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Self-efficacy as a predictor of treatment outcome in adolescent substance use disorders
Abstract
Youth substance abuse relapse prevention was examined as a function of patients' situational self-efficacy (SE), their confidence to abstain from substance use in high-risk situations. An increase in SE has been shown to be enhanced by cognitive behavioral therapy (CBT) in adults. Eighty-eight adolescent substance abusers were randomly assigned to either CBT or psycho-education (PET) group therapy. Substance use and SE were assessed at end of treatment, 3- and 9-months after the end of planned treatment. Increased SE predicted subsequent abstinence independently from drug urinalysis and treatment condition only during treatment, while previous substance use predicted subsequent self-efficacy. CBT was not differentially effective than PET in promoting SE. It is recommended that potential mediators and moderators of SE in the treatment of adolescent substance abuse should be further explored.
... The average age was 15.98 (SD = 0.43) and the gender identity of 68% of participants was male. Of the 16 independent samples, three examined family therapies (MDFT, FFT, and BSFT; Henderson et al., 2009;Horigian et al., 2015;Ozechowski, 2014), five examined brief-interventions (e.g., MI, MET; D' Amico et al., 2015;Feldstein Ewing et al., 2021;Gersh et al., 2019;Schulte et al., 2010;Winters et al., 2012Winters et al., , 2014, one examined CBT (Burleson & Kaminer, 2005), three examined the Adolescent Community Reinforcement Approach (A-CRA; Garner et al., 2007Garner et al., , 2009Hunter et al., 2014), one examined 12-step facilitation (Kelly et al., 2000), and three examined multicomponent therapies (e.g., MET/CBT with contingency management and family management; Bertrand et al., 2013;Chi et al., 2009;Stanger et al., 2009). ...
... Five studies recruited adolescents with a SUD (Burleson & Kaminer, 2005;Garner et al., 2007;Hunter et al., 2014;Kelly et al., 2000;Ozechowski, 2014), four recruited adolescents who were treatment seeking (Bertrand et al., 2013;Chi et al., 2009;Garner et al., 2009;Henderson et al., 2009), three recruited adolescents who engaged in risky use, such as SU in the past 30 days (Gersh et al., 2019;Horigian et al., 2015;Stanger et al., 2009), two recruited adolescents identified by school officials as engaging in SU (Winters et al., 2012(Winters et al., , 2014, two recruited adolescents with juvenile justice system involvement (D'Amico et al., 2015;Feldstein Ewing et al., 2021), and one recruited adolescents with lifetime SU (Schulte et al., 2010). Studies also differed with respect to treatment setting. ...
... Studies also differed with respect to treatment setting. Nine examined outpatient treatment (Burleson & Kaminer, 2005;Feldstein Ewing et al., 2021;Garner et al., 2007Garner et al., , 2009Henderson et al., 2009;Horigian et al., 2015;Hunter et al., 2014;Ozechowski, 2014;Stanger et al., 2009), one examined intensive outpatient programs (Chi et al., 2009), two examined residential treatment programs (Bertrand et al., 2013;Kelly et al., 2000), one examined a treatment in the juvenile justice system (D'Amico et al., 2015), and four examined treatments in school settings (Gersh et al., 2019;Schulte et al., 2010;Winters et al., 2012Winters et al., , 2014. Most studies examined treatment effects on multiple substances (N = 12), two solely examined cannabis use (Ozechowski, 2014;Stanger et al., 2009), and three solely examined alcohol use (Gersh et al., 2019;Horigian et al., 2015;Schulte et al., 2010). ...
Substance use disorders commonly onset during adolescence, yet the best available treatments yield only modest and transient effects. Elucidating treatment mediators is essential for improving treatment options. This review summarizes over 20 years of research on mediators of adolescent substance use treatment; k = 17 studies assessing both treatment or treatment ingredient to mediator (a path) and mediator to treatment outcome (b path) paths were included. Mediators were categorized using the Science of Behavior Change target class framework. Overall, mediation tests supported four of eight self-regulation, two of 10 stress resilience and reactivity, six of 19 interpersonal and social process, and two of four treatment engagement and adherence mediators. To enhance the capacity of this work to inform clinical practice, we recommend future research examine theoretically informed mechanisms using temporally sequenced data among other methodological guidelines.
... Two key addictions treatment constructs, self-efficacy and motivation to abstain, independently predict treatment outcome in adolescents [1,2] and adults [3][4][5][6][7][8]. Selfefficacy, or confidence, to abstain refers to an individual's belief in his/her ability to abstain, whereas motivation refers to the individual's desire or will to abstain from substance use. ...
... Little is known about how the association between confidence and motivation to abstain changes from session-to-session. In particular, early treatment sessions may be critical to increasing confidence and motivation to abstain [2,11], and strengthening the positive association between high levels of both constructs. An increase in the strength of the positive association between high levels of confidence and motivation to abstain might reflect a process whereby high levels of both mutually reinforce one another to support abstinence from substance use. ...
... This initial dip might reflect a "reality check" for youth who initially endorse relatively high pre-treatment levels of confidence and motivation to abstain. Early treatment sessions may be critical to developing a realistic view of recovery [2,11], in which one's own initial efforts and hearing about others' experiences may provide the basis for ratings of confidence and motivation to abstain through "common" processes of change that operate in group treatment [15]. ...
Introduction:
An important goal of addictions treatment is to develop a positive association between high levels of confidence and motivation to abstain from substance use. This study modeled the time-varying association between confidence and motivation to abstain from marijuana use among youth in treatment, and the time-varying effect of pre-treatment covariates (marijuana abstinence goal and perceived peer marijuana use) on motivation to abstain.
Method:
150 adolescents (75% male, 83% White) in community-based intensive outpatient treatment in Pennsylvania completed a pre-treatment assessment of abstinence goal, perceived peer marijuana use, and motivation and confidence to abstain from marijuana. Ratings of motivation and confidence to abstain also were collected after each session. A time-varying effect model (TVEM) was used to characterize changes in the association between confidence and motivation to abstain (lagged), and included covariates representing pre-treatment abstinence goal and perceived peer marijuana use.
Results:
Confidence and motivation to abstain from marijuana generally increased during treatment. The association between confidence and motivation strengthened across sessions 1-4, and was maintained through later sessions. Pre-treatment abstinence goal had an early time-limited effect (through session 6) on motivation to abstain. Pre-treatment perception of peer marijuana use had a significant effect on motivation to abstain only at session 2.
Conclusions:
Early treatment sessions represent a critical period during which the association between confidence and motivation to abstain generally increased. The time-limited effects of pre-treatment characteristics suggest the importance of early sessions in addressing abstinence goal and peer substance use that may impact motivation to abstain from marijuana.
... Individuals' confidence in their ability to abstain from substance use (i. e., relapse prevention efficacy), for example, contributes to resilience among high-risk youth, and has been shown during SUD treatment to predict an improved likelihood of abstinence (e.g., Burleson & Kaminer, 2005;Catalano et al., 1990;Gwaltney et al., 2005;Witkiewitz & Marlatt, 2004). Self-esteem is also important in youth SUD treatment for protecting against relapse, as well as promoting psychosocial functioning (Richter et al., 1991;see also;Brown et al., 1994;Zhai et al., 2015) and potentially encouraging rehabilitation compliance (e.g., Smart & Ogborne, 1994). ...
... g., 12 months). Such work is difficult to achieve given the challenges faced (and presented) by this population, but is without doubt important given that the self-report outcomes we assessed (e.g., relapse prevention efficacy) do not, in isolation, adequately explain the complexities of the addiction-relapse-recovery cycle (Burleson & Kaminer, 2005;Greenfield et al., 2012). Furthermore, the exercise service was provided as an adjunct component to the residential treatment program. ...
Objective
Evidence for the effectiveness of exercise as therapy for youth substance use disorder (SUD) is scarce. In this study, we investigated associations between exercise enjoyment and recovery outcomes for youth undergoing residential SUD treatment.
Method
Using ecological momentary assessment, each week participants reported perceptions of exercise enjoyment, relapse prevention efficacy, self-esteem, and physical health, and associations between these variables were assessed at both between- and within-person levels. There were 97 participants (age: M = 17.5, SD = 1.57, range = 14 to 21; 37 female, 60 male), with a final sample of 64 due to participants (n = 33) discontinuing treatment within 2 weeks of commencement. Of the remaining sample, 50% (n = 32) completed 3 or more assessments, 40% (n = 26) completed 5 or more, and 25% (n = 16) completed 7 or more.
Results
Relapse prevention efficacy, self-esteem, and perceived physical health increased over time in the program. Youth who, on average, enjoyed exercise more had higher self-esteem, perceived physical health, and relapse prevention efficacy than those who enjoyed it less. Additionally, on occasions when youth enjoyed exercise more (relative to their own average), they reported higher self-esteem, perceived physical health, and relapse prevention efficacy than on occasions when they reported enjoying it less.
Conclusion
Participation in—and importantly, enjoyment of—exercise was linked to key health indices and predictors of relapse for youth during SUD treatment. These findings demonstrate that participation in enjoyable structured exercise may provide an important component of successful SUD treatment.
... The causes of substance abuse are numerous and factors such as attitudes, beliefs, goals and expectancies play important roles [6]. Furthermore, there is an urgent demand to improve the short and long-term treatment outcomes of addiction [7]. Self-efficacy is a critical factor underlying the substance abuse and also its successful treatment. ...
... An example of a task-specific self-efficacy is abstinence self-efficacy. Abstinence selfefficacy is a cognitive process demonstrating patients' reliance in their ability to abstain from substance use in high-risk conditions [7]. The Abstinence self-efficacy has been readily used in the research and treatment of substance abuse behaviors. ...
Abstract
The variety and prevalence of substance abuse are growing and its consequences on physical and psychological health, as well as, on global social and economic concerns are heavy. General self-efficacy is a critical factor underlying substance abuse and its successful treatment. The present study was aimed to investigate the effect of hope therapy on general self-efficacy among substance abusers. This study was quasi–experimental with pretest–posttest and control group. The statistical population comprised all of the substance abusers who referred to addiction treatment centers. Convenience sampling method was used to select 40 participants among volunteers. The participants randomly were assigned into the experimental and control groups. The experimental group received eight sessions of two-hour of hope therapy. Both groups responded to general self-efficacy scale before and after the treatment. There was a significant improvement in general self-efficacy of substance abusers after hope therapy sessions. According to research findings, using of hope therapy could have important role in increasing the general self-efficacy of substance abusers and thereby can lead to successful treatment programs and other positive outcomes in the treatment of substance abuse.
... The typical adolescent study treated a high proportion of males (75% to 80%) with an average age of 15 years. Most had multiple substance abuse problems (illicit drugs, mainly marijuana), and less commonly alcohol dependency, alcohol/drug related problems, and/or behavioral problems/delinquency. Groups were primarily closed, ranged between 8 and 20 sessions (usually weekly), and tested a wide array of interventions including feedback and motivational interviewing (Smith, Hall, Williams, An, & Gotman, 2006), psychoeducation (Burleson & Kaminer, 2005), social learning (Battjes et al., 2004) and CBGT components (Dennis et al., 2004;Liddle et al., 2004Liddle et al., , 2009. Some multimodal approaches embedded individual and/or family sessions into the program (Dennis et al., 2004;Smith et al., 2006). ...
... A family history of alcohol abuse, specific combinations of gender and ethnicity (e.g., female and non-Caucasian) and social anxiety appear to be hindering factors (Book, Thomas, Dempsey, (2), violent episodes (1), HIV risk behavior (1), unprotected sex occasion (1) Studies comparing individual vs . (2), treatment completion and goal achievement (1) Group treatments for adolescent substance abuse : Battjes et al., 2004;Burleson and Kaminer, 2005;Dennis et al., 2004;French et al., 2008;Liddle et al., 2004Liddle et al., , 2009 (5), delinquency (1), internalized stress (1), reducing risks in family, peers (1), self-efficacy (1) TRAUMA/PTSD Amaro et al., 2007;Bradley and Follingstad, 2003;Chard, 2005;Classen et al., 2011;Cloitre and Koenen, 2001;Creamer et al., 2002;Donovan et al., 2001;Dorrepal et al., 2010;Falsetti et al., 2001;Gatz et al., 2007;Ginzburg et al., 2009;Gorey, Richter, and Snider, 2001;Hébert and Bergeron, 2007;Kibler and Lyons, 2008;Kreidler, 2005;Lau and Kristensen, 2007;Layne et al., 2001;Lundqvist et al., 2009;Lundqvist and Öjehagen, 2001;Lundqvist et al., 2006;Möller and Steel, 2002;Morrison and Treliving, 2002;Mueser et al., 2007;Rieckert and Möller, 2000;Ruzek et al., 2001;Ryan et al., 2005;Saltzman et al., 2001;Schnurr et al., 2003;Sharpe et al., 2001;Sikkema et al., 2004Sikkema et al., , 2007Sikkema et al., , 2008Spiegel et al., 2004;Toussaint et al., 2007;Vaa et al., 2002;Wallis, 2002;Westwood et al., 2010;Zlotnick et (13), PTSD diagnosis (6), self-esteem (6), anger (5), anxiety (5), coping/avoidance (5), guilt (4), assertiveness (3), social function (3), alcohol/drug severity (2), HIV risk behavior (2), grief (2), GPA (2) Randall, & Randall, 2009; LaBrie, Feres, Kenney, & Lac, 2009;McNeese-Smith et al., 2009), while higher motivation (Litt et al., 2003), social reinforcement (Lash, Burden, Monteleone, & Lehmann, 2004), music therapy (Dingle, Gleadhill, & Baker, 2008), PTSD symptom reduction (Hien et al., 2010), and contingency management (Ledgerwood, Alessi, Hanson, Godley, & Petry, 2008) enhance adherence and outcome. ...
... We consider CC to be the key ingredient that can help Community Wise participants stay well-connected to their communities, engage in activities to address SDOH, and develop meaning in their lives through the belief that they can alter their environment in a way that helps improve personal and community health. Commitment to treatment, self-efficacy, social support, and a sense of having a purpose in life have been significant predictors of successful SUD treatments (Burleson & Kaminer, 2005). ...
Background
Rates of alcohol and/or substance use (ASU) among residents of predominantly Black and marginalized communities are similar to ASU rates in White communities. Yet ASU has worse consequences in predominantly Black and marginalized communities (e.g., higher incarceration).
Objective
We randomized participants to one of 16 intervention conditions using a 2⁴ full factorial design to optimize a multilevel intervention reducing ASU among 602 formerly incarcerated men with substance-use-disorders (SUD). Candidate intervention components included (1) critical dialogue (CD; six weekly 2-hour-long group sessions vs. no CD sessions), (2) Quality of Life Wheel (QLW; six weekly 1-hour-long group sessions vs. no QLW sessions), (3) capacity building projects (CBP; six weekly 1-hour-long group sessions vs. no CBP sessions), and (4) delivery by a trained peer versus licensed facilitators. Outcome was percentage of days in which participants used alcohol, cocaine, opioid, and/or cannabis in previous 30 days.
Results
Intent-to-treat analysis did not meet a priori component selection criteria due to low intervention attendance. After controlling for intervention group attendance (percentage of sessions attended), peer-delivered CD and CBP produced statistically and clinically significant main and interaction effects in ASU over 5 months. Per the multiphase optimization strategy framework, we selected peer-delivered CD and CBP for inclusion as the optimized version of the intervention with a cost of US$1,380 per 10 individuals. No adverse intervention effects occurred.
Conclusion
CD and CBP were identified as the only potentially effective intervention components. Future research will examine strategies to improve attendance and test the optimized intervention against standard of care in a randomized-controlled-trial.
... Self-efficacy was found to predict abstinence independently of drug urinalysis and treatment conditions during treatment for youths with substance-use disorders [58]. The moderating impact of self-efficacy on relapse was examined by Liu et al. (2020). ...
A substantial portion of drug abuse research has concentrated on people with a single-substance-use disorder (SSUD), but many people abuse more than one drug. Studies have yet to examine how those with polysubstance-use disorder (PSUD) differ from those with an SSUD on the risk of relapse, self-evaluative emotions (e.g., shame and guilt), and personality factors (e.g., self-efficacy). Eleven rehab facilities in Lahore city, Pakistan were randomly chosen to provide a sample of 402 males with PSUD. For comparison, 410 age-matched males with SSUD were enlisted using a demographic form with eight questions, the State Shame and Guilt Scale, and the General Self-Efficacy Scale. Mediated moderation analysis was performed using Hayes’ process macro. The results demonstrate that shame-proneness is positively associated with relapse rate. Guilt-proneness mediates the relationship between shame-proneness and relapse rate. Self-efficacy buffers the influence of shame-proneness on relapse rate. Although the mediation and moderation effects were found in both study groups, these effects were significantly stronger among people with PSUD than those with SSUD. To be more specific, people with PSUD reported a higher overall score on shame, guilt, and relapse rate. Additionally, people with SSUD indicated a higher score on self-efficacy than those with PSUD. The findings of this study suggest that drug rehab facilities should implement a variety of strategies to raise drug users’ levels of self-efficacy, which will help to reduce their risk of relapse.
... Previous research has linked higher levels of self-efficacy to increased academic achievement (Zimmerman et al., 2017) and motivation (Zimmerman et al., 1992), perceived social competence (Spence et al., 1999;Gaudiano & Herbert, 2007), self-esteem (Hajloo, 2014;Smith & Betz, 2002), resilience (Schwarzer & Warner, 2013), self-regulation (Bouffard-Bouchard et al., 1991), preparedness to succeed in college (Chemers et al., 2001), adult career attainment (Lent et al., 1986;Stajkovic & Luthans, 1998) and happiness (Judge et al., 1998). Self-efficacy is also linked to decreased substance abuse (Burleson & Kaminer, 2005), symptoms of depression (Ehrenberg et al., 1991;Muris, 2001), social anxiety (Gaudiano & Herbert, 2007), and negative selfevaluation (Mahone et al., 1993). Further, recent literature has linked self-efficacy and growth mindset (Dweck, 2016), stating that "having high self-efficacy with a growth mindset can help a student navigate setbacks successfully because they continue to have the confidence that they can ultimately achieve their goal (self-efficacy) by increasing their effort and abilities (growth mindset)" (Transforming Education, 2020, p.11). ...
School counselors are encouraged to employ evidence-based practices to meet students' mental health needs, yet a scarcity of outcome research limits their access to adequately supported prevention and intervention resources (Griffith et al., 2019). To maximize their impact and time, school counselors should consider conducting group counseling with students. Specifically, school counselors should consider implementing Adventure Therapy (AT), a kinesthetically engaging form of group counseling that uses adventure activities to promote participation through collaborative problem solving, encourage responsible decision-making, and foster accountability among students (Christian et al., 2019). While literature supports the use of AT in schools, there is a dearth of outcome studies examining its efficacy with students. This study explored the impact of AT on 7th graders' self-efficacy (n = 19). The researchers measured Total, Academic, Social, and Emotional self-efficacy using the Self-Efficacy Questionnaire for Children at pre, mid, post, and follow-up. Results suggested AT groups were effective for increasing all types of self-efficacy for participants with males showing a greater increase. Implications for school counselors and future research are described.
... Videre rapporterte Graham et al. (1996) at gruppetilnaermingen førte til økte sosiale ferdigheter som er viktig i forhold til å forebygge tilbakefall for mange pasienter, inkludert ungdom. Burleson & Kaminer, 2005 undersøkte 400 gruppeterapi-deltakere i CYT-studien og fant at ungdom med mer alvorlige atferdsproblemer dro flere fordeler av deltagelse i en gruppe med andre med faerre problemer. Videre fant de at de med alvorlig atferdsproblemer, ikke så ut til å influere de med lavere nivå av slike problemer. ...
Denne kunnskapsoversikten oppsummerer forskningskunnskap om virksomme eller lovende modeller for behandling av rusproblemer hos ungdom. Med behandlingsmodell mener vi en intervensjon med et klart definert innhold. Generelt vil modeller for rusbehandling rette seg mot et definert rusproblem, enten problemet er begynnende eller veletablert. Behandlingsmodeller kan variere både i omfang, innhold, lengde, intensitet og teoretisk tilnærming, og iverksettes som
en del av familie- og nærmiljøbasert behandling eller behandling i institusjon. Det er glidende overganger mellom forebygging og behandling på rusfeltet, og behandlingstiltak rettet mot ungdom kan derfor også ha en forebyggende effekt. Denne kunnskapsoversikten vil primært fokusere på rusbehandlende tiltak knyttet til et definert rusproblem der målsettingen er redusert bruk av rusmidler. I tillegg er det et formål med kunnskapsoversikten å gi noen anbefalinger om
videre arbeid med å utvikle rusbehandling. Rapporten er basert på kunnskapsoppsummeringer og systematiske oversikter som vurderer
virkningen av tiltak mot alkohol- og narkotikamisbruk hos ungdom i alderen 12-26 år, med vektlegging av tiltak for ungdom under 20 år.
... In the context of substance use, self-efficacy can influence a people's ability to withdraw from drug use when they are close to other persons who consume drugs, are pressured by others to use, or are in specific settings [13]. It is often hard for people who use drugs to resist the temptation to use, and strong self-efficacy beliefs may help them resist [14]. ...
Background
Research has demonstrated that therapeutic interventions based on the self-efficacy theory produce positive outcomes for people who exhibit addictive behaviors, such as alcohol and drug use. Several questionnaires based on self-efficacy theory have been developed to evaluate the extent to which intervention programs can modify behavior. The present study describes the psychometric properties of the Farsi version of the Drug Abstinence Self-Efficacy Scale (DASES).
Design and methods
The forward–backward approach was employed to translate the DASES from English into Farsi. A cross-sectional study was conducted, and the psychometric properties of the Farsi version of the DASES were measured. Using a cluster sampling method, 400 male people who use drugs aged 20 years or older were selected from 10 addiction treatment clinics in Mazandaran, Iran. The internal consistency and test–retest methods were used to measure the reliability of the DASES. Face and content validity were measured, and the construct validity of the DASES was assessed through both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The data were analyzed using SPSS and AMOS.
Results
The results of the EFA indicated a four-factor solution for the DASES that accounted for 64.72% of the observed variance. The results obtained from the CFA demonstrated that the data fitted the model: the relative chi square (× 2/df) equaled 1.99 ( p < 0.001), and the root mean square error of approximation equaled 0.071 (90% CI = 0.059–0.082). All the comparative indices of the model were equal to or greater than 0.90 (0.91, 0.93, 0.94, 0.93, and 0.90, respectively). The Cronbach’s alpha ranged from 0.90 to 0.93, proving a satisfactory reliability. Additionally, the intraclass correlation coefficient ranged from 0.75 to 0.98, which is an acceptable result.
Conclusions
This study’s results show that the Iranian version of the DASES has good psychometric properties and is appropriate for assessing substance use behaviors among Iranian addicted persons.
... Therapeutical approaches have focused on increasing self-efficacy during the remission stages to increase self-regulation and concomitantly reduce impulsivity to enhance relapse prevention strategies (Kadden and Litt, 2011). This supports the need to identify the mediators and moderators of self-efficacy to potentiate the effectiveness of treatment programs, especially among the young-aged (Burleson and Kaminer, 2005). ...
Background
Substance Use Disorder (SUD) places a heavy burden on societal and health systems given its association with high mortality and morbidity rates worldwide, including Mauritius. Illicit substances act as a positive reinforcement and stimulate addiction through its pleasure-seeking attributes.
Aim
This study focused on identifying the risk factors leading to SUD among Mauritian male addicts as well as examining the potency of those factors in SUD development. The study also aimed at determining the prevalence of relapse and its causation.
Research setting
A cross-sectional study was conducted over a period of six months using a sample of 180 male addicts registered in a public hospital. A questionnaire investigating dimensions such as risk factors, self-esteem and peer pressure was administered.
Findings
A high percentage of relapse was noted amongst users within the first year of abstinence. Majority of respondents originated from nuclear or single parents’ family and were deprived of adequate social supports given their marital status. 57.5% of participants had a positive family history of SUD. Cannabis was the most commonly abused substance and 76.2% of the addicts were introduced to drugs through curiosity. Transposing the results against the Gateway Drug Theory showed a constant progression from soft to hard drugs for male addicts, a trend which was consistent with literature. Lastly, a theoretical model was developed based on the strong statistical association found between impulsivity and reduced thought processes prior to relapse; data revealing increased impulsivity which is a common trait in antisocial personality disorder and borderline personality disorder as being largely responsible for relapse.
Conclusion
The study was successful in bringing out the most common risk factors of SUDs which are linked to low socioeconomic status. The inability of addicts to progress with their rehabilitation given the alarming 92% of relapse was related to social pressure as prime deterrent to successful remission. Programmes involving relapse prevention must implemented in the first year of abstinence to facilitate rehabilitation.
... Müdahale programları sadece özerklik gibi içsel odağın geliştirilmesinde değil, yeni davranış tarzları ve baş etme stilleri konusunda optimal düzeyde yetkinlik desteği sunması nedeniyle de öz yeterliliğin gelişmesi için etkilidir.(34). Konuyla ilgili yapılan çalışmalar, grup çalışmalarının uzun dönemde dahi madde kullanıcılarının öz yeterlilik algıları üzerindeki olumlu etkisine vurgu yapmaktadır(35). Ancak bu çalışmada, grup çalışma sürecinin madde kullanıcılarının öz yeterliliklerinde anlamlı bir değişime neden olmadığı bulunmuştur. ...
Introduction: Group work is one of the most effective treatment methods in rehabilitation of substance use behavior. In addition, the individual’s motivation to quit substance and self-efficacy perceptions of quitting are important factors for the course of the treatment. Therefore, the aim of this study was to investigate the effect of group work process on motivational processes (intrinsic and extrinsic motivation, interpersonal help seeking and confidence-in-treatment subscales) and self-efficacy perception of substance users.
Method: This is an experimental study with 43 substance users. The Treatment Motivation Questionnaire subscales were used to measure the effect of the group work on the dimensions of treatment motivation (intrinsic motivation, extrinsic motivation, confidence-in-treatment, interpersonal help seeking), and the General Self-Efficacy Scale was used to measure the effect of group work on the self-efficacy perceptions.
Results: The group work resulted in a significant increase in participants’ intrinsic motivation and confidence-in-treatment. However, group work did not result in any significant change in extrinsic motivation, interpersonal help seeking and the perception of self-efficacy. In the follow-up process, a significant decrease was observed in the participants’ self-efficacy perceptions.
Conclusions: Group work with substance users increases the intrinsic motivation and confidence-in-treatment. Therefore, group work practices will increase the effectiveness of substance use treatment.
... depression or stress levels, negative or positive emotions) which constitute an unexplored field of study concerning addiction • the way in which clients undergoing treatment realize the meaning of life and search for it Studies have shown that the above-mentioned factors can be both linked to the best and worst possible treatment results for a client. As far as the interaction between each factor and the addiction treatment is concerned, most studies indicate that readiness for therapy (DiClemente & Scott, 1997) self-efficacy (Burleson & Kaminer, 2005;Ilgen, McKellar, & Moos, 2007;Izquierdo, de Osma, Arnedillo, & Cotaberria, 2001;Long, Hollin, & Williams, 1998;Solomon & Annis, 1990), expectations on the treatment outcome (Colon & Massey, 1988;Dearing, Barrick, Dermen, & Walitzer, 2005;Dohnke, Muller-Fahrnow, & Knauper, 2006;Joe, Flynn, Broome, & Simpson, 2007;Jones, Corbin, & Fromme, 2001;Joyce & Pipper, 1998) and the perceived social support (Majer, Jason, Ferrari, Venable, & Olson, 2002) are directly associated with positive results in treatment, such as longer and more committed engaging in treatment. ...
... 6,7 At this point, relatively little is known about mechanisms of behavior change (MOBC) in adolescents receiving substance abuse interventions, which highlights the need to study the underlying processes involved as reviewed by Black and Chung. 8 Changes in self-efficacy, 9,10 coping skills, 11 perceived difficulty to abstain, 12 and motivation or readiness to change 13 appear to account for some portion of treatment effects. ...
Background:
Commitment to change is an innovative potential mediator and mechanism of behavior change (MOBC) that has not been examined in adolescents with cannabis use. The Adolescent Substance Abuse Goal Commitment (ASAGC) questionnaire is a reliable and valid 2-scale measure developed to assess the adolescent's commitment to either abstinence or harm reduction model for adolescents, which in addition to decrease in negative consequences includes consumption reduction as a stated treatment goal. The objective of this paper is to examine the ASAGC's ability to predict adolescent substance use treatment outcome.
Methods:
During Sessions 3 and 9 of a 10-week treatment program, therapists completed the ASAGC for 170 adolescents 13-18 years of age with alcohol use disorders, the majority of whom (82%) were diagnosed with co-occurring cannabis use disorder (CUD).
Results:
Logistic regression analyses assessing goal commitment regarding cannabis use at Session 3 indicated that commitment to both abstinence and harm reduction predicted cannabis use at Session 3. However, only commitment to abstinence predicted later cannabis use (assessed at Session 9 and during aftercare). When goal commitment at Session 9 was examined, only commitment to abstinence predicted cannabis use, concurrently and longitudinally. These results indicated that adolescents who had higher scores for commitment to abstinence were less likely to be positive for cannabis use. In contrast, harm reduction was not a significant predictor of cannabis use.
Conclusions:
Findings demonstrate that goal commitment consistently predicts cannabis use treatment outcome. Commitment to abstinence specifically is a salient predictor for concurrent and future cannabis use. Further prospective study is necessary to determine whether harm reduction may be an attainable goal for some youth given normative delayed neurodevelopmental processes of inhibitive behaviors.
... Videre rapporterte Graham et al. (1996) at gruppetilnaermingen førte til økte sosiale ferdigheter som er viktig i forhold til å forebygge tilbakefall for mange pasienter, inkludert ungdom. Burleson & Kaminer, 2005 undersøkte 400 gruppeterapi-deltakere i CYT-studien og fant at ungdom med mer alvorlige atferdsproblemer dro flere fordeler av deltagelse i en gruppe med andre med faerre problemer. Videre fant de at de med alvorlig atferdsproblemer, ikke så ut til å influere de med lavere nivå av slike problemer. ...
Denne kunnskapsoversikten oppsummerer forskningskunnskap om virksomme eller lovende modeller for behandling av rusproblemer hos ungdom. Med behandlingsmodell mener vi en intervensjon med et klart definert innhold. Generelt vil modeller for rusbehandling rette seg mot et definert rusproblem, enten problemet er begynnende eller veletablert. Behandlingsmodeller kan variere både i omfang, innhold, lengde, intensitet og teoretisk tilnærming, og iverksettes som en del av familie- og nærmiljøbasert behandling eller behandling i institusjon. Det er glidende overganger mellom forebygging og behandling på rusfeltet, og behandlingstiltak rettet motungdom kan derfor også ha en forebyggende effekt. Kunnskapsoversikten fokuserer primært på rusbehandlende tiltak knyttet til et definert rusproblem der målsettingen er redusert bruk av rusmidler. I tillegg gir kunnskapsoversikten anbefalinger med hensyn til videreutvikling av rusbehandling.
... There are few methods to measure the success of SUD treatment outcomes. Self-efficacy, is considered an important indicator in the management of SUDs and in treatment outcome more specifically (Maisto et al., 2000;Burleson and Kaminer, 2005;Ilgen et al., 2005;Dolan et al., 2008;Kadden and Litt, 2011), and defined as an individual's confidence in his/her ability to abstain from certain adverse behaviors, such as substance use (Bandura, 1994). Self-efficacy is seen as an important factor in predicting behavior related to health, the successful application of coping mechanisms (Tate et al., 2008), and changing unwanted behavior (Sheeran et al., 2016). ...
Introduction: Individuals with Substance Use Disorder (SUD) often have cognitive deficits in multiple domains, including motor timing deficits, with recovery times of up to 1 year. Cognitive deficits influence treatment outcomes and abstinence. To our knowledge, timing deficits have not been investigated with regard to treatment outcome and relapse.
Methods: This prospective study tested the prognostic value of motor timing in SUD with regard to treatment outcome. The study sample consisted of 74 abstinent in-patients at a private treatment programme for drug/alcohol dependence at the Momentum Mental Healthcare clinic in Somerset West, South Africa, diagnosed with alcohol and/or cocaine dependence. Participants were tested at three points: (i) Within 72 hours of the start of the treatment programme (ii) after completion of the treatment programme at 8 weeks (measure of treatment response) through filling out self-report questionnaires and experimental motor task testing, and (iii) a third visit followed through a telephonic interview at 12-months (measure of relapse).
Results: Motor timing alone predicted 27 percent of the variance in alcohol self-efficacy score change, and 25 percent variance in cocaine self-efficacy change scores at treatment completion. Specifically, spatial errors, synchronization errors and inter- response interval errors of a spatial tapping task at baseline predicted self-efficacy in alcohol self-efficacy. Cocaine self-efficacy was predicted by spatial errors and contact times of a spatial tapping task at very high tempi (300 ms) only. The high rate of dropout at 12 months post-treatment did not allow for further analysis of the prognostic value of motor timing on relapse.
Conclusions: The results of this investigation show us that motor timing holds prognostic value with regard to treatment outcomes. Motor timing predictors for relapse require further investigation going forward.
... Furthermore, ASE is found to be predictive of treatment efficacy (DiClemente, Carbonari, Montgomery, & Hughes, 1994), thus emphasizing the importance of considering self-efficacy when providing treatment for SUDs. For example, in a study of adolescent substances users, higher ASE was predictive of lower drug use during treatment (Burleson & Kaminer, 2005). Similarly, ASE increased during treatment for use of crack cocaine, with clients reporting abstinence 1 month after treatment also reporting higher levels of ASE (Coon, Pena, & Illich, 1998). ...
Inferiority feelings have been linked theoretically to substance use; however, an empirical definition of the construct is lacking in research. The purpose of this study was to examine the adequacy in defining inferiority feelings using the empirically established constructs of self-esteem, general self-efficacy (GSE), abstinence self-efficacy (ASE), and shame using a sample of 210 undergraduate college students. Results of
the confirmatory factor analysis indicated that the overall model provided good fit for the data; however, self-esteem and shame loaded more strongly on the latent construct than did GSE and ASE. The results provide preliminary evidence for using these constructs to define inferiority feelings; however, future research is necessary to examine alternate constructs that may define inferiority feelings in other populations.
... Several studies conducted outside Africa have found strong associations between alcohol abstinence self-efficacy and alcohol use. For example, low selfefficacy for refusing heavy drinking has been found to be negatively associated with alcohol use (Gilles, Turk & Fresco 2006, while increased self-efficacy predicted subsequent abstinence from alcohol use (Burleson & Kaminer, 2005). Additionally, drinking expectations and drinking refusal self-efficacy have also been found to predict alcohol use (Oei & Jardim, 2007;Young et al., 2006). ...
There is an increasing awareness of indiscriminate alcohol use among University students worldwide. Self-efficacy to abstain from alcohol use plays a significant role in the abstinence of alcohol use by perceiving less benefits (pros) and more costs (cons) of alcohol use. However, not much is known about self-efficacy to abstain from alcohol use in relation to the pros and cons of alcohol use among Ghanaian university students. The aim of this study was to examine the role of alcohol abstinence self-efficacy in the pros and cons of alcohol use in Ghanaian university students. Participants consisted of 215 undergraduate students with a mean age of 23.5 years who completed self-report measures assessing alcohol abstinence self-efficacy and pros and cons of alcohol use. Thirty nine percent of students had never used alcohol. Adjusting for age, gender, and residence status, results of a one-way MANCOVA showed significant main effect of alcohol abstinence self-efficacy on both pros (p < 0.001) and cons (p < 0.001) of alcohol use, although the effect was stronger in cons (2 p η = 0.26) than pros (2 p η = 0.18) of alcohol use. Independent-samples t-test results showed that students classified under high (M = 11.12, SD = 11.02) alcohol abstinence self-efficacy reported more pros than those classified under low (M = 1.68, SD = 3.58) alcohol abstinence self-efficacy, t(122.25) =-8.22, p < 0.001). Similarly, those classified under high (M = 11.12, SD = 12.17) alcohol abstinence self-efficacy reported more cons than those classified under low (M = 2.03, SD = 6.66) alcohol abstinence self-efficacy, t(154.58) =-6.59, p < 0.001). Finally, while there were no gender differences in cons of alcohol use, males (M = 8.8, SD = 10.06) reported significantly higher than females (M = 4.61, SD = 8.24) on pros of alcohol use, t(209) = 2.74, p < 0.01). These findings provide preliminary evidence for the viability of reinforcing self-efficacy, particularly relating to abstinence, as a strategy to encourage abstinence from alcohol use and subsequently prevent harmful use of alcohol in Ghanaian university students.
... Social cognitive theory and self-efficacy continue to serve as important theoretical approaches to changing health behaviours. Self-efficacy around specific behaviours has been shown to be an effective skill that youth can gain, especially through target interventions for substance use (Burleson & Kaminer, 2005;Hyde, Hankins, Deale, & Marteau, 2008;Litt, Kadden, & Stephens, 2005). The difficulty in applying social cognitive theory to this study is that as an observational study, it is not part of health promotion or public health interventions. ...
Street-involved youth face difficulties due to their precarious living situation. Substance use is higher among these youth compared to the general youth population. This study examines the relationship between street-involved youth and school connection on their problem substance use. Problem substance use was defined as using marijuana 20 or more times a month, binge drinking alcohol three or more times a month, and facing consequences from severe substance use.
The study design was a two-step sequential mixed-methods approach, beginning with a quantitative analysis using probability profiling via logistic regression with 762 street-involved youth ages 12 to 18 who responded to the province wide 2006 British Columbia Street-Involved Youth Survey in Canada. The second step used qualitative interviews to collect qualitative data with street-involved youth enrolled in school the previous year and identified using substances. Themes were identified from their experiences with substance use while in school.
The probability profiling analyses uncovered school connectedness influenced problem substance use differently for young women and men. The presence of school connectedness decreased the probability of Problem Alcohol Use from 32% to 17% for young men and provided a 25% overall reduction in probability among known risk factors. The probability of Problem Marijuana Use decreased from 33% to 18% for young women as school connectedness increased; school connectedness reduced risk factors by 18%. Consequences from Substance Use was marginally protected against for young women, but school attendance protected against consequences for young men by 12%, in the presence of known risk factors.
The second step examined qualitative data collected from interviews with four young women and seven young men who were street-involved in Vancouver, Canada at the time of the study. The age for youth participation was 16 to 24; they must been in school for a month over the past year and used substances while attending school. The recruited youth were between ages 16 and 21. They said having one caring adult in school, participating in extracurricular activities, and attending schools with zero tolerance policies toward substance use were ineffective in reducing substance use or creating stronger connections to school.
... A favorable treatment outcome is heavily dependent on completion of treatment [65]. Studies have explored the interaction of specific factors and treatment outcomes including readiness for therapy, selfefficacy [66,67] treatment outcome expectations and perceived social support [68] as directly linked to positive outcomes in treatment. ...
... Group CBT has been shown to produce significant decreases in substance use (e.g., Kaminer, Burleson, & Goldberger, 2002). Further, despite concerns that group-based treatments for delinquent adolescents may have negative effects due to the potential for "deviancy training" among participants (Dishion, McCord, & Poulin, 1999), there has been no empirical evidence of a negative influence on adolescents participating in group CBT for substance use when groups are highly monitored and structured (Burleson & Kaminer, 2005). ...
Conduct and substance use problems are significant concerns for school-based mental health providers, teachers, and school administrators, given their disruptive nature and associations with poor educational outcomes. These problems can be compounded in rural areas, where youth and their families often face significant barriers to accessing effective mental health treatment. The current chapter reviews the literature on the prevalence, correlates, and risk factors for adolescent conduct and substance use problems. Evidence-based treatments are reviewed and discussed in terms of their applicability to rural school settings. Barriers to treatment specific to rural areas as well as the potential benefits and barriers to delivery of treatments for conduct problems in school settings are discussed. Conclusions include the identification of specific evidence-based treatments that are likely to be implemented effectively in rural school settings and suggestions for future research and program development.
... At this point, relatively little is known about mechanisms of behavior change (MOBC) in adolescents receiving these interventions, which highlights the need to study the underlying processes involved as reviewed byBlack & Chung, (2014). Changes in selfefficacy (Burleson & Kaminer, 2005;Moss, Kirisci, & Mezzich, 1994), coping skills (Waldron & Kaminer, 2004), perceived difficulty to abstain (King, Chung, & Maisto, 2009) and motivation or readiness to change (O'Leary & Monti, 2004) appear to account for some portion of treatment effects. Goal-setting as a predictor of AOSUD treatment outcome has not been well studied. ...
... Self-efficacy, the evaluation of ones' ability to enact a behavior, is a common pathway to behavior change 3 and is related to treatment gains through factors such as increased treatment adherence and translation of intentions to action. 7,10,23 Therefore, we expected that greater baseline self-efficacy would be associated with greater treatment-related gains. ...
Osteoarthritis (OA) of the lower extremities is a prevalent cause of disability in which symptoms interfere with mobility and activity participation. Behavioral self-management for OA symptomatology is commonly recommended; but these interventions are underutilized, unstandardized in application, and at times, unavailable in the context of clinical care. For people with chronic pain, rehabilitation professionals may select to apply activity pacing instruction as one behavioral strategy to manage symptoms. Activity pacing is widely used in combination with other pharmacological and behavioral interventions but has not been studied as a singular behavioral intervention for people with OA. The purpose of this study was to evaluate the effectiveness of an occupational therapist-delivered, time-based activity pacing program for treatment of pain, fatigue, and physical function in people with symptomatic knee or hip OA. A 3-arm randomized controlled trial was conducted in which 193 people were randomized into tailored activity pacing, general activity pacing, or usual care arms. Assessments were done at 10 weeks and 6 months post baseline. Using linear mixed models, WOMAC pain scores changed over time, decreasing the most in the general and usual care groups; only the usual care group had decreased pain over 6 months. The tailored and general activity pacing groups reported higher frequency of pacing behaviors than the usual care group at 10 weeks but pacing was not sustained at 6 months. This trial does not support the use of time-based pacing as a singular behavioral strategy for people with knee or hip OA.
... Although self-efficacy has been repeatedly linked to the best possible therapeutic outcome (Long et al., 1998, Long, Williams, Midgley & Hollin, 2000, Izquierdo et al., 2001Burleson & Kaminer, 2005;Ilgen et al., 2007;Rychtarik et al ., 1992 ;Solomon & Annis, 1990), the study presented in this paper reveals that this factor negatively predicts the transition from the first treatment phase (Counseling Centre) to the Residential Phase. This finding in the initial phase of treatment is consistent with Peele's perceptive remark (1983d) that high levels of self-efficacy are evident in those clients who refuse to accept therapeutic help and try to cure themselves. ...
Topic. In this article, we address why empowerment psychoeducation may be beneficial for individuals participating in services in a Psychosocial Rehabilitation (PSR) setting. Purpose: We provide a case example of how empowerment psychoeducation was implemented in a group at a recovery-oriented wellness center. Sources: We review the published literature that informed this group, and provide an overview of the topics addressed in sessions, including applications of empowerment, motivation, "personal medicine," overcoming stigma, and personal recovery process. We discuss our observations in implementing this tool. Conclusions and Implications for Practice: Empowerment is a frequently discussed topic in the PSR literature, and discussion about empowerment in PSR settings is valuable for all parties involved. We strongly recommend that other providers in PSR settings consider implementing a psychoeducational group on empowerment.
... Although self-efficacy has been repeatedly linked to the best possible therapeutic outcome (Long et al., 1998, Long, Williams, Midgley & Hollin, 2000, Izquierdo et al., 2001Burleson & Kaminer, 2005;Ilgen et al., 2007;Rychtarik et al ., 1992 ;Solomon & Annis, 1990), the study presented in this paper reveals that this factor negatively predicts the transition from the first treatment phase (Counseling Centre) to the Residential Phase. This finding in the initial phase of treatment is consistent with Peele's perceptive remark (1983d) that high levels of self-efficacy are evident in those clients who refuse to accept therapeutic help and try to cure themselves. ...
Objective: This research investigated how adult participants (N = 155) view individuals who are reintegrating to society. Methods: Participants were undergraduate students from a program for working adults who evaluated a reintegration scenario. The types of reintegration were based on a fictitious scenario describing either a person who is new to your neighborhood or workplace (a control condition), reintegrating following psychiatric hospitalization, reintegrating following release from a correctional facility, or reintegrating following release from a forensic psychiatric facility. Results: People reintegrating from corrections, psychiatric, and forensic/psychiatric facilities were perceived more negatively than individuals without forensic/psychiatric histories. Additionally, individuals reintegrating from such facilities were more welcomed in workplace than neighborhood settings. Limitations: This study used short, fictitious vignettes, which might not represent true societal interactions. Future research should seek larger and more diverse samples. Conclusions and Implications: Methods to reduce stigma for individuals with mental illness and criminal history are an important component of community integration, and communities in which individuals will live should be increasingly targeted in such interventions.
Background: Efforts to increase the availability of Medication Assisted Treatment for alcohol use disorder (AUD) and opioid use disorder (OUD) may be futile if patients lack motivation for recovery and are unwilling to seek treatment. Objectives: In this cross-sectional, online survey, we used the Extended Parallel Process Model (EPPM) to assess how participants at risk of AUD or OUD react to their perceived threat and assess their response to pharmacotherapy as a potential treatment. EPPM constructs were assessed using the Risk Based Diagnosis Scale. Descriptive statistics measure the proportion of treated vs untreated participants. Untreated participants were sorted into one of three groups categorizing perceived threat - low threat appraisal, and danger or fear control. Results: Of 411 total responses, most (n = 293[71.29%]) sorted into the AUD cohort and 118(28.71%) into the OUD cohort. Overall, 104(25.30%) had received treatment and 307(74.70%) didn't. Within the OUD cohort, there were 67 untreated participants - 16(23.88%) exhibited low threat appraisal, 13(19.40%) were likely to undergo fear control, and 38(56.72%) were likely to undergo danger control. Within the AUD cohort, there were 240 untreated participants - 75(31.25%) exhibited low threat appraisal, 100(41.67%) were likely to experience fear control, and 65(27.08%) were likely to experience danger control. Participants in the OUD cohort were more likely to undergo danger control than those in the AUD cohort (χ2 = 19.26, p < 0.05). Conclusions: This study identified perceived threat and efficacy when an individual was at risk of a SUD, but more insight into potential early interventions is needed - particularly in those individuals with polysubstance use disorder.
Objectives Difficulty in emotional regulation is an important component in the pathology of different types of addiction and its evaluation can be helpful in understanding and treating these difficulties. The purpose of this study is to evaluate emotional regulation in people with opioid dependence (heroin and opium), food addiction, and internet addiction compared to normal people. Methods This is a causal-comparative study. Participants were 120 eligible male addicts selected using a purposive sampling method and divided into four groups of 30 including drug addiction, food addic-tion, internet addiction, and control. Semi-structured clinical interview for DSM-IV axis I disorders, Yale Food Addiction Scale, and Young’s Internet Addiction Test were used to diagnose the addictions. Then the Difficulties in Emotion Regulation Scale (DERS) was completed. Multivariate Analysis of Variance (MANOVA) was used to analyze the collected data. Results Overall DERS score and the score of its subscales were higher in all three addiction groups compared to the control group, and this difference was statistically significant (P<0.05). There was no significant difference between the three addiction groups in subscales of “unwillingness to accept certain emotional responses” and “difficulty engaging in goal-directed behavior”, but a significant difference between the three addiction groups was observed in subscales of “difficulty controlling impulse”, “lack of emotional awareness”, “lack of access to strategies”, “lack of emotional clarity”, and overall DERS score (P<0.05). Conclusion Men with opioid dependence, internet addiction and food addiction have more difficulties in emotional regulation compared to their normal peers. Emotional regulation ability in men with internet addiction is greater than in those with food and opioid addictions. © 2021, Iran University of Medical Sciences. All rights reserved.
Background
Family members of critically ill patients experience symptoms of postintensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder. Postintensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede the recovery of such patients. Cognitive behavioral therapy has become a first-line nonpharmacological treatment of many psychological symptoms and disorders, including anxiety, depression, and posttraumatic stress. With regard to managing mild-to-moderate symptoms, the delivery of cognitive behavioral therapy via mobile technology without input from a clinician has been found to be feasible and well accepted, and its efficacy rivals that of face-to-face therapy.
Objective
The purpose of our pilot study is to examine the efficacy of using a smartphone mobile health (mHealth) app to deliver cognitive behavioral therapy and diminish the severity and prevalence of PICS-F symptoms in family members of critically ill patients.
Methods
For our pilot study, 60 family members of critically ill patients will be recruited. A repeated-measures longitudinal study design that involves the randomization of participants to 2 groups (the control and intervention groups) will be used. The intervention group will receive cognitive behavioral therapy, which will be delivered via a smartphone mHealth app. Bandura’s social cognitive theory and an emphasis on mental health self-efficacy form the theoretical framework of the study.
Results
Recruitment for the study began in August 2020. Data collection and analysis are expected to be completed by March 2022.
Conclusions
The proposed study represents a novel approach to the treatment of PICS-F symptoms and is an extension of previous work conducted by the research team. The study will be used to plan a fully powered randomized controlled trial.
Trial Registration
ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767
International Registered Report Identifier (IRRID)
DERR1-10.2196/30813
This study examines relationships between drink refusal self-efficacy (DRSE) and outcomes in project options (PO), an adolescent alcohol use early intervention. 1171 US high school students (39.3% Hispanic, 59.3% girls) participated in PO, reporting their demographics, alcohol use, and drinking reduction efforts at baseline, 30 days, and 3 months later. Items from the Drug Taking Confidence Questionnaire for Adolescents (DTCQ-A) assessed DRSE. DRSE corresponded negatively with drinking at 30 days and, among drinkers, predicted lesser use reduction attempts at 30 days and 3 months. Results indicate that, unlike in treatment settings, DRSE may not correspond to improved early intervention outcomes.
The previous scenario is based on a first-person recollection of attending a party that was developed into a virtual reality scenario by Dr. Bordnick at the Virtual Reality Clinical Research Lab. This scenario was used to construct a virtual reality platform to assess and eventually decrease alcohol craving, offering a novel approach to substance abuse treatment.
Purpose
Systemic family interventions have shown to be effective in adolescents with substance use disorder and delinquent behavior. The interventions target interactions between the adolescent and involved systems (i.e. youth, family, peers, neighbors, school, work, and society). Next to effectiveness considerations, economic aspects have gained attention. However, conventional generic quality of life measures used in health economic evaluations may not be able to capture the broad effects of systemic interventions. This study aims to identify existing outcome measures, which capture the broad effects of systemic family interventions, and allow use in a health economic framework.
Methods
We based our systematic review on clinical studies in the field. Our goal was to identify effectiveness studies of psychosocial interventions for adolescents with substance use disorder and delinquent behavior and to distill the instruments used in these studies to measure effects. Searched databases were PubMed, Education Resource Information Center (ERIC), Cochrane and Psychnet (PsycBOOKSc, PsycCRITIQUES, print). Identified instruments were ranked according to the number of systems covered (comprehensiveness). In addition, their use for health economic analyses was evaluated according to suitability characteristics such as brevity, accessibility, psychometric properties, etc.
Results
One thousand three hundred seventy-eight articles were found and screened for eligibility. Eighty articles were selected, 8 instruments were identified covering 5 or more systems.
Conclusions
The systematic review identified instruments from the clinical field suitable to evaluate systemic family interventions in a health economic framework. None of them had preference-weights available. Hence, a next step could be to attach preference-weights to one of the identified instruments to allow health economic evaluations of systemic family interventions.
Background and Purpose: Drug addiction is a complex disease specified by exacerbation and repetition, uncontrollable penchant, with involuntary seeking for drugs and continuous consumption of that, with its horrible and destructive results. According to the problems which we would be faced with them during drug addiction treatment, this article is going to study on these problems. method: For this study the theoretical foundations and retaining the existing research literature on the subject was discussed. Results: In this paper, the problems related with addiction treatment, the history of drug addiction treatment, the role of opioid preservative (Methadone and Buprenorphine) and its advantages (such as reducing criminal activities, increasing productivity, improving physical functions, Social and mental health, and limiting the blood-borne pathogens) and the weakness (such as the common side effects of constipation, dizziness, dry mouth, headache, increased transpiration, itching, nausea, sleep problems, and psychiatric disorders) are presented. Conclusion: Although long-term and even short-term addiction prevention and treatment programs will be effective, but the large population of domestic drug users remains a major concern for researchers, their families, therapists, and legal responses. An effective treatment process is one of the major challenges of contemporary research and clinical practice that should help clients to defense with destructive effects of brain addiction and behavior, and regaining control of life and restoring clients to productive functions in the family, workplace and community. addiction treatment using chemical drugs is one of the most difficult, most dangerous, and most responsible drug treatments, and the doctors should also be fully trained in the correct administration of agonist medications, and they must be so patient and educated to their patients.
The purpose of the study was to investigate the predicting role of self-efficacy and social support in addiction admission among university students. In terms of purpose, this study was a basic research; and in terms of data collection, it was an ex post facto descriptive research. Using multistage cluster sampling method, 296 (153 female and 147 male) students were selected from University of Tehran and they were asked to complete Perceived Multidimensional Social Support (Zimet et al., 1980), Self-Efficacy Scale (Schwarzer & Jerusalem, 1995), and Addiction Admission Scale (Weed et al., 1992). Results of stepwise regression analysis showed that total social support and self-efficacy can equally explain four percent of variance in addiction admission (p=0/003). In addition, among social support subscales, Family Support can explain six percent of variance in addiction admission (p=0/006). However, Friend and Significant Others components did not have a significant role in the prediction. Therefore, focusing on family-oriented and individual-based approaches in addiction prevention may be more advantageous as compared to community-based approaches.
Akbari-Zardkhaneh, S., & Zandi, S. (2016). Predicting university students' addiction admission based on their self-efficacy and social support feelings. Knowledge & Research in Applied Psychology, 17(2), 36-44. (In Persian)
Veterans from conflicts such as the wars in Iraq and Afghanistan commonly return with behavioral health problems, including Post-Traumatic Stress Disorder (PTSD) and hazardous or harmful substance use. Unfortunately, many veterans experience significant barriers to receiving evidence-based treatment, including poor treatment motivation, concerns about stigma, and lack of access to appropriate care. To address this need, the current study developed and evaluated a web-based self-management intervention based on cognitive behavioral therapy (CBT), targeting PTSD symptoms and hazardous substance use in a group of symptomatic combat veterans enrolled in VA primary care. Veterans with PTSD/subthreshold PTSD and hazardous substance use were randomized to primary care treatment as usual (TAU; n = 81) or to TAU plus a web-based CBT intervention called Thinking Forward (n = 81). Thinking Forward consisted of 24 sections (approximately 20 minutes each), accessible over 12 weeks. Participants completed baseline and 4-, 8-, 12-, 16- and 24-week follow-up assessments. Three primary outcomes of PTSD, alcohol and other drug use, and quality of life were examined. Significant treatment effects were found for heavy drinking, but not for PTSD or quality of life. The effect of the intervention on heavy drinking was mediated by intervening increases in coping, social support, self-efficacy, and hope for the future. These results demonstrate the promise of a web-based, self-management intervention for difficult-to-engage OEF/OIF veterans with behavioral health and substance use concerns.
Background:
Cannabis use disorder is the most commonly reported illegal substance use disorder in the general population; although demand for assistance from health services is increasing internationally, only a minority of those with the disorder seek professional assistance. Treatment studies have been published, but pressure to establish public policy requires an updated systematic review of cannabis-specific treatments for adults.
Objectives:
To evaluate the efficacy of psychosocial interventions for cannabis use disorder (compared with inactive control and/or alternative treatment) delivered to adults in an out-patient or community setting.
Search methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 6), MEDLINE, EMBASE, PsycINFO, the Cumulaive Index to Nursing and Allied Health Literature (CINAHL) and reference lists of articles. Searched literature included all articles published before July 2015.
Selection criteria:
All randomised controlled studies examining a psychosocial intervention for cannabis use disorder (without pharmacological intervention) in comparison with a minimal or inactive treatment control or alternative combinations of psychosocial interventions.
Data collection and analysis:
We used standard methodological procedures as expected by The Cochrane Collaboration.
Main results:
We included 23 randomised controlled trials involving 4045 participants. A total of 15 studies took place in the United States, two in Australia, two in Germany and one each in Switzerland, Canada, Brazil and Ireland. Investigators delivered treatments over approximately seven sessions (range, one to 14) for approximately 12 weeks (range, one to 56).Overall, risk of bias across studies was moderate, that is, no trial was at high risk of selection bias, attrition bias or reporting bias. Further, trials included a large total number of participants, and each trial ensured the fidelity of treatments provided. In contrast, because of the nature of the interventions provided, participant blinding was not possible, and reports of researcher blinding often were unclear or were not provided. Half of the reviewed studies included collateral verification or urinalysis to confirm self report data, leading to concern about performance and detection bias. Finally, concerns of other bias were based on relatively consistent lack of assessment of non-cannabis substance use or use of additional treatments before or during the trial period.A subset of studies provided sufficient detail for comparison of effects of any intervention versus inactive control on primary outcomes of interest at early follow-up (median, four months). Results showed moderate-quality evidence that approximately seven out of 10 intervention participants completed treatment as intended (effect size (ES) 0.71, 95% confidence interval (CI) 0.63 to 0.78, 11 studies, 1424 participants), and that those receiving psychosocial intervention used cannabis on fewer days compared with those given inactive control (mean difference (MD) 5.67, 95% CI 3.08 to 8.26, six studies, 1144 participants). In addition, low-quality evidence revealed that those receiving intervention were more likely to report point-prevalence abstinence (risk ratio (RR) 2.55, 95% CI 1.34 to 4.83, six studies, 1166 participants) and reported fewer symptoms of dependence (standardised mean difference (SMD) 4.15, 95% CI 1.67 to 6.63, four studies, 889 participants) and cannabis-related problems compared with those given inactive control (SMD 3.34, 95% CI 1.26 to 5.42, six studies, 2202 participants). Finally, very low-quality evidence indicated that those receiving intervention reported using fewer joints per day compared with those given inactive control (SMD 3.55, 95% CI 2.51 to 4.59, eight studies, 1600 participants). Notably, subgroup analyses found that interventions of more than four sessions delivered over longer than one month (high intensity) produced consistently improved outcomes (particularly in terms of cannabis use frequency and severity of dependence) in the short term as compared with low-intensity interventions.The most consistent evidence supports the use of cognitive-behavioural therapy (CBT), motivational enhancement therapy (MET) and particularly their combination for assisting with reduction of cannabis use frequency at early follow-up (MET: MD 4.45, 95% CI 1.90 to 7.00, four studies, 612 participants; CBT: MD 10.94, 95% CI 7.44 to 14.44, one study, 134 participants; MET + CBT: MD 7.38, 95% CI 3.18 to 11.57, three studies, 398 participants) and severity of dependence (MET: SMD 4.07, 95% CI 1.97 to 6.17, two studies, 316 participants; MET + CBT: SMD 7.89, 95% CI 0.93 to 14.85, three studies, 573 participants), although no particular intervention was consistently effective at nine-month follow-up or later. In addition, data from five out of six studies supported the utility of adding voucher-based incentives for cannabis-negative urines to enhance treatment effect on cannabis use frequency. A single study found contrasting results throughout a 12-month follow-up period, as post-treatment outcomes related to overall reduction in cannabis use frequency favoured CBT alone without the addition of abstinence-based or treatment adherence-based contingency management. In contrast, evidence of drug counselling, social support, relapse prevention and mindfulness meditation was weak because identified studies were few, information on treatment outcomes insufficient and rates of treatment adherence low. In line with treatments for other substance use, abstinence rates were relatively low overall, with approximately one-quarter of participants abstinent at final follow-up. Finally, three studies found that intervention was comparable with treatment as usual among participants in psychiatric clinics and reported no between-group differences in any of the included outcomes.
Authors' conclusions:
Included studies were heterogeneous in many aspects, and important questions regarding the most effective duration, intensity and type of intervention were raised and partially resolved. Generalisability of findings was unclear, most notably because of the limited number of localities and homogeneous samples of treatment seekers. The rate of abstinence was low and unstable although comparable with treatments for other substance use. Psychosocial intervention was shown, in comparison with minimal treatment controls, to reduce frequency of use and severity of dependence in a fairly durable manner, at least in the short term. Among the included intervention types, an intensive intervention provided over more than four sessions based on the combination of MET and CBT with abstinence-based incentives was most consistently supported for treatment of cannabis use disorder.
We did a systematic review of reviews with evidence on the effectiveness of prevention, early intervention, harm reduction, and treatment of problem use in young people for tobacco, alcohol, and illicit drugs (eg, cannabis, opioids, amphetamines, or cocaine). Taxation, public consumption bans, advertising restrictions, and minimum legal age are effective measures to reduce alcohol and tobacco use, but are not available to target illicit drugs. Interpretation of the available evidence for school-based prevention is affected by methodological issues; interventions that incorporate skills training are more likely to be effective than information provision—which is ineffective. Social norms and brief interventions to reduce substance use in young people do not have strong evidence of effectiveness. Roadside drug testing and interventions to reduce injection-related harms have a moderate-to-large effect, but additional research with young people is needed. Scarce availability of research on interventions for problematic substance use in young people indicates the need to test interventions that are effective with adults in young people. Existing evidence is from high-income countries, with uncertain applicability in other countries and cultures and in subpopulations differing in sex, age, and risk status. Concerted efforts are needed to increase the evidence base on interventions that aim to reduce the high burden of substance use in young people.
Self-efficacy questionnaires used with adolescents are mostly youth-adapted adult measures or scales developed to assess general perceived self-efficacy. The purpose of this study was to develop and assess the psychometric properties of the Escala de Autoeficacia para la Depresión en Adolescentes (EADA). Additionally, the Emotional Self-efficacy subscale from the Self-Efficacy Questionnaire for Children and the Children's Depression Inventory-Short Version were administered to evaluate concurrent validity among these three measures. Participants were 116 adolescents between 13 and 17 years old. Results revealed that EADA has excellent internal consistency and concurrent validity, and support its adequacy as a measure to assess youth self-perception of confidence when confronting situations related to Major Depressive Disorder.
The effective therapy of substance abuse is attributed to a wide range of factors. A relevant bibliography review has highlighted those factors, which are most commonly employed by mental health professionals: Readiness (recognition, taking steps, ambivalence), Self-efficacy, Expectation about the therapy outcome, Satisfaction by the therapy treatment, Perceived Social Support, Depression/Anxiety/Stress levels of the client (clinical profile), Positive and Negative Emotions and the way in which clients realize the Meaning of Life. These factors have been thoroughly researched for the purposes of the current study during the different treatment stages of a residential treatment program. The sample included 157 clients. In total, four measurements of the factors have been conducted in the three basic stages of treatment (Counseling Centre, Residential Phase, Social Re-integration). The analysis of the Binary Logistic Regression Design revealed a statistically significant affect in factors, such as Meaning of Life (transition process from Counselling Centre to Residential Phase), Recognition and Sex (retention in the Residential Phase), Expectation, Stress and Satisfaction (completion of Residential Phase), Taking Steps, Satisfaction, Social Support and Depression (staying in Social Integration Phase) The findings of the study both confirm the important role already recognized factors play in treatment and present the impact new factors can have on the therapeutic outcome.
Relapse following an intervention program for addiction is a clinical problem that must be investigated in order to maintain behavioral changes; however relapse is still a controversial issue, from its definition to its measurement. There is a model which explains relapse in terms of a transition associated with high-risk drug use situations. It has been found that people who increase their coping skills reduce the likelihood of relapse. The study of these strategies could therefore increase understanding of the change process. The aim of this study was to identify the link between the coping strategies proposed by adolescents in treatment and the number of relapses they experienced during a follow-up. The participants were 61 teenagers aged between 14 and 18 years. Results showed that 78% of the cases met their alcohol consumption goal, which was mainly related to the use of one or two coping strategies, particularly social support and avoidance. Social support was reported in a higher percentage by subjects who met their treatment goal. These results are discussed emphasizing on the concept of relapse. © 2014, Sociedad Mexicana de Analisis de la Conducta. All right reserved.
This chapter comments on issues related to both treatment and management of a number of misusing drugs, including: opiates; stimulants (cocaine; amphetamine and amphetamine-like substances; ecstasy and ecstasy-like drugs); and benzodiazepines. Particular focus is on the clinical pharmacology of the different drugs of misuse and on medications available. Possible promising future agents for the treatment and management of most drug-misuse conditions are also commented on. Furthermore, an update of most recent literature papers regarding the clinical usefulness of psychosocial treatment, with particular reference to CBT; contingency management and behavioural approaches is offered here.
Self-efficacy theory has been extensively applied to alcoholism treatment, theories of relapse, and relapse prevention. Most empirical studies of perceived self-efficacy to resist heavy drinking have used the Situational Confidence Questionnaire (SCQ). Among adults, this instrument has been shown to be psychometrically sound. Little is known, however, about the psychometric properties of the SCQ in the adolescent population. We administered the SCQ to a sample of 662 adolescents to evaluate its psychometric properties. Each of the eight subscales was found to be unidimensional. Invariance of the item parameters across different groups was also examined. The reliability coefficients, based on item response theory (marginal reliability) and classical measurement theory (Cronbach alpha), were found to be high. These results demonstrate that the SCQ is appropriate for use among adolescents.
Ninety-four children (aged 9-13 years) with anxiety disorders were randomly assigned to cognitive behavioral treatment or waiting-list control. Outcomes were evaluated using diagnostic status, child self-reports, parent and teacher reports, cognitive assessment and behavioral observation: maintenance was examined using 1-year follow-up data. Analyses of dependent measures indicated significant improvements over time, with the majority indicating greater gains for those receiving treatment. Treatment gains returned cases to within nondeviant limits (i.e., normative comparisons) and were maintained at 1-year follow-up. Client age and comorbid status did not moderate outcomes. A preliminary examination of treatment segments suggested that the enactive exposure (when it follows cognitive-educational training) was an active force in beneficial change. Discussion includes suggestions for future research.
The relationships among alcohol treatment, coping skills, and self-efficacy in predicting alcohol use and related consequences following treatment initiation were investigated. The participants were 77 men and 65 women who were entering either inpatient or outpatient alcohol treatment. The analyses confirmed predictions that treatment, coping skills, and self-efficacy each contributed significantly to the prediction of 12-month alcohol consumption beyond the variance accounted for by participant control variables. Only self-efficacy explained significant additional variance in the consequences outcome. Mediation analyses of the alcohol consumption variables suggested that treatment effects were not mediated by either coping skills or self-efficacy and that the effects of coping skills were not mediated by self-efficacy. The findings are interpreted as providing partial support for social learning theory approaches. Suggestions for future research are discussed.
This randomized clinical trial evaluated individual cognitive-behavioral therapy (CBT), family therapy, combined individual and family therapy, and a group intervention for 114 substance-abusing adolescents. Outcomes were percentage of days marijuana was used and percentage of youths achieving minimal use. Each intervention demonstrated some efficacy, although differences occurred for outcome measured, speed of change, and maintenance of change. From pretreatment to 4 months, significantly fewer days of use were found for the family therapy alone and the combined interventions. Significantly more youths had achieved minimal use levels in the family and combined conditions and in CBT. From pretreatment to 7 months, reductions in percentage of days of use were significant for the combined and group interventions, and changes in minimal use levels were significant for the family, combined, and group interventions.
In the present study 128 alcohol dependent men and women received 26 weeks of group treatment in one of two modalities: Cognitive-behavioral treatment (CBT) intended specifically to develop coping skills or interactional therapy intended to examine interpersonal relationships. Coping skills and drinking were assessed prior to and after treatment and up to 18 months after intake. Results indicated that both treatments yielded very good drinking outcomes throughout the follow-up period. Increased coping skills was a significant predictor of outcome. However, neither treatment effected greater increases in coping than the other. Specific coping-skills training was not essential for increasing the use of coping skills. The results raise questions about the efficacy of specific treatment elements of CBT in treatment of alcohol dependence.
This article presents the main outcome findings from two inter-related randomized trials conducted at four sites to evaluate the effectiveness and cost-effectiveness of five short-term outpatient interventions for adolescents with cannabis use disorders. Trial 1 compared five sessions of Motivational Enhancement Therapy plus Cognitive Behavioral Therapy (MET/CBT) with a 12-session regimen of MET and CBT (MET/CBT12) and another that included family education and therapy components (Family Support Network [FSN]). Trial II compared the five-session MET/CBT with the Adolescent Community Reinforcement Approach (ACRA) and Multidimensional Family Therapy (MDFT). The 600 cannabis users were predominately white males, aged 15-16. All five CYT interventions demonstrated significant pre-post treatment during the 12 months after random assignment to a treatment intervention in the two main outcomes: days of abstinence and the percent of adolescents in recovery (no use or abuse/dependence problems and living in the community). Overall, the clinical outcomes were very similar across sites and conditions; however, after controlling for initial severity, the most cost-effective interventions were MET/CBT5 and MET/CBT12 in Trial 1 and ACRA and MET/CBT5 in Trial 2. It is possible that the similar results occurred because outcomes were driven more by general factors beyond the treatment approaches tested in this study; or because of shared, general helping factors across therapies that help these teens attend to and decrease their connection to cannabis and alcohol.
The authors examined both the nonspecific effects of psychopathology and the interactions of alcohol use disorders with other specific comorbid psychiatric conditions in an adolescent population on perceived self-efficacy to resist heavy drinking. The results suggest that nonspecific psychopathology, manifested in the form of any common psychiatric disorder, is associated with decreased situational confidence to resist heavy drinking across various situations. Main effects of alcohol use disorders, and several other specific psychiatric disorders, and specific comorbid interactions were also associated with decreased situational confidence. These results have implications for the etiology, prevention, and treatment of adolescents who abuse alcohol.
Background:
Previous studies in nonclinical samples have shown psychosocial treatments to be efficacious in the treatment of adolescent depression, but few psychotherapy treatment studies have been conducted in clinically referred, depressed adolescents.
Methods:
One hundred seven adolescent patients with DSM-III-R major depressive disorder (MDD) were randomly assigned to 1 of 3 treatments: individual cognitive behavior therapy, systemic behavior family therapy (SBFT), or individual nondirective supportive therapy (NST). Treatments were 12 to 16 sessions provided in as many weeks. Intent-to-treat analyses were conducted using all follow-up data.
Results:
Of the 107 patients enrolled in the study, 78 (72.9%) completed the study, 4 (3.7%) never initiated treatment, 10 (9.3%) had exclusionary criteria that were undetected at entry, 8 (7.5%) dropped out, and 7 (6.5%) were removed for clinical reasons. Cognitive behavior therapy showed a lower rate of MDD at the end of treatment compared with NST (17.1% vs 42.4%; P=.02), and resulted in a higher rate of remission (64.7%, defined as absence of MDD and at least 3 consecutive Beck Depression Inventory scores <9) than SBFT (37.9%; P=.03) or NST (39.4%; P=.04). Cognitive behavior therapy resulted in more rapid relief in interviewer-rated (vs both treatments, P=.03) and self-reported depression (vs SBFT, P=.02). All 3 treatments showed significant and similar reductions in suicidality and functional impairment. Parents' views of the credibility of cognitive behavior therapy improved compared with parents' views of both SBFT (P=.01) and NST (P=.05).
Conclusion:
Cognitive behavior therapy is more efficacious than SBFT or NST for adolescent MDD in clinical settings, resulting in more rapid and complete treatment response.
The sensitivity of the Diagnostic Interview Schedule for Children, second edition (DISC-2.1) was examined for certain "rare" disorders: eating disorders, major depressive episode, obsessive compulsive disorder, psychosis, tic disorders, and substance use disorders.
Subjects recruited from specialized centers were interviewed with the DISC-2.1; the centers' diagnoses served as the criterion measure.
Overall the DISC showed good to excellent sensitivity (range = 0.73 to 1.0). Used alone, the DISC-P (parent interview) was generally more sensitive than the DISC-C (child interview). Areas for additional instrument revision were identified. Recommendations about informant choice by diagnosis are offered.
The strategy used in this study was useful for assessing the DISC's sensitivity for these disorders. Additional work examining specificity of the DISC remains to be done. The DISC should prove a useful adjunct in clinical settings given the ease and relatively low cost of administration.
This article reviews the research on resilience in order to delineate its significance and potential for understanding normal development. Resilience refers to the process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances. Three resilience phenomena are reviewed: (a) good outcomes in high-risk children, (b) sustained competence in children under stress, and (c) recovery from trauma. It is concluded that human psychological development is highly buffered and that long-lasting consequences of adversity usually are associated with either organic damage or severe interference in the normative protective processes embedded in the caregiving system. Children who experience chronic adversity fare better or recover more successfully when they have a positive relationship with a competent adult, they are good learners and problem-solvers, they are engaging to other people, and they have areas of competence and perceived efficacy valued by self or society. Future studies of resilience will need to focus on processes that facilitate adaptation. Such studies have the potential to illuminate the range and self-righting properties of, constraints on, and linkages among different aspects of cognitive, emotional, and social development.
The present study investigates self-generated coping strategies and efficacy ratings in high risk for relapse situations of 50 adolescents treated for drug and alcohol abuse. Coping responses and self-efficacy assessments were elicited for self-generated high risk for relapse situations in which all teens successfully abstained and for responses generally used in such situations. Abstainers and relapsers were predicted to generate similar responses for successful abstinence situations, while relapsers were expected to generate fewer coping strategies and lower self-efficacy for high risk relapse situations in general. Teens with the poorest drug use outcome reported use of significantly fewer problem solving coping strategies and less self-efficacy in general high risk relapse situations. Results are discussed in relation to the cognitive behavioral theory of relapse and to previous findings on the process of relapse in teen substance abusers.
A recent controversy in research on self-efficacy theory has been directed at the role of outcome and efficacy expectancies in the prediction of behaviour. While Bandura maintains that outcome expectancies add little information to prediction beyond that explained by efficacy expectations, others disagree. The present study explored the efficacy-outcome expectancy relationship in a population of alcoholic clients as they moved through a traditional treatment program and were contacted following a three-month aftercare period. Results indicated that outcome expectancies (defined as the costs and benefits expected to result from a change in drinking) did not predict consumption at follow-up. However, self-efficacy (defined as confidence in being able to resist the urge to drink heavily) assessed at intake of treatment, was strongly associated with the level of consumption on drinking occasions at follow-up. These findings are discussed in relation to the relevance of self-efficacy theory to research and treatment of alcoholic patients.
Psychopathology coexisting with substance abuse in adolescents is often encountered in a variety of clinical settings. Research findings suggest a major role for substance use in the etiology and prognosis of psychiatric disorders such as affective disorders, conduct disorder and antisocial personality disorder, attention-deficit hyperactivity disorder, and anxiety disorders. Psychiatric disorders also appear to have an important role in the etiology of and vulnerability to substance use problems in adolescents. Although the comorbidity of substance abuse and other psychiatric disorders in adolescents is recognized as an important factor in the treatment of adolescents, further research is needed to establish its prevalence, genetics, and clinical implications.
Monthly intreatment ratings of self-efficacy to avoid drug and alcohol abuse were examined among 419 substance abuse inpatients of a residential treatment community. Posttreatment interviews were conducted with 81 patients approximately 6 months following discharge to assess the relationship between self-efficacy and relapse. As expected, self-efficacy increased during treatment and was higher among abstainers than relapsers at follow-up. Contrary to expectations, low self-efficacy at intake was related to longer inpatient residence and more positive conditions of discharge. Furthermore, abstainers had slightly lower self-efficacy scores than relapsers at intake and increased their self-efficacy two-fold over relapsers during the course of treatment. Contrary to previous research with tobacco smoking, self-efficacy ratings at the end of treatment were not related to substance abuse at follow-up. It is proposed that the present findings are consistent with previous research in demonstrating a relationship between self-efficacy and outcome, and provide new information suggesting that low self-efficacy may be related to positive outcome under certain circumstances. Hypotheses are advanced regarding (1) the potential utility of intreatment change measures, (2) the role of underestimation in self-efficacy ratings and (3) the role of denial in substance abuse populations.
Historically research has focused on the characteristics of adults who relapse following treatment for alcohol or drug dependence. The circumstances of adolescent relapse, however, have largely gone unattended. The present study investigated the relapse rates and characteristics of adolescent posttreatment drug relapse. Seventy-five teens and their parents were interviewed while participating in an adolescent chemical dependency treatment program and at three and six months following treatment. Results indicate that a number of characteristics of adolescent relapse, including rates, are comparable to those of adults. In contrast to adult relapse, adolescent relapses occur most commonly in the presence of social pressure to drink. Situational characteristics of initial relapse experiences were different for transient or minor relapses and adolescent relapses which lead to a return to abusive drinking and drug use patterns.
Evaluated the utility and validity of A. Bandura's (see record 1977-25733-001) self-efficacy theory and G. A. Marlatt's (1978) theoretical model of relapse in a study of 78 cigarette smokers (aged 16–70 yrs) from 2 cessation programs. Pretreatment, posttreatment, and follow-up assessments of smoking behavior, self-efficacy, and mood states (Profile of Mood States) were obtained. Efficacy state was found to be significantly enhanced as the result of both treatment programs. Ss' scores on the 7 clusters from a posttreatment efficacy state inventory were used as predictor variables in a multiple regression analysis to predict which Ss would relapse and how long, on a dichotomous time variable, they would remain abstinent before relapse. A microanalysis revealed an extremely high correspondence between the cluster of smoking situations in which relapsing Ss experienced a low degree of self-efficacy and the situation in which relapse first occurred. Analysis of mood and efficacy data during follow-up indicated that relapsing Ss demonstrated aspects of a cognitive dissonance reaction and a personal attribution effect that were consistent with Marlatt's description of the abstinence violation effect. (20 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article describes a brief, standardized, cognitive-behavioral treatment program for adolescent suicide attempters and their families.
Successful Negotiation Acting Positively (SNAP) treatment consists of a series of structured activities that create a positive family atmosphere, teach problem-solving skills, shift the family's understanding of their problems to troublesome situations rather than difficult individuals, and build confidence in the treatment professional, thereby reducing conditions associated with future attempts.
SNAP treatment has been systematically administered to more than 100 suicidal adolescents and their families as part of an ongoing treatment study. Although these results are not yet available, our initial experience suggests that SNAP treatment can be delivered in a reliable fashion and is well accepted by both patients and therapists.
Although suicidality in youth constitutes a major public health problem, few therapeutic interventions have been developed specifically for suicidal adolescents. SNAP treatment addresses a number of issues critical to successful interventions with this population, including their historically poor treatment compliance, the need for family involvement in treatment, and an emphasis on coping and problem-solving strategies. Moreover, the brief, structured format of SNAP treatment is consistent with the growing trend toward standardized, empirically tested, and cost-efficient interventions.
Co-occurrence of psychiatric disorders was investigated among 52 adolescent substance abusers and 23 non-substance-abusing adolescents with conduct and/or oppositional defiant disorders, admitted to the same inpatient facility.
During independent face-to-face interviews with parent(s) or caretaker(s) and subjects, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version was administered to collect data on substance abuse, psychopathology, and sociodemographic characteristics, such as age, gender, home situation, and psychosocial stressors. A semistructured interview was used to identify the presence of substance abuse and other psychopathology among first-degree family members. Substance abuse was diagnosed according to both DSM-III-R and Halikas criteria.
Excluding conduct and oppositional defiant disorders, 85% of the substance abusers versus 65% of the non-substance abusers demonstrated psychiatric comorbidity. Substance abusers had a higher incidence of dysthymia, major depression, social phobia, and "other" diagnoses than did the comparison group (p < .05), in which oppositional defiant disorder, conduct disorder, and attention-deficit hyperactivity disorder prevailed. Overanxious disorder was predominant among female (p = .022) and conduct disorder among male substance abusers (p < or = .002). Psychopathology preceded or coincided with substance abuse, except for major depression. No correlation between the severity and type of substance abuse and the number and degree of various coexisting psychopathologies was found. Psychopathology in parents and siblings of substance abusers was similar to that of non-substance abusers.
These data indicate that adolescent substance abusers are at high risk for comorbid psychopathology and need to be carefully evaluated for psychiatric comorbidity to provide them with a comprehensive treatment plan.
In substance abusers, low end-of-treatment self-efficacy is thought to be a predictor of increased vulnerability of relapse following treatment. This study is an evaluation of relationships between end-of-treatment self-efficacy, aftercare, and drinking outcomes in a subsample of male alcoholics participating in a treatment outcome study. After completing Behavioral Marital Therapy (BMT), the alcoholics and their spouses were randomly assigned to either an aftercare or a no additional treatment condition and followed up for 1 year. In subjects who received no additional treatment, low self-efficacy at the end of BMT predicted poorer drinking outcomes, even after drinking behavior during BMT was controlled for. For subjects in the aftercare condition, self-efficacy at the end of BMT did not predict drinking outcomes. Explanations for the results, as well as implications for models of relapse, are discussed.
The present study examines whether skills for coping with relapse-risk situations assessed during treatment can predict outcome in adolescents treated for drug and alcohol abuse. After the exclusion of individuals who evidenced low commitment to change, who were institutionalized following treatment, or for whom outcome data were unreliable, analyses were conducted on 57 adolescents. It was hypothesized that coping factors reflecting problem-focused, social-support, self-blame, and wishful-thinking strategies would predict 6-month outcome status. A multiple regression analysis found that the coping factors accounted for significant variance in the prediction of a composite measure of treatment outcome and also predicted variables reflecting total days using and initial length of abstinence. Examination of the influence of coping factors in relation to outcome revealed that wishful thinking and social support contributed significantly to the prediction of total days using and length of initial abstinence, respectively. These findings were interpreted to suggest that one's cognitive approach to coping may impact drug and alcohol relapse by reducing appraised stress in a relapse-risk situation and, thus, decreasing active coping efforts. Additionally, these results highlight the importance to successful outcome of utilizing social resources. The findings are interpreted to suggest that interventions aimed at cognitive aspects of coping and enhancing social support in substance abusing teens may be useful in preventing relapse.
After reviewing the empirical literature, we suggest that advances in the assessment and treatment of alcohol problems have the following important implications for health care system reform: (1) alcohol use disorders and problems associated with alcohol use are prevalent and are complicated by various comorbid conditions, and they result in large costs to the health care system and to society; (2) alcohol treatment generally results in reduced drinking and more efficient use of health care resources; (3) specific treatments have demonstrated effectiveness; (4) screening and assessment instruments with excellent sensitivity to the heterogeneity of alcohol problems have been developed; (5) evidence that specific treatments have differential effectiveness with different patients groups is accumulating; and (6) good evidence exists for the effectiveness of brief interventions, particularly with less severe and chronic alcohol problems. These findings suggest that alcohol treatment services in a reformed health care system should include (1) universal coverage for alcohol treatment, including full benefits for outpatient care; (2) a rational system of assessment and triage for treatment, including an increased emphasis on screening and brief interventions in primary medical care settings; (3) a full range of treatment services that vary in intensity; and (4) addictions treatment provider incentives and contingencies to provide treatments of proven effectiveness. When fully implemented, an efficient approach to the treatment of alcohol-related problems will result in one of the largest pools of cost savings in a reformed American health care system.
We evaluated the EZ-SCREEN Test Kit (Editek, Inc., Burlington, NC), a point-of-care screening test for the presence of cocaine metabolite (benzoylecgonine; BE), cannabinoids (tetrahydrocannabinol; THC) and opiates in urine. Patient specimens (n = 34) were tested in the laboratory using both Abbott Laboratories ADx (ADx) and EZ-SCREEN (EZS-LAB), and by the nursing staff of an inpatient substance abuse treatment program using the EZ-SCREEN (EZS-RN). We found comparable analytical efficiency between methods used in the laboratory (> 95% for all three analytes with EZS-LAB and ADx) but lower efficiency for THC and BE with point-of-care testing (approximately 82% for EZS-RN). Efficiency for EZS-RN opiates was 100%. We conclude that the EZ-SCREEN Test Kit may not be suitable for use in a busy clinical setting, unless specific measures are taken to insure the accuracy of point-of-care testing (e.g., minimal interruption or distraction, careful training). We recommend that prior to routine use of point-of-care testing products they be evaluated under normal working conditions with personnel who will eventually be required to perform routine testing.
The present study was undertaken to assess the factor structure and psychometric validity of the Adolescent Relapse Coping Questionnaire (ARCQ). The ARCQ is designed to assess alcohol and other drug abusing adolescents coping with situations providing temptations for alcohol and other drug use.
This was a prospective longitudinal study of 136 (79 male) alcohol and other drug abusing adolescents who were an average of 16.9 years old. Consecutive admissions were recruited from two adolescent, inpatient alcohol and drug abuse treatment facilities. Subjects completed the ARCQ as part of a 1-year-posttreatment interview and were subsequently interviewed 2 years posttreatment.
Analyses yielded three coping factors which were evaluated for construct and criterion validity. Factor 1 contained generic cognitive and behavioral problem-solving strategies, Factor 2 represented self-critical cognitions and Factor 3 included abstinence-focused coping strategies. The factors had good internal consistency (alpha = .78 to .82) and collectively accounted for 40% of the variance in the principle components analysis. The abstinence-oriented coping factor was significantly correlated with current alcohol and drug use and measures of situation appraisal, and significantly predicted alcohol and drug use during the year following assessment.
The findings provide evidence for the psychometric validity of the ARCQ, provide convergent validation for the utility of the temptation-coping construct and further highlight differences between adult and teen addictive relapse.
The purpose of this paper is to provide an historical overview of the development of the taxonomy of high-risk situations for relapse in patients receiving abstinence-based treatment for alcoholism. Research conducted during the 1970s on determinants of relapse is briefly reviewed, beginning with a preliminary analysis of relapse patterns in alcoholics treated with aversion therapy. Theoretical foundations underlying the development of the taxonomy are then discussed with an emphasis on social-learning theory and its implications for cognitive-behavioral interventions for relapse prevention. Findings supporting the efficacy of coping-skills training for high-risk relapse situations, based on a prospective treatment outcome study for inpatient alcoholics, are also presented in support of the clinical validity of the relapse model. The paper concludes with a description of the refined and extended taxonomy of high-risk situations and the associated cognitive-behavioral model of relapse described in the Marlatt & Gordon (1985) text on relapse prevention.
The perceived ability to engage in situation-specific behaviors (self-efficacy) to overcome nicotine dependence and alcohol abuse has been shown to correlate significantly with and be predictive of the actual ability to engage in such behaviors. Self-efficacy is also related to subsequent behavior change during treatment and maintenance of this change after treatment termination. In this study, part of national outcome study, the relationship between self-efficacy and drug use was investigated in a subsample of regular cocaine users (n = 294) who completed at least three months of treatment in community-based outpatient treatment programs. Frequency of cocaine and other drug use was reported for the period of 1 year before treatment and a 1 month and 3 months in treatment. Self-efficacy regarding resisting drug use was measured at 1 and 3 months in treatment. Self-efficacy at 1 month was correlated with cocaine use at 1 month and self-efficacy contributed to the prediction of self-reported drug use at 1 month over and above pretreatment and demographic variables. Similarly, self-efficacy at 3 months was correlated with cocaine use at 3 months and contributed to the prediction of self-reported drug use at 3 months. These outcomes were obtained even though over 75% of subjects reported no drug use during treatment. The results supported previous findings suggesting that increased self-efficacy regarding resisting drug use is associated with lower rates of drug use during treatment, and that self-efficacy enhancement may be an important intervention in the treatment of cocaine use.
Previous studies in nonclinical samples have shown psychosocial treatments to be efficacious in the treatment of adolescent depression, but few psychotherapy treatment studies have been conducted in clinically referred, depressed adolescents.
One hundred seven adolescent patients with DSM-III-R major depressive disorder (MDD) were randomly assigned to 1 of 3 treatments: individual cognitive behavior therapy, systemic behavior family therapy (SBFT), or individual nondirective supportive therapy (NST). Treatments were 12 to 16 sessions provided in as many weeks. Intent-to-treat analyses were conducted using all follow-up data.
Of the 107 patients enrolled in the study, 78 (72.9%) completed the study, 4 (3.7%) never initiated treatment, 10 (9.3%) had exclusionary criteria that were undetected at entry, 8 (7.5%) dropped out, and 7 (6.5%) were removed for clinical reasons. Cognitive behavior therapy showed a lower rate of MDD at the end of treatment compared with NST (17.1% vs 42.4%; P = .02), and resulted in a higher rate of remission (64.7%, defined as absence of MDD and at least 3 consecutive Beck Depression Inventory scores < 9) than SBFT (37.9%; P = .03) or NST (39.4%; p = .04). Cognitive behavior therapy resulted in more rapid relief in interviewer-rated (vs both treatments, P = .03) and self-reported depression (vs SBFT, P = .02). All 3 treatments showed significant and similar reductions in suicidality and functional impairment. Parents' views of the credibility of cognitive behavior therapy improved compared with parents' views of both SBFT (P = .01) and NST (P = .05).
Cognitive behavior therapy is more efficacious than SBFT or NST for adolescent MDD in clinical settings, resulting in more rapid and complete treatment response.
The state of the art for treatment efficacy studies now requires manual guided treatments and tests of therapist adherence. This report provides findings regarding adherence assessment of therapists participating in an investigation of treatment matching in adolescent substance abusers. The Group Sessions Rating Scale (GSRS), a group-therapy process measure, was studied to determine its appropriateness for assessing group treatment of adolescents with a) substance use disorders (SUD), b) interrater reliability, c) internal consistency, and d) ability to discriminate the active ingredients of cognitive-behavioral therapy (CBT) from interactional therapy (IT). Interrater reliabilities were moderate to high, with those for CBT generally higher than those for IT. Internal consistency of CBT items was moderate, whereas those of IT were moderately high. Discriminability between the two treatment modalities was high. The frequency of active ingredients was generally therapy-specific: high for the relevant and low for the nonrelevant therapeutic modality items. The GSRS was found to be effective in the measurement of treatment process in adolescents with SUD.
This study tested the hypothesis that dually diagnosed adolescent substance abusers could be matched to effective treatments on the basis of their comorbid psychopathology. Specifically, patients with externalizing disorders would have better outcomes when treated with cognitive-behavioral group treatment (CBT), and subjects with internalizing disorders without comorbid externalizing disorders would fare better in interactional group treatment (IT). Thirty-two dually diagnosed adolescent substance abusers were randomized into two 12-week manual guided outpatient group psychotherapies: CBT and IT. At 3-month follow-up, no patient-treatment matching effects were identified. Adolescents assigned to CBT demonstrated a significant reduction in severity of substance use compared with those assigned to IT. Improvement in severity of family function showed a trend in favor of CBT. School function, peer-social relationships, legal problems, and psychiatric severity all showed a consistent nonsignificant direction in favor of CBT over IT. CBT appears to be a promising short-term psychosocial intervention for adolescents.
In order to test the hypothesis that adolescent substance abusers could be matched to effective treatments on the basis of their comorbid psychopathology, 32 dually diagnosed adolescents were randomized into two short-term outpatient group psychotherapies: cognitive-behavioral treatment (CBT), and interactional treatment (IT). Two follow-up assessments were conducted at 3 and 15 months after planned treatment completion. As reported recently, at the three-month follow-up, no patient-treatment matching effects were identified. However, adolescents assigned to CBT demonstrated a significant reduction in severity of substance abuse compared to those assigned to IT. At 15-month follow-up, there were no differential improvements as a function of therapy type. However, subjects in general maintained significant treatment gains on the substance abuse, family function, and psychiatric status domains of the Teen-Addiction Severity Index (T-ASI), and both CBT and IT were associated with similar long-term gains. Large scale, randomized, controlled treatment studies are further recommended to examine the findings of this small-scale pilot study.
This review examined support for the hypothesis that cognitive-behavioral treatment (CBT) for alcohol dependence works through increasing cognitive and behavioral coping skills.
Ten studies were identified that examined the hypothesized mechanisms of action of CBT. These studies involved random assignment (or its near equivalent) of participants to CBT and at least one comparison condition.
Although numerous analyses of the possible causal links have been conducted to evaluate whether CBT works through increasing coping, the results indicate little support for the hypothesized mechanisms of action of CBT.
Research has not yet established why CBT is an effective treatment for alcohol dependence. Negative findings may reflect methodological flaws of prior studies. Alternatively, findings may indicate one or more conceptual assumptions underlying CBT require revision.
The objective of this study was to compare the efficacy of cognitive behavioral therapy (CBT) versus psychoeducational therapy (PET) for adolescent substance abusers. Eighty-eight consecutively referred predominantly dually diagnosed adolescents were randomized to one of two eight-week, outpatient group psychotherapy conditions. Drug urinalysis and the Teen-Addiction Severity Index (T-ASI) were used as outcome measurements. Treatment completion rate was 86%, follow-up location rate was 95%, and rates of posttreatment at 3- and 9-month follow-up evaluation were 80% and 65%, respectively. Comorbid conduct disorder was significantly associated with treatment noncompletion and reduced follow-up rate. CBT subjects exhibited significantly lower rates of positive urinalysis than did PET subjects for older youth and male subjects at 3-month follow-up evaluation. Most T-ASI subscales indicated sound improvement from baseline to 3- and 9-month follow-up evaluation across conditions. Reduction in substance use was achieved regardless of treatment conditions. Replication of these findings, continued exploration of potential matching effects of conduct disorder, age, and gender to singular or integrative treatment modalities, and exploration of aftercare programs for the maintenance or enhancement of treatment gains are warranted.
The relationship between self-efficacy and the cessation of alcohol- and drug-dependent behavior was examined in this study. Evidence suggests that the Relapse Prevention Approach may incorrectly specify a relationship between self-efficacy and recovery. Instead of high situational coping self-efficacy, it may be that the acknowledgment of a loss of control over alcohol and drug use, or low controlled use self-efficacy, promotes recovery because the addict embraces the need for lifelong abstinence. Findings from a prospective study of 356 drug treatment outpatients indicate that low controlled use self-efficacy predicted higher levels of abstinence acceptance independent from the possible influences of alcohol and drug use histories and treatment history. A decrease in controlled use self-efficacy overtime was associated with an increase in abstinence acceptance, and high and increasing levels of abstinence acceptance predicted alcohol and drug abstinence. Contrary to the Relapse Prevention Approach, controlled use self-efficacy does not predict severity or level of use for those who relapse or continue to use alcohol and other drugs. These findings suggest a new social-cognitive theory of recovery--the Addicted-Self Model. This model asserts that the cessation of alcohol- and drug-dependent behavior is more likely to occur when the addict attributes the loss of control over drug and alcohol use to a stable, permanent property of the self and embraces the need for life-long abstinence.
Cognitive-behavioral therapy (CBT) approaches to intervention for adolescent substance use disorders has been limited and formal controlled clinical efficacy trials have been rare. Moreover, the early literature on the efficacy of CBT for adolescent substance abuse has been characterized by significant methodological limitations. Recent innovations in the treatment of adolescent substance abuse and the recent completion of several randomized clinical trials has brightened the picture with respect to establishing the empirical support for CBT. The aim of this review is to integrate the findings from controlled trials of CBT for adolescent substance abuse.
Studies representing randomized clinical trials were reviewed using criteria provided by Lonigan et al. and Nathan & Gorman as a guide.
Despite some prominent differences in design and methodology, the studies reviewed provide consistent empirical evidence that group and individual CBT are associated with significant and clinically meaningful reductions in adolescent substance use. The evidence for the efficacy of group therapy is particularly important, countering the assertion that aggregating problem youths into group treatment settings is associated with iatrogenic effects. The findings from the randomized trials reviewed represent significant developments in treatment outcome research and lay the foundation for validating CBT for adolescent substance use disorders. Future research directions include improving short- and long-term outcomes, enhancing treatment motivation and engagement, and identifying mechanisms and processes associated with positive change, especially for youths with comorbid conditions.
Situational Confidence Questionnaire (SCQ-39) user's guide. Toronto7 Addiction Research Foundation Social learning theory
- H M Annis
- J M Graham
Annis, H. M., & Graham, J. M. (1988). Situational Confidence Questionnaire (SCQ-39) user's guide. Toronto7 Addiction Research Foundation. Bandura, A. (1977). Social learning theory. Englewood-Cliffs, NJ7 Prentice-Hall.
Assessment of expectancies in alcohol-dependent clients
- Annis
Annis, H. M., & Davies, C. S. (1988). Assessment of expectancies in alcohol-dependent clients. In D. Donovan, & G. A. Marlatt (Eds.), Assessment of addictive behaviors (pp. 84 – 111). New York, NY7 Guilford Press.
Use situations and confidence levels of adolescent alcohol and drug abusers with concomitant psychopathology. College on problems of drug dependence annual meeting
- F F Shiralipour
- A M Abrantes
- S A Brown
Shiralipour, F. F., Abrantes, A. M., & Brown, S. A. (2000, June). Use situations and confidence levels of adolescent alcohol and drug abusers with concomitant psychopathology. College on problems of drug dependence annual meeting San Juan, Puerto Rico.
Situational Confidence Questionnaire (SCQ-39) Toronto7 Addiction Research Foundation
- H M Annis
Annis, H. M. (1987). Situational Confidence Questionnaire (SCQ-39). Toronto7 Addiction Research Foundation.
Cognitive-behavioral coping skills and psychoeducation therapies for adolescent substance abuse
- Kaminer
Therapy for youth with anxiety disorders: A second randomized clinical trial
- Kendall
Use situations and confidence levels of adolescent alcohol and drug abusers with concomitant psychopathology
- Shiralipour