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Meisel SN, Pielech M, Magill M, Sawyer K, Miranda R. Mechanisms of Behavior Change in Adolescent Substance Use Treatment: A Systematic Review of Treatment Mediators and Recommendations for Advancing Future Research. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2024; 31:154-173. [PMID: 38883554 PMCID: PMC11178260 DOI: 10.1037/cps0000089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Substance use disorders commonly onset during adolescence, yet the best available treatments yield only modest and transient effects. Elucidating treatment mediators is essential for improving treatment options. This review summarizes over 20 years of research on mediators of adolescent substance use treatment; k = 17 studies assessing both treatment or treatment ingredient to mediator (a path) and mediator to treatment outcome (b path) paths were included. Mediators were categorized using the Science of Behavior Change target class framework. Overall, mediation tests supported four of eight self-regulation, two of 10 stress resilience and reactivity, six of 19 interpersonal and social process, and two of four treatment engagement and adherence mediators. To enhance the capacity of this work to inform clinical practice, we recommend future research examine theoretically informed mechanisms using temporally sequenced data among other methodological guidelines.
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Affiliation(s)
- Samuel N. Meisel
- Center for Alcohol and Addiction Studies, Brown University
- E. P. Bradley Hospital, Riverside, Rhode Island, United States
| | | | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University
| | - Kelsey Sawyer
- Center for Alcohol and Addiction Studies, Brown University
| | - Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University
- E. P. Bradley Hospital, Riverside, Rhode Island, United States
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2
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Hassan AN, Agabani Z, Ahmed F, Shapiro B, Le Foll B. The Impact of religiosity/spirituality on slowing the progression of substance use: Based on the National Epidemiological Survey of Alcohol and Related Conditions (NESARC-III). Int J Soc Psychiatry 2023; 69:1399-1408. [PMID: 36951385 DOI: 10.1177/00207640231162819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Religiosity has been suggested to be protective against substance use disorder (SUD) initiation but its impact of the progression of development is not known. AIMS This study investigated the impact of religiosity/spirituality on the development of heavy use and SUD following substance use initiation (alcohol, cannabis, and tobacco) utilizing data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. METHOD Individuals with a known age at onset of substance initiation were included (n = 30,590, n = 11,126, and n = 14,083; for alcohol, cannabis, or tobacco users, respectively). Religiosity was measured by importance of religious/spiritual beliefs and frequency of religious service attendance. The percentage of individuals who progressed to an SUD after substance initiation in each substance was estimated. Discrete-time analysis and survival analysis were used to measure the impact of religiosity on the progression from substance initiation to heavy use and from heavy use to SUD. RESULTS After controlling for various variables, religious services attendance frequency was statistically associated with a slower progression from substance initiation to heavy use for all three substances: tobacco by 8% to 15%, cannabis by 5% to 26%, and alcohol 9% (p ⩽ .01). Religious importance was associated with slower progression to heavy use in cannabis users by 16% to 21% (p ⩽ .02). Religiosity (believes and attendance) was associated with slowed progression from heavy use to SUD development in alcohol users only. CONCLUSIONS The findings illustrate strongest association between attending religious services and lower probabilities of progressing to heavy/daily use after substance use initiation for alcohol, tobacco, and cannabis users. This indicates the potential use of religious services as social support for individuals with risky substance use.
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Affiliation(s)
- Ahmed N Hassan
- Department of Psychiatry, Department of Medicine, King Abdulaziz University, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, ON, Canada
| | - Zena Agabani
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, ON, Canada
| | - Fardowsa Ahmed
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - Benjamin Shapiro
- Department of Psychiatry and Behavioral Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Bernard Le Foll
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
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Lum A, Damianidou D, Bailey K, Cassel S, Unwin K, Beck A, Kelly PJ, Argent A, Deane FP, Langford S, Baker AL, McCarter K. SMART recovery for youth: a small, exploratory qualitative study examining the potential of a mutual-aid, peer support addictive behaviour change program for young people. Addict Sci Clin Pract 2023; 18:30. [PMID: 37198715 DOI: 10.1186/s13722-023-00379-w] [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: 07/08/2022] [Accepted: 03/29/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND SMART (Self-Management and Recovery Training) Recovery is a mutual-aid program informed by cognitive behaviour therapy and motivational interviewing that provides support for a range of addictive behaviours. SMART Recovery has not been adapted to target young people with addictive behaviours despite the potential to overcome important barriers affecting youth engagement in other addiction programs. This study aimed to engage young people and SMART Recovery facilitators in qualitative interviews and focus groups to explore the potential of such a program and gain specific insights for its development. METHODS We conducted qualitative interviews and a focus group with five young people (aged between 14 and 24 years) and eight key stakeholders (including seven SMART Recovery facilitators) to obtain recommendations on how best to reach, engage, and support young people with addictive behaviours in a tailored SMART Recovery program. Qualitative data was transcribed and analysed using iterative categorization. RESULTS Five key themes were identified when developing and delivering youth-targeted SMART Recovery. [1] 'Discussing personal experiences to promote a shared identity' refers to the benefits of creating a forum where personal stories are used to connect with others and validate one's experiences. [2] 'Flexible and patient approach' emphasises a preference for facilitators to take a more gentle, less direct approach that allows for discussion beyond addictive behaviours. [3] 'Balancing information and skills with the space for discussion' acknowledges that youth want to connect in a variety of ways, beyond discussion of addictive behaviours, and that they wish to lead skill sharing and development. [4] 'Conveying a community for youth through language' highlighted the need to focus on connecting youth and to avoid the use of generic language to engage young people. [5] 'Group logistics and competing demands' refers to the logistical considerations of implementing a group program for youth that takes into account their competing demands and group accessibility. CONCLUSION The findings point to considerations for developing youth specific mutual-aid groups, in particular a youth-targeted SMART Recovery program, such as by ensuring the conversation is youth-led and with an informal and flexible approach to guide group discussion.
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Affiliation(s)
- Alistair Lum
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Despoina Damianidou
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Kylie Bailey
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Stephanie Cassel
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Katherine Unwin
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Alison Beck
- University of Wollongong and Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Peter J Kelly
- University of Wollongong and Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Angela Argent
- SMART Recovery Australia, 33 Saunders St, Pyrmont, NSW, 2009, Australia
| | - Frank P Deane
- University of Wollongong and Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Sophie Langford
- Headspace Newcastle, 582 Hunter St, Newcastle West, NSW, 2302, Australia
| | - Amanda L Baker
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Kristen McCarter
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
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Lu W, Xu L, Goodwin RD, Muñoz-Laboy M, Sohler N. Widening Gaps and Disparities in the Treatment of Adolescent Alcohol and Drug Use Disorders. Am J Prev Med 2023; 64:704-715. [PMID: 36894480 DOI: 10.1016/j.amepre.2023.01.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION The overall prevalence of alcohol use disorders and drug use disorders in adolescents has been declining in recent years, yet little is known about treatment use for these disorders among adolescents. This study aimed to examine the patterns and demographics of treatment of alcohol use disorders, drug use disorders, and both conditions among U.S. adolescents. METHODS This study used publicly available data for adolescents aged 12-17 years from the annual cross-sectional surveys of the National Survey on Drug Use and Health, 2011-2019. Data were analyzed between July 2021 and November 2022. RESULTS From 2011 to 2019, fewer than 11%, 15%, and 17% of adolescents with 12-month alcohol use disorders, drug use disorders, and both conditions received treatment, respectively, with significant decreases in treatment use for drug use disorders (OR=0.93; CI=0.89, 0.97; p=0.002). Overall, treatment use in outpatient rehabilitation facilities and self-help groups was most common but decreased over the course of the study period. Extensive disparities in treatment use were further identified on the basis of adolescents' gender, age, race, family structure, and mental health. CONCLUSIONS To improve adolescent treatment use for alcohol and drug use disorders, assessments and engagement interventions that are gender specific, developmentally appropriate, culturally sensitive, and contextually informed are especially needed.
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Affiliation(s)
- Wenhua Lu
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, New York.
| | - Lei Xu
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, School of Public Health, The City University of New York, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Nancy Sohler
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, New York
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Gıynaş Ayhan M. Perceived social support and clinical characteristics in males with opioid use disorder on maintenance therapy. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2157768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Medine Gıynaş Ayhan
- Department of Psychiatry, Faculty of Medicine, Aksaray University, Aksaray, Turkey
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Scheuer H, Kuklinski MR, Sterling SA, Catalano RF, Beck A, Braciszewski J, Boggs J, Hawkins JD, Loree AM, Weisner C, Carey S, Elsiss F, Morse E, Negusse R, Jessen A, Kline-Simon A, Oesterle S, Quesenberry C, Sofrygin O, Yoon T. Parent-focused prevention of adolescent health risk behavior: Study protocol for a multisite cluster-randomized trial implemented in pediatric primary care. Contemp Clin Trials 2022; 112:106621. [PMID: 34785305 PMCID: PMC8802622 DOI: 10.1016/j.cct.2021.106621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 01/03/2023]
Abstract
Evidence-based parenting interventions play a crucial role in the sustained reduction of adolescent behavioral health concerns. Guiding Good Choices (GGC) is a 5-session universal anticipatory guidance curriculum for parents of early adolescents that has been shown to reduce substance use, depression symptoms, and delinquent behavior. Although prior research has demonstrated the effectiveness of evidence-based parenting interventions at achieving sustained reductions in adolescent behavioral health concerns, public health impact has been limited by low rates of uptake in community and agency settings. Pediatric primary care is an ideal setting for implementing and scaling parent-focused prevention programs as these settings have a broad reach, and prevention programs implemented within them have the potential to achieve population-level impact. The current investigation, Guiding Good Choices for Health (GGC4H), tests the feasibility and effectiveness of implementing GGC in 3 geographically and socioeconomically diverse large integrated healthcare systems. This pragmatic, cluster randomized clinical trial will compare GGC parenting intervention to usual pediatric primary care practice, and will include approximately 3750 adolescents; n = 1875 GGC intervention and n = 1875 usual care. The study team hypothesizes that adolescents whose parents are randomized into the GGC intervention arm will show reductions in substance use initiation, the study's primary outcomes, and other secondary (e.g., depression symptoms, substance use prevalence) and exploratory outcomes (e.g., health services utilization, anxiety symptoms). The investigative team anticipates that the implementation of GGC within pediatric primary care clinics will successfully fill an unmet need for effective preventive parenting interventions. Trial registration: Clinicaltrials.govNCT04040153.
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Affiliation(s)
- Hannah Scheuer
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, USA.
| | - Margaret R Kuklinski
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, USA.
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Richard F Catalano
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, USA.
| | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd, Suite 200, Aurora, CO 80014, USA.
| | - Jordan Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI 48202, USA.
| | - Jennifer Boggs
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd, Suite 200, Aurora, CO 80014, USA.
| | - J David Hawkins
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, USA.
| | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI 48202, USA.
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Susan Carey
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, USA.
| | - Farah Elsiss
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI 48202, USA.
| | - Erica Morse
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd, Suite 200, Aurora, CO 80014, USA.
| | - Rahel Negusse
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Andrew Jessen
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd, Suite 200, Aurora, CO 80014, USA.
| | - Andrea Kline-Simon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Sabrina Oesterle
- Southwest Interdisciplinary Research Center, 201 N. Central Ave., 33rd Floor, Phoenix, AZ 85004, USA.
| | - Charles Quesenberry
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Oleg Sofrygin
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Tae Yoon
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI 48202, USA.
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Monico LB, Ludwig A, Lertch E, Schwartz RP, Fishman M, Mitchell SG. Post-residential treatment outpatient care preferences: Perspectives of youth with opioid use disorder. J Subst Abuse Treat 2021; 137:108692. [PMID: 34920900 DOI: 10.1016/j.jsat.2021.108692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/14/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION We know little about what youth with opioid use disorders (OUD) think about outpatient substance use treatment and 12-step meetings following discharge from residential substance use treatment. This study explores youths' preferences between intensive outpatient treatment (IOP) and community-based 12-step groups. METHOD The study recruited youth (n = 35) from a larger randomized trial (N = 288) that examined the effectiveness of extended-release naltrexone versus treatment-as-usual. This study asked the youth to participate in semi-structured qualitative interviews at baseline, 3 months, and 6 months post-residential treatment discharge. Qualitative interviews probed youths' key decision points during the six-months following residential treatment for OUD, including medication and counseling, and 12-step continuation in the community. RESULTS Qualitative analyses revealed three overarching themes related to youths' preferences for either IOP or 12-step meetings: structure of recovery support, mechanisms of accountability, and relationships. CONCLUSION Despite varying preferences, this analysis highlights the complexity of benefits that youth report receiving from each approach. Research has yet to determine the degree to which these approaches are complementary or supplementary for this population.
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Affiliation(s)
- Laura B Monico
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Ariel Ludwig
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Elizabeth Lertch
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Marc Fishman
- Mountain Manor Treatment Center, 3800 Frederick Ave, Baltimore, MD 21229, United States of America
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
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Meisel SN, Padovano HT, Miranda R. Combined pharmacotherapy and evidence-based psychosocial Cannabis treatment for youth and selection of cannabis-using friends. Drug Alcohol Depend 2021; 225:108747. [PMID: 34052685 PMCID: PMC8282736 DOI: 10.1016/j.drugalcdep.2021.108747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/13/2021] [Accepted: 03/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Theoretical models of behavior change argue that youth should decrease their time with cannabis-using friends and increase their time with non-using friends during treatment. Informed by behavior-change models of recovery and socialization and selection peer-influence models, the current study examined whether combining evidence-based psychosocial treatment with adjunctive pharmacotherapy helps youth decrease their affiliations with cannabis-using friends and increase their affiliations with non-using friends during cannabis misuse treatment. METHODS Youth ages 15-24 years (51 % male), participated in a double-blind randomized clinical trial that tested the effects of motivational enhancement and cognitive behavioral therapy (MET-CBT) plus topiramate (N = 39) or placebo (N = 26) on cannabis craving and use. Ecological momentary assessment data, collected via smartphones throughout the six-week intervention, assessed youths' time with cannabis-using and non-using friends, cannabis use, and craving in daily life. Multiple group multilevel structural equation modeling tested study hypotheses. RESULTS Across the topiramate (48 % completion rate) and placebo (77 % completion rate) conditions, greater time spent with cannabis-using friends promoted greater next day cannabis use and craving (socialization effect). In turn, cannabis craving, but not use, promoted continued selection of cannabis-using friends. This indirect effect was only supported in the placebo condition due to the selection piece of this cycle not being significant for youth who received topiramate. Neither cannabis craving nor use were associated with time with non-using friends the next day. CONCLUSIONS MET-CBT and adjunctive topiramate pharmacotherapy interrupted youth selection processes. This finding suggests that changing peer affiliations could be one mechanism by which treatments can work.
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Affiliation(s)
- Samuel N. Meisel
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912, USA.; E. P. Bradley Hospital, Riverside, RI 02915
| | | | - Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912, USA; E. P. Bradley Hospital, Riverside, RI, 02915, USA.
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Livne O, Wengrower T, Feingold D, Shmulewitz D, Hasin DS, Lev-Ran S. Religiosity and substance use in U.S. adults: Findings from a large-scale national survey. Drug Alcohol Depend 2021; 225:108796. [PMID: 34119881 PMCID: PMC8918021 DOI: 10.1016/j.drugalcdep.2021.108796] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND In recent decades, the US religious landscape has undergone considerable change such as a decline in religious service attendance. These changes may indicate that religious social support structures have deteriorated, possibly leading to a decrease in strengths of associations with substance use. Considering this, and given limitations of past studies (e.g., limited control for potential confounders), large-scale general population studies are needed to reexamine associations between religiosity domains and substance use. METHODS This cross-sectional study used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309). In unadjusted and adjusted models, controlling for religiosity domains and other covariates, we examined associations between three religiosity domains (importance of religiosity/spirituality, service attendance, and religious affiliation) and DSM-5 SUD. Focusing on service attendance, we also examined associations with other substance use-related outcomes. RESULTS Among religiosity domains, only frequency of service attendance was associated with SUD across most substances. Frequent service attendees had lower odds of alcohol use disorder (adjusted OR [aOR] = 0.4, 95 % CI 0.33,0.51), tobacco use disorder (aOR = 0.3, 95 % CI 0.22,0.33) and cannabis use disorder (aOR = 0.4, 95 % CI 0.24,0.68), compared to non-service attendees. For alcohol and tobacco, the protective effect of frequent service attendance was more robust for SUD than for respective substance use. CONCLUSIONS Despite decreasing rates of religious belief and practice in the US, service attendance independently lowered the odds of substance use and SUD across multiple substances. Results may inform religious leaders and clinicians about the value of utilizing religious social support structures in the prevention and treatment of substance use and SUD.
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Affiliation(s)
- Ofir Livne
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Tovia Wengrower
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Dvora Shmulewitz
- New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Deborah S. Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Shaul Lev-Ran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Lev Hasharon Medical Center, Netanya, Israel
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Shim JY. The study of a Christian 12-Step Program for Christian Smartphone-Addicted Adolescents: A Biblical Perspective. JOURNAL OF RELIGION AND HEALTH 2021; 60:1780-1795. [PMID: 33638815 DOI: 10.1007/s10943-020-01170-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
The aim of this study was to explore the suitability of a Christian 12-step program based on a biblical perspective for smartphone-addicted adolescents. The study found that "repentance" and "realizing ones' calling" were the main similarities between the 12-step program's core principles and biblical themes. Based on a biblical analysis the 12 step program however features some limitations, including an ambiguous definition of the "great power", a superficial understanding of sin, and a need to consider adolescents' characteristics. This study suggests the following strategies: (1) diagnosis of adolescents' image of God and transformation of this image into a biblical image of God, (2) intervention regarding sin through a holistic perspective, (3) adolescents' recognition of their own calling, and (4) an adult counselor working to trigger social learning in 12 steps. Finally, for application within Christian counselling, the study suggests a cognitive therapeutic approach based on a biblical image of God and a systematic evaluative process of sin in addicted adolescents.
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Affiliation(s)
- Jung Yeon Shim
- Department of Theology, Anyang University, Anyang, GyeongGi-Do, Korea.
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Abstract
Although rates of alcohol and other substance use disorders in adolescents have been estimated for decades, little is known about the prevalence, pathways, and predictors of remission and long-term recovery among adolescents. This article provides an integrative review of the literature on youth recovery. A final selection of 39 relevant articles was grouped into five sections: treatment outcomes, special emphasis populations, recovery-oriented systems of care, families, and non-abstinence-based approaches. The review recommends more adolescent research in three basic areas: more research about medication-assisted treatment and recovery as well as harm reduction approaches for adolescents; expansion of research on recovery practices for youth who do not receive treatment due to personal choice or societal disparities; and more life course research, which may begin with adolescent participants and extend across the life span. Additionally, the authors suggest the recovery capital model for adolescents and the neuroscience of addiction may provide additional precision and direction for the study of youth recovery.
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Affiliation(s)
- Andrew J Finch
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee
| | - Jordan Jurinsky
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee
| | - Billie May Anderson
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee
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12
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Shim JY. Christian Spirituality and Smartphone Addiction in Adolescents: A Comparison of High-Risk, Potential-Risk, and Normal Control Groups. JOURNAL OF RELIGION AND HEALTH 2019; 58:1272-1285. [PMID: 30610513 DOI: 10.1007/s10943-018-00751-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The goal of this study was to compare aspects of Christian spirituality such as God's image and sense of spiritual well-being among three groups: the high-risk, potential-risk and normal control groups for smartphone addiction. Participants were: 11 adolescents in the high-risk group for smartphone addiction; 20 adolescents who were potentially at risk of smartphone addiction, and 254 adolescents who were in the normal control group. The results showed that the high-risk group for smartphone addiction adolescent group showed low levels of spiritual well-being and positive image of God comparing to those in the potential-risk and control groups. Each group had specific and distinctive features. Consideration of potential clinical interventions, limitations of the current study, and suggestions for future research are discussed.
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Kizilkurt OK, Gıynaş FF. Factors affecting treatment motivation among Turkish patients receiving inpatient treatment due to alcohol/substance use disorder. J Ethn Subst Abuse 2019; 19:594-609. [PMID: 30676293 DOI: 10.1080/15332640.2018.1548324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Motivation is a significant factor in the treatment of addiction and has been proven to be a predictor of treatment outcomes. The present study investigated the effects of clinical variables, perceived social support, temperament, and personality traits on treatment motivation. This study included 100 patients whose detoxification treatment was completed following hospitalization in Alcohol and Drug Research, Treatment, and Training Center (AMATEM). Treatment motivations were assessed through Motivation for Treatment scale (MfT). Addiction Profile Index (API) was used to evaluate drug use characteristics, craving, and the effects of drug use on life. Temperament and character traits and perceived social support were evaluated by Temperament and Character Inventory (TCI) and Multidimensional Scale of Perceived Social Support (MSPSS), respectively. The number of treatment admissions, presence of a history of previous inpatient treatment, completed inpatient treatment, social support from the family, harm avoidance, substance use characteristics, craving, and the effect of substance on life showed differences while motivations of the patients were compared. Presence of a history of previously completed inpatient treatment, presence of high social support from the family, and significant recognition of the effects of substance on own life were evaluated as the factors predicting high motivation. The present study demonstrated that social support from family, previously completed inpatient treatment, and effect of substance in life had significant impact on motivation. Therefore, the assessment of these factors will aid in better understanding this population and in the design of long-term treatment plans.
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Affiliation(s)
- Ozlem Kazan Kizilkurt
- Department of Psychiatry, School of Medicine, University of Maltepe, Istanbul, Turkey
| | - Fikret Ferzan Gıynaş
- University of Health Sciences Erenköy Mental Research and Training Hospital, Istanbul, Turkey
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Yeterian JD, Bursik K, Kelly JF. "God put weed here for us to smoke": A mixed-methods study of religion and spirituality among adolescents with cannabis use disorders. Subst Abus 2018; 39:484-492. [PMID: 29558286 PMCID: PMC6430642 DOI: 10.1080/08897077.2018.1449168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND A growing literature on adults with substance use disorders (SUDs) suggests that religious and spiritual processes can support recovery, such that higher levels of religiosity and/or spirituality predict better substance use outcomes. However, studies of the role of religion and spirituality in adolescent SUD treatment response have produced mixed findings, and religiosity and spirituality have rarely been examined separately. METHODS The present study examined religiosity and spirituality as predictors of outcomes in an outpatient treatment adolescent sample (N = 101) in which cannabis was the predominant drug of choice. Qualitative data were used to contextualize the quantitative findings. RESULTS Results showed that higher levels of spirituality at posttreatment predicted increased cannabis use at 6-month follow-up (β = .237, p = .043), whereas higher levels of baseline spirituality predicted a lower likelihood of heavy drinking at posttreatment (odds ratio [OR] = .316, P = .040). Religiosity did not predict substance use outcomes at later time points. When asked to describe the relation between their religious/spiritual views and their substance use, adolescents described believing that they had a choice about their substance use and were in control of it, feeling more spiritual when under the influence of cannabis, and being helped by substance use. CONCLUSIONS Together, findings suggest that for adolescents with SUDs, religion and spirituality may not counteract the use of cannabis, which may be explained by adolescents' views of their substance use as being consistent with their spirituality and under their control.
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Affiliation(s)
- Julie D. Yeterian
- Suffolk University, Boston, MA
- Massachusetts General Hospital, Boston, MA
| | | | - John F. Kelly
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Kelly JF, Bergman BG, Fallah-Sohy N. MECHANISMS OF BEHAVIOR CHANGE IN 12-STEP APPROACHES TO RECOVERY IN YOUNG ADULTS. CURRENT ADDICTION REPORTS 2018; 5:134-145. [PMID: 30416931 PMCID: PMC6224158 DOI: 10.1007/s40429-018-0203-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Empirical evidence indicates that, in general, treatments which systematically engage adults with freely available twelve-step mutual-help organizations (TSMHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) often enhance treatment outcomes while reducing health care costs. Also evident is that TSMHOs facilitate recovery through mechanisms similar to those mobilized by professional interventions, such as increased abstinence self-efficacy and motivation, as well changing social networks. Much less is known, however, regarding the utility of these resources specifically for young adults and whether the TSMHO mechanisms are similar or different for young adults. This article provides a narrative review of the clinical and public health utility of TSMHOs for young adults, and summarizes theory and empirical research regarding how young adults benefit from TSMHOs. RECENT FINDINGS Results indicate that, compared to older adults, young adults are less likely to attend TSMHOs and attend less frequently, but derive similar benefit. The mechanisms, however, by which TSMHOs help, differ in nature and magnitude. Also, young adults appear to derive greater benefit initially from meetings attended by similar aged peers, but this benefit diminishes over time. SUMMARY Findings offer developmentally specific insights into TSMHO dynamics for young adults and inform knowledge of broader recovery needs and challenges.
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Affiliation(s)
- John F Kelly
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, 151 Merrimac Street, 6 Floor, Boston, MA 02114
| | - Brandon G Bergman
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, 151 Merrimac Street, 6 Floor, Boston, MA 02114
| | - Nilofar Fallah-Sohy
- Recovery Research Institute, Massachusetts General Hospital & Harvard Medical School, 151 Merrimac Street, 6 Floor, Boston, MA 02114
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Buckheit KA, Moskal D, Spinola S, Maisto SA. Clinical Course and Relapse among Adolescents Presenting for Treatment of Substance Use Disorders: Recent Findings. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0209-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kelly JF, Kaminer Y, Kahler CW, Hoeppner B, Yeterian J, Cristello JV, Timko C. A pilot randomized clinical trial testing integrated 12-Step facilitation (iTSF) treatment for adolescent substance use disorder. Addiction 2017; 112:2155-2166. [PMID: 28742932 PMCID: PMC5673563 DOI: 10.1111/add.13920] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/11/2017] [Accepted: 06/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The integration of 12-Step philosophy and practices is common in adolescent substance use disorder (SUD) treatment programs, particularly in North America. However, although numerous experimental studies have tested 12-Step facilitation (TSF) treatments among adults, no studies have tested TSF-specific treatments for adolescents. We tested the efficacy of a novel integrated TSF. DESIGN Explanatory, parallel-group, randomized clinical trial comparing 10 sessions of either motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT; n = 30) or a novel integrated TSF (iTSF; n = 29), with follow-up assessments at 3, 6 and 9 months following treatment entry. SETTING Out-patient addiction clinic in the United States. PARTICIPANTS Adolescents [n = 59; mean age = 16.8 (1.7) years; range = 14-21; 27% female; 78% white]. INTERVENTION AND COMPARATOR The iTSF integrated 12-Step with motivational and cognitive-behavioral strategies, and was compared with state-of-the-art MET/CBT for SUD. MEASUREMENTS Primary outcome: percentage days abstinent (PDA); secondary outcomes: 12-Step attendance, substance-related consequences, longest period of abstinence, proportion abstinent/mostly abstinent, psychiatric symptoms. FINDINGS Primary outcome: PDA was not significantly different across treatments [b = 0.08, 95% confidence interval (CI) = -0.08 to 0.24, P = 0.33; Bayes' factor = 0.28). SECONDARY OUTCOMES during treatment, iTSF patients had substantially greater 12-Step attendance, but this advantage declined thereafter (b = -0.87; 95% CI = -1.67 to 0.07, P = 0.03). iTSF did show a significant advantage at all follow-up points for substance-related consequences (b = -0.42; 95% CI = -0.80 to -0.04, P < 0.05; effect size range d = 0.26-0.71). Other secondary outcomes did not differ significantly between treatments, but effect sizes tended to favor iTSF. Throughout the entire sample, greater 12-Step meeting attendance was associated significantly with longer abstinence during (r = 0.39, P = 0.008), and early following (r = 0.30, P = 0.049), treatment. CONCLUSION Compared with motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), in terms of abstinence, a novel integrated 12-Step facilitation treatment for adolescent substance use disorder (iTSF) showed no greater benefits, but showed benefits in terms of 12-Step attendance and consequences. Given widespread use of combinations of 12-Step, MET and CBT in adolescent community out-patient settings in North America, iTSF may provide an integrated evidence-based option that is compatible with existing practices.
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Affiliation(s)
- John F Kelly
- Recovery Research Institute Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yifrah Kaminer
- University of Connecticut Health Sciences Center, Farmington, CT, USA
| | | | - Bettina Hoeppner
- Recovery Research Institute Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie Yeterian
- Recovery Research Institute Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie V Cristello
- Recovery Research Institute Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christine Timko
- VA Palo Alto Health Care System and Stanford University Medical School, Menlo Park, CA, USA
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Hallgren KA, McCrady BS, Caudell TP, Witkiewitz K, Tonigan JS. Simulating drinking in social networks to inform alcohol prevention and treatment efforts. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:763-774. [PMID: 28921997 DOI: 10.1037/adb0000308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescent drinking influences, and is influenced by, peer alcohol use. Several efficacious adolescent alcohol interventions include elements aimed at reducing susceptibility to peer influence. Modeling these interventions within dynamically changing social networks may improve our understanding of how such interventions work and for whom they work best. We used stochastic actor-based models to simulate longitudinal drinking and friendship formation within social networks using parameters obtained from a meta-analysis of real-world 10th grade adolescent social networks. Levels of social influence (i.e., friends affecting changes in one's drinking) and social selection (i.e., drinking affecting changes in one's friendships) were manipulated at several levels, which directly impacted the degree of clustering in friendships based on similarity in drinking behavior. Midway through each simulation, one randomly selected heavy-drinking actor from each network received an "intervention" that either (a) reduced their susceptibility to social influence, (b) reduced their susceptibility to social selection, (c) eliminated a friendship with a heavy drinker, or (d) initiated a friendship with a nondrinker. Only the intervention that eliminated targeted actors' susceptibility to social influence consistently reduced that actor's drinking. Moreover, this was only effective in networks with social influence and social selection that were at higher levels than what was found in the real-world reference study. Social influence and social selection are dynamic processes that can lead to complex systems that may moderate the effectiveness of network-based interventions. Interventions that reduce susceptibility to social influence may be most effective among adolescents with high susceptibility to social influence and heavier-drinking friends. (PsycINFO Database Record
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Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - Thomas P Caudell
- Department of Electrical and Computer Engineering, University of New Mexico
| | - Katie Witkiewitz
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
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Religious Beliefs and Their Relevance for Treatment Adherence in Mental Illness: A Review. RELIGIONS 2017. [DOI: 10.3390/rel8080150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lui CK, Sterling SA, Chi FW, Lu Y, Campbell CI. Socioeconomic differences in adolescent substance abuse treatment participation and long-term outcomes. Addict Behav 2017; 68:45-51. [PMID: 28088743 DOI: 10.1016/j.addbeh.2017.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/15/2016] [Accepted: 01/04/2017] [Indexed: 11/28/2022]
Abstract
Socioeconomic status (SES) has been consistently linked to poorer access, utilization and outcomes of health care services, but this relationship has been understudied in adolescent substance abuse treatment research. This study examined SES differences in adolescent's treatment participation and long-term outcomes of abstinence and 12-step attendance over five years after treatment. Data are from 358 adolescents (ages 13-18) who were recruited at intake to substance abuse treatment between 2000 and 2002 at four Kaiser Permanente Northern California outpatient treatment programs. Follow-up interviews of adolescents and their parents were conducted at 1, 3, and 5years, with over 80% response rates across time points. Using parent SES as a proxy for adolescent SES, no socioeconomic differences were found in treatment initiation, treatment retention, or long-term abstinence from alcohol or drugs. Parent education, but not parent income, was significantly associated with 12-step attendance post-treatment such that adolescents with higher parent education were more likely to attend than those with lower parent education. Findings suggest a lack of socioeconomic disparities in substance abuse treatment participation in adolescence, but potential disparities in post-treatment 12-step attendance during the transition from adolescence to young adulthood.
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Affiliation(s)
- Camillia K Lui
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA.
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA
| | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612, USA
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Abstract
Specific treatments targeting adolescents with substance use disorders (SUDs) have been developed over the last couple of decades. Despite these developmentally tailored treatments, long-term abstinence rates remain relatively low among adolescents receiving care. Research over the last decade has increasingly focused on adolescents with comorbid substance use and psychiatric disorders, in recognition of the barriers caused by inadequate treatment of co-occurring psychiatric disorders. Treatments targeting dually diagnosed youth are now regarded as essential to improving SUD treatment outcomes, but remain underutilized. A variety of treatment modalities such as behavioral therapy, family therapy, 12-step groups, motivational interviewing, contingency management, and combinations of these interventions have been modified for adolescents. In this article, we review the research on these treatments, as they apply to dually diagnosed youth. Furthermore, we explore the evidence for various treatments targeting comorbid SUD, specific to the presence of externalizing or internalizing disorders. The current evidence base supports the importance of integrated treatment targeting both SUD and psychiatric disorders simultaneously. High-quality treatment programs offering combinations of behavioral and family therapy, particularly with motivational interviewing and contingency management, are particularly well supported. In addition, we review various psychotropic medication treatments that have also been studied in conjunction with adolescent SUD treatment. Finally, we review research on post-treatment, supportive care that has been shown to improve long-term SUD outcomes. Recently conceptualized modular treatments, which offer personalized combinations of evidence-based treatments for specific disorders, have been proposed as a means of improving outcomes. Future research on modular programs must test the efficacy of individualized treatments when applied to combinations of psychiatric and SUDs in adolescents.
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Passetti LL, Godley MD, Kaminer Y. Continuing care for adolescents in treatment for substance use
disorders. Child Adolesc Psychiatr Clin N Am 2016; 25:669-84. [PMID: 27613345 PMCID: PMC5018300 DOI: 10.1016/j.chc.2016.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescents who enter treatment for substance use often do not complete the program and do not connect with continuing care services. Most return to some level of substance use. Our review found 10 outcome studies of continuing care treatment. More assertive approaches can increase continuing care initiation rates and rapid initiation of continuing care makes a difference in reducing substance use. Continuing care is appropriate for those who complete treatment and for those who do not. Adaptive treatment designs hold promise for establishing decision rules as to which adolescents need low-intensity continuing care services and which need more intensive care.
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Affiliation(s)
| | - Mark D. Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761
| | - Yifrah Kaminer
- Alcohol Research Center, University of Connecticut School of
Medicine, 263 Farmington Avenue, Farmington, CT 06030
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Kelly JF, Yeterian JD, Cristello JV, Kaminer Y, Kahler CW, Timko C. Developing and Testing Twelve-Step Facilitation for Adolescents with Substance Use Disorder: Manual Development and Preliminary Outcomes. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:55-64. [PMID: 27429548 PMCID: PMC4941867 DOI: 10.4137/sart.s39635] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/10/2016] [Accepted: 05/11/2016] [Indexed: 12/04/2022]
Abstract
Adolescent substance use disorder treatment programs are often based on the 12-step philosophy of Alcoholics Anonymous and/or link adolescents to these free resources. Despite this, no studies have developed and rigorously tested a twelve-step facilitation (TSF) intervention for young people, leaving a significant evidence gap. This study describes the first systematic development of an outpatient adolescent TSF treatment. An integrated twelve-step facilitation (iTSF) treatment incorporated TSF, motivational enhancement therapy, and cognitive behavioral therapy elements and was developed in an iterative manner with weekly feedback provided by 36 adolescents (M age 17 years [SD = 1.4]; 52.8% white) with DSM-IV substance use disorder recruited from the community. Assessments were conducted at baseline and at three and six months. Participants completed 6 of 10 sessions on average (8 participants completed all 10). Notable treatment developments were the inclusion of “in-services” led by Marijuana Anonymous members, including parents in a portion of individual sessions to provide a rationale for TSF, and use of a Socratic therapeutic interaction style. Acceptability and feasibility of the treatment were excellent (treatment satisfaction was 4.29 [SD = 0.59] out of 5). In keeping with TSF theory, the intervention substantially increased 12-step participation, and greater participation related to greater abstinence. iTSF is a replicable manualized treatment that can be implemented and tested in outpatient settings. Given the widespread compatibility of iTSF with the current adolescent treatment, if found efficacious, iTSF could be relatively easily adopted, implemented, and sustained and could provide an evidence-based option that could undergird current practice.
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Affiliation(s)
- John F Kelly
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie D Yeterian
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie V Cristello
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yifrah Kaminer
- University of Connecticut Department of Psychiatry, Farmington, CT, USA
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Livermore, CA, USA.; Stanford University School of Medicine, Stanford, CA, USA
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Bekkering GE, Mariën D, Parylo O, Hannes K. The Effectiveness of Self-Help Groups for Adolescent Substance Misuse: A Systematic Review. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2016. [DOI: 10.1080/1067828x.2014.981772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stoutenberg M, Rethorst CD, Lawson O, Read JP. Exercise training - A beneficial intervention in the treatment of alcohol use disorders? Drug Alcohol Depend 2016; 160:2-11. [PMID: 26652900 PMCID: PMC6083864 DOI: 10.1016/j.drugalcdep.2015.11.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 11/13/2015] [Accepted: 11/17/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND A growing body of evidence suggests that exercise training may have multiple beneficial effects in individuals with mental health or substance use disorders. Yet, relatively little knowledge exists regarding the benefits of exercise training to augment treatment for alcohol use disorders (AUDs). PURPOSE The purpose of this narrative review is to present a summary of the growing body of published literature supporting exercise training as a treatment strategy for individuals with AUDs. We will provide evidence on the myriad of ways in which exercise may exert a positive effect on AUD outcomes including stress, anxiety, impulsivity, and depression. Further, we will explore how these mechanisms share common neurobiological pathways. The role of exercise in enhancing the social environment and increasing individual self-efficacy to reduce excess and/or inappropriate alcohol consumption will also be discussed. DISCUSSION We will conclude with a description of completed investigations involving exercise training and provide suggestions for next steps in this innovative field of study.
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Affiliation(s)
- Mark Stoutenberg
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Clinical Research Building, Suite 1008, Miami, FL 33136, USA.
| | - Chad D. Rethorst
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Olivia Lawson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Clinical Research Building, Suite 1008, Miami, FL 33136, USA
| | - Jennifer P. Read
- Department of Psychology, The State University of New York at Buffalo, 213 Park Hall, Buffalo, NY 14260, USA
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Laudet AB, Harris K, Kimball T, Winters KC, Moberg DP. In college and in recovery: Reasons for joining a Collegiate Recovery Program. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2016; 64:238-46. [PMID: 26731130 PMCID: PMC4852860 DOI: 10.1080/07448481.2015.1117464] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Collegiate Recovery Programs (CRPs), a campus-based peer support model for students recovering from substance abuse problems, grew exponentially in the past decade, yet remain unexplored. METHODS This mixed-methods study examines students' reasons for CRP enrollment to guide academic institutions and referral sources. Students (N = 486) from the 29 CRPs nationwide operating in 2012 completed an online survey in 2013. RESULTS Students were somewhat older than traditional age (mean age = 26). Now sober for 3 years (mean), they had experienced severe dependence on multiple substances. One third reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. Top reasons for joining a CRP were the need for same-age peer recovery support and wanting to "do college sober," recognizing that college life challenges sobriety. CONCLUSIONS CRPs appear to meet their mission of allowing recovering students to pursue educational goals in "an abstinence hostile environment." Findings emphasize the need for more institutions to address the support needs of students in recovery.
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Affiliation(s)
- Alexandre B Laudet
- a Center for the Study of Addictions and Recovery, National Development and Research Institutes, Inc. , New York , New York , USA
| | - Kitty Harris
- b Center for the Study of Addiction and Recovery, Texas Tech University , Lubbock , Texas , USA
| | - Thomas Kimball
- b Center for the Study of Addiction and Recovery, Texas Tech University , Lubbock , Texas , USA
| | - Ken C Winters
- c Department of Psychiatry , University of Minnesota , Minneapolis , Minnesota , USA
| | - D Paul Moberg
- d Population Health Institute, School of Medicine and Public Health, University of Wisconsin , Madison , Wisconsin , USA
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Black JJ, Chung T. Mechanisms of change in adolescent substance use treatment: how does treatment work? Subst Abus 2015; 35:344-51. [PMID: 24901750 DOI: 10.1080/08897077.2014.925029] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Adolescent substance use treatment outcome research generally shows small to moderate effects in reducing substance use, with no specific "brand" of treatment emerging as clearly superior to any other, and treatment gains that fade over time. The relatively weak and temporary effects of treatment call for improving the potency and durability of intervention effects. In response to this call, this critical narrative review summarizes research on mechanisms of change for both adults and adolescents in substance use treatment, with a particular focus on reviewing what is known regarding "how" adolescent substance use treatment works. METHODS A comprehensive review of the adolescent (aged 11-18) substance use treatment literature was conducted to identify empirical studies that examined mediators of intervention effects. Relevant databases (e.g., PsychINFO, MEDLINE) were searched using key words (e.g., "mediator"), and relevant articles from reference sections of identified studies and review papers were considered. RESULTS Studies of mechanisms of psychotherapy change are rare in the adult, and particularly adolescent, substance use treatment outcome literature. The 4 adolescent studies that examined substance use treatment mechanisms found that positive social support, motivation to abstain, and positive parenting behaviors mediated treatment effects. To date, research has not supported therapy-specific mechanisms of change, finding instead that "common" processes of change largely account for improvements in outcome across distinct "brands" of treatment. CONCLUSIONS The lack of empirical support for treatment-specific mechanisms of change may be due to the need for greater precision in defining and measuring treatment-specific causal chains. Future directions include neuroscience approaches to examining changes in brain functioning that are associated with treatment response and recovery and examining mechanisms in adaptive treatment designs, which can accommodate individual differences in targets for intervention and response to treatment.
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Affiliation(s)
- Jessica J Black
- a Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania , USA
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Bergman BG, Hoeppner BB, Nelson LM, Slaymaker V, Kelly JF. The effects of continuing care on emerging adult outcomes following residential addiction treatment. Drug Alcohol Depend 2015; 153:207-14. [PMID: 26116368 PMCID: PMC4510025 DOI: 10.1016/j.drugalcdep.2015.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Professional continuing care services enhance recovery rates among adults and adolescents, though less is known about emerging adults (18-25 years old). Despite benefit shown from emerging adults' participation in 12-step mutual-help organizations (MHOs), it is unclear whether participation offers benefit independent of professional continuing care services. Greater knowledge in this area would inform clinical referral and linkage efforts. METHODS Emerging adults (N=284; 74% male; 95% Caucasian) were assessed during the year after residential treatment on outpatient sessions per week, percent days in residential treatment and residing in a sober living environment, substance use disorder (SUD) medication use, active 12-step MHO involvement (e.g., having a sponsor, completing step work, contact with members outside meetings), and continuous abstinence (dichotomized yes/no). One generalized estimating equation (GEE) model tested the unique effect of each professional service on abstinence, and, in a separate GEE model, the unique effect of 12-step MHO involvement on abstinence over and above professional services, independent of individual covariates. RESULTS Apart from SUD medication, all professional continuing care services were significantly associated with abstinence over and above individual factors. In the more comprehensive model, relative to zero 12-step MHO activities, odds of abstinence were 1.3 times greater if patients were involved in one activity, and 3.2 times greater if involved in five activities (lowest mean number of activities in the sample across all follow-ups). CONCLUSIONS Both active involvement in 12-step MHOs and recovery-supportive, professional services that link patients with these community-based resources may enhance outcomes for emerging adults after residential treatment.
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Affiliation(s)
- Brandon G. Bergman
- Massachusetts General Hospital (Boston, MA)
,Harvard Medical School (Boston, MA)
| | - Bettina B. Hoeppner
- Massachusetts General Hospital (Boston, MA)
,Harvard Medical School (Boston, MA)
| | - Lindsay M. Nelson
- Hazelden Betty Ford Foundation’s Butler Center for Research (Center City, MN)
| | - Valerie Slaymaker
- Hazelden Betty Ford Foundation’s Butler Center for Research (Center City, MN)
| | - John F. Kelly
- Massachusetts General Hospital (Boston, MA)
,Harvard Medical School (Boston, MA)
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Souza JD, Villar Luis MA, Ventura CA, Barbosa SP, Santos CBD. Perception of social support: a comparative study between men with and without substance-related disorders. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.966343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | | | - Cláudia Benedita dos Santos
- Department of Maternal Infant Nursing and Public Health, Ribeirão Preto College of Nursing/WHO Collaborating Centre for Nursing Research Development, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Watson JA, Greene MC, Kelly JF. Outpatient Alcohol and Drug Treatment for Adolescents with Co-Occurring Conduct Disorder. ALCOHOLISM TREATMENT QUARTERLY 2014. [DOI: 10.1080/07347324.2014.949119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hoeppner BB, Hoeppner SS, Kelly JF. Do young people benefit from AA as much, and in the same ways, as adult aged 30+? A moderated multiple mediation analysis. Drug Alcohol Depend 2014; 143:181-8. [PMID: 25150401 PMCID: PMC10071823 DOI: 10.1016/j.drugalcdep.2014.07.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/14/2014] [Accepted: 07/18/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Research has shown that participation in Alcoholics Anonymous (AA) confers significant recovery benefit to adults suffering from alcohol use disorder (AUD). Concerns persist, however, that AA may not work as well for younger adults, who tend to have shorter addiction histories, different social circumstances, and less spiritual/religious interest than adults. METHODS Secondary data analysis of Project MATCH, using a prospective, moderated multiple mediation analysis to test and compare six previously identified mechanisms of change in younger adults (n=266) vs. adults aged 30+ (n=1460). Nine clinical sites within the United States. Treatment-seeking adults (n=1726) suffering from AUD who participated in 12 weeks of outpatient treatment and completed follow-ups at 3-, 9- and 15-months. AA attendance during treatment; mediators at 9 months; and outcomes [percentage of days abstinent (PDA) and drinks per drinking day (DDD)] at 15 months. RESULTS AA attendance was associated with improved drinking outcomes in both younger adults (PDA: F(1, 247)=8.55, p<0.01; DDD: F(1, 247)=15.93, p<0.01) and adults aged 30+ (PDA: F(1, 1311)=86.58, p<0.01; DDD: F(1, 1311)=11.96, p<0.01). Only two of the six hypothesized pathways (i.e., decreases in pro-drinking social networks, self-efficacy in social situations) appeared to work in younger adults. CONCLUSION Unidentified mechanisms of behavior change that are mobilized by AA participation appear to be at work in young people. Once identified, these mechanisms may shed new light on how exactly AA confers similar benefits for young people and, more broadly, may enhance our understanding of recovery-related change for young adults that could yield novel intervention targets.
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Affiliation(s)
- Bettina B Hoeppner
- Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 60 Staniford Street, Boston, MA 02114, United States.
| | - Susanne S Hoeppner
- Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 60 Staniford Street, Boston, MA 02114, United States
| | - John F Kelly
- Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, 60 Staniford Street, Boston, MA 02114, United States
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Yeterian JD, Bursik K, Kelly JF. Religiosity as a Predictor of Adolescents' Substance Use Disorder Treatment Outcomes. Subst Abus 2014; 36:453-61. [PMID: 25222569 DOI: 10.1080/08897077.2014.960550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND A growing body of research on adults with substance use disorders (SUDs) suggests that higher levels of religiosity and/or spirituality are associated with better treatment outcomes. However, investigation into the role of religiosity and spirituality in adolescent SUD treatment response remains scarce. The present study examines religiosity as a predictor of treatment outcomes in an adolescent sample, with alcohol/other drug problem recognition as a hypothesized moderator of this relationship. Problem recognition was selected as a moderator in an attempt to identify a subset of adolescents who would be more likely to use religious resources when attempting to change their substance use. METHODS One hundred twenty-seven outpatient adolescents aged 14 to 19 (Mage=16.7, SD=1.2, 24% female) were followed for 1 year after treatment intake. Growth curve analyses were used to assess the impact of baseline religiosity and problem recognition on subsequent abstinence rates, drug-related consequences, and psychological distress. RESULTS On average, abstinence did not change significantly during the follow-up period, whereas drug-related consequences and psychological distress decreased significantly. Religiosity did not predict changes in abstinence or psychological distress over time. Religiosity did predict reductions in drug-related consequences over time (b=-0.20, t=-2.18, P=.03). However, when problem recognition was added to the model, the impact of religiosity on consequences became nonsignificant, and there was no interaction between religiosity and problem recognition on consequences. CONCLUSIONS The main hypothesis was largely unsupported. Possible explanations include that the sample was low in religiosity and few participants were actively seeking sobriety at treatment intake. Findings suggest adolescent outpatients with SUD may differ from their adult counterparts in the role that religiosity plays in recovery.
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Affiliation(s)
- Julie D Yeterian
- a Department of Psychology, Suffolk University , Boston , Massachusetts , USA.,b Department of Psychiatry, Center for Addiction Medicine Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Krisanne Bursik
- b Department of Psychiatry, Center for Addiction Medicine Massachusetts General Hospital , Boston , Massachusetts , USA
| | - John F Kelly
- b Department of Psychiatry, Center for Addiction Medicine Massachusetts General Hospital , Boston , Massachusetts , USA.,c Department of Psychiatry, Harvard Medical School , Boston , Massachusetts , USA
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Pagano ME, Kelly JF, Scur MD, Ionescu RA, Stout RL, Post SG. Assessing youth participation in AA-related helping: validity of the Service to Others in Sobriety (SOS) questionnaire in an adolescent sample. Am J Addict 2014; 22:60-6. [PMID: 23398228 DOI: 10.1111/j.1521-0391.2013.00322.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 06/19/2012] [Accepted: 08/10/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The positive outcomes derived from participation in Alcoholics Anonymous-related helping (AAH) found among adults has spurred study of AAH among minors with addiction. AAH includes acts of good citizenship in AA, formal service positions, public outreach, and transmitting personal experience to another fellow sufferer. Addiction research with adolescents is hindered by few validated assessments of 12-step activity among minors. This study provides psychometric findings of the "Service to Others in Sobriety (SOS)" questionnaire as completed by youths. METHODS Multi-informant data was collected prospectively from youth self-reports, clinician-rated assessments, biomarkers, and medical chart records for youths (N = 195) after residential treatment. RESULTS Few youths (7%) did not participate in any AAH during treatment. Results indicated the SOS as a unidimensional scale with adequate psychometric properties, including inter-informant reliability (r = .5), internal consistency (alpha = .90), and convergent validity (rs = -.3 to .3). Programmatic AAH activities distinguished abstinent youths in a random half-sample, and replicated on the other half-sample. The SOS cut-point of 40 indicated high AAH participation. CONCLUSIONS AND SIGNIFICANCE The SOS appears to be a valid measure of AAH, suggesting clinical utility for enhancing treatment and identifying service opportunities salient to sobriety.
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Affiliation(s)
- Maria E Pagano
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
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Chung T, Sealy L, Abraham M, Ruglovsky C, Schall J, Maisto SA. Personal Network Characteristics of Youth in Substance Use Treatment: Motivation for and Perceived Difficulty of Positive Network Change. Subst Abus 2014; 36:380-8. [PMID: 24960629 DOI: 10.1080/08897077.2014.932319] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Among youth in substance use treatment, peer substance use consistently predicts worse treatment outcomes. This study characterized personal (egocentric) networks of treated youth and examined predictors of adolescents' motivation and perceived difficulty in making changes in the peer network to support recovery. METHODS Adolescents (aged 14-18; N = 155) recruited from substance use treatment reported on substance use severity, motivation to abstain from substance use, abstinence goals such as "temporary abstinence," motivation and perceived difficulty in reducing contact with substance-using peers, and personal network characteristics. Personal network variables included composition (proportion of abstinent peers) and structure (number of network members, extent of ties among members) for household and nonhousehold (peer) members. RESULTS Although a majority of peer network members were perceived as using alcohol or marijuana, youth in treatment had relatively high motivation to abstain from substance use. However, treated youths' motivation to reduce contact with substance-using peers was relatively low. In particular, a goal of temporary abstinence was associated with lower motivation to change the peer network. For marijuana, specifically, network composition features (proportion of abstinent peers) were associated with motivation and perceived difficulty to change the peer network. For marijuana, in particular, network structural variables (extent of ties among members) were associated only with perceived difficulty of changing the peer network. CONCLUSIONS Despite high motivation to abstain from substance use during treatment, adolescents reported low motivation to reduce contact with substance-using peers. Personal motivation to abstain and abstinence goal predicted motivation to reduce contact with substance-using peers. In contrast, particularly for marijuana, network structure predicted perceived difficulty of network change. Results highlight the potential utility of addressing motivation and perceived difficulty to change the peer network as part of youth network-based interventions.
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Affiliation(s)
- Tammy Chung
- a Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania , USA
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35
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Witbrodt J, Ye Y, Bond J, Chi F, Weisner C, Mertens J. Alcohol and drug treatment involvement, 12-step attendance and abstinence: 9-year cross-lagged analysis of adults in an integrated health plan. J Subst Abuse Treat 2014; 46:412-9. [PMID: 24342024 PMCID: PMC3943492 DOI: 10.1016/j.jsat.2013.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 10/15/2013] [Accepted: 10/29/2013] [Indexed: 11/20/2022]
Abstract
This study explored causal relationships between post-treatment 12-step attendance and abstinence at multiple data waves and examined indirect paths leading from treatment initiation to abstinence 9-years later. Adults (N = 1945) seeking help for alcohol or drug use disorders from integrated healthcare organization outpatient treatment programs were followed at 1-, 5-, 7- and 9-years. Path modeling with cross-lagged partial regression coefficients was used to test causal relationships. Cross-lagged paths indicated greater 12-step attendance during years 1 and 5 and were casually related to past-30-day abstinence at years 5 and 7 respectfully, suggesting 12-step attendance leads to abstinence (but not vice versa) well into the post-treatment period. Some gender differences were found in these relationships. Three significant time-lagged, indirect paths emerged linking treatment duration to year-9 abstinence. Conclusions are discussed in the context of other studies using longitudinal designs. For outpatient clients, results reinforce the value of lengthier treatment duration and 12-step attendance in year 1.
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Affiliation(s)
- Jane Witbrodt
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608-1010, USA.
| | - Yu Ye
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608-1010, USA.
| | - Jason Bond
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608-1010, USA
| | - Felicia Chi
- Kaiser Permanente Division of Research, 2000 Broadway, 3rd floor, Oakland, CA 94612, USA
| | - Constance Weisner
- Kaiser Permanente Division of Research, 2000 Broadway, 3rd floor, Oakland, CA 94612, USA; Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave, Box F-0984, San Francisco, CA 94143, USA
| | - Jennifer Mertens
- Kaiser Permanente Division of Research, 2000 Broadway, 3rd floor, Oakland, CA 94612, USA
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36
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Rodriguez L, Smith JA. ‘Finding Your Own Place’: An Interpretative Phenomenological Analysis of Young Men’s Experience of Early Recovery from Addiction. Int J Ment Health Addict 2014. [DOI: 10.1007/s11469-014-9479-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bergman BG, Greene MC, Hoeppner BB, Slaymaker V, Kelly JF. Psychiatric comorbidity and 12-step participation: a longitudinal investigation of treated young adults. Alcohol Clin Exp Res 2014; 38:501-10. [PMID: 24033550 PMCID: PMC3946781 DOI: 10.1111/acer.12249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 05/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence indicates that 12-step mutual-help organizations (MHOs), such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), can play an important role in extending and potentiating the recovery benefits of professionally delivered addiction treatment among young adults with substance use disorders (SUD). However, concerns have lingered regarding the suitability of 12-step organizations for certain clinical subgroups, such as those with dual diagnosis (DD). This study examined the influence of diagnostic status (DD vs. SUD-only) on both attendance and active involvement (e.g., having a sponsor, verbal participation during meetings) in, and derived benefits from, 12-step MHOs following residential treatment. METHODS Young adults (N = 296; 18 to 24 years old; 26% female; 95% Caucasian; 47% DD [based on structured diagnostic interview]), enrolled in a prospective naturalistic study of SUD treatment effectiveness, were assessed at intake and 3, 6, and 12 months posttreatment on 12-step attendance/active involvement and percent days abstinent (PDA). t-Tests and lagged, hierarchical linear models (HLM) examined the extent to which diagnostic status influenced 12-step participation and any derived benefits, respectively. RESULTS For DD and SUD-only patients, posttreatment attendance and active involvement in 12-step organizations were similarly high. Overall, DD patients had significantly lower PDA relative to SUD-only patients. All patients appeared to benefit significantly from attendance and active involvement on a combined 8-item index. Regarding the primary effects of interest, significant differences did not emerge in derived benefit between DD and SUD-only patients for either attendance (p = 0.436) or active involvement (p = 0.062). Subsidiary analyses showed, however, that DD patients experienced significantly greater abstinence-related benefit from having a 12-step sponsor. CONCLUSIONS Despite concerns regarding the clinical utility of 12-step MHOs for DD patients, findings indicate that DD young adults participate and benefit as much as SUD-only patients, and may benefit more from high levels of active involvement, particularly having a 12-step sponsor. Future work is needed to clarify how active 12-step involvement might offset the additional recovery burden of a comorbid mental illness on substance use outcomes.
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Affiliation(s)
- Brandon G Bergman
- Center for Addiction Medicine , Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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38
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Laudet A, Harris K, Kimball T, Winters KC, Moberg DP. Collegiate Recovery Communities Programs: What do we know and what do we need to know? JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2014; 14:84-100. [PMID: 24634609 PMCID: PMC3952555 DOI: 10.1080/1533256x.2014.872015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
As the broad construct of recovery increasingly guides addiction services and policy, federal agencies have called for the expansion of peer-driven recovery support services. The high prevalence of substance use and abuse in colleges and universities in the U.S. constitute a significant obstacle to pursuing an education for the unknown number of youths who have attained remission from substance use dependence. Collegiate Recovery Programs (CRPs) are an innovative and growing model of peer-driven recovery support delivered on college campuses. Although no systematic research has examined CRPs, available site-level records suggest encouraging outcomes: low relapse rates and above average academic achievement. The number of CRPs nationwide is growing, but there is a noticeable lack of data on the model, its students and their outcomes. We review the literature supporting the need for the expansion of CRPs, present information on the diversity of CRP services and outline key areas where research is needed.
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Morgan-Lopez AA, Saavedra LM, Hien DA, Campbell AN, Wu E, Ruglass L. Synergy between seeking safety and twelve-step affiliation on substance use outcomes for women. J Subst Abuse Treat 2013; 45:179-89. [PMID: 23558158 PMCID: PMC4153737 DOI: 10.1016/j.jsat.2013.01.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 01/16/2013] [Accepted: 01/28/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Recovery Management paradigm provides a conceptual framework for the examination of joint impact of a focal treatment and post-treatment service utilization on substance abuse treatment outcomes. We test this framework by examining the interactive effects of a treatment for comorbid PTSD and substance use, Seeking Safety, and post-treatment Twelve-Step Affiliation (TSA) on alcohol and cocaine use. METHOD Data from 353 women in a six-site, randomized controlled effectiveness trial within the NIDA Clinical Trials Network were analyzed under latent class pattern mixture modeling. LCPMM was used to model variation in Seeking Safety by TSA interaction effects on alcohol and cocaine use. RESULTS Significant reductions in alcohol use among women in Seeking Safety (compared to health education) were observed; women in the Seeking Safety condition who followed up with TSA had the greatest reductions over time in alcohol use. Reductions in cocaine use over time were also observed but did not differ between treatment conditions nor were there interactions with post-treatment TSA. CONCLUSIONS Findings advance understanding of the complexities for treatment and continuing recovery processes for women with PTSD and SUDs, and further support the chronic disease model of addiction.
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40
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Bonelli RM, Koenig HG. Mental disorders, religion and spirituality 1990 to 2010: a systematic evidence-based review. JOURNAL OF RELIGION AND HEALTH 2013; 52:657-73. [PMID: 23420279 DOI: 10.1007/s10943-013-9691-4] [Citation(s) in RCA: 214] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Religion/spirituality has been increasingly examined in medical research during the past two decades. Despite the increasing number of published studies, a systematic evidence-based review of the available data in the field of psychiatry has not been done during the last 20 years. The literature was searched using PubMed (1990-2010). We examined original research on religion, religiosity, spirituality, and related terms published in the top 25 % of psychiatry and neurology journals according to the ISI journals citation index 2010. Most studies focused on religion or religiosity and only 7 % involved interventions. Among the 43 publications that met these criteria, thirty-one (72.1 %) found a relationship between level of religious/spiritual involvement and less mental disorder (positive), eight (18.6 %) found mixed results (positive and negative), and two (4.7 %) reported more mental disorder (negative). All studies on dementia, suicide, and stress-related disorders found a positive association, as well as 79 and 67 % of the papers on depression and substance abuse, respectively. In contrast, findings from the few studies in schizophrenia were mixed, and in bipolar disorder, indicated no association or a negative one. There is good evidence that religious involvement is correlated with better mental health in the areas of depression, substance abuse, and suicide; some evidence in stress-related disorders and dementia; insufficient evidence in bipolar disorder and schizophrenia, and no data in many other mental disorders.
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Chi FW, Sterling S, Campbell CI, Weisner C. 12-step participation and outcomes over 7 years among adolescent substance use patients with and without psychiatric comorbidity. Subst Abus 2013; 34:33-42. [PMID: 23327502 PMCID: PMC3558833 DOI: 10.1080/08897077.2012.691780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examines the associations between 12-step participation and outcomes over 7 years among 419 adolescent substance use patients with and without psychiatric comorbidities. Although level of participation decreased over time for both groups, comorbid adolescents participated in 12-step groups at comparable or higher levels across time points. Results from mixed-effects logistic regression models indicated that for both groups, 12-step participation was associated with both alcohol and drug abstinence at follow-ups, increasing the likelihood of either by at least 3 times. Findings highlight the potential benefits of 12-step participation in maintaining long-term recovery for adolescents with and without psychiatric disorders.
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Affiliation(s)
- Felicia W Chi
- Divisionof Research, Kaiser Permanente Northern California, 2000 Broadway,Oakland, CA 94612–2403, USA.
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42
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Mundt MP, Parthasarathy S, Chi FW, Sterling S, Campbell CI. 12-Step participation reduces medical use costs among adolescents with a history of alcohol and other drug treatment. Drug Alcohol Depend 2012; 126:124-30. [PMID: 22633367 PMCID: PMC3430743 DOI: 10.1016/j.drugalcdep.2012.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/12/2012] [Accepted: 05/02/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adolescents who attend 12-step groups following alcohol and other drug (AOD) treatment are more likely to remain abstinent and to avoid relapse post-treatment. We examined whether 12-step attendance is also associated with a corresponding reduction in health care use and costs. METHODS We used difference-in-difference analysis to compare changes in seven-year follow-up health care use and costs by changes in 12-step participation. Four Kaiser Permanente Northern California AOD treatment programs enrolled 403 adolescents, 13-18-years old, into a longitudinal cohort study upon AOD treatment entry. Participants self-reported 12-step meeting attendance at six-month, one-year, three-year, and five-year follow-up. Outcomes included counts of hospital inpatient days, emergency room (ER) visits, primary care visits, psychiatric visits, AOD treatment costs and total medical care costs. RESULTS Each additional 12-step meeting attended was associated with an incremental medical cost reduction of 4.7% during seven-year follow-up. The medical cost offset was largely due to reductions in hospital inpatient days, psychiatric visits, and AOD treatment costs. We estimate total medical use cost savings at $145 per year (in 2010 U.S. dollars) per additional 12-step meeting attended. CONCLUSIONS The findings suggest that 12-step participation conveys medical cost offsets for youth who undergo AOD treatment. Reduced costs may be related to improved AOD outcomes due to 12-step participation, improved general health due to changes in social network following 12-step participation, or better compliance to both AOD treatment and 12-step meetings.
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Affiliation(s)
- Marlon P Mundt
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison 53715, USA.
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Ullman SE, Najdowski CJ, Adams EB. Women, Alcoholics Anonymous, and Related Mutual Aid Groups: Review and Recommendations for Research. ALCOHOLISM TREATMENT QUARTERLY 2012. [DOI: 10.1080/07347324.2012.718969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gangi J, Darling CA. Adolescent Substance-Use Frequency Following Self-Help Group Attendance and Outpatient Substance Abuse Treatment. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2012. [DOI: 10.1080/1067828x.2012.702937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Yeterian JD, Dow SJ, Kelly JF. Ensuring Retention in Longitudinal Studies: A Practical Evaluation of an Intensive Follow-up Protocol and Suggested Adaptations. INTERNATIONAL JOURNAL OF SOCIAL RESEARCH METHODOLOGY 2012; 15:10.1080/13645579.2011.623958. [PMID: 24260012 PMCID: PMC3832212 DOI: 10.1080/13645579.2011.623958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ensuring retention in longitudinal studies of individuals with substance use disorders (SUD) is a continual challenge for researchers. This study made several modifications to a highly intensive follow-up protocol (Scott, 2004), originally designed for adults with SUD, in order to adapt it to a group of adolescents in low-intensity outpatient SUD treatment (N = 127, M age 16.7 yrs) and to accommodate limitations in the financial resources available for study staffing and transportation. In the present sample, adolescent participants generally found it unreasonable for study staff to request to contact people outside their immediate family in order to locate them and to attempt to schedule interviews 3-6 months in advance, as specified in the original protocol. Changes were made to accommodate these concerns and follow-up rates remained high (85-91%). Even though this study is limited by its non-experimental nature, it provides a replicable example of a scaled-down, less costly version of a highly intensive follow-up protocol that can be used to achieve high follow-up rates in studies of adolescents with SUD. We hope this will be encouraging for researchers and program evaluators who have limited resources or who work with participants who express concerns about privacy or study burden.
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Affiliation(s)
| | | | - John F. Kelly
- Massachusetts General Hospital-Harvard Medical School, Boston, MA
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Krentzman AR, Battle D, Pagano ME, Andrade FH, Bradley JC, Delva J, Johnson SM, Robinson EAR. The Role of Religiousness on Substance-Use Disorder Treatment Outcomes: A Comparison of Black and White Adolescents. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2012; 3:113-128. [PMID: 22970338 PMCID: PMC3437261 DOI: 10.5243/jsswr.2012.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study compares 41 Black and 124 White adolescents at intake and discharge from a residential treatment program for substance-use disorders. Study data were obtained as part of a larger study (N = 195) that sought to assess the relationship of helping behavior and addiction recovery. This post-hoc analysis aims to identify cultural strengths that may be associated with recovery from substance-use disorders among Black adolescents. Using regression analyses and controlling for the severity of substance use and background variables that distinguish racial groups, religious practices and behaviors at intake were examined. Specifically, Black youth and White youth were compared on treatment outcomes, including alcohol or drug use during treatment, drug craving, 12-Step work, and 12-Step helping. The burden of health and socioeconomic disparities at intake did not disproportionately disfavor Black adolescents. Outcomes related to 12-Step measures were similar between Black and White youth. White adolescents reported higher craving scores at discharge, and Black adolescents were more likely to use drugs during treatment. High levels of religiousness at treatment intake were linked to greater 12-Step work and greater 12-Step helping at discharge. High levels of religiousness at intake were not related to drug use during treatment or to craving scores at discharge. The relationship between intake levels of religiousness and treatment-related outcomes did not differ by race.
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Witbrodt J, Mertens J, Kaskutas LA, Bond J, Chi F, Weisner C. Do 12-step meeting attendance trajectories over 9 years predict abstinence? J Subst Abuse Treat 2012; 43:30-43. [PMID: 22206631 PMCID: PMC3320672 DOI: 10.1016/j.jsat.2011.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 09/30/2011] [Accepted: 10/05/2011] [Indexed: 10/14/2022]
Abstract
This study grouped treatment-seeking individuals (n = 1825) by common patterns of 12-step attendance using 5 waves of data (75% interviewed Year 9) to isolate unique characteristics and use-related outcomes distinguishing each class profile. The "high" class reported the highest attendance and abstention. The "descending" class reported high baseline alcohol severity, long treatment episodes, and high initial attendance and abstinence, but by Year 5, their attendance and abstinence dropped. The "early-drop" class, which started with high attendance and abstinence but with low problem severity, reported no attendance after Year 1. The "rising" class, with fairly high alcohol and psychiatric severity throughout, reported initially low attendance, followed by increasing attendance paralleling their abstention. Last, the "low" and "no" classes, which reported low problem severity and very low/no attendance, had the lowest abstention. Female gender and high alcohol severity predicted attendance all years. Consistent with a sustained benefit for 12-step exposure, abstinence patterns aligned much like attendance profiles.
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Affiliation(s)
- Jane Witbrodt
- Alcohol Research Group, Emeryville, CA 94608-1010, USA.
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Chi FW, Campbell CI, Sterling S, Weisner C. Twelve-Step attendance trajectories over 7 years among adolescents entering substance use treatment in an integrated health plan. Addiction 2012; 107:933-42. [PMID: 22151625 PMCID: PMC3311783 DOI: 10.1111/j.1360-0443.2011.03758.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS This study examines 12-Step attendance trajectories over 7 years, factors associated with the trajectories, and relationships between the trajectories and long-term substance use outcomes among adolescents entering out-patient substance use treatment in a private, non-profit integrated managed-care health plan. DESIGN Longitudinal observational study. SETTING Four Kaiser Permanente Northern California substance use treatment programs. PARTICIPANTS A total of 391 adolescents entering treatment between 2000 and 2002 who completed at least one follow-up interview in year 1, and at least one during years 3-7, after treatment entry. MEASUREMENTS Alcohol and drug use, 12-Step meeting attendance and activity involvement and post-treatment medical service utilization. FINDINGS Semiparametric group-based modeling identified three distinct 12-Step attendance trajectory groups over 7 years: low/no attendance (60%), early but not continued (26%) and continued (14%). There were lower proportions of males and of adolescents with prior substance use treatment experience in the low/no attendance group (P = 0.019 and P = 0.003, respectively). In addition, those in the low/no attendance group had lower perception on circumstances, motivation and readiness for treatment at baseline (P = 0.023). Multivariate logistic generalized estimating equation analyses found that those in the continued group were more likely to be abstinent from both alcohol and drugs during follow-ups than those in the low/no attendance group [odds ratio (OR) = 2.40, P = 0.003 and OR = 1.96, P = 0.026, respectively]. However, no differences in long-term outcomes were found between those in the other two groups. CONCLUSION Robust connection with 12-Step groups appears to be associated with better long-term outcomes among adolescents with substance use disorders.
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Affiliation(s)
- Felicia W. Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612
| | - Cynthia I. Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612,Department of Psychiatry, University of California, San Francisco, CA 94143
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Galanter M, Dermatis H, Santucci C. Young People in Alcoholics Anonymous: The Role of Spiritual Orientation and AA Member Affiliation. J Addict Dis 2012; 31:173-82. [DOI: 10.1080/10550887.2012.665693] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marc Galanter
- a Division of Alcoholism and Drug Abuse, NYU School of Medicine , New York , New York , USA
| | - Helen Dermatis
- a Division of Alcoholism and Drug Abuse, NYU School of Medicine , New York , New York , USA
| | - Courtney Santucci
- a Division of Alcoholism and Drug Abuse, NYU School of Medicine , New York , New York , USA
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Kelly JF, Urbanoski K. Youth recovery contexts: the incremental effects of 12-step attendance and involvement on adolescent outpatient outcomes. Alcohol Clin Exp Res 2012; 36:1219-29. [PMID: 22509904 DOI: 10.1111/j.1530-0277.2011.01727.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 10/25/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND A major barrier to youth recovery is finding suitable sobriety-supportive social contexts. National studies reveal most adolescent addiction treatment programs link youths to community 12-step fellowships to help meet this challenge, but little is known empirically regarding the extent to which adolescents attend and benefit from 12-step meetings or whether they derive additional gains from active involvement in prescribed 12-step activities (e.g., contact with a sponsor and other fellowship members). Greater knowledge in this area would enhance the efficiency of clinical continuing care recommendations. METHODS Adolescent outpatients (N = 127; M age 16.7; 75% male; 87% white) enrolled in a naturalistic study of treatment effectiveness were assessed at intake and 3, 6, and 12 months later using standardized assessments. Mixed-effects models, controlling for static and time-varying confounds, examined the concurrent and lagged effects of 12-step attendance and active involvement on abstinence over time. RESULTS The proportion attending 12-step meetings was relatively low across follow-up (24 to 29%), but more frequent attendance was independently associated with greater abstinence in concurrent and, to a lesser extent, lagged models. An 8-item composite measure of 12-step involvement did not enhance outcomes over and above attendance, but separate components did; specifically, greater contact with a 12-step sponsor outside of meetings and more verbal participation during meetings. CONCLUSIONS The benefits of 12-step participation observed among adult samples extend to adolescent outpatients. Community 12-step fellowships appear to provide a useful sobriety-supportive social context for youths seeking recovery, but evidence-based youth-specific 12-step facilitation strategies are needed to enhance outpatient attendance rates.
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Affiliation(s)
- John F Kelly
- Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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