Family environment factors and substance abuse severity in an HMO adolescent treatment population

Day-level shifts in social contexts during youth cannabis use treatment

OBJECTIVE

Social context plays a critical role in youth cannabis use. Yet few studies have examined if and when social contexts shift during cannabis use treatment. This study examined daily shifts in youths' social contexts with the goal of characterizing how specific social contexts (e.g., time with cannabis-using friends or siblings) relate to cannabis craving and use during cannabis treatment.

METHOD

Participants were 65 cannabis users (51% male), ages 15-24 years, who participated in a double-blind randomized clinical trial that tested the effects of motivational enhancement and cognitive behavioral therapies plus either adjunctive pharmacotherapy or placebo on cannabis craving and use. Ecological momentary assessment (EMA) data, collected from a pre-randomization period through the completion of the six-week intervention, assessed youths' social contexts, cannabis use, and craving.

RESULTS

Time-varying effects models identified shifts in social contexts during treatment. Overall, time spent with cannabis-using friends and siblings decreased, where time spent with non-using friends or alone increased across the trial. Time with parents or non-using siblings was unchanged. Comparing the relative associations of social contexts with same-day craving and use, more time with cannabis-using friends and with siblings was uniquely associated with greater craving and use.

CONCLUSIONS

Social context is an important factor in youth substance-use treatment. While time spent with cannabis-using friends and siblings decreased over treatment for all participants, those who continued to spend time with using individuals reported greater craving and use. This research supports increased attention to shifting youths' social contexts to enhance treatment success. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Internet Dependency and Its Relation to Sexual Desire and Satisfaction in Married Clients Referred to Healthcare Centers in Tabriz, Iran

Background:

Internet dependency has become one of the 21^st century dilemmas affecting different aspects of married life such as sexual relationships. Considering the importance of family in the Iranian society, this study aimed to determine how internet dependency is related to sexual desires and satisfaction among married clients of healthcare centers.

Materials and Methods:

This cross-sectional study was conducted on 326 married clients referred to healthcare centers in Tabriz City, Iran, between February and August 2019. Proportionate stratified random sampling was used based on the health complexes and the healthcare centers covered by them. One of the healthcare centers covered by each complex was selected randomly. The data collection tools included a demographic characteristics checklist, the Internet Addiction Test (IAT), the Index of Sexual Satisfaction (ISS), and the Hurlbert Index of Sexual Desire (HISD). The collected data were analyzed using the Pearson correlation coefficient test and multiple linear regression model.

Results:

The mean (SD) was 37.33 (15.37) for of internet dependency, 59.20 (17.27) for sexual desire, and 104.45 (22.81) for sexual satisfaction. There was a negative correlation between internet dependency and sexual satisfaction (r = -0.47, p < 0.001). This correlation remained significant (B = -0.41, df = 9, p < 0.001,) even when occupation (B = 3.66, p = 0.01), satisfaction with married life (B = 15.34, p < 0.001), and sexual desire (B = 0.60, p < 0.001) were adjusted as potential confounding factors.

Conclusions:

Internet dependency can cause a reduction in sexual desire and sexual satisfaction. Designing educational interventions in healthcare centers is recommended to manage the use of internet and to inform clients about the effects that internet dependency may have.

With friends like these…: Peer delinquency influences across age cohorts on smoking, alcohol and illegal substance use

Background

Discussions and debate about youth smoking, alcohol use, and illegal substance use (collectively referred to as youth substance use) continue to receive wide attention among researchers, policymakers, and the general public. Previous research has suggested that peer delinquency is a particularly strong correlate of youth substance use. The current study focuses on the influence of delinquent peers on substance use, and how peer delinquency influences change across age cohorts of youth.

Method

The current study examines multiple correlates for youth substance use in a sample of 8,256 youth (mean age 14), with the goal of identifying the influence of delinquent peers across age cohorts while controlling for other correlates. Data was collected from the Ohio version of the Youth Risk Behavior Surveillance System (YRBSS) developed by the Centers for Disease Control.

Results

Results from multiple regression analyses identified peer delinquency as the strongest correlate of youth substance use even when other relevant factors related to family, neighborhood, and media use were controlled. Correlations between peer delinquency and substance use behavior increased across age cohorts and for individuals who first used in middle teen years (13–16) irrespective of current age.

Interpretation.

Age appears to be a moderating factor regarding the correlation between peer delinquency and youth substance abuse. Primary and secondary prevention and intervention strategies that focus on peers are potentially more likely to reduce youth substance use and improve peer relationships than those focused on other areas such as schools or media.

Drug use and its associated factors among money boys in Hunan Province, China

OBJECTIVES

To describe drug use, types of drugs and related factors among money boys in Hunan Province, China.

STUDY DESIGN

A cross-sectional study was conducted between July 2012 and January 2013.

METHODS

Based on respondent-driven sampling, researchers located seven 'seeds' via a gay-dating website: http://www.ixxqy.org. After three waves of recruitment, 234 money boys were enrolled. They were asked to complete a 23-item questionnaire regarding demographic characteristics, drug use, a history of human immunodeficiency virus infection and family environment. Descriptive statistics and logistic regression analysis were conducted using Statistical Package for the Social Sciences Version 20.0.

RESULTS

In total, 205 valid questionnaires were collected. Based on the data collected, 80 (39.0%) money boys had used drugs within the last 3 months. Rush popper (36.6%) and methamphetamine (12.7%) were used most commonly, and other drugs used were ecstasy (7.8%), ketamine (5.9%), marijuana (2.4%), morphine (1.5%), heroin (1.0%) and cocaine (0.5%). Factors included in the logistic regression were length of service (odds ratio [OR] 0.395, 95% confidence interval [CI] 0.175-0.896), being an only child (OR 2.272, 95% CI 1.108-4.659), relationship between parents (OR 0.428, 95% CI 0.213-0.858) and social network (OR 2.387, 95% CI 1.144-4.970). A shorter length of service and a good relationship between parents were protective factors against drug use, while being an only child and having a wide social network were risk factors.

CONCLUSION

Drug use is common among money boys. This study found that length of service, being an only child, relationship between parents and social network are associated with drug use.

Substance abuse treatment response in a Latino sample: the influence of family conflict

Latino Americans report underutilization of treatment and poor treatment response for substance use and abuse compared to other racial/ethnic groups; thus, it is important to assess factors that contribute to these disparities. The current study objective was to assess the influence of family conflict on substance abuse treatment response in a sample of Latino Americans using two different yet complementary analyses. First, ordinary least squares regression was used to assess the association between overall family conflict and pre- and post-treatment substance use. Second, repeated measures latent class analysis was used to identify groups based on family member conflict and timing of conflict during treatment. Findings indicated that family conflict contributed unique variance to concurrent substance use; however pre-treatment family conflict was not related to post-treatment outcomes. Results also identified three distinct family conflict groups: no/low conflict, pre-treatment conflict, and post-treatment conflict who differed in pre- and post-treatment substance use. Post hoc investigation revealed that those who experienced pre-treatment conflict but low post-treatment conflict showed the greatest decrease in substance use. Findings highlight the importance of considering family conflict during all stages of treatment for Latino American substance users.

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

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

12-Step participation reduces medical use costs among adolescents with a history of alcohol and other drug treatment

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.

Gender-specific relationships between depressive symptoms, marijuana use, parental communication and risky sexual behavior in adolescence

A large body of research has identified correlates of risky sexual behavior, with depressive symptoms and marijuana use among the most consistent psychosocial predictors of sexual risk. However, substantially less research has examined the relationship between these risk variables and adolescent risky sexual behavior over time as well as the interaction of these individual-level predictors with family-level variables such as parenting factors. Additionally, most studies have been restricted to one index of risky sexual behavior, have not taken into account the complex role of gender, and have not controlled for several of the factors that independently confer risk for risky sexual behavior. Therefore, the current study investigated the association between depressive symptoms and parameters of parenting on marijuana use, number of sexual partners and condom usage measured 9 months later for both boys and girls. Participants were 9th and 10th grade adolescents (N = 1,145; 57.7% female). We found that depressive symptoms may be a gender-specific risk factor for certain indices of risky sexual behavior. For boys only, marijuana use at Time 2 accounted for the variance in the relationship between depressive symptoms at Time 1 and number of partners at Time 2. Additionally, strictness of family rules at Time 1 was associated with the number of partners with whom girls engaged in sex at Time 2, but only among those with lower levels of depressive symptoms at Time 1. Results from the current investigation speak to the utility of examining the complex, gender-specific pathways to sexual risk in adolescents. Findings suggest that treatment of mental health and substance use problems may have important implications in rates of risky sexual behavior and, conceivably, controlling the high rates of serious individual and public health repercussions.

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

AIMS

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

DESIGN

Longitudinal observational study.

SETTING

Four Kaiser Permanente Northern California substance use treatment programs.

PARTICIPANTS

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

MEASUREMENTS

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

FINDINGS

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

CONCLUSION

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

Parental relationship satisfaction in French young adults associated with alcohol abuse and dependence

Alcohol consumption is a major risk factor for disease in developed countries. In addition to genetic susceptibility, alcohol consumption is shaped by one's social and family environment. With data from 2009, we examined associations between satisfaction with familial relationships and alcohol abuse and dependence using a national sample of 1101 French young adults aged 22-35. Alcohol-related problems were measured with the Alcohol Use Disorders Identification Test (AUDIT). Main exposure variables included young adults' self-report of satisfaction with parental relationships. In adjusted logistic regression models, having a poor relationship with one's mother (OR=1.8, 95%CI 1.0-3.6) or father (OR=1.8, 95% CI 1.0-3.2) was associated with alcohol abuse and dependence. Gender stratified analyses indicated unsatisfactory maternal relationships were associated with alcohol problems in women (OR=2.6, 95%CI 1.1-6.6); unsatisfactory paternal relationships were suggestive of alcohol abuse in men (OR=2.0, 95%CI 0.9-4.7), but not in women. Non-cohabitation with a romantic partner was associated with an almost three-fold increase of alcohol abuse and dependence in men (OR=2.8, 95% CI 1.6-4.8). The quality of parental relationships may be important for alcohol abuse, particularly when the parent is the same gender. Family-centered approaches may be considered in prevention efforts to reduce problem drinking in French young adults.

Peer influences on adolescent alcohol and other drug use outcomes

PURPOSE

To examine the role of family environment and peer networks in abstinence outcomes for adolescents 1 year after intake to alcohol and other drug (AOD) treatment.

DESIGN

Survey of 419 adolescents 13 to 18 years of age at consecutive intakes to AOD treatment programs at four sites of a large health system, with telephone follow-up survey 1 year after intake.

METHODS

Examined association of 1-year abstinence with baseline characteristics. Using logistic regression, we examined characteristics predicting 1-year abstinence and predicting having fewer than four substance-using friends at 1 year.

RESULTS

We found that family environment scores related to family conflict, limit setting, and positive family experiences, were not related to abstinence outcomes, but peer networks were related. Adolescents with fewer (less than four) AOD-using friends were more likely to be abstinent than those with four or more AOD-using friends (65% vs. 41%, p= .0002). Having fewer than four AOD-using friends at intake predicted abstinence at 1 year (odds ratio [OR]= 2.904, p= .0002) and also predicted having fewer than four AOD-using friends at 1 year (OR= 2.557, p= 0.0007).

CONCLUSIONS

Although family environment is an important factor in the development of AOD problems in adolescents, it did not play a significant role in treatment success. The quality of adolescent peer networks did independently predict positive outcomes.

CLINICAL RELEVANCE

For physicians, advanced practice registered nurses, and other primary and behavioral care providers who screen and care for adolescents with AOD and other behavioral problems, our finding suggest the importance of focusing on improving the quality of their peer networks.

Gender differences in the association between family conflict and adolescent substance use disorders

PURPOSE

The objectives of this study were (1) to examine whether the association between childhood family conflict and the risk of substance use disorders (SUDs) in adolescence differs by gender, and (2) to determine whether anxious/depressive symptoms and conduct problems explain this association among adolescent males and females.

METHODS

Data were obtained from 1,421 children aged 10-16 years at the time of enrollment in the Project on Human Development in Chicago Neighborhoods. We assessed gender differences in the association between childhood family conflict and adolescent SUDs by fitting a logistic regression model that included the interaction of gender and family conflict. We also investigated whether conduct problems and anxious/depressive symptoms explained the association between family conflict and SUDs differently for males and females through gender-specific mediation analyses.

RESULTS

The association between childhood family conflict and SUDs in adolescence differed by gender (p = .04). Family conflict was significantly associated with SUDs among females (OR: 1.61; CI: 1.20-2.15), but not among males (OR: 1.00; CI: .76-1.32). The elevated risk of SUDs among females exposed to family conflict was partly explained by girls' conduct problems, but not by anxious/depressive symptoms.

CONCLUSIONS

Females living in families with elevated levels of conflict were more likely to engage in acting out behaviors, which was associated with the development of SUDs. Future epidemiologic research is needed to help determine when this exposure is most problematic with respect to subsequent mental health outcomes and the most crucial time to intervene.

Substance use among adolescents of parents living with HIV in New York City

We examined the relationship of community, interpersonal, and personal risk and protective factors to substance use among adolescents of parents with HIV (PWH). Families with HIV (n = 269 PWH and 409 adolescents) from New York City were recruited, and multivariate models were used to examine the associations. Adjusting for age, gender, and ethnicity, substance use was positively associated in univariate analyses with parental substance use, family conflict, adolescent emotional distress, and adverse life events; having academically oriented friends and religiosity were protective. In the multivariate model, multiple problem behaviors (e.g., delinquency) and substance-using peers were significantly associated with substance use. The patterns of associations between the risk factors and substance use are similar to those of adolescents in families not impacted by HIV. Interventions aimed at improving parental care, reducing maladaptive peer networks, and decreasing problem behaviors are important strategies to explore in future prevention studies.

MLD. Caracterización de estudiantes de la carrera de enfermería sobre consumo de drogas lícitas e ilícitas

Se trata de un estudio cuantitativo, descriptivo y transversal que buscó caracterizar el uso de drogas entre estudiantes del segundo año de la carrera de Licenciatura en Enfermería. Se aplicó un cuestionario autoadministrado a 119 estudiantes, el que se dividió en información: general, sociodemográfica, económica, personal, familiar, sociocultural y, sobre el consumo de drogas. El estudio evidenció que los estudiantes poseen factores protectores para la prevención del consumo o el avance del uso problemático de drogas; pero, por otro lado poseen también factores de riesgo importantes que deben ser tomados en cuenta en programas de prevención, por ejemplo: estilos de vida no saludables, consumo de drogas de personas cercanas a ellos (familiares, amigos o compañeros). A pesar de que el alcohol y tabaco ocupan el primer lugar de consumo, tanto en el entorno inmediato del grupo de estudiantes seleccionados como en el ámbito nacional, ellos no lo consideran un problema tan grande si comparado con las drogas ilícitas.

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

AIMS

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

DESIGN

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

MEASURES

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

FINDINGS

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

CONCLUSIONS

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

Self-initiated tobacco cessation and substance use outcomes among adolescents entering substance use treatment in a managed care organization

PURPOSE

Adolescents with substance use (SU) problems have high rates of tobacco use, yet SU treatment has historically ignored treatment for tobacco use. Barriers to such efforts include the belief that tobacco cessation could compromise other SU abstinence. This study examines self-initiated tobacco cessation and 12-month alcohol and drug abstinence in adolescents entering SU treatment in a private, managed care organization.

RESULTS

Self-initiated tobacco cessation at 6 months, and at both 6 and 12 months, were related to higher odds of drug abstinence but not alcohol abstinence.

CONCLUSION

Self-initiated tobacco cessation was not related to poor SU outcomes, and may be important to maintaining drug abstinence. Implementing tobacco cessation efforts in SU treatment can be challenging, but comprised SU outcomes may not be a barrier. The positive associations for drug abstinence and lack of associations for alcohol abstinence could be due to differences in motivation, medical conditions, or to the illicit nature of drug use. Tobacco use has serious long-term health consequences, and tobacco cessation efforts in adolescent SU treatment programs need further research.

Living without a strong father figure: a context for teen mothers' experience of having become sexually active

Family dynamics have often been considered central to understanding high risk behavior among adolescents. During a phenomenological study of their experiences of having become sexually active, ten teen mothers shared their personal stories. Some of the information shared represented features of the teens' life-world, or the context of their experiences. One feature of the life-world the participants described, living without a strong father figure, was seen as an important general context for these teens' experiences of having become sexually active. While there is evidence in the literature that growing up with an absent father is related to early onset of sexual activity, the experience of a father who might be present but not emotionally connected to his daughter has not been well explored. Therefore, this research offers a richer and deeper perspective on teen sexual behavior.

The experience of having become sexually active for teen mothers

The purpose of this phenomenological study was to describe teen mothers' experience of having become sexually active. Most scholars who have studied teen sexual behavior have used quantitative methods and measured constructs such as self-esteem. Prior to data-gathering, literature about teen sexual behavior was reviewed and set aside to enable a more direct focus on data. Parental consent for participation was obtained for participants under 18. Of the 10 participants (aged 16 to 19 years), all had at least one living child. Each participant took part in 3 audiotaped interviews. Data about perceptions, actions, and intentions were compared across each participant's interviews and interviews of all participants. Four phenomena were discerned as ways in which participants had structured their experiences: (a) making a safe place, (b) redefining myself, (c) creating my own life story, and (c) engaging with the unknown. Compared to prior literature, the phenomena offer a richer and deeper perspective on teen sexual behavior. Findings suggest that efforts to increase perceptions of safety, to support personal identity, to bolster creativity, and to offer exploratory opportunities beyond sexual encounters could enhance effectiveness of programs designed to prevent early-onset sexual activity.

Substance use, education, employment, and criminal activity outcomes of adolescents in outpatient chemical dependency programs

Although the primary outcome of interest in clinical evaluations of addiction treatment programs is usually abstinence, participation in these programs can have a wide range of consequences. This study evaluated the effects of treatment initiation on substance use, school attendance, employment, and involvement in criminal activity at 12 months post-admission for 419 adolescents (aged 12 to 18) enrolled in chemical dependency recovery programs in a large managed care health plan. Instrumental variables estimation methods were used to account for unobserved selection into treatment by jointly modeling the likelihood of participation in treatment and the odds of attaining a certain outcome or level of an outcome. Treatment initiation significantly increased the likelihood of attending school, promoted abstinence, and decreased the probability of adolescent employment, but it did not significantly affect participation in criminal activity at the 12-month follow-up. These findings highlight the need to address selection in a non-experimental study and demonstrate the importance of considering multiple outcomes when assessing the effectiveness of adolescent treatment.

Práticas educativas parentais: a percepção de adolescentes com e sem dependência química

O uso de drogas vem acontecendo de forma cada vez mais precoce e com substâncias mais nocivas. Pesquisas nesta área procuram identificar os fatores de risco e de proteção, sendo que a família ou, mais especificamente, as práticas educativas parentais, podem atuar como ambos. O presente artigo teve como objetivo principal investigar a percepção das práticas educativas parentais de adolescentes com e sem diagnóstico de dependência química. Participaram da pesquisa 48 adolescentes de ambos os sexos, com idades variando entre 14 e 19 anos. Os participantes foram divididos em dois grupos (com e sem diagnóstico de dependência química) com 24 participantes cada um. Os dois grupos foram pareados de acordo com gênero, idade e nível socioeconômico. Foram aplicados dois instrumentos: o Questionário de Fatores de Risco para Dependência Química e o Parents' Report. Para a análise estatística foram utilizados o teste do Qui-Quadrado e o teste de Mann-Whitney. Os resultados mostraram que houve diferença significativa entre as percepções dos dois grupos: enquanto as práticas educativas parentais socialmente desejáveis estavam mais associadas aos participantes sem diagnóstico de dependência química, as práticas socialmente indesejáveis estavam mais associadas aos participantes com diagnóstico.

Outpatient drug abuse treatment for Hispanic adolescents

The objective of this article is to review the state of the science in evidence-based drug abuse treatments for Hispanic adolescents, highlight scientific opportunities, and offer recommendations to further the field of drug abuse treatment for this population. The article is divided into seven sections: boundaries for this review, drug abuse and associated problems, behavioral treatment, cultural issues in hispanic adolescent behavioral drug abuse treatment, pharmacological treatment, gender differences in treatment, and scientific opportunities/recommendations. Although only one treatment approach, Brief Strategic Family Therapy, has been empirically shown to be efficacious in treating Hispanic adolescent drug abusers, with some modifications other treatments may also have the potential to be efficacious with Hispanic adolescents. Family-based approaches, which typically appear to be most efficacious with adolescents in general, may also have the greatest potential to treat drug abuse in Hispanic adolescents.

Adolescents entering chemical dependency treatment in private managed care: ethnic differences in treatment initiation and retention

PURPOSE

There has been little research on adolescents of different ethnicities in chemical dependency (CD) treatment, despite a focus on ethnic disparities in health care in recent years. In particular, little is known about ethnic differences in utilization of adolescent CD services.

METHODS

We examined treatment initiation and treatment retention in a sample of African American, Native American, Latino, Asian American, and Caucasian adolescents entering CD treatment in a private, managed care health plan (n = 419). Our conceptual framework included ethnicity as the main factor as well as measures of external pressure and internal motivation/readiness for treatment, family environment, psychiatric co-morbidities, and severity of alcohol and drug problems. Logistic and Poisson regression were used to examine differences.

RESULTS

The study found ethnic differences in treatment initiation and treatment retention. Native American adolescents had lower odds of returning after intake to initiate treatment compared with Caucasians (odds ratio [OR] .35, p = .009), and African American youth spent less time in treatment than Caucasians (RR: .49, p < .001).

CONCLUSIONS

Study findings indicate differences in treatment initiation for Native Americans and in treatment retention for African Americans. Intake and orientation sessions offer an opportunity to intervene with Native American youth. Given their high psychiatric co-morbidity, they may also benefit from the availability of psychiatric services. Even after adjusting for severity, we found shorter treatment retention for African American adolescents and suggest that organizational factors, such as cultural competency, may play an important role.