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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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2
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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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Godley MD, Passetti LL, Hunter BD, Griffin BA. Volunteer Recovery Support for Adolescents: Using propensity score based methods to understand dosage effects within a randomized controlled trial. J Subst Abuse Treat 2022; 132:108637. [PMID: 34654584 PMCID: PMC8671322 DOI: 10.1016/j.jsat.2021.108637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/15/2021] [Accepted: 10/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND In a recently published randomized controlled trial (RCT) of Volunteer Recovery Support for Adolescents (VRSA), a secondary finding indicated that better adherence to planned VRSA telephone session frequency resulted in significantly higher remission rates relative to lower session adherence. However, interpretation of this dose-response relationship may have been confounded by participant characteristics such as baseline levels of substance use and mental health problems. METHODS The present study used statistical methods designed to approximate RCTs when comparing more than two nonequivalent groups that include an assessment of the potential impact of omitted variables. Classification and Regression Tree (CRT) analysis was used to establish the cut-point between high (H) and low (L) VRSA dosage groups. Because we were interested in generalizing to youth with poor attendance, the L-VRSA group served as the reference group. Balancing weights for H-VRSA and a services as usual (SAU) control group were calculated to ensure similarity of baseline pretreatment characteristics to the reference group, and sensitivity of findings to unobserved confounding variables was assessed. RESULTS Findings suggested that superior remission rates at the end of the intervention phase were the result of high adherence to planned VRSA session frequency. Recommendations to achieve high VRSA participation among a larger segment of youth and to test whether longer VRSA duration improves the stability of recovery outcomes are provided. CONCLUSION Few published dose-response studies have adequately controlled for selection confounds from both observed and unobserved confounding. As such, the present study aims to both assess the impact of different dosage levels of VRSA and provide a template for how to apply state-of-the-art statistical methods designed to approximate randomized controlled trials to such studies.
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Affiliation(s)
- Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, USA.
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, USA.
| | - Brooke D Hunter
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, USA.
| | - Beth Ann Griffin
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, USA.
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Dahlberg M, Boson K, Anderberg M, Wennberg P. Long-Term Outcomes for Young People With Substance Use Problems in Outpatient Treatment: Gender-Specific Patterns. Front Psychiatry 2022; 13:888197. [PMID: 35656352 PMCID: PMC9152000 DOI: 10.3389/fpsyt.2022.888197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
This study presents the results of a longitudinal research project focusing on long-term outcomes among young people after initiation of outpatient treatment for substance use problems (SUP) in Sweden. Young people are defined with the age group 13-25 years. A clinical sample of 451 young people (29% girls, median age 17 years) completed a structured interview at baseline and was followed using official records one, two, and 3 years after initiation of treatment. Gender-specific patterns at intake were described and bivariate associations and logistic regressions were calculated to analyse the links between risk factors at treatment start and indications of substance use problems 3 years later. Significantly more boys than girls displayed indications of continued SUP at 3-year follow-up. More specifically, 49% of the boys vs. 35% of the girls were identified through records as still having problems with substance use. Predictive risk factors also displayed gender-specific patterns. Primary drug use frequency and age at intake predicted indications of SUP among boys but not among girls. Placement in foster care/residential homes, depression, and early drug debut had significant predictive value regarding indications of SUP among females but not among males. Girls also displayed a greater psychosocial burden at treatment start, but a more favorable treatment outcome at follow-up. Youths with a heavy risk load at treatment start (i.e., over six risk factors) did not display a greater risk of SUP at 3-year follow-up, although our results suggest that this subgroup has indications of continued problems with mental health. Consequently, future studies should further explore gender-specific treatment pathways for young people with substance use problems. Since women and girls seem to have different risk factors, co-occurring psychiatric problems and more experiences of trauma compared to men, they might need multidimensional and more comprehensive treatment interventions that run over a longer period of time.
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Affiliation(s)
- Mikael Dahlberg
- Department of Pedagogy and Learning, Linnaeus University, Växjö, Sweden
| | - Karin Boson
- Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway.,Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Mats Anderberg
- Department of Social Work, Linnaeus University, Växjö, Sweden
| | - Peter Wennberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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5
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Williams IL. An Apologetic Interpretation of Alcoholics Anonymous (AA): Timeless Wisdom, Outdated Language. Subst Use Misuse 2021; 56:1079-1094. [PMID: 33970771 DOI: 10.1080/10826084.2021.1892134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Twelve Steps of Alcoholics Anonymous (AA) has proven to be an effective aid in recovery for many people with alcohol use disorder. While constructive criticisms of AA can be beneficial to the organization, other criticisms have merely served as rhetorical devices intent on discrediting the 12-step approach. OBJECTIVES This paper examines six prominent critiques of AA, paying special attention to the premises, tone, and factual basis of the statements. Interpretations grounded in AA literature are offered to address claims or critiques around prominent themes, which are organized into two main classes: purported causes of alcoholism and factors maintaining alcoholism. RESULTS Findings reveal tenuous statements in the AA literature that appear contradictory and thereby invite a misreading. These statements, some of which misrepresent the tenets of AA and its founders, underscore certain vocal criticisms that are not entirely unfounded. While many pages of the AA literature are imbued with timeless wisdom, even the most apologetic interpretations-distilled into benefit-of-the-doubt renderings-largely falter in defending the nature of the language that originated in the early 1900s at odds with 21st century understandings of alcohol use disorder. Conclusions/Importance: The AA literature essentially presents a valid target for critics, fueling resistance to this free community-based resource that may prevent people who could benefit from AA from seeking the help of the 12-steps.
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6
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Godley MD, Passetti LL, Hunter BD, Greene AR, White WL. A randomized trial of Volunteer Recovery Support for Adolescents (VRSA) following residential treatment discharge. J Subst Abuse Treat 2019; 98:15-25. [PMID: 30665599 DOI: 10.1016/j.jsat.2018.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/24/2018] [Accepted: 11/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
| | - Brooke D Hunter
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
| | - Alison R Greene
- Indiana University, 1025 E. 7th St., Bloomington, IN 47405, United States of America; The University of Arizona, Southwest Institute for Research on Women, 181 S. Tucson Blvd., Ste. 101, Tucson, AZ 85716, United States of America.
| | - William L White
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761, United States of America.
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Schonbrun YC, Anderson BJ, Johnson JE, Kurth M, Timko C, Stein MD. Barriers to Entry into 12-Step Mutual Help Groups among Justice-Involved Women with Alcohol Use Disorders. ALCOHOLISM TREATMENT QUARTERLY 2019; 37:25-42. [DOI: 10.1080/07347324.2018.1424596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yael Chatav Schonbrun
- Butler Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA
| | | | | | - Megan Kurth
- Butler Hospital, Providence, Rhode Island USA
| | - Christine Timko
- VA Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, CA USA
| | - Michael D. Stein
- Butler Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA
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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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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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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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12
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McPherson S, Brooks O, Barbosa-Leiker C, Lederhos C, Lamp A, Murphy S, Layton M, Roll J. Examining Longitudinal Stimulant Use and Treatment Attendance as Parallel Outcomes in Two Contingency Management Randomized Clinical Trials. J Subst Abuse Treat 2015; 61:18-25. [PMID: 26456717 DOI: 10.1016/j.jsat.2015.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/25/2015] [Accepted: 08/28/2015] [Indexed: 11/26/2022]
Abstract
The primary aim of this study was to examine stimulant use and longitudinal treatment attendance in one 'parallel outcomes' model in order to determine how these two outcomes are related to one another during treatment, and to quantify how the intervention impacts these two on- and off-target outcomes differently. Data came from two multi-site randomized clinical trials (RCTs) of contingency management (CM) that targeted stimulant use. We used parallel multilevel modeling to examine the impact of multiple pre-specified covariates, including selected Addiction Severity Index (ASI) scores, age and sex, in addition to CM on concurrent attendance and stimulant use in two separate analyses, i.e., one per trial. In one trial, CM was positively associated with attending treatment throughout the trial (β=0.060, p<0.05). In the second trial, CM predicted negative urinalysis ((-)UA) over the 12-week treatment period (β=0.069, p<0.05). In both trials, there was a significant, positive relationship between attendance and (-)UA submission, but in the first trial a (-)UA at both baseline and over time was related to attendance over time (r=0.117; r=0.013, respectively) and in the second trial, a (-)UA submission at baseline was associated with increased attendance over time (r=0.055). These findings indicate that stimulant use and treatment attendance over time are related but distinct outcomes that, when analyzed simultaneously, portray a more informative picture of their predictors and the separate trajectories of each. This 'indirect reinforcement' between two clinically meaningful on-target (directly reinforced behavior) and off-target (indirectly reinforced behavior) outcomes is in need of further examination in order to fully exploit the potential clinical benefits that could be realized in substance use disorder treatment trials.
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Affiliation(s)
- Sterling McPherson
- Washington State University, College of Nursing; Washington State University, Program of Excellence in Addictions Research; Washington State University, Translational Addictions Research Center; Washington State University, Department of Health Policy and Administration.
| | - Olivia Brooks
- Washington State University, College of Nursing; Washington State University, Program of Excellence in Addictions Research; Washington State University, Translational Addictions Research Center
| | - Celestina Barbosa-Leiker
- Washington State University, College of Nursing; Washington State University, Program of Excellence in Addictions Research; Washington State University, Translational Addictions Research Center
| | - Crystal Lederhos
- Washington State University, College of Nursing; Washington State University, Program of Excellence in Addictions Research; Washington State University, Translational Addictions Research Center
| | - Amanda Lamp
- Washington State University, Program of Excellence in Addictions Research; Washington State University, Elson S. Floyd College of Medicine
| | - Sean Murphy
- Washington State University, College of Nursing; Washington State University, Program of Excellence in Addictions Research; Washington State University, Translational Addictions Research Center; Washington State University, Department of Health Policy and Administration
| | - Matthew Layton
- Washington State University, Program of Excellence in Addictions Research; Washington State University, Translational Addictions Research Center; Washington State University, Elson S. Floyd College of Medicine
| | - John Roll
- Washington State University, College of Nursing; Washington State University, Program of Excellence in Addictions Research; Washington State University, Translational Addictions Research Center; Washington State University, Department of Health Policy and Administration
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13
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Conrad KM, Conrad KJ, Passetti LL, Funk RR, Dennis ML. Validation of the Full and Short-Form Self-Help Involvement Scale Against the Rasch Measurement Model. EVALUATION REVIEW 2015; 39:395-427. [PMID: 26275980 PMCID: PMC4591028 DOI: 10.1177/0193841x15599645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Substance use disorders (SUDs) are one of the nation's most costly problems in terms of dollars, disability, and death. Self-help programs are among the varied recovery support options available to address SUD, and evaluation of these programs depends on good measurement. There exists an unmet need for a psychometrically sound, brief, efficient measure of self-help involvement for individuals with SUD that is valid across different substances and age-groups. METHODS Using data from 2,101 persons presenting for SUD treatment, the full 21-item Global Appraisal of Individual Needs Self-Help Involvement Scale (SHIS) and a newly developed 11-item short-form version were validated against the Rasch measurement model and each other. Differential item functioning (DIF) was assessed by primary substance and age. RESULTS Both versions met Rasch psychometric criteria. The full scale had minor misfit with no DIF for alcohol, marijuana, or opioids but a few instances of DIF for amphetamine and cocaine users as well as for age, in that youth tended to endorse several easier items more frequently than did adults. The 11-item short form had neither misfit nor DIF by substance and only minor DIF by age was highly correlated with the full version and was relatively more efficient. Criterion-related validity was supported for both. CONCLUSIONS Both the long and short versions of SHIS are psychometrically sound measures of a more comprehensive conceptualization of self-help involvement for SUDs that can be used as part of an in-depth assessment or as a short measure that lessens respondent burden.
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Affiliation(s)
- Karen M Conrad
- University of Illinois at Chicago School of Public Health, Chicago, IL USA Program Metrics, LLC, Oak Park, IL, USA
| | - Kendon J Conrad
- University of Illinois at Chicago School of Public Health, Chicago, IL USA Program Metrics, LLC, Oak Park, IL, USA
| | - Lora L Passetti
- Chestnut Health Systems Lighthouse Institute, Normal, IL, USA
| | - Rodney R Funk
- Chestnut Health Systems Lighthouse Institute, Normal, IL, USA
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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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15
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Abstract
Scientific advances in the past 15 years have clearly highlighted the need for recovery management approaches to help individuals sustain recovery from chronic substance use disorders. This article reviews some of the recent findings related to recovery management: (1) continuing care, (2) recovery management checkups, (3) 12-step or mutual aid, and (4) technology-based interventions. The core assumption underlying these approaches is that earlier detection and re-intervention will improve long-term outcomes by minimizing the harmful consequences of the condition and maximizing or promoting opportunities for maintaining healthy levels of functioning in related life domains. Economic analysis is important because it can take a year or longer for such interventions to offset their costs. The article also examines the potential of smartphones and other recent technological developments to facilitate more cost-effective recovery management options.
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Affiliation(s)
- Michael L Dennis
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA,
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16
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Fisher EA. Recovery Supports for Young People: What Do Existing Supports Reveal About the Recovery Environment? PJE. PEABODY JOURNAL OF EDUCATION 2014; 89:258-270. [PMID: 24999290 PMCID: PMC4078875 DOI: 10.1080/0161956x.2014.897104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article seeks to address how our understanding of the recovery process and resulting supports can be made more comprehensive: how can links from treatment to home to school to communities be made so that there are fewer and fewer recovery gaps for adolescents? Using the ecology of recovery model developed by White (2009) as the impetus for such a review, the article discusses the challenges inherent within adolescent substance abuse recovery, factors impacting successful recovery, and programs addressing this issue that have been empirically studied. Studied programs can be categorized as (1) formalized aftercare recovery and (2) recovery communities, and both examples will be described using existing literature. From the review of existing recovery support research and resources, the discussion highlights gaps and future research areas in order to address the complexity of recovery among young people.
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17
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Abstract
PURPOSE OF REVIEW The focus of this review is to examine service utilization, treatment effectiveness, and future directions for adolescents who misuse substances. RECENT FINDINGS Although the effectiveness of treatments has improved in the last two decades, young people's utilization of services has remained relatively stable. This is disconcerting because early intervention improves outcomes and deterioration is associated with physical, psychological, and social problems. The requirement for coordinated service provision across a wide range of treatment agencies cannot be emphasized enough, because young substance misusers come to services with a variety of symptoms and problems. It is encouraging that, to date, treatment studies indicate that adolescents in almost all types of treatment reduce their use of substances. The greatest reductions are shown for family therapy, followed by cognitive behavior therapy (CBT), motivational enhancement therapy (MET)/CBT, MET behavior therapy, and pharmacological treatment. Despite the developing treatment literature, important methodological limitations restrict comparability between studies. SUMMARY The requirement for holistic, systematic assessments should include adolescents' social contexts, trauma, and psychiatric and physical illnesses because they are the cornerstones to understanding engagement and retention. Our review shows the importance of coordinating primary healthcare, mental health, and substance abuse treatment facilities, and highlights networking between other providers as integral to providing an optimal response to this unpredictable, often marginalized, group.
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