A pilot study of low-cost contingency management to increase attendance in an adolescent substance abuse program

Numerous studies demonstrate the efficacy of contingency management (CM) for improving patient outcomes, yet it is rarely used in treatment settings due to the high cost of implementation. This quasi-experimental study (N = 52) examined the effect of a low-cost "Fishbowl" CM intervention on attendance/retention in an early intervention adolescent substance abuse program. The CM group attended significantly more sessions compared to the control group. Furthermore, the CM intervention costs $3.27 per patient per session. Our findings support the use of low-cost CM to improve adolescent attendance in clinical settings.

Text message reminders to improve outpatient therapy attendance among adolescents: a pilot study

High rates of missed appointments and attrition are common barriers to treatment for adolescents attending outpatient mental health treatment. Such figures indicate a need for innovative strategies to engage youth in treatment. The current quasi-experimental pilot study examined the feasibility, acceptability, and preliminary efficacy of text message (TM) appointment reminders to improve attendance in a sample of 48 adolescents attending outpatient therapy. The sample was approximately 46% Latino and 40% African American with an equal number of males and females. Adolescents receiving TM reminders demonstrated significantly higher rates of attendance (65%) than a historical control group (49%) (p < .05). Participants in the TM group received reminders for the majority (88%) of their scheduled sessions with only 4% of reminders not received due to phone-related problems. Additionally, TM reminders received high patient satisfaction ratings. Findings from the present study suggest that TM reminders may be a cost-effective and developmentally appropriate strategy for engaging adolescents in treatment.

Baseline depressive symptoms predict poor substance use outcome following adolescent residential treatment

OBJECTIVE

To characterize baseline depressive symptoms among substance-abusing adolescents and determine their association with post residential treatment substance use outcomes.

METHOD

In total, 153 adolescents (mean age 6.6 years, +/- 0.11) entering residential treatment were assessed at intake and at 3, 6, 9, and 12 months. Beck Depression Inventory (BDI) and Global Appraisal of Individual Needs were administered to assess depression, other risk factors, and substance use. A regression model was developed with 10 risk factors including BDI scores of >/=11 versus <11 to predict the outcome measure mean percentage of days in the past 90 days with any (nonnicotine) substance use.

RESULTS

At intake, 55% had BDI scores of >/=11. A baseline BDI score of >/=11 was significantly associated with greater mean percentage of days of substance use (27.5 +/- 3.8% versus 15.4 +/- 4.0% days, p <.01) across 1-year follow-up. Two other factors were significant: length of drug career >2 years and having an opioid use disorder.

CONCLUSIONS

Results from this prospective study, although preliminary, suggest the association of depressive symptoms with poorer substance outcomes and the utility of the BDI as a prognostic tool. They highlight the need for interventions targeting co-occurring depressive symptoms that may improve adolescent substance treatment outcomes.

Clinical characteristics and treatment outcomes of adolescent heroin users

Heroin use among adolescents is a major social and health problem, and has been increasing over the past decade, but has not been extensively studied. This study compared characteristics of adolescent heroin users (n = 56) to adolescent non heroin users (n = 93) at entry to short-term residential treatment through 12 months posttreatment. The heroin group was comprised of more females, older adolescents, and more Caucasians. At baseline, heroin users reported more days of drug use, days high, days not meeting responsibilities, and had more substance abuse and dependence symptoms. Heroin users also showed greater severity on multiple indicators of functional impairment and psychological distress. Although adolescent heroin users appear to represent a distinct subpopulation with multiple indicators of heightened severity, they respond to treatment with significant reductions in drug use, psychological symptoms, illegal activities, and overall psychosocial impairment. Furthermore, adolescent heroin users respond to treatment in the same remitting/relapsing pattern as non heroin users, yet their higher severity persists over a 12 month follow-up period. Further research is needed to generalize these findings to other settings, and to guide the development and evaluation of treatment options for adolescent heroin users.

Smoking habits and attitudes in a methadone maintenance treatment population

This study characterized smoking habits and attitudes about quitting in methadone maintenance treatment (MMT) patients, with attention to race and gender differences. Of 179 patients surveyed, 92% (n = 165) were current smokers. These patients reported smoking a mean of 24.8 cigarettes per day. Mean age at smoking initiation was 13.6 years with 53% starting at age 13 or younger. The mean Fagerstrom tolerance questionnaire (FTQ) score was 7.5. Blacks as compared to Whites smoked fewer cigarettes per day (21.6 versus 27.5), had lower expired CO levels (18.8 versus 21.6 ppm), but higher urinary cotinine levels (1812 versus 1419 ng/ml) and were more likely to smoke menthol cigarettes (95 versus 46%). Females scored higher than males on the FTQ measures of nicotine dependence (8.0 versus 7.2), and lower than males on a measure of quit smoking self-efficacy. Subjects in the sample as a whole were well aware of health risks of smoking, as indicated by high scores on health risk perception questions. Sixty-one percent (n = 110) of subjects planned to quit within the next 6 months, 57% were 'very interested' in an on-site quit smoking program and 80% expressed interest in using nicotine replacement products. Overall, these results indicate high rates of smoking in MMT patients, confirm within a drug abusing population prior findings of racial differences in smoking habits, and suggest that MMT patients are interested in quitting and in using nicotine replacement products. The data support feasibility of implementing smoking cessation treatments with this population in a setting that allows for convenient access to patients and close monitoring of progress.

The role of helplessness in the response to disease modifying drugs in rheumatoid arthritis

Fifty patients with rheumatoid arthritis participated in an assessment of their helplessness before and after a 3-month disease modifying drug trial. A multidimensional approach measuring helplessness was used, assessing cognitive, affective, and behavioral components. Both before and after the drug trial, helplessness indices accounted for a highly significant amount of variation in self-reported pain and functional disability. Moreover, Time 1 helplessness predicted greater flare activity after the drug trial. Helplessness indices, however, did not correlate with joint examination measures within time periods, nor did they predict change in these measures over the drug trial. The importance of the role of helplessness in subjective and objective measures of clinical status in persons undergoing drug therapy is discussed.