise could be potential effective treatments for reducing depression and anxiety in both healthy and clinical populations. However, there is a scarcity of systematic reviews summarizing the clinical evidence conducted among individuals with substance use disorders. This study tries to fill up this gap. Methods A systematic search using Medline, EMbase, PsychINFO, Eric, SPORTDiscus, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese National Knowledge Infrastructure (CNKI), Wanfang, and the Chinese Scientific Journal (VIP) databases was initiated to identify randomized controlled trials (RCTs) and non-randomized comparison studies (NRS) assessing the effect of Tai Chi and Qigong versus various comparison groups on depression and anxiety related outcomes. Study quality was evaluated using a Checklist to Evaluate a Report of a Nonpharmacological Trial (CLEAR-NPT) designed for nonpharmacological trial. Results One RCT and six NRS with a total of 772 participants were identified. Some of them were meta-analyzed to examine the pooled effects based on different types of intervention and controls. The results of meta-analyses suggested the effect of Tai Chi was comparable to treatment as usual (TAU) on depression (standardized mean difference (SMD) = − 0.17[− 0.52, 0.17]). Qigong exercise appears to result in improvement on anxiety compared to that of medication (SMD = -1.12[− 1.47, − 0.78]), and no treatment control (SMD = -0.52[− 0.77, − 0.27]). Conclusion The findings suggest potentially beneficial effect of Qigong exercise on symptoms of anxiety among individuals with drug abuse. Considering the small number and overall methodological weakness of included studies and lack of RCTs, results should be interpreted with caution and future rigorously designed RCTs are warranted to provide more reliable evidence.
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Affiliation(s)
- Fang Liu
- Faculty of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Jiabao Cui
- Faculty of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Xuan Liu
- Faculty of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Kevin W Chen
- Faculty of Physical Education, Shenzhen University, Shenzhen, 518060, China.,Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Xiaorong Chen
- Faculty of Physical Education, Shenzhen University, Shenzhen, 518060, China
| | - Ru Li
- Faculty of Physical Education, Shenzhen University, Shenzhen, 518060, China.
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Prescription opioid misuse among adolescents and emerging adults in the United States: A scoping review. Prev Med 2020; 132:105972. [PMID: 31904397 PMCID: PMC7024638 DOI: 10.1016/j.ypmed.2019.105972] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023]
Abstract
The U.S. opioid epidemic is a critical public health problem. As substance use and misuse typically begin in adolescence and emerging adulthood, there is a critical need for prevention efforts for this key developmental period to disrupt opioid misuse trajectories, reducing morbidity and mortality [e.g., overdose, development of opioid use disorders (OUD)]. This article describes the current state of research focusing on prescription opioid misuse (POM) among adolescents and emerging adults (A/EAs) in the U.S. Given the rapidly changing nature of the opioid epidemic, we applied PRISMA Scoping Review (PRISMA-ScR) guidelines to identify empirical articles published in the past 5 years (January 2013-September 2018) from nine databases examining POM among A/EAs (ages 10-25) in the U.S. Seventy-six articles met our inclusion criteria focusing on POM in the following areas: cross-sectional surveys (n = 60), longitudinal cohort studies (n = 5), objective, non-self-reported data sources (n = 9), and interventions (n = 2). Final charted data elements were organized by methodology and sample, with results tables describing design, sample, interventions (where applicable), outcomes, and limitations. Most studies focused on the epidemiology of POM and risk/protective factors, including demographic (e.g., sex, race), individual (e.g., substance use, mental health), and social (e.g., peer substance use) factors. Despite annual national surveys conducted, longitudinal studies examining markers of initiation and escalation of prescription opioid misuse (e.g., repeated overdoses, time to misuse) are lacking. Importantly, few evidence-based prevention or early intervention programs were identified. Future research should examine longitudinal trajectories of POM, as well as adaptation and implementation of promising prevention approaches.
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Stein L, Martin R, Clair-Michaud M, Lebeau R, Hurlbut W, Kahler CW, Monti PM, Rohsenow D. A randomized clinical trial of motivational interviewing plus skills training vs. Relaxation plus education and 12-Steps for substance using incarcerated youth: Effects on alcohol, marijuana and crimes of aggression. Drug Alcohol Depend 2020; 207:107774. [PMID: 31927162 PMCID: PMC7316199 DOI: 10.1016/j.drugalcdep.2019.107774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/15/2019] [Accepted: 11/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Motivational Interviewing plus Cognitive Behavior Therapy (MI/CBT) has been used to reduce adolescent substance use, but has rarely been applied in youth correctional settings. This trial compared MI/CBT against Relaxation Training plus Substance-Education/12-Steps (RT/SET) to reduce substance use and crime among incarcerated youth. METHODS Participants (N = 199) were incarcerated juveniles (64.8 % non-White, 10.1 % girls, mean age of 17.1 years). Two individual sessions of MI (or RT) were followed by 10 group sessions of CBT (or SET). Youth were randomized to condition with follow-ups at 3- and 6-months after release. Major outcomes included alcohol, marijuana and crimes involving aggression. RESULTS A marginal treatment by time interaction was found for percent heavy drinking days, with follow-up tests indicating less alcohol use in RT/SET than MI/CBT at 6 months, and increased use within MI/CBT from 3 to 6 months. A significant treatment by time interaction was found for alcohol-related predatory aggression, with follow-up tests indicating fewer youth engaged in this behavior from 3 to 6 months within RT/SET, and weak evidence favoring MI/CBT over RT/SET at 3 months. General predatory aggression decreased from 3 to 6-months for both treatments. CONCLUSIONS Although weak evidence was found favoring MI/CBT with respect to alcohol-related predatory aggression, results generally support RT/SET in reducing percent heavy drinking days.
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Affiliation(s)
- L.A.R. Stein
- Department of Psychology, The University of Rhode Island, 130 Flagg Road, Kingston, RI 02881,Center for Alcohol & Addiction Studies, Brown University, Brown University, Box G-S121-5, 121 South Main Street, Providence, RI 02912,Department of Behavioral & Social Sciences, Brown University, Box G-S121-4, 121 South Main Street, Providence, RI 02912,Rhode Island Training School, 300 New London Avenue, Cranston, RI 02920,Corresponding Author:
| | - Rosemarie Martin
- Center for Alcohol & Addiction Studies, Brown University, Brown University, Box G-S121-5, 121 South Main Street, Providence, RI 02912
| | | | - Rebecca Lebeau
- Rhode Island Executive Office of Health & Human Services, 3 West Road, Cranston, RI 02920
| | - Warren Hurlbut
- Administration of Justice, Salve Regina University, 100 Ochre Street, Newport, RI 02840
| | - Christopher W. Kahler
- Center for Alcohol & Addiction Studies, Brown University, Brown University, Box G-S121-5, 121 South Main Street, Providence, RI 02912,Department of Behavioral & Social Sciences, Brown University, Box G-S121-4, 121 South Main Street, Providence, RI 02912
| | - Peter M. Monti
- Center for Alcohol & Addiction Studies, Brown University, Brown University, Box G-S121-5, 121 South Main Street, Providence, RI 02912
| | - Damaris Rohsenow
- Center for Alcohol & Addiction Studies, Brown University, Brown University, Box G-S121-5, 121 South Main Street, Providence, RI 02912
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Hennessy EA, Finch AJ. Adolescent recovery capital and recovery high school attendance: An exploratory data mining approach. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:669-676. [PMID: 31724415 PMCID: PMC6889019 DOI: 10.1037/adb0000528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recovery high schools (RHSs) provide a recovery-supportive academic environment for adolescents in recovery from a substance use disorder and are located across the United States. However, only a small proportion of the 160,000 youth in recovery each year in the United States enroll in RHSs posttreatment, indicating that many youth do not access this relapse prevention resource despite its effectiveness. Thus, this study uses the adolescent-adapted recovery capital model (RCAM) to understand individual- and community-level predictors of attendance and identify disparities leading to barriers to accessing RHSs. Data were collected as part of a multisite observational study of adolescents in recovery (N = 294). Logistic regressions and classification trees explored which different recovery capital factors predicted the odds of attending an RHS for at least 28 days during a 12-month period (n = 171) versus a non-RHS (e.g., traditional school: n = 123). The RCAM model is a useful theoretical framework for examining predictors of RHS attendance, and both analysis methods identified multiple unique predictors of RHS attendance. The strongest predictors of RHS attendance were individual-level factors, including problem-solving skills, 12-Step frequency, and financial resources. The classification trees highlighted additional interactions that should be explored in future empirical research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Hides L, Quinn C, Stoyanov S, Kavanagh D, Baker A. Psychological interventions for co-occurring depression and substance use disorders. Cochrane Database Syst Rev 2019; 2019:CD009501. [PMID: 31769015 PMCID: PMC6953216 DOI: 10.1002/14651858.cd009501.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Comorbid depression and substance use disorders are common and have poorer outcomes than either disorder alone. While effective psychological treatments for depression or substance use disorders are available, relatively few randomised controlled trials (RCTs) have examined the efficacy of these treatments in people with these comorbid disorders. OBJECTIVES To assess the efficacy of psychological interventions delivered alone or in combination with pharmacotherapy for people diagnosed with comorbid depression and substance use disorders. SEARCH METHODS We searched the following databases up to February 2019: Cochrane Central Register of Controlled Trials, PubMed, Embase, CINAHL, Google Scholar and clinical trials registers. All systematic reviews identified, were handsearched for relevant articles. SELECTION CRITERIA The review includes data from RCTs of psychological treatments for people diagnosed with comorbid depression and substance use disorders, using structured clinical interviews. Studies were included if some of the sample were experiencing another mental health disorder (e.g. anxiety); however, studies which required a third disorder as part of their inclusion criteria were not included. Studies were included if psychological interventions (with or without pharmacotherapy) were compared with no treatment, delayed treatment, treatment as usual or other psychological treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Seven RCTs of psychological treatments with a total of 608 participants met inclusion criteria. All studies were published in the USA and predominately consisted of Caucasian samples. All studies compared different types of psychological treatments. Two studies compared Integrated Cognitive Behavioural Therapy (ICBT) with Twelve Step Facilitation (TSF), another two studies compared Interpersonal Psychotherapy for Depression (IPT-D) with other treatment (Brief Supportive Therapy (BST) or Psychoeducation). The other three studies compared different types or combinations of psychological treatments. No studies compared psychological interventions with no treatment or treatment as usual control conditions. The studies included a diverse range of participants (e.g. veterans, prisoners, community adults and adolescents). All studies were at high risk of performance bias, other main sources were selection, outcome detection and attrition bias. Due to heterogeneity between studies only two meta-analyses were conducted. The first meta-analysis focused on two studies (296 participants) comparing ICBT to TSF. Very low-quality evidence revealed that while the TSF group had lower depression scores than the ICBT group at post-treatment (mean difference (MD) 4.05, 95% confidence interval (CI) 1.43 to 6.66; 212 participants), there was no difference between groups in depression symptoms (MD 1.53, 95% CI -1.73 to 4.79; 181 participants) at six- to 12-month follow-up. At post-treatment there was no difference between groups in proportion of days abstinent (MD -2.84, 95% CI -8.04 to 2.35; 220 participants), however, the ICBT group had a greater proportion of days abstinent than the TSF group at the six- to 12-month follow-up (MD 10.76, 95% CI 3.10 to 18.42; 189 participants). There were no differences between the groups in treatment attendance (MD -1.27, 95% CI -6.10 to 3.56; 270 participants) or treatment retention (RR 0.95, 95% CI 0.72 to 1.25; 296 participants). The second meta-analysis was conducted with two studies (64 participants) comparing IPT-D with other treatment (Brief Supportive Psychotherapy/Psychoeducation). Very low-quality evidence indicated IPT-D resulted in significantly lower depressive symptoms at post-treatment (MD -0.54, 95% CI -1.04 to -0.04; 64 participants), but this effect was not maintained at three-month follow-up (MD 3.80, 95% CI -3.83 to 11.43) in the one study reporting follow-up outcomes (38 participants; IPT-D versus Psychoeducation). Substance use was examined separately in each study, due to heterogeneity in outcomes. Both studies found very low-quality evidence of no significant differences in substance use outcomes at post-treatment (percentage of days abstinent, IPD versus Brief Supportive Psychotherapy; MD -2.70, 95% CI -28.74 to 23.34; 26 participants) or at three-month follow-up (relative risk of relapse, IPT-D versus Psychoeducation; RR 0.67, 95% CI 0.30 to 1.50; 38 participants). There was also very low-quality evidence for no significant differences between groups in treatment retention (RR 1.00, 95% CI 0.81 to 1.23; 64 participants). No adverse events were reported in any study. AUTHORS' CONCLUSIONS The conclusions of this review are limited due to the low number and very poor quality of included studies. No conclusions can be made about the efficacy of psychological interventions (delivered alone or in combination with pharmacotherapy) for the treatment of comorbid depression and substance use disorders, as they are yet to be compared with no treatment or treatment as usual in this population. In terms of differences between psychotherapies, although some significant effects were found, the effects were too inconsistent and small, and the evidence of too poor quality, to be of relevance to practice.
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Affiliation(s)
- Leanne Hides
- The University of QueenslandSchool of PsychologySt Lucia, BrisbaneQueenslandAustralia4072
| | - Catherine Quinn
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Stoyan Stoyanov
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - David Kavanagh
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Amanda Baker
- University of Newcastle, CallaghanCentre for Brain and Mental Health ResearchNewcomen Street, James Fletcher HospitalNewcastleNew South WalesAustralia2300
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Burrow-Sánchez JJ, Hops H. A randomized trial of culturally accommodated versus standard group treatment for Latina/o adolescents with substance use disorders: Posttreatment through 12-month outcomes. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2019; 25:311-322. [PMID: 30507211 PMCID: PMC6738333 DOI: 10.1037/cdp0000249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Latina/o adolescents are at particular risk for substance use disorders (SUDs) and effective treatments are needed. Some critics indicate that standard evidence-based treatments may not meet the needs of Latina/o adolescents and culturally accommodated treatments are needed; however, few comparative studies have been conducted to test this assumption. This randomized trial was designed to test a standard group-based version of a cognitive-behavioral treatment (S-CBT) against its culturally accommodated equivalent (A-CBT) for a sample of Latina/o adolescents with SUDs. METHOD Seventy Latina/o adolescents were randomly assigned to 1 of 2 treatment conditions and followed over 4 posttreatment time points with the last at 12-months. Generalized longitudinal mixed models for count data were conducted to evaluate treatment differences across time for adolescent substance use. The cultural variables ethnic identity, acculturation, and familism were included in the analysis as potential moderators of treatment outcome. RESULTS A significant difference was found at the 12-month follow-up in favor of the culturally accommodated treatment (d = .92, 95% confidence interval, CI [.43, 1.42]) and parental familism moderated treatment outcome (d = .60, 95% CI [.12, 1.08]). CONCLUSION This is one of the first studies to demonstrate that a culturally accommodated treatment differentially improved outcomes compared with that of its standard equivalent for a sample of Latina/o adolescents with SUDs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Nwokeoma BN, Ede MO, Ugwuanyi C, Mezieobi D, Ugwoezuonu AU, Amoke C, Egenti NT, Nwosu N, Oforka TO, Victor-Aigbodion V, Offordile EE, Ezeh NE, Eze CO, Eluu PE, Ugwuanyi BE, Uzoagba NC, Ugwonna GO, Chukwu CL, Amadi KC, Eseadi C. Efficacy of prison-based cognitive behavioral rehabilitation intervention on violent sexual behaviors among sex offenders in Nigerian prisons. Medicine (Baltimore) 2019; 98:e16103. [PMID: 31335669 PMCID: PMC6708968 DOI: 10.1097/md.0000000000016103] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/30/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/OBJECTIVE Evidence showed that reoffending habits are increasing among offenders with violent sexual behaviors. Given the recidivism rates, a psychotherapeutic intervention becomes imperative. This study examined the efficacy of prison-based cognitive behavioral rehabilitation intervention (PCBRI) on violent sexual behaviors among sex offenders in Nigerian prisons. METHOD A total of45 participants were the sample size. Compulsive Sexual Behavior Inventory and Hypersexual Behavior Inventory were employed in assessing the participants at 3 points. Using a simple random allocation sequence, 23 participants were exposed to PCBRI programme and 22 participants allocated to control condition. The data obtained were analyzed using repeated measures 2-way analysis of variance. RESULTS Results indicated a significant effect of the treatment on violent sexual behaviors among sex offenders in Nigerian prisons exposed to the PCBRI programme when compared to the no-intervention group. Result also showed a significant interaction effect of time and group on sex offenders with violent sexual behaviors. Follow-up tests showed significant decrease in violent sexual behaviors after 6 months for the PCBRI group in comparison to the control group. CONCLUSION This study concluded that PCBRI approach is a type of psychotherapy that reduces violent sexual behaviors among sex offenders in Southeast Nigeria.
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Affiliation(s)
| | - Moses O. Ede
- Department of Educational Foundations, Faculty of Education
| | | | - Daniel Mezieobi
- Department of Social Science Education, University of Nigeria, Nsukka, Enugu State
| | | | - Chijioke Amoke
- Department of Educational Foundations, Faculty of Education
| | | | - Nneka Nwosu
- Department of Educational Foundations, Faculty of Education
| | | | | | | | - Ngozi E. Ezeh
- Department of Educational Foundations, Faculty of Education
| | | | - Patrick E. Eluu
- Department of Arts and Social Science Education, Faculty of Education, Alex Ekwueme Federal University, Ndufu-Alike Ebonyi State
| | - Benedict E. Ugwuanyi
- Department of Social Science Education, University of Nigeria, Nsukka, Enugu State
| | - Ngozi C. Uzoagba
- Medical Library, College of Medicine, University of Nigeria, Ituku Ozalla Enugu Campus, Enugu, Nigeria
| | - Grace O. Ugwonna
- Department of Social Science Education, University of Nigeria, Nsukka, Enugu State
| | | | - Kingley C. Amadi
- Department of Sociology and Anthropology, Faculty of Social Sciences
| | - Chiedu Eseadi
- Department of Educational Foundations, Faculty of Education
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Russell BS, Hutchison M, Fusco A. Emotion Regulation Outcomes and Preliminary Feasibility Evidence From a Mindfulness Intervention for Adolescent Substance Use. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2019. [DOI: 10.1080/1067828x.2018.1561577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kaminer Y, Ohannessian CM, Burke RH. Goal commitment predicts cannabis use for adolescents in treatment. Subst Abus 2019; 40:496-500. [PMID: 30810498 DOI: 10.1080/08897077.2019.1573207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Commitment to change is an innovative potential mediator and mechanism of behavior change (MOBC) that has not been examined in adolescents with cannabis use. The Adolescent Substance Abuse Goal Commitment (ASAGC) questionnaire is a reliable and valid 2-scale measure developed to assess the adolescent's commitment to either abstinence or harm reduction model for adolescents, which in addition to decrease in negative consequences includes consumption reduction as a stated treatment goal. The objective of this paper is to examine the ASAGC's ability to predict adolescent substance use treatment outcome. Methods: During Sessions 3 and 9 of a 10-week treatment program, therapists completed the ASAGC for 170 adolescents 13-18 years of age with alcohol use disorders, the majority of whom (82%) were diagnosed with co-occurring cannabis use disorder (CUD). Results: Logistic regression analyses assessing goal commitment regarding cannabis use at Session 3 indicated that commitment to both abstinence and harm reduction predicted cannabis use at Session 3. However, only commitment to abstinence predicted later cannabis use (assessed at Session 9 and during aftercare). When goal commitment at Session 9 was examined, only commitment to abstinence predicted cannabis use, concurrently and longitudinally. These results indicated that adolescents who had higher scores for commitment to abstinence were less likely to be positive for cannabis use. In contrast, harm reduction was not a significant predictor of cannabis use. Conclusions: Findings demonstrate that goal commitment consistently predicts cannabis use treatment outcome. Commitment to abstinence specifically is a salient predictor for concurrent and future cannabis use. Further prospective study is necessary to determine whether harm reduction may be an attainable goal for some youth given normative delayed neurodevelopmental processes of inhibitive behaviors.
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Affiliation(s)
- Yifrah Kaminer
- Alcohol Research Center and Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
| | - Christine M Ohannessian
- Alcohol Research Center and Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, Connecticut, USA.,Center for Behavioral Health, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Rebecca H Burke
- Alcohol Research Center and Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, Connecticut, USA
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Rohde P, Turner CW, Waldron HB, Brody JL, Jorgensen J. Depression Change Profiles in Adolescents Treated for Comorbid Depression/Substance Abuse and Profile Membership Predictors. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2018; 47:595-607. [PMID: 26890999 PMCID: PMC6122600 DOI: 10.1080/15374416.2015.1118695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Using data from a randomized trial in which adolescents with depressive and substance use disorders (SUD) received treatments for both disorders in either a sequenced or coordinated manner, we (a) determine the number and nature of depression response profiles through 1-year posttreatment and (b) examine whether 8 previously identified factors predict profile membership. There were 170 adolescents (M age = 16.4 years; 22% female; 28% Hispanic, 61% Non-Hispanic White) with comorbid depressive disorder/SUD randomized to one of three sequences of receiving the Adolescent Coping With Depression Course and Functional Family Therapy for SUD (depression treatment followed by SUD treatment; SUD treatment followed by depression treatment; coordinated treatment). Depression was assessed at 7 points from baseline to 1-year follow-up. A 4-class solution fit the data best, with groups labeled Mildly Depressed Responders (57.1%), Depressed Responders (18.8%), Depressed Non-Responders (12.9%), and Depressed with Recurrence (11.2%). The 4 change profiles differed on indices of all but 1 predictor (age); most differences were driven by lower scores among Mildly Depressed Responders. Profile membership was most strongly predicted by depression severity, cognitive distortions, hopelessness, and global functioning. The strongest predictor of Nonresponse was low family cohesion, whereas Recurrence was associated with hopelessness, suicide attempts, and starting treatment near the end of the school year. Most depressed adolescents experienced a positive response that was maintained. Understanding the most common profiles of depression change during and following treatment and the variables that predict change can help improve treatment outcomes and advance tailoring efforts.
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Kaminer Y, Ohannessian CM, McKay JR, Burke RH, Flannery K. Goal commitment predicts treatment outcome for adolescents with alcohol use disorder. Addict Behav 2018; 76:122-128. [PMID: 28800496 DOI: 10.1016/j.addbeh.2017.07.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/16/2017] [Accepted: 07/30/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Commitment to change is an innovative potential mediator and mechanism of behavior change (MOBC) that has not been examined in adolescents with substance use disorders (SUD). The Adolescent Substance Abuse Goal Commitment (ASAGC) questionnaire is a reliable and valid 2-scale measure developed to assess the adolescent's commitment to either abstinence or harm reduction (HR) that includes consumption reduction as a stated treatment goal. The objective of this study was to examine the ASAGC's ability to predict alcohol use treatment outcome. METHOD During sessions three and nine of a 10-week treatment program, therapists completed the ASAGC for 170 adolescents 13-18years of age with alcohol use disorder (AUD). Drinking behaviors were assessed during and after a continued-care phase until 12-month from study onset. RESULTS Analysis of Variance results indicated that adolescents who reported no alcohol use had significantly higher scores on the commitment to abstinence scale than adolescents who reported alcohol use. None of the ANOVA models were significant for commitment to HR. When treatment outcome was examined, commitment to abstinence consistently predicted number of drinking days, number of heavy drinking days, and the maximum number of drinks post-treatment. In contrast, commitment to HR did not predict any of the drinking outcomes. These results suggest that the more adolescents were committed to abstinence during treatment, the less they used and abused alcohol after treatment completion. CONCLUSIONS In addition to the ASAGC's ability to differentiate between commitment to abstinence and commitment to HR, study findings demonstrate that goal commitment consistently predicts AUD treatment outcome.
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Affiliation(s)
- Yifrah Kaminer
- Alcohol Research Center and Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030-2103, United States.
| | - Christine McCauley Ohannessian
- Alcohol Research Center and Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030-2103, United States; Children's Center for Community Research, Connecticut Children's Medical Center, Hartford, CT 06106, United States
| | - James R McKay
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, United States
| | - Rebecca H Burke
- Alcohol Research Center and Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030-2103, United States
| | - Kaitlin Flannery
- Children's Center for Community Research, Connecticut Children's Medical Center, Hartford, CT 06106, United States; Department of Psychology, University of Connecticut, Storrs, CT 06269-1020, United States
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Schawo S, Bouwmans C, van der Schee E, Hendriks V, Brouwer W, Hakkaart L. The search for relevant outcome measures for cost-utility analysis of systemic family interventions in adolescents with substance use disorder and delinquent behavior: a systematic literature review. Health Qual Life Outcomes 2017; 15:179. [PMID: 28927410 PMCID: PMC5606120 DOI: 10.1186/s12955-017-0722-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Systemic family interventions have shown to be effective in adolescents with substance use disorder and delinquent behavior. The interventions target interactions between the adolescent and involved systems (i.e. youth, family, peers, neighbors, school, work, and society). Next to effectiveness considerations, economic aspects have gained attention. However, conventional generic quality of life measures used in health economic evaluations may not be able to capture the broad effects of systemic interventions. This study aims to identify existing outcome measures, which capture the broad effects of systemic family interventions, and allow use in a health economic framework. METHODS We based our systematic review on clinical studies in the field. Our goal was to identify effectiveness studies of psychosocial interventions for adolescents with substance use disorder and delinquent behavior and to distill the instruments used in these studies to measure effects. Searched databases were PubMed, Education Resource Information Center (ERIC), Cochrane and Psychnet (PsycBOOKSc, PsycCRITIQUES, print). Identified instruments were ranked according to the number of systems covered (comprehensiveness). In addition, their use for health economic analyses was evaluated according to suitability characteristics such as brevity, accessibility, psychometric properties, etc. RESULTS One thousand three hundred seventy-eight articles were found and screened for eligibility. Eighty articles were selected, 8 instruments were identified covering 5 or more systems. CONCLUSIONS The systematic review identified instruments from the clinical field suitable to evaluate systemic family interventions in a health economic framework. None of them had preference-weights available. Hence, a next step could be to attach preference-weights to one of the identified instruments to allow health economic evaluations of systemic family interventions.
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Affiliation(s)
- S. Schawo
- Institute for Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - C. Bouwmans
- Institute for Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - E. van der Schee
- Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, Parnassia Bavo Group, Monsterseweg 83, 2553 RJ The Hague, The Netherlands
| | - V. Hendriks
- Parnassia Addiction Research Centre (PARC), Brijder Addiction Treatment, Parnassia Bavo Group, Monsterseweg 83, 2553 RJ The Hague, The Netherlands
- Curium, Leiden University Medical Centre, Department of Child and Adolescent Psychiatry, Leiden University, Leiden, The Netherlands
| | - W. Brouwer
- Institute for Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - L. Hakkaart
- Institute for Medical Technology Assessment & Institute of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Rabani-Bavojdan M, Rabani-Bavojdan M, Rajabizadeh G, Kaviani N, Bahramnejad A, Ghaffari Z, Shafiei-Bafti M. The Effectiveness of the Harm Reduction Group Therapy Based on Bandura's Self-Efficacy Theory on Risky Behaviors of Drug-Dependent Sex Worker Women. ADDICTION & HEALTH 2017; 9:175-182. [PMID: 29657698 PMCID: PMC5894797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/19/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effectiveness of the harm reduction group therapy based on Bandura's self-efficacy theory on risky behaviors of sex workers in Kerman, Iran. METHODS A quasi-experimental two-group design (a random selection with pre-test and post-test) was used. A risky behaviors questionnaire was used to collect. The sample was selected among sex workers referring to drop-in centers in Kerman. Subjects were allocated to two groups and were randomly classified into two experimental and control groups. The sample group consisted of 56 subjects. The experimental design was carried out during 12 sessions, and the post-test was performed one month and two weeks after the completion of the sessions. The results were analyzed statistically. FINDINGS By reducing harm based on Bandura's self-efficacy theory, the risky behaviors of the experimental group, including injection behavior, sexual behavior, violence, and damage to the skin, were significantly reduced in the pre-test compared to the post-test (P < 0.010). CONCLUSION The harm reduction group therapy based on Bandura's self-efficacy theory can reduce the risky behaviors of sex workers.
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Affiliation(s)
| | | | - Ghodratollah Rajabizadeh
- Associate Professor, Department of Psychiatry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Nahid Kaviani
- Health Deputy, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Bahramnejad
- PhD Candidate, Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Mehdi Shafiei-Bafti
- General Practitioner, Deputy for Health, Kerman University of Medical Sciences, Kerman, Iran
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Wu SS, Schoenfelder E, Hsiao RCJ. Cognitive Behavioral Therapy and Motivational Enhancement Therapy. Child Adolesc Psychiatr Clin N Am 2016; 25:629-43. [PMID: 27613342 DOI: 10.1016/j.chc.2016.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although cognitive behavioral therapy (CBT) is widely recognized as the preferred treatment of psychiatric disorders, less is known about the application of CBT to substance use disorders, particularly in adolescence. This article discusses how CBT conceptualizes substance use and how it is implemented as a treatment of adolescent substance abuse. The article draws on several manuals for CBT that implement it as a standalone treatment or in combination with motivational enhancement therapies. Also reviewed are several studies that examined the efficacy of CBT. Finally, the implications are discussed. Numerous starting resources are provided to help a clinician implement CBT.
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Affiliation(s)
- Sarah S Wu
- Psychiatry and Behavioral Health, Seattle Children's Hospital, 4800 Sand Point Way, OA.5.154, PO Box 5371, Seattle, Washington 98145-5005, USA
| | - Erin Schoenfelder
- Psychiatry and Behavioral Health, Seattle Children's Hospital, 4800 Sand Point Way, OA.5.154, PO Box 5371, Seattle, Washington 98145-5005, USA
| | - Ray Chih-Jui Hsiao
- Child and Adolescent Psychiatry Residency Training Program, Washington State Medical Association, University of Washington School of Medicine, 4800 Sand Point Way Northeast, Mailstop OA.5.154, PO Box 5371, Seattle, WA 98105-0371, USA; Adolescent Substance Abuse Program, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Mailstop OA.5.154, PO Box 5371, Seattle, WA 98105-0371, USA.
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Thomasius R, Sack PM, Arnaud N, Hoch E. [Treatment of alcohol-related disorders in children and adolescents: Age-specific treatment recommendations from the new interdisciplinary S3-guideline]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 44:295-303; quiz 304-5. [PMID: 27434689 DOI: 10.1024/1422-4917/a000435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective Alcohol-related disorders typically have an early onset. However, current treatment provisions often fail to address developmental aspects adequately. Recently, the new evidence- and interdisciplinary consensus-based German S3-guideline (National Clinical Practice Guideline) was established for the screening, diagnosis, and treatment of alcohol-related disorders in young patients. For the first time it includes population-specific recommendations. Method For this new S3-guideline, 23 source guidelines, 28 systematic reviews, and 2,213 study reports were analyzed. An interdisciplinary consensus conference devised 174 recommendations with 14 specific recommendations for children and adolescents. Depending on the quality of evidence, they issued “must,” “should,” and “can” recommendations or a “clinical consensus point (CCP).“ Results For the psychotherapeutic treatment of children and adolescents with alcohol-related disorders, a “must” recommendation was devised for motivational interviewing, cognitive behavior therapy, and inclusion of family members in treatment. Recommendations for family-based therapies are heterogeneous. For psychosocial therapies (psychoeducation, parent counseling, ergotherapy, also hospital schools) a CCP was devised. Concerning pharmacological treatment, the evidence base was insufficient; only for treating comorbid disorders (ADHS) could a CCP be derived. As to differential indications, elevated risks for suicide, for treatment dropout, and for delinquency influenced by copatients should be considered (CCP). Conclusions Numerous population-specific recommendations have been issued for the treatment of alcohol-related disorders in youths. However, urgent research requirements have been identified especially in medical drug treatment.
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Affiliation(s)
- Rainer Thomasius
- 1 Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf
| | - Peter-Michael Sack
- 1 Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf
| | - Nicolas Arnaud
- 1 Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf
| | - Eva Hoch
- 2 Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit (ZI), Mannheim
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Thayer RE, Feldstein Ewing SW. Adolescent psychotherapy for addiction medicine. PROGRESS IN BRAIN RESEARCH 2016; 224:305-22. [DOI: 10.1016/bs.pbr.2015.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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Kaminer Y, Burleson JA, Burke R, Litt MD. The efficacy of contingency management for adolescent cannabis use disorder: a controlled study. Subst Abus 2015; 35:391-8. [PMID: 25010430 DOI: 10.1080/08897077.2014.933724] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study was performed to investigate the efficacy of a voucher-based reinforcement therapy (VBRT) rewarding drug-free urine for adolescents with cannabis use disorder. METHODS A controlled 10-week study where 59 adolescents aged 14-18 years were assigned by cohorts into groups of either an integrated cognitive-behavioral therapy (CBT) and VBRT or CBT with attendance-based reward program. Substance use was monitored by twice-weekly urinalysis. Other measures were collected at pre- and posttreatment and at 3-month follow-up. RESULTS There was no significant difference in the linear change between conditions for cannabis use either from Sessions 1 to 10 or between end-of-treatment to 3-month follow-up. Also, self-efficacy and coping response did not show improvement during treatment. CONCLUSIONS In this study, the addition of contingency management (CM) to CBT in youth was not found to be more efficacious than similar compensation rewarding attendance only. Continued examination of the efficacy of CM and its interaction with the associated mechanisms of behavior change of CBT in youth is necessary. Examination of the effect of the magnitude of the reward as well as considering the emotional and cognitive developmental differences from adults is warranted.
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Affiliation(s)
- Yifrah Kaminer
- a Alcohol Research Center , University of Connecticut Health Center , Farmington , Connecticut , USA
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Pugatch M, Knight JR, McGuiness P, Sherritt L, Levy S. A group therapy program for opioid-dependent adolescents and their parents. Subst Abus 2015; 35:435-41. [PMID: 25174347 DOI: 10.1080/08897077.2014.958208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Opioid dependence is a significant problem for adolescents in the United States. Psychosocial treatment for adolescents with opioid use disorders may be effective, although it has not been well studied. METHODS This paper describes a 13-week psychoeducational group therapy program with parallel tracks for adolescents with opioid use disorders and their parents attending an outpatient substance use program in a children's hospital. In addition to group therapy, participating adolescents received medical care, including medication-assisted treatment for opioid dependence, drug testing, medical follow-up, psychopharmacology, individual counseling, and parent guidance. Data were collected as part of a quality improvement project for the program. Forty-two adolescents and 72 parents attended the group program between 2006 and 2009. Frequencies were computed and a weighted kappa was used to assess agreement between adolescent and parent reports of use and driving risk. RESULTS Of the 42 adolescents participating in the 13-week group program, 36 (86%) completed 3 or more group sessions, and 24 (57%) completed 10 or more sessions. Twenty-two (52%) adolescent participants reported abstinence from all substances on each of their weekly evaluations. Adolescent-parent agreement for substance use was good to very good: weighted kappa (95% confidence interval) .76 (.60, .87), but poor for driving risk, weighted kappa .11 (-.20, .40). CONCLUSIONS Completion rates and self-report of outcomes from this group program indicate promise and warrant further testing.
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Affiliation(s)
- Marianne Pugatch
- a Adolescent Substance Abuse Program, Boston Children's Hospital , Boston , Massachusetts , USA
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Kaminer Y, Ohannessian CM, McKay JR, Burke RH. The Adolescent Substance Abuse Goal Commitment (ASAGC) Questionnaire: An Examination of Clinical Utility and Psychometric Properties. J Subst Abuse Treat 2015; 61:42-6. [PMID: 26531893 DOI: 10.1016/j.jsat.2015.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 11/15/2022]
Abstract
Commitment to change is an innovative potential mediator or mechanism of behavior change that has not been examined in adolescents with substance use disorders (SUD). The Adolescent Substance Abuse Goal Commitment (ASAGC) questionnaire is a 16-item measure developed to assess an individual's commitment to his/her stated treatment goal. The objectives of this study are to explore the research and clinical utility of the commitment construct as measured by the ASAGC. During sessions 3 and 9 of a 10-week SUD treatment, therapists completed the ASAGC for 170 13-18 year-old adolescents. An exploratory factor analysis was conducted on the ATAGC items. Concurrent validity with related constructs, self-efficacy and motivation for change, was examined as well. At both sessions, the factor analysis resulted in two scales--Commitment to Recovery and Commitment to Harm Reduction. The ASAGC scales were found to demonstrate a high level of internal consistency (alpha coefficients ranged from .92 to .96 over time). In contrast to the Commitment to Harm Reduction scale, the Commitment to Recovery scale consistently correlated with scales from the Situational Confidence Questionnaire assessing self-efficacy, evidencing concurrent validity. Similarly, the Commitment to Recovery scale was related to the Problem Recognition Questionnaire, providing further evidence of the validity of the ASAGC. The ASAGC is a reliable and valid clinical research instrument for the assessment of adolescents' commitment to their substance abuse treatment goal. Clinical researchers may take advantage of the clinical utility of the ASAGC including its ability to differentiate between commitment to abstinence versus commitment to harm reduction.
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Affiliation(s)
- Yifrah Kaminer
- Alcohol Research Center and Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030.
| | - Christine McCauley Ohannessian
- Alcohol Research Center and Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030; Children's Center for Community Research, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106
| | - James R McKay
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104
| | - Rebecca H Burke
- Alcohol Research Center and Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030
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Ruggiero KJ, Price M, Adams Z, Stauffacher K, McCauley J, Danielson CK, Knapp R, Hanson RF, Davidson TM, Amstadter AB, Carpenter MJ, Saunders BE, Kilpatrick DG, Resnick HS. Web Intervention for Adolescents Affected by Disaster: Population-Based Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2015; 54:709-17. [PMID: 26299292 PMCID: PMC4548271 DOI: 10.1016/j.jaac.2015.07.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/01/2015] [Accepted: 07/06/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the efficacy of Bounce Back Now (BBN), a modular, Web-based intervention for disaster-affected adolescents and their parents. METHOD A population-based randomized controlled trial used address-based sampling to enroll 2,000 adolescents and parents from communities affected by tornadoes in Joplin, MO, and several areas in Alabama. Data collection via baseline and follow-up semi-structured telephone interviews was completed between September 2011 and August 2013. All families were invited to access the BBN study Web portal irrespective of mental health status at baseline. Families who accessed the Web portal were assigned randomly to 1 of 3 groups: BBN, which featured modules for adolescents and parents targeting adolescents' mental health symptoms; BBN plus additional modules targeting parents' mental health symptoms; or assessment only. The primary outcomes were adolescent symptoms of posttraumatic stress disorder (PTSD) and depression. RESULTS Nearly 50% of families accessed the Web portal. Intent-to-treat analyses revealed time × condition interactions for PTSD symptoms (B = -0.24, SE = 0.08, p < .01) and depressive symptoms (B = -0.23, SE = 0.09, p < .01). Post hoc comparisons revealed fewer PTSD and depressive symptoms for adolescents in the experimental versus control conditions at 12-month follow-up (PTSD: B = -0.36, SE = 0.19, p = .06; depressive symptoms: B = -0.42, SE = 0.19, p = 0.03). A time × condition interaction also was found that favored the BBN versus BBN + parent self-help condition for PTSD symptoms (B = 0.30, SE = 0.12, p = .02) but not depressive symptoms (B = 0.12, SE = 0.12, p = .33). CONCLUSION Results supported the feasibility and initial efficacy of BBN as a scalable disaster mental health intervention for adolescents. Technology-based solutions have tremendous potential value if found to reduce the mental health burden of disasters. CLINICAL TRIAL REGISTRATION INFORMATION Web-based Intervention for Disaster-Affected Youth and Families; http://clinicaltrials.gov; NCT01606514.
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Affiliation(s)
- Kenneth J Ruggiero
- Medical University of South Carolina (MUSC) and the Ralph H. Johnson VA Medical Center, Charleston, SC.
| | | | | | | | | | | | | | | | - Tatiana M Davidson
- Medical University of South Carolina (MUSC) and the Ralph H. Johnson VA Medical Center, Charleston, SC
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Martin RA, Stein LAR, Clair M, Cancilliere MK, Hurlbut W, Rohsenow DJ. Adolescent Substance Treatment Engagement Questionnaire for Incarcerated Teens. J Subst Abuse Treat 2015; 57:49-56. [PMID: 26021405 DOI: 10.1016/j.jsat.2015.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 04/14/2015] [Accepted: 04/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment engagement is often measured in terms of treatment retention and drop out, resource utilization, and missed appointments. Since persons may regularly attend treatment sessions but not pay close attention, actively participate, or comply with the program, attendance may not reflect the level of effort put into treatment. Teens in correctional settings may feel coerced to attend treatment, making it necessary to develop measures of treatment involvement beyond attendance. This study describes the development and validation of the Adolescent Substance Treatment Engagement Questionnaire (ASTEQ), Teen and Counselor versions. METHODS The psychometric properties of the ASTEQ were examined in a sample of incarcerated teens (N = 205) and their counselors. Principal component analysis was conducted on teen and counselor versions of the questionnaire. RESULTS Scales of positive and negative treatment engagement were found, reflecting both overt behaviors (joking around, talking to others) and attitudes (interest in change). Significant correlations with constructs related to treatment attitudes and behaviors, and misbehaviors (including substance use) demonstrate good concurrent and predictive validity. Teen and counselor ratings of engagement produced validity correlations in the medium effect size range. CONCLUSIONS These measures comprise a valid and reliable method for measuring treatment engagement for incarcerated teens.
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Affiliation(s)
- Rosemarie A Martin
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912.
| | - Lynda A R Stein
- The University of Rhode Island, Kingston, RI, 02881; The Rhode Island Training School, 40 Howard Avenue, Cranston, RI, 02920
| | - Mary Clair
- The University of Rhode Island, Kingston, RI, 02881; The Rhode Island Training School, 40 Howard Avenue, Cranston, RI, 02920
| | | | - Warren Hurlbut
- The Rhode Island Training School, 40 Howard Avenue, Cranston, RI, 02920
| | - Damaris J Rohsenow
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912; Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI, 02908
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Yuen EK, Gros K, Welsh KE, McCauley J, Resnick HS, Danielson CK, Price M, Ruggiero KJ. Development and preliminary testing of a web-based, self-help application for disaster-affected families. Health Informatics J 2015; 22:659-75. [PMID: 25933798 DOI: 10.1177/1460458215579292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Technology-based self-help interventions have the potential to increase access to evidence-based mental healthcare, especially for families affected by natural disasters. However, development of these interventions is a complex process and poses unique challenges. Usability testing, which assesses the ability of individuals to use an application successfully, can have a significant impact on the quality of a self-help intervention. This article describes (a) the development of a novel web-based multi-module self-help intervention for disaster-affected adolescents and their parents and (b) a mixed-methods formal usability study to evaluate user response. A total of 24 adolescents were observed, videotaped, and interviewed as they used the depressed mood component of the self-help intervention. Quantitative results indicated an above-average user experience, and qualitative analysis identified 120 unique usability issues. We discuss the challenges of developing self-help applications, including design considerations and the value of usability testing in technology-based interventions, as well as our plan for widespread dissemination.
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Affiliation(s)
| | - Kirstin Gros
- Ralph H. Johnson Veterans Affairs Medical Center, USA; Medical University of South Carolina, USA
| | | | | | | | | | | | - Kenneth J Ruggiero
- Medical University of South Carolina, USA; Ralph H. Johnson Veterans Affairs Medical Center, USA
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Culturally adapted cognitive behaviour therapy for Māori with major depression. COGNITIVE BEHAVIOUR THERAPIST 2015. [DOI: 10.1017/s1754470x14000233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractMāori are the indigenous people of New Zealand and in 2006 comprised approximately 15% of the country's population. Epidemiological data suggests Māori experience rates of depression that are higher than the general population and are less likely to engage in treatment for mental health issues. The main aim of this study was to evaluate the effectiveness of an adapted approach to psychotherapy with Māori. The broad goals of which were to provide empirically grounded guidance for therapists aspiring to provide best practice to their Māori clients. This paper documents the evaluation of a cognitive behavioural therapy (CBT) treatment protocol specifically designed and adapted for delivery to adult Māori clients with a diagnosis of depression. The treatment protocol was administered to 16 Māori clients with a primary diagnosis of depression. The adapted treatment incorporated Māori processes for engagement, spirituality, family involvement and metaphor. The intervention exhibited considerable promise with large significant reductions in depressive symptomatology in the participant group. Furthermore, significant reductions in negative cognition were observed. This is the first piece of applied clinical research that has examined the effectiveness of an individual psychological therapy exclusively with Māori and the first to examine individual psychotherapy outcomes with an indigenous population using an effectiveness study. The findings have a number of implications for the treatment of Māori clients with depression. This study provides useful guidelines for clinicians providing psychological treatment to Māori and provides strong support for the cultural adaptation of psychological treatment with ethnic minority groups.
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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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Ruggiero KJ, Davidson TM, McCauley J, Gros KS, Welsh K, Price M, Resnick HS, Danielson CK, Soltis K, Galea S, Kilpatrick DG, Saunders BE, Nissenboim J, Muzzy W, Fleeman A, Amstadter AB. Bounce Back Now! Protocol of a population-based randomized controlled trial to examine the efficacy of a Web-based intervention with disaster-affected families. Contemp Clin Trials 2014; 40:138-49. [PMID: 25478956 DOI: 10.1016/j.cct.2014.11.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/24/2014] [Accepted: 11/25/2014] [Indexed: 01/24/2023]
Abstract
Disasters have far-reaching and potentially long-lasting effects on youth and families. Research has consistently shown a clear increase in the prevalence of several mental health disorders after disasters, including depression and posttraumatic stress disorder. Widely accessible evidence-based interventions are needed to address this unmet need for youth and families, who are underrepresented in disaster research. Rapid growth in Internet and Smartphone access, as well as several Web based evaluation studies with various adult populations has shown that Web-based interventions are likely to be feasible in this context and can improve clinical outcomes. Such interventions also are generally cost-effective, can be targeted or personalized, and can easily be integrated in a stepped care approach to screening and intervention delivery. This is a protocol paper that describes an innovative study design in which we evaluate a self-help Web-based resource, Bounce Back Now, with a population-based sample of disaster affected adolescents and families. The paper includes description and justification for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this study design include the use of address-based sampling to recruit a population-based sample of disaster-affected adolescents and parents, telephone and Web-based assessments, and development and evaluation of a highly individualized Web intervention for adolescents. Challenges related to large-scale evaluation of technology-delivered interventions with high-risk samples in time-sensitive research are discussed, as well as implications for future research and practice.
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Affiliation(s)
- Kenneth J Ruggiero
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina (MUSC), Charleston, SC, United States; Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC, 29401, United States.
| | - Tatiana M Davidson
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina (MUSC), Charleston, SC, United States; National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, United States
| | - Jenna McCauley
- Clinical Neuroscience Division, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, United States
| | - Kirstin Stauffacher Gros
- Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC, 29401, United States
| | - Kyleen Welsh
- Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC, 29401, United States; National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, United States
| | - Matthew Price
- Center for Research on Emotion, Stress, and Technology, University of Vermont, Burlington, VT, United States
| | - Heidi S Resnick
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, United States
| | - Carla Kmett Danielson
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, United States
| | - Kathryn Soltis
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina (MUSC), Charleston, SC, United States; National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, United States
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Dean G Kilpatrick
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, United States
| | - Benjamin E Saunders
- National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, MUSC, Charleston, SC, United States
| | - Josh Nissenboim
- Fuzzco, Inc., 95 Cannon Street, Charleston, SC, United States
| | - Wendy Muzzy
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina (MUSC), Charleston, SC, United States; Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC, 29401, United States
| | - Anna Fleeman
- Abt SRBI, 275 Seventh Avenue, Ste. 2700, New York, NY, United States
| | - Ananda B Amstadter
- Department of Psychiatry, Psychology, and Human and Molecular Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States
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Winters KC, Tanner-Smith EE, Bresani E, Meyers K. Current advances in the treatment of adolescent drug use. Adolesc Health Med Ther 2014; 5:199-210. [PMID: 25429247 PMCID: PMC4241949 DOI: 10.2147/ahmt.s48053] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Research on the development and efficacy of drug abuse treatment for adolescents has made great strides recently. Several distinct models have been studied, and these approaches range from brief interventions to intensive treatments. This paper has three primary aims: to provide an overview of conceptual issues relevant to treating adolescents suspected of drug-related problems, including an overview of factors believed to contribute to a substance use disorder, to review the empirical treatment outcome literature, and to identify areas of need and promising directions for future research.
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Affiliation(s)
- Ken C Winters
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Treatment Research Institute, Philadelphia, PA, USA
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Siegel JP. Emotional Regulation in Adolescent Substance Use Disorders: Rethinking Risk. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2014. [DOI: 10.1080/1067828x.2012.761169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Stein LAR, Clair M, Martin RA, Soenksen S, Lebeau R, Rohsenow DJ, Kahler CW, Hurlbut W, Monti PM. Measuring behaviors of individual adolescents during group-based substance abuse intervention. Subst Abus 2014; 35:408-17. [PMID: 25127289 DOI: 10.1080/08897077.2014.949337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Group treatment is delivered in youth correctional facilities, yet groups may be iatrogenic. Few measures with demonstrated psychometric properties exist to track behaviors of individuals during groups. The authors assessed psychometrics for the Group Process-Individual Level measure (GP-IL) of group treatment. METHODS N = 152 teens were randomized to 1 of 2 groups (10 sessions each). Adolescents, counselors, and observers rated teen behaviors at sessions 3 and 10. GP-IL assesses reinforcement for deviancy and positive behaviors, member rejection, and counselor connection and praise. RESULTS Internal consistency and 1-month stability were demonstrated. Concurrent validity is supported by correlations with measures expected to be associated with group behavior (e.g., coping skills). Counselors and observers rated more deviancy during interactive skills-building groups versus didactic psychoeducational groups (P ≤ .005). Scales evidenced incremental validity. CONCLUSIONS GP-IL offers a sound method of tracking adolescent behaviors for professionals working with groups. Counselors ratings were most reliable and valid overall.
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Affiliation(s)
- L A R Stein
- a Center for Social Sciences Research and Department of Psychology, University of Rhode Island , Kingston , Rhode Island , USA
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Rohde P, Waldron HB, Turner CW, Brody J, Jorgensen J. Sequenced versus coordinated treatment for adolescents with comorbid depressive and substance use disorders. J Consult Clin Psychol 2014; 82:342-8. [PMID: 24491069 DOI: 10.1037/a0035808] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We evaluated 3 methods of integrating interventions for depression (Adolescent Coping With Depression Course; CWD) and substance use disorders (Functional Family Therapy; FFT), examining (a) treatment sequence effects on substance use and depression outcomes and (b) whether the presence of major depressive disorder (MDD) moderated effects. METHOD Participants were 170 adolescents (ages 13-18; 22% female; 61% non-Hispanic White) with comorbid depressive disorder (54% MDD, 18% dysthymia) and substance use disorders who were randomized to (a) FFT followed by CWD (FFT/CWD), (b) CWD followed by FFT (CWD/FFT), or (c) coordinated FFT and CWD (CT). Acute treatment (24 treatment sessions provided over 20 weeks) and 6- and 12-month follow-up effects are presented for substance use (percentage of days of substance use; Timeline Followback) and depression (Children's Depression Rating Scale-Revised). RESULTS FFT/CWD achieved better substance use outcomes than CT at posttreatment, and 6- and 12-month follow-ups; substance use effects for CWD/FFT were intermediate. For participants with baseline MDD, the CWD/FFT sequence resulted in lower substance use than either FFT/CWD or CT. Depressive symptoms decreased significantly in all 3 treatment sequences with no evidence of differential effectiveness during or following treatment. Attendance was lower for the second of both sequenced interventions. A large proportion of the sample received treatment outside the study, which predicted better outcomes in the follow-up. CONCLUSIONS Depression reductions occurred early in all 3 treatment sequences. Of the examined treatment sequences, FFT/CWD appeared most efficacious for substance use reductions but addressing depression early in treatment may improve substance use outcomes in the presence of MDD.
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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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Donnellan D, Murray C, Harrison J. An investigation into adolescents' experience of cognitive behavioural therapy within a child and adolescent mental health service. Clin Child Psychol Psychiatry 2013; 18:199-213. [PMID: 22669971 DOI: 10.1177/1359104512447032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive Behavioural Therapy (CBT) is frequently referenced within NICE (National Institute for Clinical Excellence) guidance and is a recommended psychological therapy for a number of different mental health disorders for both adults and children. This is due to the current body of quantitative research around CBT demonstrating its efficacy for a range of mental health difficulties. However, CBT has not been as well addressed within the qualitative field and this gap in research is even more obvious when looking at CBT conducted with children and adolescents. This interpretative phenomenological study explored adolescents' experiences of a course of CBT within a Child and Adolescent Mental Health Service (CAMHS) in a one-to-one format. Three female adolescents who had completed an agreed contract of therapy with the CBT service took part in semi-structured interviews. Four superordinate themes emerged from analysis and highlighted components within CBT that were important to the sample. These were engagement, the therapeutic relationship, the impact of CBT on change and the manner in which CBT was delivered. The findings are discussed with relevance to current policy and pertinent literature as well as implications for service delivery and future research.
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Affiliation(s)
- Deanna Donnellan
- Clinical Psychology Doctorate Programme, Lancaster University, UK.
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45
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Ryan SR, Stanger C, Thostenson J, Whitmore JJ, Budney AJ. The impact of disruptive behavior disorder on substance use treatment outcome in adolescents. J Subst Abuse Treat 2012; 44:506-14. [PMID: 23228436 DOI: 10.1016/j.jsat.2012.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 10/30/2012] [Accepted: 11/05/2012] [Indexed: 11/30/2022]
Abstract
The current study examined the impact of disruptive behavior disorder (DBD) on substance use outcomes in an adolescent sample. Sixty-eight adolescents and their caregivers were randomized to one of two fourteen-week, outpatient treatments: Motivational Enhancement Therapy/Cognitive Behavior Therapy (MET/CBT)+Parent Management Training+Contingency Management (CM; experimental) and MET/CBT+Parent Drug Education (attention control). This study assessed abstinence, substance use, externalizing behavior, and parenting outcomes over five assessment periods for youth with DBD (DBD(+)) and without DBD (DBD(-)). Results showed DBD(+)/experimental adolescents reported fewer days of marijuana use than DBD(+)/control adolescents. Results also showed that parents of DBD(-) adolescents in the experimental condition reported significantly better parenting outcomes compared to DBD(-)/control. Substance abuse treatment for adolescents with DBD which includes a component such as contingency management and parent training has the potential to contribute to substance use outcomes. Such treatment strategies, however, should include additional support for parents.
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Affiliation(s)
- Stacy R Ryan
- University of Arkansas for Medical Sciences, Center for Addiction Research., Little Rock, AR 72205, USA.
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Spas J, Ramsey S, Paiva AL, Stein L. All might have won, but not all have the prize: optimal treatment for substance abuse among adolescents with conduct problems. Subst Abuse 2012; 6:141-55. [PMID: 23170066 PMCID: PMC3498967 DOI: 10.4137/sart.s10389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Considerable evidence from the literature on treatment outcomes indicates that substance abuse treatment among adolescents with conduct problems varies widely. Treatments commonly used among this population are cognitive-behavioral therapy (CBT), 12-step facilitation, multisystemic therapy (MST), psychoeducation (PE), and motivational interviewing (MI). This manuscript thoroughly and systematically reviews the available literature to determine which treatment is optimal for substance-abusing adolescents with conduct problems. Results suggest that although there are several evidence-based and empirically supported treatments, those that incorporate family-based intervention consistently provide the most positive treatment outcomes. In particular, this review further reveals that although many interventions have gained empirical support over the years, only one holds the prize as being the optimal treatment of choice for substance abuse treatment among adolescents with conduct problems.
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Affiliation(s)
- Jayson Spas
- The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior and Medicine, Division of General Internal Medicine at Rhode Island Hospital, 111 Plain Street, Suite 119, Providence, RI 02903, USA
| | - Susan Ramsey
- The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior and Medicine Division of General Internal Medicine at Rhode Island Hospital, 111 Plain Street, Suite 117, Providence, RI 02903, USA
| | - Andrea L. Paiva
- University of Rhode Island Cancer Prevention Research Center, 2 Chafee Road, Kinston, RI 02881, USA
| | - L.A.R. Stein
- University of Rhode Island, Department of Psychology, 2 Lower College Road, Kinston, RI 02881, USA
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Tanner-Smith EE, Wilson SJ, Lipsey MW. The comparative effectiveness of outpatient treatment for adolescent substance abuse: a meta-analysis. J Subst Abuse Treat 2012; 44:145-58. [PMID: 22763198 DOI: 10.1016/j.jsat.2012.05.006] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 05/02/2012] [Accepted: 05/30/2012] [Indexed: 11/19/2022]
Abstract
Meta-analysis was used to synthesize research on the effects of outpatient treatment on substance use outcomes for adolescents with substance use disorders. An extensive literature search located 45 eligible experimental or quasi-experimental studies reporting 73 treatment-comparison group pairs, with many of the comparison groups also receiving some treatment. The first analysis examined 250 effect sizes for the substance use outcomes of adolescents receiving different types of treatment relative to the respective comparison groups. As a category, family therapy programs were found to be more effective than their comparison conditions, whereas no treatment programs were less effective. However, not all treatment types were compared with each other in the available research, making it difficult to assess the comparative effectiveness of the different treatments. To provide a more differentiated picture of the relative improvement in substance use outcomes for different treatments, a second analysis examined 311 pre-post effect sizes measuring changes in substance use for adolescents in the separate treatment and comparison arms of the studies. The adolescents in almost all types of treatment showed reductions in substance use. The greatest improvements were found for family therapy and mixed and group counseling. Longer treatment duration was associated with smaller improvements, but other treatment characteristics and participant characteristics had little relationship to the pre-post changes in substance use. Based on these findings family therapy is the treatment with the strongest evidence of comparative effectiveness, although most types of treatment appear to be beneficial in helping adolescents reduce their substance use.
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Pathways to care: narratives of American Indian adolescents entering substance abuse treatment. Soc Sci Med 2012; 74:2037-45. [PMID: 22472275 DOI: 10.1016/j.socscimed.2012.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 01/30/2012] [Accepted: 02/01/2012] [Indexed: 11/20/2022]
Abstract
Using data from 89 American Indian adolescents and guided by the Network Episode Model, this paper analyses pathways to residential substance abuse treatment and their correlates. These adolescents were recruited at admission to a tribally-operated substance abuse treatment program in the southern United States from October 1998 to May 2001. Results from the qualitative analyses of these adolescent's pathways to care narratives indicated that 35% ultimately agreed with the decision for their entry into treatment; 41% were Compelled to enter treatment by others, usually by their parents, parole officers, and judges; and 24% did not describe a clear pathway to care. In the multinomial logistic regression model examining correlates of these pathways to care classifications, adolescents who described pathways indicative of agreement also reported greater readiness for treatment than the adolescents who described compelled or no clear pathways to care. Adolescents who described a Compelled pathway were less likely to meet diagnostic criteria for Conduct Disorder and described fewer social network ties. We were unable to find a relationship between pathways classifications and referral source, suggesting these narratives were subjective constructions of pathways to care rather than a factual representation of this process. In the final logistic regression model examining correlates of treatment completion, articulating a pathway to care, whether it was one of agreement or of being compelled into treatment, predicted a greater likelihood of completing treatment. Overall, these narratives and their correlates are highly consistent with the Network-Episode Model's emphasis on the interaction of self, situation, and social network in shaping the treatment seeking process, demonstrating the applicability of this model to understanding the treatment seeking process in this special population and suggests important considerations for understanding the dynamics of service utilization across diverse communities.
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Lou YC, Lin HF. Estimate of global research trends and performance in family therapy in Social Science Citation Index. Scientometrics 2011. [DOI: 10.1007/s11192-011-0549-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Riggs PD, Winhusen T, Davies RD, Leimberger JD, Mikulich-Gilbertson S, Klein C, Macdonald M, Lohman M, Bailey GL, Haynes L, Jaffee WB, Hodgkins C, Whitmore E, Trello-Rishel K, Tamm L, Acosta MC, Royer-Malvestuto C, Subramaniam G, Fishman M, Holmes BW, Kaye ME, Vargo MA, Woody GE, Nunes EV, Liu D, Liu D. Randomized controlled trial of osmotic-release methylphenidate with cognitive-behavioral therapy in adolescents with attention-deficit/hyperactivity disorder and substance use disorders. J Am Acad Child Adolesc Psychiatry 2011; 50:903-14. [PMID: 21871372 PMCID: PMC3164797 DOI: 10.1016/j.jaac.2011.06.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 06/06/2011] [Accepted: 06/14/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of osmotic-release methylphenidate (OROS-MPH) compared with placebo for attention-deficit/hyperactivity disorder (ADHD), and the impact on substance treatment outcomes in adolescents concurrently receiving cognitive-behavioral therapy (CBT) for substance use disorders (SUD). METHOD This was a 16-week, randomized, controlled, multi-site trial of OROS-MPH + CBT versus placebo + CBT in 303 adolescents (aged 13 through 18 years) meeting DSM-IV diagnostic criteria for ADHD and SUD. Primary outcome measures included the following: for ADHD, clinician-administered ADHD Rating Scale (ADHD-RS), adolescent informant; for substance use, adolescent-reported days of use in the past 28 days. Secondary outcome measures included parent ADHD-RS and weekly urine drug screens (UDS). RESULTS There were no group differences on reduction in ADHD-RS scores (OROS-MPH: -19.2, 95% confidence interval [CI], -17.1 to -21.2; placebo, -21.2, 95% CI, -19.1 to -23.2) or reduction in days of substance use (OROS-MPH: -5.7 days, 95% CI, 4.0-7.4; placebo: -5.2 days, 95% CI, 3.5-7.0). Some secondary outcomes favored OROS-MPH, including lower parent ADHD-RS scores at 8 (mean difference = 4.4, 95% CI, 0.8-7.9) and 16 weeks (mean difference =6.9; 95% CI, 2.9-10.9) and more negative UDS in OROS-MPH (mean = 3.8) compared with placebo (mean = 2.8; p = .04). CONCLUSIONS OROS-MPH did not show greater efficacy than placebo for ADHD or on reduction in substance use in adolescents concurrently receiving individual CBT for co-occurring SUD. However, OROS-MPH was relatively well tolerated and was associated with modestly greater clinical improvement on some secondary ADHD and substance outcome measures. Clinical Trial Registration Information-Attention Deficit Hyperactivity Disorder (ADHD) in Adolescents with Substance Use Disorders (SUD); http://www.clinicaltrials.gov; NCT00264797.
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