Article

Evidence-Based Psychosocial Treatments for Adolescent Substance Abuse

Oregon Research Institute, Eugene, OR 97403, USA.
Journal of Clinical Child & Adolescent Psychology (Impact Factor: 1.92). 02/2008; 37(1):238-61. DOI: 10.1080/15374410701820133
Source: PubMed

ABSTRACT

This review synthesized findings from 17 studies since 1998 regarding evaluation of outpatient treatments for adolescent substance abuse. These studies represented systematic design advances in adolescent clinical trial science. The research examined 46 different intervention conditions with a total sample of 2,307 adolescents. The sample included 7 individual cognitive behavior therapy (CBT) replications (n = 367), 13 group CBT replications (n = 771), 17 family therapy replications (n = 850) and 9 minimal treatment control conditions (n = 319). The total sample was composed of approximately 75% males, and the ethnic/racial distribution was approximately 45% White, 25% Hispanic, 25% African American, and 5% other groups. Meta-analysis was used to evaluate within-group effect sizes as well as differences between active treatment conditions and the minimal treatment control conditions. Methodological rigor of studies was classified using Nathan and Gorman (2002108.

Nathan , P. E. , & Gorman , J. M. ( 2002 ). Efficacy, effectiveness, and the clinical utility of psychotherapy research. In
P. E. Nathan &
J. M. Gorman (Eds.), A guide to treatments that work ( , 2nd ed. , pp. 642 – 654 ). New York : Oxford University Press . View all references) criteria, and treatments were classified using criteria for well-established and probably efficacious interventions based on Chambless et al. (199625.

Chambless , D. L. ( 1996 ). In defense of dissemination of empirically supported psychological interventions . Clinical Psychology: Science and Practice , 3 , 230 – 235 . View all references). Three treatment approaches, multidimensional family therapy, functional family therapy, and group CBT emerged as well-established models for substance abuse treatment. However, a number of other models are probably efficacious, and none of the treatment approaches appeared to be clearly superior to any others in terms of treatment effectiveness for adolescent substance abuse.

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Available from: Charles Turner, Mar 20, 2015
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    • "Psychosocial intervention is the current mainstay in treating adolescent substance use disorders (SUDs), including cannabis use disorder. However, this modality has only modest effect sizes and has failed to yield robust abstinence outcomes, driving the search for efficacious augmentative pharmacological agents (Budney, Vandrey, & Stanger, 2010; Waldron & Turner, 2008). In light of recent promising pharmacologic interventions to treat adolescent SUDs (Gray et al., 2012), an important question to ask is: Which group of adolescents will have a favorable response to a specific type of SUD treatment? "
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    ABSTRACT: Background: In light of recent progress toward pharmacologic interventions to treat adolescent cannabis use disorder, it is important to consider which adolescent characteristics may be associated with a favorable response to treatment. This study presents secondary analyses from a parent randomized controlled trial of N-acetylcysteine (NAC) in adolescents with cannabis use disorder. We hypothesized that high pretreatment impulsivity and medication non-adherence would be associated with reduced abstinence rates. Methods: Participants were treatment-seeking adolescents (N=115) who met criteria for cannabis use disorder and were assessed for pretreatment impulsivity. They received 1200mg NAC or placebo orally twice daily for 8weeks. An intent-to-treat analysis using a repeated-measures logistic regression model was used to relate pretreatment impulsivity (Barratt Impulsiveness Scale) and treatment group to abstinence rates, measured by urine cannabinoid tests. To explore mechanisms by which NAC may reduce cannabis use, relationships between impulsivity, adherence, and abstinence were assessed in a second statistical model using data from participants with recorded adherence and urine cannabinoid test results (n=54). Results: In the intent-to-treat analysis, low pretreatment impulsivity, NAC treatment, and negative baseline urine cannabinoid test results independently increased the odds of having negative urine cannabinoid tests during treatment (OR=2.1, 2.3, and 5.3 respectively). In the sample of participants with adherence data (n=54), adherence tripled the odds of abstinence. Notably, the effect of adherence on abstinence was only observed in the NAC treatment group. Lastly, although the highly impulsive participants had reduced rates of abstinence, highly impulsive individuals adherent to NAC treatment had increased abstinence rates compared to non-adherent individuals. Conclusion: Low impulsivity, NAC treatment, medication adherence, and baseline negative cannabinoid testing were associated with increased rates of abstinence in adolescents seeking treatment for cannabis use disorder. Efforts to optimize pharmacotherapy adherence may be particularly crucial for highly impulsive individuals. Understanding and addressing factors, such as impulsivity and adherence, which may affect outcomes, may aid in the successful evaluation and development of potentially promising pharmacotherapies.
    Full-text · Article · Dec 2015 · Journal of substance abuse treatment
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    • "Previous reviews ( Vaughn & Howard, 2004; Waldron & Turner, 2008) indicate that MDFT is a promising treatment for young drug abusers. However, the only meta-analysis thus far conducted (Waldron & Turner, 2008) included MDFT as part of a broad category of family therapy rather than including MDFT as a distinct treatment model. In contrast, this review examines the effect of MDFT and by aggregating results of all relevant studies on MDFT and so contributes to the knowledge about treatment of young drug abusers and their families. "
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    ABSTRACT: Purpose: This review evaluates the evidence of the effects of multidimensional family therapy (MDFT) on drug use reduction in young people for the treatment of nonopioid drug use.
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    • "Youth substance use remains a public health concern, with early use associated with increased risk for later abuse and use-related problems (e.g., Ellickson, Tucker, Klein, & Saner, 2004; Jacobsen et al., 2005; Tucker, Ellickson, Orlando, Martino, & Klein, 2005) along with substantial financial costs to individuals and society as a whole (Miller, 2004; National Research Council, 2004). Current early substance use prevention and intervention programs have been found to be limited in their effectiveness (Ennett et al., 1994; Ennett et al., 2003; Waldron & Turner, 2008). Thus, a better understanding of factors that influence risk for early substance use is important for the improvement of current substance use prevention and intervention strategies. "
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    ABSTRACT: The current study evaluated the link between proactive (goal-oriented) and reactive (behavior in response to a perceived threat) aggression and lifetime alcohol, tobacco, and marijuana use in a sample of 152 predominantly Hispanic (94.7%) high school students. Furthermore, the impact of neighborhood violence and gender invariance on these associations were examined. Findings suggested unique associations between proactive, not reactive, aggression and use of all three substances. No significant interactions between the aggression subtypes and neighborhood violence were evident, and no gender differences emerged. Findings suggest targeting proactive aggression for the prevention of substance use for both males and females.
    No preview · Article · Oct 2014 · Journal of Child & Adolescent Substance Abuse
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