A comprehensive and comparative review of adolescent substance abuse treatment outcome.

Abstract

There are relatively few studies on adolescent substance abuse treatment. The ones that exist tend to be methodologically weak. Methodologically stronger studies have usually found most adolescents receiving treatment to have significant reductions in substance use and problems in other life areas in the year following treatment. Average rate of sustained abstinence after treatment is 38% (range 30-55) at 6 months and 32% at 12 months (range 14-47). Variables most consistently related to successful outcome are treatment completion, low pre-treatment substance use, and peer/parent social support/nonuse of substances. There is evidence that treatment is superior to no treatment, but insufficient evidence to compare the effectiveness of treatment types. The exception to this is that outpatient family therapy appears superior to other forms of outpatient treatment. 3There have been several reviews and commentaries on the adolescent drug treatment literature (e.g., Brown, 1993; Brown, Mott and Myers 1990; Bukstein, 1994; Davidge and Forman, 1988; Dusenbury, Khuri and Millman, 1992;Kaminer, 1994;Spicer, 1991; U.S. Department of Health and Human Services, 1995a; Winters, Latimer and Stinchfield, in press). The most thorough review has been that of Catalano, Hawkins, Wells, Miller and Brewer (1990/1991). In this review Catalano and his colleagues identified 16 treatment outcome studies and an additional 13 studies that examined factors affecting treatment progress or treatment outcome. Four of these studies were multi-site, multi-program evaluations (Friedman, Glickman and Morrissey, 1986; Drug Abuse Reporting Program (DARP) reported in Sells and Simpson, 1979; Treatment Outcome Prospective Study (TOPS) reported in Hubbard, Cavanaugh, Craddock and Rachal, 1985; and the Uniform Data Collection System (UDCS) reported in Rush, 1979). In their review of all of these studies, they concluded that treatment was likely better than no treatment, but there was no evidence that one treatment type was superior to another. Pre-treatment factors associated with outcome were race, seriousness of substance use, criminality, and educational status. During-treatment factors predictive of outcome were time in treatment for residential programs, involvement of family in treatment, experienced staff who used practical problem solving, and programs that provided comprehensive services (school, recreation, vocation, contraceptive). Posttreatment factors were believed to be the most important determinants of outcome. These included involvement in work and school, association with nonusing friends, and involvement in leisure activities.Unfortunately, Catalano et al. 's (1990/1991) review has several limitations. Catalano et al. (1990Catalano et al. ( /1991, as well as several other reviewers of the adolescent literature (e.g. Newcomb and Bentler, 1989), have pointed out that the small number of treatment outcome studies makes conclusions very tentative. For comparison purposes, in the adult literature, there have been over 1000 stud...

Validity of Adolescent Self-Report of Substance Use

“…However, in all other respects the heterogeneous demographics and situational characteristics (e.g., school attendance, % on probation, etc.) of our sample is very similar to what is found in the general adolescent treatment population (10,21) and in the general adolescent substance-abusing population (50).…”

“…If adolescent self-report only has fair validity at intake then limited weight should be given to it in formulation of the treatment plan and/or formulation must proceed more slowly, as self-report improves. Secondly, therapeutic engagement is thought to be one of the more important factors in treatment success with adolescents (48). To the clinician, invalid self-report may serve as a useful indicator of the need for improved engagement.…”

“…Only a very small minority of substance abuse treatment facilities for adolescents currently provide biochemical verification of substance use. Adolescents entering substance abuse treatment may be a population with higher rates of underreporting, as most enter treatment because of parental, school or legal pressure rather than because they want to themselves (21).…”

Internalizing and externalizing behaviors and their association with the treatment of adolescents with substance use disorder

“…The pattern of outcome data associated with the treatment group is comparable to outcome findings observed in other adolescent drug treatment studies, including those that have investigated general 12-Step approaches (Harrison & Hoffman, 1989;Winters et al, 2000) and other treatment approaches (Deas & Thomas, 2001;Williams et al, 2000). However, when the separate treatment groups defined by typology are examined, a different outcome picture emerges.…”

Joint trajectory analysis of treated adolescents' alcohol use and symptoms over 1 year

“…Relative to baseline level of alcohol involvement, treated adolescents appeared to show a reduction in alcohol use and symptoms that was generally maintained over short-term follow-up (cf. Williams et al, 2000). Among the four alcohol use trajectories (Abstainers, Low use, Increasing, High use) that were identified, Abstainer and Low use groups represented the majority of the sample.…”