Journal of Child & Adolescent Substance Abuse, 2007
... Bryan R. Garner, MS (E-mail: [email protected]), is Research Scientist and Matt G. Orndor... more ... Bryan R. Garner, MS (E-mail: [email protected]), is Research Scientist and Matt G. Orndorff, BS (E-mail: [email protected] ... being a research participant include (1) interest in the particular research topic (Kaye, Lawton, & Kaye, 1990; Young & Dombrowski, 1989); (2 ...
Comparisons of well-developed practice-based interventions with research-based interventions are ... more Comparisons of well-developed practice-based interventions with research-based interventions are rare. This quasi-experimental study compares the outcomes of 274 adolescents (75% male; 63% weekly+ users; 54% dependent; 27% prior treatment; 73% with co-occurring problems) who received Chestnut Health System's best-practice Outpatient Treatment (CHS) or Cannabis Youth Treatment (CYT) research-based interventions. Ninety-five percent of participants completed follow-up interviews at three, six, nine, and 12 months after their intake GAIN interview. Initially, the CYT cohort scores indicated greater severity on several substance-related measures, while the CHS cohort scored higher on prior mental health treatment, victimization, and illegal activities measures. Adolescents in the CHS cohort were more likely to have longer lengths of stay and receive over three times as many hours of treatment. Mixed effects models revealed that CHS participants were significantly more likely to report a decrease in recovery environment risk, an increase in self-help attendance after treatment, and greater decreases in emotional problems, while CYT participants were significantly more likely to report decreases in their substance use. The results suggest that neither the best-practice nor the research-based interventions were clearly superior and call for a more rigorous randomized field experiment to better understand the differences in effectiveness between interventions.
ABSTRACT. Integrated treatment for youth with substance use disorders (SUDs) and co-occurring psy... more ABSTRACT. Integrated treatment for youth with substance use disorders (SUDs) and co-occurring psychiatric disorders is recommended; however, there are few studies that have evaluated integrated treatment approaches. This paper includes a brief review of cognitive-behavioral and family therapies, since they have been demonstrated to be effective treatments for the disorders that commonly co-occur with substance use. It also describes how an integrated treatment paradigm has been implemented using one Empirically Supported Treatment, the Adolescent Community Reinforcement Approach (A-CRA). There is existing research that supports the use of several A-CRA procedures to treat substance use and commonly co-occurring psychiatric disorders. In the absence of further research, it is reasonable in the interim to train clinicians in treatments that incorporate components that have been found to be effective for both substance use and commonly co-occurring psychiatric disorders. These treatments can then be adapted as needed based on an individual youth's set of problems. Further research is needed to test treatments for various combinations of SUDs and psychiatric disorders (i.e., depression, trauma-related problems, conduct disorder/behavior problems, and attention-deficit/hyperactivity disorder [ADHD]).
Participation of young people in recovery support meetings is a promising yet largely understudie... more Participation of young people in recovery support meetings is a promising yet largely understudied area. This article reviews the history of youth involvement in meetings, summarizes current research, and discusses issues to consider when making referrals. Professionals may want to research local meetings, help young people structure time before and after meetings, become familiar with group customs, investigate a variety of support groups, interact with support group service structures, develop a list of reliable group members to connect youths to the recovering community, and implement assertive referral strategies.
Background: Substance use disorders (SUDs) are one of the nation's most costly problems in terms ... more Background: Substance use disorders (SUDs) are one of the nation's most costly problems in terms of dollars, disability, and death. Self-help programs are among the varied recovery support options available to address SUD, and evaluation of these programs depends on good measurement. There exists an unmet need for a psychometrically sound, brief, efficient measure of self-help involvement for individuals with SUD that is valid across different substances and age-groups. Methods: Using data from 2,101 persons presenting for SUD treatment, the full 21-item Global Appraisal of Individual Needs Self-Help Involvement Scale (SHIS) and a newly developed 11-item short-form version were validated against the Rasch measurement Downloaded from model and each other. Differential item functioning (DIF) was assessed by primary substance and age. Results: Both versions met Rasch psychometric criteria. The full scale had minor misfit with no DIF for alcohol, marijuana, or opioids but a few instances of DIF for amphetamine and cocaine users as well as for age, in that youth tended to endorse several easier items more frequently than did adults. The 11-item short form had neither misfit nor DIF by substance and only minor DIF by age was highly correlated with the full version and was relatively more efficient. Criterion-related validity was supported for both. Conclusions: Both the long and short versions of SHIS are psychometrically sound measures of a more comprehensive conceptualization of self-help involvement for SUDs that can be used as part of an in-depth assessment or as a short measure that lessens respondent burden.
As with many public health-related illnesses, continuing care is a necessary component for recove... more As with many public health-related illnesses, continuing care is a necessary component for recovery from a substance use disorder. Adolescent treatment providers are in need of additional evidence-based recovery support services because existing services were designed for adult populations. To address this issue, the Recovery Services for Adolescents and Families (RSAF) program is testing three promising recovery supports: (1) telephone monitoring and support calls, (2) recovery-oriented social networking website, and (3) a family program using the Community Reinforcement Approach Family Training (CRAFT) method. Four sites in the U.S. are involved in the RSAF project including Bloomington, Illinois; Fitchburg, Massachusetts; Seattle, Washington; and Tucson, Arizona. The project protocol engages adolescents after they leave treatment. Adolescents are contacted by a trained telephone support volunteer via phone or text message to check on the youth's recovery experience and their ...
The present quasi-experiment examined the direct and indirect effects of recovery support telepho... more The present quasi-experiment examined the direct and indirect effects of recovery support telephone calls following adolescent substance use disorder treatment. Six-month outcome data from 202 adolescents who had received recovery support calls from primarily pre-professional (i.e., college-level social service students) volunteers was compared to 6-month outcome data from a matched comparison sample of adolescents (n = 404). Results suggested adolescents in the recovery support sample had significantly greater reductions in their recovery environment risk relative to the comparison sample (β = -.17). Path analysis also suggested that the reduction in recovery environment risk produced by recovery support calls had indirect impacts (via recovery environment risk) on reductions in social risk (β = .22), substance use (β = .23), and substance-related problems (β = .16). Finally, moderation analyses suggested the effects of recovery support calls did not differ by gender, but were sign...
Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse, 2014
ABSTRACT. Integrated treatment for youth with substance use disorders (SUDs) and co-occurring psy... more ABSTRACT. Integrated treatment for youth with substance use disorders (SUDs) and co-occurring psychiatric disorders is recommended; however, there are few studies that have evaluated integrated treatment approaches. This paper includes a brief review of cognitive-behavioral and family therapies, since they have been demonstrated to be effective treatments for the disorders that commonly co-occur with substance use. It also describes how an integrated treatment paradigm has been implemented using one Empirically Supported Treatment, the Adolescent Community Reinforcement Approach (A-CRA). There is existing research that supports the use of several A-CRA procedures to treat substance use and commonly co-occurring psychiatric disorders. In the absence of further research, it is reasonable in the interim to train clinicians in treatments that incorporate components that have been found to be effective for both substance use and commonly co-occurring psychiatric disorders. These treatmen...
In many treatment systems, adolescents referred to residential treatment have the most serious al... more In many treatment systems, adolescents referred to residential treatment have the most serious alcohol or other substance use disorders and are at high risk of relapse. Upon discharge, these adolescents are typically referred to continuing care services, however, linkage to these services is often problematic. In this study, 114 adolescents (76% male) who stayed at least 7 days in residential treatment were randomly assigned to receive either usual continuing care (UCC) or UCC plus an assertive continuing care protocol (ACC) involving case management and the adolescent community reinforcement approach. ACC participants were significantly more likely to initiate and receive more continuing care services, to be abstinent from marijuana at 3 months postdischarge, and to reduce their 3-month postdischarge days of alcohol use. Preliminary findings demonstrate an ACC approach designed for adolescents can increase linkage and retention in continuing care and improve short-term substance use outcomes. D
Comparisons of well-developed practice-based interventions with research-based interventions are ... more Comparisons of well-developed practice-based interventions with research-based interventions are rare. This quasi-experimental study compares the outcomes of 274 adolescents (75% male; 63% weekly+ users; 54% dependent; 27% prior treatment; 73% with co-occurring problems) who received Chestnut Health System's best-practice Outpatient Treatment (CHS) or Cannabis Youth Treatment (CYT) research-based interventions. Ninety-five percent of participants completed follow-up interviews at three, six, nine, and 12 months after their intake GAIN interview. Initially, the CYT cohort scores indicated greater severity on several substance-related measures, while the CHS cohort scored higher on prior mental health treatment, victimization, and illegal activities measures. Adolescents in the CHS cohort were more likely to have longer lengths of stay and receive over three times as many hours of treatment. Mixed effects models revealed that CHS participants were significantly more likely to report a decrease in recovery environment risk, an increase in self-help attendance after treatment, and greater decreases in emotional problems, while CYT participants were significantly more likely to report decreases in their substance use. The results suggest that neither the best-practice nor the research-based interventions were clearly superior and call for a more rigorous randomized field experiment to better understand the differences in effectiveness between interventions.
This exploratory study used in-depth interviews with 12 adolescent participants and four parents ... more This exploratory study used in-depth interviews with 12 adolescent participants and four parents to describe their perceptions of outpatient substance abuse treatment. Adolescents found treatment to be different than they had expected, expressed preferences for different session formats (group, individual, family), and defined treatment success in different ways than their parents. There were no common themes regarding what adolescents and parents liked best or least about treatment. Findings suggest several implications for treatment providers and areas for future study: (a) the need to provide detailed descriptions of treatment to referral sources and orientation for adolescents and their parents prior to entry; (b) the need to make skill-building sessions interesting and limit their repetition; (c) the need to group adolescents by severity or problem type; (d) the need for flexibility and assertive outreach to improve family involvement in treatment; and (e) the need to provide adolescent treatment consumers and their parents with data regarding treatment success from a number of perspectives (e.g. substance use, associated problems, school performance). This study illustrates that adolescents and their parents are important sources of information about the treatment experience and may provide useful ideas for enhancing treatment engagement and retention.
The American Society on Addiction Medicine&am... more The American Society on Addiction Medicine's Patient Placement criteria are commonly used in adolescent treatment. However, the use of these criteria and how they affect the course of treatment and interact with adolescent change has not been examined. Twelve-month treatment patterns were examined for 176 adolescents who entered their first ever episode in a treatment system using these criteria. Forty-one percent of the adolescents received additional treatment after their initial outpatient episode with over 30 unique treatment sequences (i.e., various combinations of outpatient, intensive outpatient, and residential treatment). Significant differences in treatment patterns were found between the change trajectory groups. For example, adolescents who participated in only one outpatient treatment episode were more likely to be in the low alcohol and drug use (AOD) group and less likely to have high rates of time in a controlled environment or to report moderate AOD use. Over one-third of the adolescents participated in additional treatment and almost one-quarter of those who only participated in outpatient treatment had problematic use. These findings suggest the need for clinical monitoring protocols that can be used to identify adolescents needing additional treatment or recovery services.
Clinicians in adolescent substance abuse treatment programs often recommend attendance at 12-Step... more Clinicians in adolescent substance abuse treatment programs often recommend attendance at 12-Step meetings; however, there has been no systematic study of their referral practices or possible influence on attendance rates. Quantitative and qualitative data were used to examine: (a) the self-help referral practices of clinicians employed in adolescent substance abuse treatment programs; and (b) the potential relationship between practices and self-help attendance. Data were analyzed from open-ended interviews with 28 clinicians at eight CSAT-funded SCY sites and from follow-up interviews with over 1,600 adolescents. Results indicated that clinicians referred adolescents almost exclusively to 12-Step groups. Various factors were considered when recommending attendance, including substance use severity and ability to grasp 12-Step concepts. Meeting age composition and availability were common influences when suggesting specific meetings. Clinicians who described their treatment programs as "12-Step based" and actively linked adolescents to groups tended to be employed at sites that had the highest overall rates of self-help attendance. Findings suggest that if clinicians want to facilitate self-help attendance, they might assess the "fit" between individual adolescents and particular meetings. Additionally, programs may want to develop and train staff in standardized referral procedures. Further research is needed to empirically test referral strategies with adolescents.
Participation of young people in recovery support meetings is a promising yet largely understudie... more Participation of young people in recovery support meetings is a promising yet largely understudied area. This article reviews the history of youth involvement in meetings, summarizes current research, and discusses issues to consider when making referrals. Professionals may want to research local meetings, help young people structure time before and after meetings, become familiar with group customs, investigate a variety of support groups, interact with support group service structures, develop a list of reliable group members to connect youths to the recovering community, and implement assertive referral strategies.
ABSTRACT Mutual support groups have the potential to be a powerful support network for youth with... more ABSTRACT Mutual support groups have the potential to be a powerful support network for youth with substance use problems. There is a long history of youth being referred to and participating in these groups, yet research regarding the effectiveness of their participation is in its early stages. In recent years, a small but growing body of literature has been devoted to this topic. This article: (1) summarizes the history of youth involvement in mutual support groups; (2) reviews research on youth involvement in mutual support meetings and evidence of effectiveness; (3) describes implementation of and lessons learned from a pilot study that attempted to increase youth attendance and involvement with three types of 12-step groups; and (4) provides recommendations for future research related to mutual support groups and youth.
Journal of Consulting and Clinical Psychology, 2014
Most adolescents relapse within 90 days of discharge from residential substance use treatment. We... more Most adolescents relapse within 90 days of discharge from residential substance use treatment. We hypothesized that contingency management (CM), assertive continuing care (ACC), and their combination (CM + ACC) would each be more effective than usual continuing care (UCC). Following residential treatment, 337 adolescents were randomized to 4 continuing care conditions: UCC alone, CM, ACC, or CM + ACC. UCC was available across all conditions. Outcome measures over 12 months included percentage of days abstinent from alcohol, heavy alcohol, marijuana, and any alcohol or other drugs (AOD) using self-reports and toxicology testing and remission status at 12 months. CM had significantly higher rates of abstinence than UCC for heavy alcohol use, t(297) = 2.50, p < .01, d = 0.34; any alcohol use, t(297) = 2.58, p < .01, d = 0.36; or any AOD use, t(297) = 2.12, p = .01, d = 0.41; and had a higher rate in remission, odds ratio (OR) = 2.45, 90% confidence interval (CI) [1.18, 5.08], p = .02. ACC had significantly higher rates of abstinence than UCC from heavy alcohol use, t(297) = 2.66, p < .01, d = 0.31; any alcohol use, t(297) = 2.63, p < .01, d = 0.30; any marijuana use, t(297) = 1.95, p = .02, d = 0.28; or any AOD use, t(297) = 1.88, p = .02, d = 0.30; and had higher rates in remission, OR = 2.31, 90% CI [1.10, 4.85], p = .03. The ACC + CM condition was not significantly different from UCC on any outcomes. CM and ACC are promising continuing care approaches after residential treatment. Future research should seek to further improve their effectiveness.
Journal of Child & Adolescent Substance Abuse, 2007
... Bryan R. Garner, MS (E-mail: [email protected]), is Research Scientist and Matt G. Orndor... more ... Bryan R. Garner, MS (E-mail: [email protected]), is Research Scientist and Matt G. Orndorff, BS (E-mail: [email protected] ... being a research participant include (1) interest in the particular research topic (Kaye, Lawton, & Kaye, 1990; Young & Dombrowski, 1989); (2 ...
The treatment response of 139 pregnant and postpartum women in gender-specific residential substa... more The treatment response of 139 pregnant and postpartum women in gender-specific residential substance abuse treatment was investigated. These women were assessed with the Addiction Severity Index (ASI) at intake and six months after their discharge. A factor analysis performed with these women's ASI composite scores revealed two distinct factors: a substance use severity factor primarily from the alcohol and drug composite scores, and a general life distress factor primarily from the medical, legal, family/social and psychiatric composite scores. A cluster analysis of the pre-and post-ASI factor scores revealed four main subgroups of women (ranging in size from 14 to 41%) that had different patterns of change in response to treatment. Patterns of change could accurately be predicted for 71% of the women based on intake ASI severity composite scores, history of prior treatment, and service bundle received. q
Journal of Child & Adolescent Substance Abuse, 2007
... Bryan R. Garner, MS (E-mail: [email protected]), is Research Scientist and Matt G. Orndor... more ... Bryan R. Garner, MS (E-mail: [email protected]), is Research Scientist and Matt G. Orndorff, BS (E-mail: [email protected] ... being a research participant include (1) interest in the particular research topic (Kaye, Lawton, & Kaye, 1990; Young & Dombrowski, 1989); (2 ...
Comparisons of well-developed practice-based interventions with research-based interventions are ... more Comparisons of well-developed practice-based interventions with research-based interventions are rare. This quasi-experimental study compares the outcomes of 274 adolescents (75% male; 63% weekly+ users; 54% dependent; 27% prior treatment; 73% with co-occurring problems) who received Chestnut Health System's best-practice Outpatient Treatment (CHS) or Cannabis Youth Treatment (CYT) research-based interventions. Ninety-five percent of participants completed follow-up interviews at three, six, nine, and 12 months after their intake GAIN interview. Initially, the CYT cohort scores indicated greater severity on several substance-related measures, while the CHS cohort scored higher on prior mental health treatment, victimization, and illegal activities measures. Adolescents in the CHS cohort were more likely to have longer lengths of stay and receive over three times as many hours of treatment. Mixed effects models revealed that CHS participants were significantly more likely to report a decrease in recovery environment risk, an increase in self-help attendance after treatment, and greater decreases in emotional problems, while CYT participants were significantly more likely to report decreases in their substance use. The results suggest that neither the best-practice nor the research-based interventions were clearly superior and call for a more rigorous randomized field experiment to better understand the differences in effectiveness between interventions.
ABSTRACT. Integrated treatment for youth with substance use disorders (SUDs) and co-occurring psy... more ABSTRACT. Integrated treatment for youth with substance use disorders (SUDs) and co-occurring psychiatric disorders is recommended; however, there are few studies that have evaluated integrated treatment approaches. This paper includes a brief review of cognitive-behavioral and family therapies, since they have been demonstrated to be effective treatments for the disorders that commonly co-occur with substance use. It also describes how an integrated treatment paradigm has been implemented using one Empirically Supported Treatment, the Adolescent Community Reinforcement Approach (A-CRA). There is existing research that supports the use of several A-CRA procedures to treat substance use and commonly co-occurring psychiatric disorders. In the absence of further research, it is reasonable in the interim to train clinicians in treatments that incorporate components that have been found to be effective for both substance use and commonly co-occurring psychiatric disorders. These treatments can then be adapted as needed based on an individual youth's set of problems. Further research is needed to test treatments for various combinations of SUDs and psychiatric disorders (i.e., depression, trauma-related problems, conduct disorder/behavior problems, and attention-deficit/hyperactivity disorder [ADHD]).
Participation of young people in recovery support meetings is a promising yet largely understudie... more Participation of young people in recovery support meetings is a promising yet largely understudied area. This article reviews the history of youth involvement in meetings, summarizes current research, and discusses issues to consider when making referrals. Professionals may want to research local meetings, help young people structure time before and after meetings, become familiar with group customs, investigate a variety of support groups, interact with support group service structures, develop a list of reliable group members to connect youths to the recovering community, and implement assertive referral strategies.
Background: Substance use disorders (SUDs) are one of the nation's most costly problems in terms ... more Background: Substance use disorders (SUDs) are one of the nation's most costly problems in terms of dollars, disability, and death. Self-help programs are among the varied recovery support options available to address SUD, and evaluation of these programs depends on good measurement. There exists an unmet need for a psychometrically sound, brief, efficient measure of self-help involvement for individuals with SUD that is valid across different substances and age-groups. Methods: Using data from 2,101 persons presenting for SUD treatment, the full 21-item Global Appraisal of Individual Needs Self-Help Involvement Scale (SHIS) and a newly developed 11-item short-form version were validated against the Rasch measurement Downloaded from model and each other. Differential item functioning (DIF) was assessed by primary substance and age. Results: Both versions met Rasch psychometric criteria. The full scale had minor misfit with no DIF for alcohol, marijuana, or opioids but a few instances of DIF for amphetamine and cocaine users as well as for age, in that youth tended to endorse several easier items more frequently than did adults. The 11-item short form had neither misfit nor DIF by substance and only minor DIF by age was highly correlated with the full version and was relatively more efficient. Criterion-related validity was supported for both. Conclusions: Both the long and short versions of SHIS are psychometrically sound measures of a more comprehensive conceptualization of self-help involvement for SUDs that can be used as part of an in-depth assessment or as a short measure that lessens respondent burden.
As with many public health-related illnesses, continuing care is a necessary component for recove... more As with many public health-related illnesses, continuing care is a necessary component for recovery from a substance use disorder. Adolescent treatment providers are in need of additional evidence-based recovery support services because existing services were designed for adult populations. To address this issue, the Recovery Services for Adolescents and Families (RSAF) program is testing three promising recovery supports: (1) telephone monitoring and support calls, (2) recovery-oriented social networking website, and (3) a family program using the Community Reinforcement Approach Family Training (CRAFT) method. Four sites in the U.S. are involved in the RSAF project including Bloomington, Illinois; Fitchburg, Massachusetts; Seattle, Washington; and Tucson, Arizona. The project protocol engages adolescents after they leave treatment. Adolescents are contacted by a trained telephone support volunteer via phone or text message to check on the youth's recovery experience and their ...
The present quasi-experiment examined the direct and indirect effects of recovery support telepho... more The present quasi-experiment examined the direct and indirect effects of recovery support telephone calls following adolescent substance use disorder treatment. Six-month outcome data from 202 adolescents who had received recovery support calls from primarily pre-professional (i.e., college-level social service students) volunteers was compared to 6-month outcome data from a matched comparison sample of adolescents (n = 404). Results suggested adolescents in the recovery support sample had significantly greater reductions in their recovery environment risk relative to the comparison sample (β = -.17). Path analysis also suggested that the reduction in recovery environment risk produced by recovery support calls had indirect impacts (via recovery environment risk) on reductions in social risk (β = .22), substance use (β = .23), and substance-related problems (β = .16). Finally, moderation analyses suggested the effects of recovery support calls did not differ by gender, but were sign...
Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse, 2014
ABSTRACT. Integrated treatment for youth with substance use disorders (SUDs) and co-occurring psy... more ABSTRACT. Integrated treatment for youth with substance use disorders (SUDs) and co-occurring psychiatric disorders is recommended; however, there are few studies that have evaluated integrated treatment approaches. This paper includes a brief review of cognitive-behavioral and family therapies, since they have been demonstrated to be effective treatments for the disorders that commonly co-occur with substance use. It also describes how an integrated treatment paradigm has been implemented using one Empirically Supported Treatment, the Adolescent Community Reinforcement Approach (A-CRA). There is existing research that supports the use of several A-CRA procedures to treat substance use and commonly co-occurring psychiatric disorders. In the absence of further research, it is reasonable in the interim to train clinicians in treatments that incorporate components that have been found to be effective for both substance use and commonly co-occurring psychiatric disorders. These treatmen...
In many treatment systems, adolescents referred to residential treatment have the most serious al... more In many treatment systems, adolescents referred to residential treatment have the most serious alcohol or other substance use disorders and are at high risk of relapse. Upon discharge, these adolescents are typically referred to continuing care services, however, linkage to these services is often problematic. In this study, 114 adolescents (76% male) who stayed at least 7 days in residential treatment were randomly assigned to receive either usual continuing care (UCC) or UCC plus an assertive continuing care protocol (ACC) involving case management and the adolescent community reinforcement approach. ACC participants were significantly more likely to initiate and receive more continuing care services, to be abstinent from marijuana at 3 months postdischarge, and to reduce their 3-month postdischarge days of alcohol use. Preliminary findings demonstrate an ACC approach designed for adolescents can increase linkage and retention in continuing care and improve short-term substance use outcomes. D
Comparisons of well-developed practice-based interventions with research-based interventions are ... more Comparisons of well-developed practice-based interventions with research-based interventions are rare. This quasi-experimental study compares the outcomes of 274 adolescents (75% male; 63% weekly+ users; 54% dependent; 27% prior treatment; 73% with co-occurring problems) who received Chestnut Health System's best-practice Outpatient Treatment (CHS) or Cannabis Youth Treatment (CYT) research-based interventions. Ninety-five percent of participants completed follow-up interviews at three, six, nine, and 12 months after their intake GAIN interview. Initially, the CYT cohort scores indicated greater severity on several substance-related measures, while the CHS cohort scored higher on prior mental health treatment, victimization, and illegal activities measures. Adolescents in the CHS cohort were more likely to have longer lengths of stay and receive over three times as many hours of treatment. Mixed effects models revealed that CHS participants were significantly more likely to report a decrease in recovery environment risk, an increase in self-help attendance after treatment, and greater decreases in emotional problems, while CYT participants were significantly more likely to report decreases in their substance use. The results suggest that neither the best-practice nor the research-based interventions were clearly superior and call for a more rigorous randomized field experiment to better understand the differences in effectiveness between interventions.
This exploratory study used in-depth interviews with 12 adolescent participants and four parents ... more This exploratory study used in-depth interviews with 12 adolescent participants and four parents to describe their perceptions of outpatient substance abuse treatment. Adolescents found treatment to be different than they had expected, expressed preferences for different session formats (group, individual, family), and defined treatment success in different ways than their parents. There were no common themes regarding what adolescents and parents liked best or least about treatment. Findings suggest several implications for treatment providers and areas for future study: (a) the need to provide detailed descriptions of treatment to referral sources and orientation for adolescents and their parents prior to entry; (b) the need to make skill-building sessions interesting and limit their repetition; (c) the need to group adolescents by severity or problem type; (d) the need for flexibility and assertive outreach to improve family involvement in treatment; and (e) the need to provide adolescent treatment consumers and their parents with data regarding treatment success from a number of perspectives (e.g. substance use, associated problems, school performance). This study illustrates that adolescents and their parents are important sources of information about the treatment experience and may provide useful ideas for enhancing treatment engagement and retention.
The American Society on Addiction Medicine&am... more The American Society on Addiction Medicine's Patient Placement criteria are commonly used in adolescent treatment. However, the use of these criteria and how they affect the course of treatment and interact with adolescent change has not been examined. Twelve-month treatment patterns were examined for 176 adolescents who entered their first ever episode in a treatment system using these criteria. Forty-one percent of the adolescents received additional treatment after their initial outpatient episode with over 30 unique treatment sequences (i.e., various combinations of outpatient, intensive outpatient, and residential treatment). Significant differences in treatment patterns were found between the change trajectory groups. For example, adolescents who participated in only one outpatient treatment episode were more likely to be in the low alcohol and drug use (AOD) group and less likely to have high rates of time in a controlled environment or to report moderate AOD use. Over one-third of the adolescents participated in additional treatment and almost one-quarter of those who only participated in outpatient treatment had problematic use. These findings suggest the need for clinical monitoring protocols that can be used to identify adolescents needing additional treatment or recovery services.
Clinicians in adolescent substance abuse treatment programs often recommend attendance at 12-Step... more Clinicians in adolescent substance abuse treatment programs often recommend attendance at 12-Step meetings; however, there has been no systematic study of their referral practices or possible influence on attendance rates. Quantitative and qualitative data were used to examine: (a) the self-help referral practices of clinicians employed in adolescent substance abuse treatment programs; and (b) the potential relationship between practices and self-help attendance. Data were analyzed from open-ended interviews with 28 clinicians at eight CSAT-funded SCY sites and from follow-up interviews with over 1,600 adolescents. Results indicated that clinicians referred adolescents almost exclusively to 12-Step groups. Various factors were considered when recommending attendance, including substance use severity and ability to grasp 12-Step concepts. Meeting age composition and availability were common influences when suggesting specific meetings. Clinicians who described their treatment programs as "12-Step based" and actively linked adolescents to groups tended to be employed at sites that had the highest overall rates of self-help attendance. Findings suggest that if clinicians want to facilitate self-help attendance, they might assess the "fit" between individual adolescents and particular meetings. Additionally, programs may want to develop and train staff in standardized referral procedures. Further research is needed to empirically test referral strategies with adolescents.
Participation of young people in recovery support meetings is a promising yet largely understudie... more Participation of young people in recovery support meetings is a promising yet largely understudied area. This article reviews the history of youth involvement in meetings, summarizes current research, and discusses issues to consider when making referrals. Professionals may want to research local meetings, help young people structure time before and after meetings, become familiar with group customs, investigate a variety of support groups, interact with support group service structures, develop a list of reliable group members to connect youths to the recovering community, and implement assertive referral strategies.
ABSTRACT Mutual support groups have the potential to be a powerful support network for youth with... more ABSTRACT Mutual support groups have the potential to be a powerful support network for youth with substance use problems. There is a long history of youth being referred to and participating in these groups, yet research regarding the effectiveness of their participation is in its early stages. In recent years, a small but growing body of literature has been devoted to this topic. This article: (1) summarizes the history of youth involvement in mutual support groups; (2) reviews research on youth involvement in mutual support meetings and evidence of effectiveness; (3) describes implementation of and lessons learned from a pilot study that attempted to increase youth attendance and involvement with three types of 12-step groups; and (4) provides recommendations for future research related to mutual support groups and youth.
Journal of Consulting and Clinical Psychology, 2014
Most adolescents relapse within 90 days of discharge from residential substance use treatment. We... more Most adolescents relapse within 90 days of discharge from residential substance use treatment. We hypothesized that contingency management (CM), assertive continuing care (ACC), and their combination (CM + ACC) would each be more effective than usual continuing care (UCC). Following residential treatment, 337 adolescents were randomized to 4 continuing care conditions: UCC alone, CM, ACC, or CM + ACC. UCC was available across all conditions. Outcome measures over 12 months included percentage of days abstinent from alcohol, heavy alcohol, marijuana, and any alcohol or other drugs (AOD) using self-reports and toxicology testing and remission status at 12 months. CM had significantly higher rates of abstinence than UCC for heavy alcohol use, t(297) = 2.50, p < .01, d = 0.34; any alcohol use, t(297) = 2.58, p < .01, d = 0.36; or any AOD use, t(297) = 2.12, p = .01, d = 0.41; and had a higher rate in remission, odds ratio (OR) = 2.45, 90% confidence interval (CI) [1.18, 5.08], p = .02. ACC had significantly higher rates of abstinence than UCC from heavy alcohol use, t(297) = 2.66, p < .01, d = 0.31; any alcohol use, t(297) = 2.63, p < .01, d = 0.30; any marijuana use, t(297) = 1.95, p = .02, d = 0.28; or any AOD use, t(297) = 1.88, p = .02, d = 0.30; and had higher rates in remission, OR = 2.31, 90% CI [1.10, 4.85], p = .03. The ACC + CM condition was not significantly different from UCC on any outcomes. CM and ACC are promising continuing care approaches after residential treatment. Future research should seek to further improve their effectiveness.
Journal of Child & Adolescent Substance Abuse, 2007
... Bryan R. Garner, MS (E-mail: [email protected]), is Research Scientist and Matt G. Orndor... more ... Bryan R. Garner, MS (E-mail: [email protected]), is Research Scientist and Matt G. Orndorff, BS (E-mail: [email protected] ... being a research participant include (1) interest in the particular research topic (Kaye, Lawton, & Kaye, 1990; Young & Dombrowski, 1989); (2 ...
The treatment response of 139 pregnant and postpartum women in gender-specific residential substa... more The treatment response of 139 pregnant and postpartum women in gender-specific residential substance abuse treatment was investigated. These women were assessed with the Addiction Severity Index (ASI) at intake and six months after their discharge. A factor analysis performed with these women's ASI composite scores revealed two distinct factors: a substance use severity factor primarily from the alcohol and drug composite scores, and a general life distress factor primarily from the medical, legal, family/social and psychiatric composite scores. A cluster analysis of the pre-and post-ASI factor scores revealed four main subgroups of women (ranging in size from 14 to 41%) that had different patterns of change in response to treatment. Patterns of change could accurately be predicted for 71% of the women based on intake ASI severity composite scores, history of prior treatment, and service bundle received. q
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