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Boson K, Anderberg M, Melander Hagborg J, Wennberg P, Dahlberg M. Adolescents with substance use problems in outpatient treatment: a one-year prospective follow-up study focusing on mental health and gender differences. Subst Abuse Treat Prev Policy 2022; 17:53. [PMID: 35840967 PMCID: PMC9284845 DOI: 10.1186/s13011-022-00482-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Although several studies have found a high incidence of coexisting mental health problems among adolescents with substance use problems, follow-up studies addressing how these conditions change over time are rare. The study will describe and analyze indications of mental health problems and how various risk factors predict outcomes 1 year after initial treatment contact. In addition, gender-specific risk factors are explored. Methods A clinical sample of 455 adolescents (29% girls, median age 17 years) answered a structural interview at baseline and were followed up using official records 1 year after initiated treatment. Bivariate associations and logistic regressions were conducted to analyse the links between risk factors at the individual, social, and structural levels as well as links between various mental illness symptoms at treatment start and indications of mental health problems 1 year later were analysed. Results The results show that mental health problems among adolescents largely persisted 1 year after start of outpatient care for substance use problems. Forty-two per cent of the sample displayed indications of mental health problems at follow-up, and registrations for both outpatient treatment and psychiatric medication were more common among the girls. Girls also reported more mental illness symptoms at treatment start than boys did, especially anxiety. Depression and suicidal thoughts had predictive values regarding indications of mental health problems and small cumulative effects were found for 6–10 co-occurring risk factors. Conclusions Adolescents with depression and suicidal thoughts at treatment start should yield attention among clinicians as these general risk factors could predict indication of mental health problems at 1 year follow-up effectively. Also, patients with more than six co-occurring risk factors seem more vulnerable for continued mental health problems. Generally, girls displayed a greater mental health and psychosocial burden at treatment initiation and were more likely to show indication of mental health problems at follow-up. These results suggests that girls are more likely to get psychiatric out-treatment parallel to, or after, substance abuse treatment. We recommend further investigation of gender differences and gender-specific needs in substance use treatment.
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Anderberg M, Dahlberg M, Wennberg P. Adolescents with substance abuse problems in outpatient treatment: A one-year prospective follow-up study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 38:466-479. [PMID: 35308818 PMCID: PMC8900184 DOI: 10.1177/1455072521995611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
Aim: There is a lack of knowledge about how adolescents with substance abuse problems manage after taking part in treatment. It is also difficult to perform traditional follow-up studies with this group. This article presents the outcome of a prospective study of 455 adolescents who underwent outpatient treatment, based on data taken from official registers. It aims to describe and analyse indications of continued use of substance (CUS) and how various risk and protective factors predict outcomes after initiated treatment at a Maria clinic in Sweden. Design: The study is based on structured interviews at intake, and the data that indicated CUS were taken from several different national registers. The analyses included descriptive data and bivariate associations, logistic regressions and a CHAID analysis. Results: Almost two thirds of the adolescents have no indication of CUS at one-year follow-up. The ten studied risk factors independently were weak predictors of CUS and it was instead the accumulation of risk factors that were linked to a negative outcome. Conclusion: The majority of adolescents who start outpatient treatment for substance abuse problems return to a lesser extent in registers that may indicate a continued problem with alcohol and drugs one year later. A concentration of more than five risk factors appears to be associated with a registration. The study also provides an example of an alternative method for following up adolescents with alcohol and drug abuse problems.
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Wiedmann M, Atzendorf J, Basedow LA, Roessner V, Golub Y, Kuitunen-Paul S. [Substance Use, Resulting Disorders, and Collateral Mental Disorders Among Adolescents in a Special Outpatient Institutions for Addictions]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2022; 50:105-119. [PMID: 35005989 DOI: 10.1024/1422-4917/a000846] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Substance Use, Resulting Disorders, and Collateral Mental Disorders Among Adolescents in a Special Outpatient Institutions for Addictions Abstract. Objective: Only few clinics offer the outpatient treatment of substance use disorders (SUDs) among adolescents. Therefore, only limited data describe substance use patterns, SUDs, and co-occurring psychiatric disorders characteristic of adolescents who present in such outpatient clinics specialized in the treatment of SUDs. Method: Via interview we collected data from n = 201 patients between 12 and 19 years concerning their substance use, SUDs, and current co-occurring psychiatric disorders. We created descriptive presentation of data regarding use patterns, SUDs, and co-occurring disorders divided by sex and current age. Results: Tobacco (88 %) and cannabis (86 %) were the most frequently used substances. 67 % of all patients presented with more than one SUD, cannabis use disorder being the most prevalent one (84 %). 72 % presented with at least one co-occurring disorder, with conduct disorders (40 %), attention deficit (hyperactivity) disorders (21 %), and depressive disorders (18 %) being the most frequent ones. Conclusions: Adolescent SUD patients often present with co-occurring psychiatric disorders. Institutions for adolescent SUD treatment should also focus on treating co-occurring conduct disorders, depression, and attention deficit disorders.
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Affiliation(s)
- Melina Wiedmann
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, Technische Universität Dresden, Dresden
| | - Josefine Atzendorf
- Munich Center for the Economics of Aging (MEA), Max-Plank-Institut für Sozialrecht und Sozialpolitik, München
| | - Lukas Andreas Basedow
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, Technische Universität Dresden, Dresden
| | - Veit Roessner
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, Technische Universität Dresden, Dresden
| | - Yulia Golub
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, Technische Universität Dresden, Dresden
| | - Sören Kuitunen-Paul
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, Technische Universität Dresden, Dresden
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4
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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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Yonek JC, Velez S, Satre DD, Margolis K, Whittle A, Jain S, Tolou-Shams M. Addressing adolescent substance use in an urban pediatric federally qualified health center. J Subst Abuse Treat 2021; 135:108653. [PMID: 34840042 DOI: 10.1016/j.jsat.2021.108653] [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: 02/23/2021] [Revised: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Screening, brief intervention, and referral to treatment (SBIRT) is a systematic approach to identification and intervention for individuals at risk for substance use disorders. Prior research indicates that SBIRT is underutilized in pediatric primary care. Yet few studies have examined procedures for identifying and addressing substance use in clinics that serve publicly insured adolescents (i.e., federally qualified health centers [FQHC]). This descriptive, multi-method study assessed adolescent substance use frequency and provider perspectives to inform SBIRT implementation in an urban pediatric FQHC in California. METHODS A medical record review assessed substance use frequency and correlates among publicly insured adolescents aged 12-17 years who completed a well-child visit in pediatric primary care between 2014 and 2017 (N = 2252). Data on substance use (i.e., alcohol, illicit drugs, and tobacco) were from a health assessment tool mandated by Medicaid. Semi-structured interviews with 12 providers (i.e., pediatricians, nurse practitioners, behavioral health clinicians) elicited information about the current clinic workflow for adolescent substance use and barriers and facilitators to SBIRT implementation. RESULTS Of 1588 adolescents who completed the assessment (70.5%), 6.8% reported current substance use. Self-reported use was highest among non-Hispanic Black (15.2%) adolescents and those with co-occurring depressive symptoms (14.4%). Provider-reported challenges to implementing SBIRT included a lack of space for confidential screening and a lack of referral options. Providers favored implementing technology-based tools such as tablets for adolescent pre-visit screening and electronic medical record-based decision support to facilitate brief intervention and treatment referrals. CONCLUSIONS This study fills a substantial research gap by examining factors that impede and support SBIRT implementation in pediatric FQHC settings. Successful SBIRT implementation in these settings could significantly reduce the unmet need for substance use treatment among uninsured and publicly insured adolescents. Pediatric primary care and urgent care providers perceived SBIRT to be feasible, and health information and digital technologies may facilitate the integration of SBIRT into clinic workflows. Ensuring confidentiality for screening and expanding referral options for adolescents in need of community-based addiction treatment are also critical to increasing SBIRT uptake.
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Affiliation(s)
- Juliet C Yonek
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Sarah Velez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States.
| | - Kathryn Margolis
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Amy Whittle
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Shonul Jain
- Department of Pediatrics at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 6B, San Francisco, CA 94110, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Building 5, Suite 7M, San Francisco, CA 94110, United States.
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Predictors and moderators of marijuana and heavy alcohol use outcomes in adolescents treated for co-occurring substance use and psychiatric disorders in a randomized controlled trial. J Subst Abuse Treat 2021; 131:108536. [PMID: 34238628 DOI: 10.1016/j.jsat.2021.108536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/15/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The current study identifies predictors and moderators of substance use outcomes for 111 adolescents with co-occurring substance use and psychiatric disorders who participated in a randomized controlled trial that compared the effectiveness of two home-based treatments: an integrated cognitive behavioral therapy (I-CBT) protocol, in which masters-level clinic staff received intensive training and ongoing supervision in the use of this protocol versus a treatment-as-usual (TAU) comparison condition in which therapists received a continuing education-style CBT workshop in the same protocol. METHOD The study conducted exploratory predictor and moderator analyses of marijuana and heavy alcohol use outcomes using candidate variables across four domains of psychological characteristics: adolescent substance use, adolescent psychiatric symptoms, parent, and family. RESULTS Regardless of treatment condition, low parental monitoring at baseline, as assessed by a videotaped interaction task, but not self-report, predicted greater percentage of marijuana use and heavy alcohol use days over the 6-month follow-up period. If parents entered treatment with low levels of parental monitoring, adolescents in the I-CBT condition reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU over the 6-month follow-up period. Greater adolescent aggression and parental emotion dysregulation at baseline also predicted greater percentage of marijuana use days over the 6-month follow-up period for the sample as a whole. Adolescents in the I-CBT condition who reported low positive urgency at baseline reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU care over the 6-month follow-up period. CONCLUSION The article discusses implications for clinical decision-making, improving treatment effectiveness, and tailoring interventions for adolescents with co-occurring substance use and psychiatric disorders.
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7
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MacPherson HA, Wolff J, Nestor B, Frazier E, Massing-Schaffer M, Graves H, Esposito-Smythers C, Spirito A. Parental Monitoring Predicts Depressive Symptom and Suicidal Ideation Outcomes in Adolescents Being Treated for Co-Occurring Substance Use and Psychiatric Disorders. J Affect Disord 2021; 284:190-198. [PMID: 33607509 PMCID: PMC7926270 DOI: 10.1016/j.jad.2021.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Comorbidity of substance use disorders (SUDs) with mood disorders and other psychiatric conditions is common. Parenting processes and family functioning are impaired in adolescents with SUDs and mood disorders, and parent/family factors predict intervention response. However, limited research has examined the relationship between parent/family factors and mood symptom treatment response in adolescents with comorbid SUDs and psychiatric conditions. METHOD This study examined the predictive effects of parenting processes and family functioning on depressive symptoms and suicidal ideation (SI) in a randomized controlled trial of integrated cognitive-behavioral therapy vs. treatment as usual for 111 adolescents with comorbid SUDs and psychiatric disorders. Measures of parenting processes, family functioning, depressive symptoms, and SI were completed at baseline and 3-, 6-, and 12-month follow-ups. Exploratory analyses involved mixed-effects regression models. RESULTS Across treatment conditions, depressive symptoms and SI improved over 12 months. Family functioning domains of family roles (d=0.47) and affective involvement (d=0.39) significantly improved across treatment conditions over 12 months. Higher baseline parental monitoring predicted improved trajectory of depressive symptoms (d=0.44) and SI (d=0.46). There were no significant predictive effects for baseline family functioning or other parenting processes (listening, limit setting). LIMITATIONS Limitations include the modest sample, attrition over follow-up, and generalizability to samples with higher rates of mood disorders and/or uncomplicated mood disorders. CONCLUSIONS Parental monitoring may be an important prognostic indicator of depressive symptoms and SI in adolescents with co-occurring SUDs and psychiatric conditions, and therefore may be useful to assess and target in treatment, in addition to family functioning.
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Affiliation(s)
- Heather A. MacPherson
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA,Emma Pendleton Bradley Hospital, East Providence, RI,
USA,Corresponding Author: Heather A. MacPherson, 1011
Veterans Memorial Parkway, East Providence, RI 02915, Phone: (401) 432-1162,
Fax: (401) 432-1607,
| | - Jennifer Wolff
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA,Rhode Island Hospital, Providence, RI, USA
| | - Bridget Nestor
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
| | - Elisabeth Frazier
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA,Emma Pendleton Bradley Hospital, East Providence, RI,
USA
| | - Maya Massing-Schaffer
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
| | - Hannah Graves
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
| | | | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert
Medical School of Brown University, Providence, RI, USA
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8
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Parthasarathy S, Kline-Simon AH, Jones A, Hartman L, Saba K, Weisner C, Sterling S. Three-Year Outcomes After Brief Treatment of Substance Use and Mood Symptoms. Pediatrics 2021; 147:peds.2020-009191. [PMID: 33372122 PMCID: PMC7786828 DOI: 10.1542/peds.2020-009191] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Screening, brief intervention, and referral to treatment (SBIRT) for adolescents exhibiting co-occurring substance use and mental health problems may improve outcomes and have long-lasting effects. This study examined the relationship between access to SBIRT and substance use, depression and medical diagnoses, and health services use at 1 and 3 years postscreening for such adolescents. METHODS The study draws from a cluster-randomized trial comparing SBIRT to usual care (UC) for adolescents endorsing past-year substance use and recent mood symptoms during visits to a general pediatrics clinic between November 1, 2011, and October 31, 2013, in a large, integrated health system (N = 1851); this sample examined the subset of adolescents endorsing both problems (n = 289). Outcomes included depression, substance use and medical diagnoses, and emergency department and outpatient visits 1 and 3 years later. RESULTS The SBIRT group had lower odds of depression diagnoses at 1 (odds ratio [OR] = 0.31; confidence interval [CI] = 0.11-0.87) and 3 years (OR = 0.51; CI = 0.28-0.94) compared with the UC group. At 3 years, the SBIRT group had lower odds of a substance use diagnosis (OR = 0.46; CI = 0.23-0.92), and fewer emergency department visits (rate ratio = 0.65; CI = 0.44-0.97) than UC group. CONCLUSIONS The findings suggest that SBIRT may prevent health complications and avert costly services use among adolescents with both mental health and substance use problems. As SBIRT is implemented widely in pediatric primary care, training pediatricians to discuss substance use and mental health problems can translate to positive outcomes for these vulnerable adolescents.
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Affiliation(s)
- Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and
| | - Andrea H. Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and
| | - Ashley Jones
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and
| | | | - Katrina Saba
- The Permanente Medical Group, Oakland, California
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and
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9
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Wolff J, Esposito-Smythers C, Frazier E, Stout R, Gomez J, Massing-Schaffer M, Nestor B, Cheek S, Graves H, Yen S, Hunt J, Spirito A. A randomized trial of an integrated cognitive behavioral treatment protocol for adolescents receiving home-based services for co-occurring disorders. J Subst Abuse Treat 2020; 116:108055. [PMID: 32741505 PMCID: PMC9106275 DOI: 10.1016/j.jsat.2020.108055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/17/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022]
Abstract
The current study conducted a preliminary test of whether community mental health clinic staff could implement a multicomponent cognitive behavioral treatment, developed for adolescents with substance misuse (alcohol and/or marijuana) and comorbid psychiatric symptoms. We randomized a total of 111 families, with an adolescent 12-18 years old, referred to a home-based services program for youth with co-occurring substance use and mental health problems, to receive treatment from either masters-level therapists who received intensive cognitive behavioral therapy (I-CBT) training or from masters-level therapists who took part in a typical brief continuing education-style CBT workshop (treatment as usual, or TAU). Each family's therapist and insurance company determined the frequency and intensity of treatment. We administered follow-up assessments at 3, 6, and 12 months. There was a small, but not statistically significant, reduction in the percent days of heavy drinking and marijuana use over time for both conditions, with the overall effect across the three follow-up points favoring the I-CBT condition. There were no differences on alcohol use days or other drug use. There was also a small, but nonsignificant, positive effect over time on externalizing symptoms, depressed mood, and anxiety, favoring the I-CBT condition. Youth in the I-CBT condition relative to TAU had significantly fewer juvenile justice contacts, while the pattern of costly service use varied, with higher rates at 6-month and lower rates at 12-month follow-ups. If therapists pay greater attention to parent training and provide more parent-adolescent communication sessions, outcomes may improve above standard community care. Training enhancements, to better meet the needs of community therapists and their clinic settings, may also produce better overall results for parents and adolescents.
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Affiliation(s)
- Jennifer Wolff
- Brown University, Department of Psychiatry and Human Behavior, United States of America; Rhode Island Hospital, Providence, RI, United States of America.
| | | | - Elisabeth Frazier
- Brown University, Department of Psychiatry and Human Behavior, United States of America; Emma Pendleton Bradley Hospital, Riverside, RI, United States of America
| | - Robert Stout
- Brown University, Department of Psychiatry and Human Behavior, United States of America; Decision Sciences Institute, United States of America
| | - Judy Gomez
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Maya Massing-Schaffer
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Bridget Nestor
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Shayna Cheek
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Hannah Graves
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Shirley Yen
- Brown University, Department of Psychiatry and Human Behavior, United States of America
| | - Jeffrey Hunt
- Brown University, Department of Psychiatry and Human Behavior, United States of America; Emma Pendleton Bradley Hospital, Riverside, RI, United States of America
| | - Anthony Spirito
- Brown University, Department of Psychiatry and Human Behavior, United States of America
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10
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Hahn AM, Adams ZW, Chapman J, McCart MR, Sheidow AJ, de Arellano MA, Danielson CK. Risk reduction through family therapy (RRFT): Protocol of a randomized controlled efficacy trial of an integrative treatment for co-occurring substance use problems and posttraumatic stress disorder symptoms in adolescents who have experienced interpersonal violence and other traumatic events. Contemp Clin Trials 2020; 93:106012. [PMID: 32339768 PMCID: PMC7194734 DOI: 10.1016/j.cct.2020.106012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022]
Abstract
Decades of research demonstrate that childhood exposure to traumatic events, particularly interpersonal violence experiences (IPV; sexual abuse, physical abuse, witnessing violence), increases risk for negative behavioral and emotional outcomes, including substance use problems (SUP) and posttraumatic stress disorder (PTSD). Despite this well-established link-including empirical support for shared etiological and functional connections between SUP and PTSD -the field has been void of a gold standard treatment for adolescent populations. To address this gap, our team recently completed a large randomized controlled trial to evaluate the efficacy of Risk Reduction through Family Therapy (RRFT), an integrative and exposure-based risk-reduction and treatment approach for adolescents who have experienced IPV and other traumatic events. The purpose of this paper is to provide a detailed description of the design and methods of this RCT designed to reduce SUP, PTSD symptoms, and related risk behaviors, with outcomes measured from pre-treatment through 18 months post-entry. Specifically, the recruitment and sampling procedures, assessment measures and methods, description of the intervention, and planned statistical approaches to evaluating the full range of outcomes are detailed. Clinical and research implications of this work are also discussed.
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Affiliation(s)
- Austin M Hahn
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Zachary W Adams
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | - Michael A de Arellano
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Carla Kmett Danielson
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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11
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Danielson CK, Adams Z, McCart MR, Chapman JE, Sheidow AJ, Walker J, Smalling A, de Arellano MA. Safety and Efficacy of Exposure-Based Risk Reduction Through Family Therapy for Co-occurring Substance Use Problems and Posttraumatic Stress Disorder Symptoms Among Adolescents: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:574-586. [PMID: 32022827 PMCID: PMC7042939 DOI: 10.1001/jamapsychiatry.2019.4803] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE No empirically supported treatments have been evaluated to address co-occurring substance use problems (SUP) and posttraumatic stress disorder (PTSD) symptoms among adolescents in an integrative fashion. This lack is partially owing to untested clinical lore suggesting that delivery of exposure-based PTSD treatments to youth with SUP might be iatrogenic. OBJECTIVE To determine whether an exposure-based, integrative intervention for adolescents with SUP and PTSD symptoms-risk reduction through family therapy (RRFT)-resulted in improved outcomes relative to a treatment-as-usual (TAU) control condition consisting primarily of trauma-focused cognitive behavioral therapy. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial enrolled 124 participants who were recruited from November 1, 2012, through January 30, 2017. Adolescents (aged 13-18 years) who engaged in nontobacco substance use at least once during the past 90 days, experienced at least 1 interpersonal traumatic event, and reported 5 or more PTSD symptoms were enrolled. Blinded assessments were collected at baseline and at 3, 6, 12, and 18 months after baseline. Recruitment and treatment took place in community-based child advocacy centers in the Southeastern United States. Data were analyzed from August 2 through October 4, 2018, and were based on intention to treat. INTERVENTIONS Participants were randomized to receive RRFT (n = 61) or TAU (n = 63). MAIN OUTCOMES AND MEASURES Primary outcomes focused on number of nontobacco substance-using days measured with the timeline follow-back method and PTSD symptom severity using the UCLA (University of California, Los Angeles) PTSD Reaction Index for DSM-IV completed by adolescents and caregivers. Secondary outcomes focused on marijuana, alcohol, and polysubstance use and PTSD criterion standard (re-experiencing, avoidance, and hyperarousal) symptom severity. RESULTS In all, 124 adolescents (mean [SD] age, 15.4 [1.3] years; 108 female [87.1%]) were randomized. For primary outcomes relative to TAU, RRFT yielded significantly greater reductions in substance-using days from baseline to month 12 (event rate [ER], 0.28; 95% CI, 0.12-0.65) and month 18 (ER, 0.10; 95% CI, 0.04-0.24). Significant reductions in PTSD symptoms were observed within groups for RRFT from baseline to months 3 (β = -9.25; 95% CI, -12.95 to -5.55), 6 (β = -16.63; 95% CI = -20.40 to -12.87), 12 (β = -17.51; 95% CI, -21.62 to -13.40), and 18 (β = -19.02; 95% CI, -23.07 to -14.96) and for TAU from baseline to months 3 (β = -9.62; 95% CI, -13.16 to -6.08), 6 (β = -13.73; 95% CI, -17.43 to -10.03), 12 (β = -15.53; 95% CI, -19.52 to -11.55), and 18 (β = -13.88; 95% CI, -17.69 to -10.09); however, between-group differences were not observed. CONCLUSIONS AND RELEVANCE In this study, RRFT and TAU demonstrated within-group improvements in SUP and PTSD symptoms, with greater improvement for substance use and PTSD avoidance and hyperarousal symptoms among adolescents randomized to RRFT compared with TAU. No evidence of the worsening of SUP was observed in either condition. These results suggest that this exposure-based treatment is safe, feasibly delivered by community-based clinicians, and offers an effective approach to inform clinical practice. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01751035.
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Affiliation(s)
- Carla Kmett Danielson
- Department of Psychiatry & Behavioral Sciences, National Crime Victims Research & Treatment Center, Medical University of South Carolina, Charleston
| | - Zachary Adams
- Adolescent Behavioral Health Research Program, Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | | | | | | | - Jesse Walker
- Department of Psychiatry & Behavioral Sciences, National Crime Victims Research & Treatment Center, Medical University of South Carolina, Charleston
| | - Anna Smalling
- Dee Norton Child Advocacy Center, Charleston, South Carolina
| | - Michael A. de Arellano
- Department of Psychiatry & Behavioral Sciences, National Crime Victims Research & Treatment Center, Medical University of South Carolina, Charleston
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Moise C, Varma M, Stewart D. Interpersonal Consequences Predicting Adolescent Substance Use: Examining the Role of Temptation Coping, Motivation, and Impulsivity. Subst Use Misuse 2020; 55:1640-1649. [PMID: 32460576 DOI: 10.1080/10826084.2020.1756848] [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: 10/24/2022]
Abstract
Background: Adolescent substance use is highly prevalent and problematic; it has been reported as one of the most pertinent leading health concerns in the United States. The current longitudinal study examined the presence of peer and parental interpersonal relationship consequences (IP) as a motivating factor in activating coping skills to decrease the frequency of adolescent substance use, while further evaluating the role of impulsivity within that process. Objectives: Two main hypotheses were proposed: (1) IP will decrease substance use frequency mediated by increases in motivation and temptation coping; and (2) impulsivity will moderate the link between coping and substance use frequency. Participants included 343 adolescents between the ages of 13-19 (M = 16.23) referred to Project READY, a school-based substance use intervention. Assessments were completed during Sessions 1 and 4 of the intervention. Results: Serial mediation analyses indicated temptation coping, baseline alcohol use, and Time 2 marijuana use were the only statistically significant predictors of Time 2 alcohol use. Temptation coping and baseline marijuana use were the only statistically significant predictors of Time 2 marijuana use. Conclusions: Once adolescents' baseline and concurrent substance use were incorporated into the model, there was no statistical significance of the indirect effects. Results provided a stronger examination of the factors related to long-term substance use among adolescents. Knowing that temptation coping and baseline substance use levels were significant predictors of time 2 substance use independent of interpersonal consequences and motivation to change provides a structural frame and highlights need for early intervention.
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Affiliation(s)
- Claudine Moise
- Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts, USA
| | - Malini Varma
- School of Psychology Family and Community, Clinical Psychology, Seattle Pacific University, Seattle, Washington, USA
| | - David Stewart
- Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts, USA
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Bagot KS, Kaminer Y. Harm Reduction for Youth in Treatment for Substance Use Disorders: One Size Does Not Fit All. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0217-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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14
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Sterling S, Kline-Simon AH, Jones A, Satre DD, Parthasarathy S, Weisner C. Specialty addiction and psychiatry treatment initiation and engagement: Results from an SBIRT randomized trial in pediatrics. J Subst Abuse Treat 2017; 82:48-54. [PMID: 29021115 PMCID: PMC5679476 DOI: 10.1016/j.jsat.2017.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Many adolescents needing specialty addiction or psychiatry treatment never access care. We examined initiation and engagement with addiction and/or psychiatry treatment among adolescents referred to treatment from a trial comparing two different modalities of delivering Screening, Brief Intervention and Referral to Treatment (SBIRT) to Usual Care in pediatric primary care. We hypothesized that both intervention arms would have higher initiation and engagement rates than usual care. METHODS We randomized all pediatricians (n=52) in a pediatric primary care clinic to three arms: 1) pediatrician-only arm, in which pediatricians were trained to deliver SBIRT for substance use and/or mental health problems; 2) embedded-behavioral health clinician (embedded-BHC arm), in which pediatricians referred adolescents who endorsed substance use and/or mental health problems to a BHC; and 3) Usual Care (UC). We used electronic health record (EHR) data to examine specialty addiction and psychiatry treatment initiation and engagement rates after referral. RESULTS Among patients who screened positive for substance use and/or mental health problems and were referred to specialty addiction and/or psychiatry (n=333), those in the embedded-BHC arm had almost four times higher odds of initiating treatment than those in the pediatrician-only arm, OR=3.99, 95% CI=[1.99-8.00]. Compared to UC, those in the pediatrician-only arm had lower odds of treatment initiation (OR=0.53, 95% CI=[0.28-0.99]), while patients in the embedded-BHC arm had marginally higher odds (OR=1.83, 95% CI=[0.99-3.38]). Black patients and those with other/unknown race/ethnicity had lower odds of treatment initiation compared with white adolescents; there were no gender or age differences. We found no differences in treatment engagement across the three arms. CONCLUSIONS Embedded BHCs can have a significant positive impact on facilitating treatment initiation for pediatric primary care adolescents referred to addiction and/or psychiatry services. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov #NCT02408952.
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Affiliation(s)
- Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403, United States.
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403, United States.
| | - Ashley Jones
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403, United States.
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403, United States; Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States.
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403, United States.
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403, United States; Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States.
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15
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Northam JC, Magor-Blatch LE. Adolescent therapeutic community treatment – an Australian perspective. THERAPEUTIC COMMUNITIES 2016. [DOI: 10.1108/tc-01-2016-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to provide an overview of the adolescent therapeutic community (ATC) literature – drawing on studies primarily from the USA with consideration made to the Australian context.
Design/methodology/approach
A review of the efficacy research for ATCs is considered, and the characteristics of Australians accessing ATC treatment are discussed in the context of developmental needs.
Findings
Similarities are found in what precipitates and perpetuates adolescent substance use in the USA and Australia, and therefore, what appears to facilitate effective treatment utilising the therapeutic community model.
Originality/value
The paper provides a valuable perspective for Australian services, and explores the application of the ATC model within the Australian treatment context.
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Mason MJ, Aplasca A, Morales-Theodore R, Zaharakis N, Linker J. Psychiatric Comorbidity and Complications. Child Adolesc Psychiatr Clin N Am 2016; 25:521-32. [PMID: 27338972 DOI: 10.1016/j.chc.2016.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article highlights the prevalence of co-occurring disorders among adolescents and underscores the complexity and opportunities of treating these patients in a systematic, comprehensive approach. As evidenced by this review, the need exists to develop and test models of care that integrate co-occurring disorders into both psychiatric and substance abuse treatment settings. The challenge for pediatric practitioners is to provide detailed assessments linked to evidence-based treatment plans to account for the variations in adolescent development and the unique risk factor profile of each patient. The issues related to co-morbidity are vast and continue to grow with rapidly increasing research literature.
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Affiliation(s)
- Michael J Mason
- Department of Psychiatry, Commonwealth Institute for Child & Family Studies, Virginia Commonwealth University, 515 North 10th Street, P.O.Box 980489, Richmond, VA 23298-0489, USA.
| | - Alexis Aplasca
- Department of Psychiatry, Commonwealth Institute for Child & Family Studies, Virginia Commonwealth University, 515 North 10th Street, P.O.Box 980489, Richmond, VA 23298-0489, USA
| | - Rosa Morales-Theodore
- Department of Psychiatry, Commonwealth Institute for Child & Family Studies, Virginia Commonwealth University, 515 North 10th Street, P.O.Box 980489, Richmond, VA 23298-0489, USA
| | - Nikola Zaharakis
- Department of Psychiatry, Commonwealth Institute for Child & Family Studies, Virginia Commonwealth University, 515 North 10th Street, P.O.Box 980489, Richmond, VA 23298-0489, USA
| | - Julie Linker
- Department of Psychiatry, Commonwealth Institute for Child & Family Studies, Virginia Commonwealth University, 515 North 10th Street, P.O.Box 980489, Richmond, VA 23298-0489, 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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18
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Chen G, Elisha E, Timor U, Ronel N. Why Do Adolescents Drop Out of a Therapeutic Community for People With Drug Addiction? JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2015. [DOI: 10.1080/1067828x.2014.918002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Mechanisms of Alcohol Use Disorder Severity in Adolescents with Co-occurring Depressive Symptoms: Findings from a School-Based Substance Use Intervention. SCHOOL MENTAL HEALTH 2014. [DOI: 10.1007/s12310-014-9138-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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20
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Godley SH, Smith JE, Passetti LL, Subramaniam G. The Adolescent Community Reinforcement Approach (A-CRA) as a Model Paradigm for the Management of Adolescents With Substance Use Disorders and Co-Occurring Psychiatric Disorders. Subst Abus 2014; 35:352-63. [DOI: 10.1080/08897077.2014.936993] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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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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22
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Do improvements in substance use and mental health symptoms during treatment translate to long-term outcomes in the opposite domain? J Subst Abuse Treat 2014; 47:339-46. [PMID: 25124259 DOI: 10.1016/j.jsat.2014.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 06/26/2014] [Accepted: 06/30/2014] [Indexed: 11/24/2022]
Abstract
Providers who treat adolescents with co-occurring substance use and mental health issues may prioritize treatment of one set of symptoms believing that improvements in one domain will result in improvements of the other. However, limited empirical data for adolescents provide evidence of such "spillover effects." Using data from 2900 youth in an outpatient treatment, we examined whether during-treatment changes in substance use or mental health symptoms predicted 12-month outcomes in the analogous and opposite domains. There was very little evidence of spillover effects, only that youth with no internal distress at 0 and 3 months reported lower levels of substance use problems at 12-months relative to youth with internal distress that stayed the same from 0 to 3 months. These findings suggest that providers treat both sets of substance use and mental health symptoms in an integrated manner given that these symptoms commonly co-occur among youth with either set.
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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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24
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Joe GW, Knight DK, Becan JE, Flynn PM. Recovery among adolescents: models for post-treatment gains in drug abuse treatments. J Subst Abuse Treat 2013; 46:362-73. [PMID: 24238715 DOI: 10.1016/j.jsat.2013.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 09/20/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
Recovery among adolescents undergoing substance abuse treatment was modeled in terms of pre-treatment motivation, therapeutic relationships, psychological functioning, treatment retention, legal pressures, DSM diagnoses, and client demographics. To address between program differences, a within-covariance matrix, based on 547 youth, was used. Applicability of the results across treatment modalities was also examined. The data were from the NIDA-sponsored DATOS Adolescent study. Results from structural equation models (estimated using Mplus) indicated that higher pre-treatment motivation predicted stronger counselor and in-treatment peer relationships, better counselor relationships and retention predicted less illegal drug use at follow-up, and DSM diagnosis was important in the treatment process. Overall, illegal drug use at follow-up was associated with post-treatment alcohol consumption, cigarette use, condom nonuse, psychological distress, criminality, and school non-attendance. The results document the importance of motivation and therapeutic relationships on recovery, even when taking into account the relative effects of legal pressures, DSM diagnoses, and demographics.
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Affiliation(s)
- George W Joe
- Texas Christian University, Fort Worth, TX 76129, USA.
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25
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Godley SH, Hunter BD, Fernández-Artamendi S, Smith JE, Meyers RJ, Godley MD. A comparison of treatment outcomes for adolescent community reinforcement approach participants with and without co-occurring problems. J Subst Abuse Treat 2013; 46:463-71. [PMID: 24462478 DOI: 10.1016/j.jsat.2013.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/16/2013] [Accepted: 10/29/2013] [Indexed: 11/28/2022]
Abstract
This study examined the relationship between Adolescent Community Reinforcement Approach (A-CRA) participation with treatment engagement, retention, and satisfaction, and with substance use and emotional problem outcomes. Participants had substance use disorders (SUD) only or co-occurring substance use and psychiatric problems. Those with co-occurring problems reported more days of substance use and emotional problems at intake to treatment than those with SUD only. All groups received equivalent exposure to A-CRA during treatment implementation. At the 12-month follow-up, adolescents classified as externalizers (n = 468) or those with both externalizing and internalizing problems (n = 674) had significantly greater improvement in their days of abstinence and substance problems relative to adolescents with substance use disorders only (n = 666). Additionally, adolescents reporting symptoms of internalizing (n = 154), externalizing, or both externalizing and internalizing disorders had significantly greater improvements in days of emotional problems relative to adolescents with SUD only.
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Affiliation(s)
- Susan H Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761.
| | | | | | | | | | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61761
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26
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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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Sabri B. Severity of Victimization and Co-Occurring Mental Health Disorders Among Substance Using Adolescents. CHILD & YOUTH CARE FORUM 2012; 41:37-55. [PMID: 23204820 PMCID: PMC3507377 DOI: 10.1007/s10566-011-9151-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND: Co-occurring mental health disorders are widespread among substance using adolescents. Severity of victimization may be an important factor in explaining co-occurrence of mental health problems among adolescents with substance misuse problems. PURPOSE: The purpose of this study was to evaluate whether severe victimization experiences were shared risk factors for internalizing only, externalizing only, and co-occurring internalizing and externalizing disorders among victimized substance-using adolescents. METHOD: Data for this cross-sectional study were obtained from a multisite research project. Adolescents, ages 11-18, participated in a comprehensive screening program for substance abuse at 106 Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT)-funded grantee sites throughout the United States. RESULTS: Longer duration/frequent victimization, more than one type of victimization, and recent victimization were related to co-occurring internalizing and externalizing disorders. Victimization by a trusted person, however, was only related to internalizing disorders. CONCLUSION: The findings show that some indicators of severe victimization experiences are shared risk factors for internalizing, for externalizing, and for co-occurring internalizing and externalizing problems, thus providing support for the common factors model of co-morbidity. These findings suggest that practitioners in substance abuse treatment must thoroughly assess for severe victimization experiences among adolescents presenting with co-occurring mental health issues. Treatment planning and interventions may focus on helping adolescents cope effectively with their victimization experiences and addressing their MH needs.
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Affiliation(s)
- Bushra Sabri
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Sabri B, Coohey C, Campbell J. Multiple victimization experiences, resources, and co-occurring mental health problems among substance-using adolescents. VIOLENCE AND VICTIMS 2012; 27:744-763. [PMID: 23155724 PMCID: PMC3506025 DOI: 10.1891/0886-6708.27.5.744] [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
This study examined the relationship between multiple types of victimization experiences, psychological and social resources, and co-occurring mental health problems among substance-using adolescents. Data for this cross-sectional study were obtained from a multisite research project in which adolescents ages 11-18 years participated in a comprehensive screening program for substance misuse. Multiple types of victimization, low self-efficacy beliefs, lack of support for victimization issues, and available sources of emotional support were positively related to co-occurring mental health problems. These findings suggest that treatment planning and interventions may focus on helping adolescents cope effectively with their victimization experiences and addressing their mental health needs. Particular emphasis may be placed on enhancing self-efficacy and social skills so that adolescents may benefit from their available sources of social support.
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Affiliation(s)
- Bushra Sabri
- Johns Hopkins University, Baltimore, Maryland 21205, USA.
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Morgan TB, Crane DR. Cost-effectiveness of family-based substance abuse treatment. JOURNAL OF MARITAL AND FAMILY THERAPY 2010; 36:486-498. [PMID: 21039660 DOI: 10.1111/j.1752-0606.2010.00195.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In order to compete in a financially sensitive health care system, family systems-based treatments must demonstrate effective clinical results as well as cost-effectiveness. Cost-effectiveness research can demonstrate to health care insurers and policy makers which treatments are viable options for implementation. The present literature review identified eight cost-effectiveness family-based substance abuse treatment studies. The results suggest that certain family-based treatments are cost-effective and warrant consideration for inclusion in health care delivery systems.
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Affiliation(s)
- Triston B Morgan
- Marriage and Family Therapy, Brigham Young University, Provo, Utah 84602, USA.
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Straussner SLA, Byrne H. Alcoholics Anonymous: Key Research Findings from 2002–2007. ALCOHOLISM TREATMENT QUARTERLY 2009. [DOI: 10.1080/07347320903209665] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stathis SL, Letters P, Doolan I, Whittingham D. Developing an integrated substance use and mental health service in the specialised setting of a youth detention centre. Drug Alcohol Rev 2009; 25:149-55. [PMID: 16627304 DOI: 10.1080/09595230500537613] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article describes the frequency of co-morbid substance use and mental health problems of young people within the youth justice system and demonstrates that mental health and drug and alcohol services can be integrated and work effectively. The establishment of an integrated Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) to juveniles in detention represents a shift away from the traditional paradigm of separate services frequently found throughout Australia. The development of referral procedures and adolescent-focused treatment programmes that are tailored to the specific needs of this disadvantaged population are discussed. A wide-ranging literature review illustrates the consequences of the high prevalence of co-morbid substance use and mental health problems in juveniles within the youth justice system. A retrospective and descriptive account is given of the expansion of the MHATODS, including the recruitment of an Indigenous health worker, the incorporation of an automatic referral process for young people with substance use problems and the development of a brief four-session drug and alcohol counselling programme and a group relapse prevention programme. The proportion of Indigenous clients referred to MHATODS is now equitable to referrals of non-Indigenous youth. The introduction of an automatic voluntary referral process resulted in an increase in referrals for drug and alcohol assessment and counselling from 17% to 64% of total referrals. Of those young people commencing the drug and alcohol programme, 32% completed all sessions. While young people reportedly enjoyed the group programme, feedback from participants indicated that they felt vulnerable in a group setting. MHATODS recognises the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has developed an integrated treatment service for juveniles in detention. The service has expanded its referral base for substance use problems by employing an Indigenous health worker, and initiating an automatic referral process for young people admitted into detention who have a history of significant substance use. Early evidence indicates increased utilisation of drug and alcohol services by young people in detention.
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Affiliation(s)
- Stephen L Stathis
- Child and Family Therapy Unit, Royal Children's Hospital, Herston, Australia.
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Garner BR, Godley SH, Funk RR, Dennis ML, Smith JE, Godley MD. Exposure to Adolescent Community Reinforcement Approach treatment procedures as a mediator of the relationship between adolescent substance abuse treatment retention and outcome. J Subst Abuse Treat 2009; 36:252-64. [PMID: 18715742 PMCID: PMC2675944 DOI: 10.1016/j.jsat.2008.06.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 06/13/2008] [Accepted: 06/22/2008] [Indexed: 11/17/2022]
Abstract
Data from 399 adolescents, who participated in one of four randomly controlled trials of the Adolescent Community Reinforcement Approach (A-CRA) intervention, were used to examine the extent to which exposure to A-CRA procedures mediated the relationship between treatment retention and outcomes. Although zero-order correlations indicated that retention in treatment was a significant predictor of alcohol and other drug (AOD) use (r = -0.18, p < .001), this relationship was reduced to nonsignificance (p = .39) when exposure to A-CRA procedures was included in the model. Overall, the final model evidenced a very good fit (root mean square error of approximation = .00; comparative fit index = 1.00) and explained 29% and 43% of the variance in adolescents' posttreatment AOD use and AOD-related problems, respectively. In addition, Chi-Squared Automatic Interaction Detection analysis was used to derive a target level of A-CRA exposure, which was found to be significantly related to being in recovery at follow-up. The current findings are useful, as little research to date has identified significant mediators of the relationship between retention and treatment outcomes or identified target thresholds of treatment exposure.
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Edelen MO, Tucker JS, Wenzel SL, Paddock SM, Ebener P, Dahl J, Mandell W. Treatment process in the therapeutic community: Associations with retention and outcomes among adolescent residential clients. J Subst Abuse Treat 2007; 32:415-21. [PMID: 17481465 DOI: 10.1016/j.jsat.2006.10.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 10/23/2006] [Accepted: 10/27/2006] [Indexed: 11/24/2022]
Abstract
This study examined associations of a new multidimensional measure of therapeutic community (TC) treatment process, the Dimensions of Change Instrument (DCI), with treatment retention (n = 397) and posttreatment outcomes (n = 207) among adolescent residential clients. Adolescents who increased during the first 30 days in treatment on three of the eight DCI factors (Positive Self-Attitude and Commitment to Abstinence; Problem Recognition; Social Network) were more likely to stay in treatment for 90 days or more. Although change in DCI factor scores was not directly predictive of posttreatment outcomes, staying in treatment for 90 days or more increased the likelihood of attending 12-step meetings and having a 12-step sponsor after leaving treatment. Several demographic and pretreatment characteristics also predicted retention, posttreatment outcomes, or both. Much remains to be learned about how the TC treatment process produces positive outcomes for adolescents; however, results from this study highlight components of the treatment process that may be particularly important for practitioners to consider and monitor in their clients.
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Bukstein OG, Cornelius J, Trunzo AC, Kelly TM, Wood DS. Clinical predictors of treatment in a population of adolescents with alcohol use disorders. Addict Behav 2005; 30:1663-73. [PMID: 16165305 DOI: 10.1016/j.addbeh.2005.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 07/12/2005] [Accepted: 07/13/2005] [Indexed: 11/15/2022]
Abstract
The purpose of this paper is to identify potential predictors of treatment utilization, among both psychiatric and drug and alcohol variables. The subjects were 393 adolescents and young adults, age 12.9 to 18.11 years, who met DSM-IV criteria for a lifetime history of either alcohol abuse or alcohol dependence at baseline assessment. DSM-IV psychiatric and AUD diagnoses were obtained by semi-structure interviews (K-SADS and SCID). Other alcohol and drug variables were obtained by the Alcohol Consumption Questionnaire and other self-reports. The results of these analyses suggest that there are few potential predictors associated with substance use disorder (SUD) treatment. For mental health (MH) treatment, depression in the form of Major Depressive Disorder was relatively strong associated at baseline and follow-up, while Attention Deficit Hyperactivity Disorder and Conduct Disorder appear to be associated with MH treatment at follow-up. For SUD treatments, there are essentially no variables strongly associated with treatment. The best potential predictors of who enters treatment and how long they stay may not be related to comorbidity or other dimensional variables of clinical severity. Rather, treatment utilization appears to be related to environmental factors, which may include family factors, adolescent and parental motivation, access to treatment, or to the use of appropriate treatment modalities.
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Affiliation(s)
- Oscar G Bukstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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