Adolescent Substance Abuse Research and Clinical Advances 1st Edition by Howard Liddle, Cynthia Rowe 0521823587 9780521823586

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ISBN 10: 0521823587

ISBN 13: 9780521823586

Author: Howard A. Liddle, Cynthia L. Rowe

This book was first published in 2006. Adolescent drug abuse is one of the most challenging disorders to treat. It impacts on schools, community-based programs, mental health and medical facilities, and juvenile justice settings. This book provides practitioners, program developers and policy makers with practical information for improving outcomes in adolescent substance abuse. The authors cover a range of issues, including empirically based treatment development protocols, how to incorporate innovative treatment models into diverse clinical settings; research advances; interventions with special populations, culturally based intervention guidelines, and recommendations for practice and policy.

Adolescent Substance Abuse Research and Clinical Advances 1st Table of contents:

1 Treating adolescent substance abuse: state of the science

A brief history of adolescent substance abuse treatment research

Theoretical, empirical, and methodological foundations for research

Practice and policy trends in treatment for adolescent substance abuse

Comprehensive assessment and integrative treatment planning with adolescent substance abusers

Empirically based interventions for adolescent substance abuse: research and practice implications

Culturally based treatment development for adolescent substance abusers

Next steps in adolescent substance abuse treatment research

References

Part I Theoretical, empirical, and methodological foundations for research into treatment of adolesc

2 The developmental context for adolescent substance abuse intervention

The developmental model

The influence of each domain

The childhood domain

The adolescent personality domain

The family relations domain

Parent-adolescent mutual attachment

Parental discipline

The parental drug use and personality domain

The marital relationship domain

The peer domain

The larger context

Ethnicity

The biological domain

Interactions of individual, family, peer, and environmental factors

Risk/protective interactions

Individual characteristics as buffers

Ethnic identity as a protective factor

Familial factors as buffers

Environmental factors as buffers

Protective/protective interactions

Individual characteristics as enhancers of protective factors

Ethnic identity as an enhancer of protective factors

Familial factors as enhancers of protective factors

Peer factors as enhancers of protective factors

Implications for prevention and treatment

Individual treatment

Family treatment

Group treatments

Large group/community approaches

Conclusions

Acknowledgements

References

3 Recent methodological and statistical advances: a latent variable growth modeling framework

A latent variable approach to growth curve modeling

Typical approaches to studying change

Toward an integrated developmental model

Specification of the latent variable growth model

Intercept

Slope

Representing the shape of growth over time

Including predictors and sequelae of change

Multivariate and higher-order extensions

Analyzing treatment effectiveness: modeling between-subjects effects

Added growth models

Alternative approaches to analyzing treatment effects: interrupted time series models

Incorporating effects of the social context: hierarchical or multilevel designs

Full information maximum likelihood

Limited information multilevel latent growth modeling

Modeling unobserved heterogeneity: treatment audience profiling

Growth mixture modeling

Conclusions

Advantages of the latent variable growth model

Incorporating missing data in latent variable growth models

Design issues: sample size selection and power estimation

Limitations of the latent variable growth model

Summary

Acknowledgements

References

4 Clinical course of youth following treatment for alcohol and drug problems

Adolescent relapse patterns following drug and alcohol treatment: treatment outcome studies

The process of relapse for adolescents

Factors that predict success for adolescents following drug and alcohol treatment

Self-help group attendance

Personal/environmental characteristics

Alternative pathways to success

Special challenges youth face in controlling drug and alcohol use after treatment

Comorbidity

Neurocognitive factors

Developmental transitions

Conclusions

References

5 Cannabis Youth Treatment intervention: preliminary findings and implications

Treatments and their rationale

Motivational enhancement treatment/cognitive-behavior therapy 5 sessions

Motivational enhancement treatment/cognitive-behavior therapy 12 sessions

Family Support Network

The adolescent community reinforcement approach (ACRA)

Multidimensional family therapy

Overview of field trials

Highlights of findings

Co-occurring problems are the norm

Problem recognition and low motivation are endemic

Common subtypes are related to changes in substance use and problems

Treatment participation was high

Treatments reduced use and problems

Trial 1

Trial 2

Treatments are affordable

Therapists overall reacted positively to treatment manuals

Implications and next steps

Why were retention rates so high?

Why were the clinical outcomes so similar?

If treatments were effective, why was there a need for continuing care?

Would therapists in the community accept and/or use manual-guided therapies?

Would the level of therapist supervision utilized in the program be realistic or even necessary in a

Why have reactions to the Cannabis Youth Treatment experiments been mixed?

What is happening with the manuals?

What are our plans for the future?

References

Part II Practice and policy trends in treatment for adolescent substance abuse

6 Epidemiological trends and clinical implications of adolescent substance abuse in Europe

Prevalence of substance use

Across Europe

European Schools Project on Alcohol and other Drugs

The Health Behaviour in School-aged Children Survey

European Monitoring Centre for Drugs and Drug Addiction

Specific European countries

United Kingdom

Germany

Austria

Switzerland

Finland

Prevalence of substance abuse and dependence

The Netherlands and Spain

Germany

Finland

Summary

Comorbidity and temporal sequences of disorders

Risk factors

Socioenvironmental factors (e.g., age and gender)

Substance-related factors (e.g., attitudes toward drug use and peer drug use)

Intrapersonal factors

Interpersonal factors

Political implications of adolescent substance abuse: a response from the European Union

Clinical implications of adolescent substance abuse: response from Germany

Conclusions

References

7 The Drug Abuse Treatment Outcomes Studies: outcomes with adolescent substance abusers

Drug Abuse Reporting Program

Characteristics of the youth admissions

Treatment retention and posttreatment outcomes

Treatment Outcomes Prospective Study

Youth characteristics

In-treatment services provided to youth

Treatment retention and post-treatment outcomes

The Drug Abuse Treatment Outcome Studies

Characteristics of programs in the youth study

Residential treatment programs

Outpatient drug-free programs

Short-term inpatient programs

Youth characteristics

Demographic characteristics

Drug use

Mental disorders

Criminal involvement

Comparison of the Treatment Outcome Perspectives Study and the Drug Abuse Treatment Outcomes Studies

Changes in characteristics of adolescents in TOPS & DATOS-A

Changes in treatment service profiles

Treatment processes

Motivation and engagement

Services received

Retention

Treatment outcomes among patients in the Drug Abuse Treatment Outcome Studies for Adolescents

Drug use

Alcohol use

Outcomes for youth with comorbid mental disorders

Criminal activity

Risk of infection with human immunodeficiency virus

Differences by ethnicity

Differences by gender

Conclusions

Acknowledgements

References

8 Adolescent treatment services: the context of care

Background

Systems of care: the existing system

The optimal system

Providers of care

Financing mechanisms and funding streams

Technology transfer and treatment quality

Conclusions and recommendations

References

9 The principles of service organization and practice in England

The legal framework in England

Recent policy initiatives

The Health Advisory Service

Aims, objectives and principles of the Substance of Young Needs 2001 Review

A Strategic Framework

Tier 1

Tier 2

Tier 3

Tier 4

Links between tiers

Example of tiers of service

Links of the framework with evidence

Achievements

Conclusions

References

10 Health services with drug-abusing adolescents: the next frontier of research

Effective

Patient Centered

Timing

Efficient

Equitable

Redesign

Note

References

Part III Comprehensive assessment and integrative treatment planning with adolescent substance abuse

11 Clinical perspectives on the assessment of adolescent drug abuse

Assessment model

Print resources

Public access internet sites

Developmental considerations

Method

Client self-report

Diagnostic interviews

Timeline follow-back

Self-report questionnaires

Validity of self-report

Data other than client self-report

Clinical implications of data sources

Source

Parents

Peers

Archival records

Clinical implications of data from other sources

Content

Drug use history

Abuse and dependence diagnostic symptoms

Family functioning and parenting practices

Peer drug involvement

Educational status

Coexisting psychopathology

Clinical implications of content factors

Bridging assessment and referral decisions

Conclusions and future directions

Acknowledgement

References

12 Psychopharmacology of adolescents with substance use disorders: using diagnostic-specific treatme

Current status of pharmacotherapy

Lessons from the adult literature

Pharmacological treatment studies in adolescents

Withdrawal treatment

Substitution therapy

Craving reduction and blocking strategies

Aversive therapy

Tobacco cessation

The pharmacological treatment of comorbid disorders in adolescents

Importance of comorbidity in adolescents

Mood disorders

Attention-deficit hyperactivity disorder

The current status of pharamacotherapy in adolescents with substance use disorders

Future directions in research

Training of investigators

Extension of the adult literature on agents for withdrawal, substitution, craving, or blocking

Studies of adolescents with specific comorbid psychiatric disorders, using specific agents

The use of multicenter trials

The use of common, salient variables among studies

Studies of safety, abuse, and diversion

Studies of compliance and the development of motivational strategies to improve compliance

Multimodal studies using a combination of pharmacotherapy and psychosocial intervention modalities

Acknowledgement

References

13 Developmentally informed diagnostic and treatment considerations in comorbid conditions

Developmental context and bidirectional impact of substance use and comorbid psychiatric disorders

The role of psychiatric comorbidity

Disruptive behavior disorders

Internalizing disorders

Integrated clinical assessment of adolescent substance abuse and comorbidity

A clinical approach to integrating treatment of substance abuse and comorbidity

1. Initiating treatment

2. Assessing suitability for pharmacotherapy

3. Pharmacotherapy principles

4. Choosing specific medications for comorbidity

5. Evaluating improvement

6. Dealing with relapse

Conclusions

Acknowledgements

References

14 Prevention of infection with human immunodeficiency virus in adolescent substance abusers

Structure and message of the chapter

Co-occurring patterns of HIV risk and substance use in adolescents

Levels of intervention

Individual-level interventions: prevention counseling

Prevention case management

Small-group interventions

Accounting for the effectiveness of group interventions

Limitations of group interventions

Intervening at the family level

Community-level interventions

Future as context: research to advance prevention of HIV infection and substance abuse in adolescent

References

Part IV Empirically based interventions for adolescent substance abuse: research and practical impli

15 Adolescent therapeutic communities: future directions for practice and research

Background and history

The empirical basis for the therapeutic community approach

Outcome studies

The prototypical adolescent therapeutic community

Treatment protocol

The role of family

Continuity of care/after-care

Adolescent therapeutic communities in the twenty-first century

Methodological issues

Clinical issues

Client issues

Treatment issues

Policy issues

Conclusions

References

16 School-based group treatment for adolescent substance abuse

Why use schools for delivery of substance abuse treatment

What is known about effective school-based treatments?

The student assistance program

The Teen Intervention Project

Development of a standardized Westchester model student assistance program

Study design and preliminary results

Mechanisms of change in group counseling

Conclusions and future directions

Acknowledgements

References

17 Profiles of change in behavioral and family interventions for adolescent substance abuse and depe

Classifying patterns of change

An examination of differences in individual outcomes

Cluster analysis procedures

Individual profiles of change

Predictors of profiles

Profiles of change associated with family therapy

Implications for treatment

Conclusions

References

18 Behavioral management approaches for adolescent substance abuse

Behavior analysis

Principles of contingency management for the treatment of substance abuse

Contingency management for the treatment of adolescent substance abuse

Implementation issues

Concerns

Conclusions

Acknowledgements

References

19 Evidence-based cognitive?behavioral therapies for adolescent substance use disorders: application

Theoretical models underlying cognitive?behavioral intervention approaches

Randomized clinical trials for adolescent substance abuse treatment

Cognitive?behavioral therapy for common comorbid psychiatric disorders

Depression

Anxiety disorders

Post-traumatic stress disorder

Conduct disorders/antisocial behavior

Client?treatment matching

Treatment modality: group or individual intervention

Mechanisms of change in cognitive?behavioral therapy for substance abuse disorders

Clinical implications and future research directions

Acknowledgements

References

Part V Culturally based treatment development for adolescent substance abusers

20 Family-centered treatment for American Indian adolescent substance abuse: toward a culturally and

American Indian communities

Toward a family-centered inpatient treatment

Effectiveness and enhancement research

Pilot research

Enhancement research

Evaluation model

The enhancement condition

Analysis of outcomes

Conclusions

Acknowledgements

References

21 Using treatment development methods to enhance the family-based treatment of Hispanic adolescents

Empirically supported treatments and Hispanics

Shortcomings of current efforts to ensure ??cultural competence??

Utilizing basic research and treatment development mechanisms to enhance a family treatment

Development of an integrative family therapy for Hispanic adolescents

Developing a draft manual

Adolescent developmental literature

Family process and treatment of adolescent drug abuse

Culture-related variables and processes

Acculturation and externalizing behavior

Acculturation and parenting practices

Immigration-related experiences and parent-adolescent attachment

Hispanic values and family processes

Designing interventions to integrate the relevant literature

Creating thematic modules

Creation of a manual with a flexible design

Integration of individual treatment

Pilot cases to refine the interventions

A basic research study to investigate empirically the links between culture-related factors and fami

A small randomized trial to test the efficacy of the intervention

Conclusions and implications for blending research and practice

References

Part VI Building the future

22 The road ahead: achievements and challenges for research into the treatment of adolescent substan

Remaining gaps and future directions

Policy: learning how to use science to improve practice

A call to action: policy development to address the research?practice gap

Doing our homework

Creating a policy plan

The advocacy vacuum

Action items: recommendations to conceptualize and launch policy work

Fact-finding

Political strategy 101: build coalitions

Plan strategically

Link to other initiatives

Train the next generation

Seek more funding

The road ahead: policy as the missing link between research and practice

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