Disorders - Substance Use Disorders
Liddle, Howard A., Rowe, Cynthia L., Dakof, Gayle A., Henderson, Craig E., Greenbaum, Paul E.
Research has established the dangers of early onset substance use for young adolescents and its links to a host of developmental problems. Because critical developmental detours can begin or be exacerbated during early adolescence, specialized interventions that target known risk and protective factors in this period are needed. This controlled trial (n = 83) provided an experimental test comparing multidimensional family therapy (MDFT) and a peer group intervention with young teens. Participants were clinically referred, were of low income, and were mostly ethnic minority adolescents (average age = 13.73 years). Treatments were manual guided, lasted 4 months, and were delivered by community agency therapists. Adolescents and parents were assessed at intake, at 6-weeks post-intake, at discharge, and at 6 and 12 months following treatment intake. Latent growth curve modeling analyses demonstrated the superior effectiveness of MDFT over the 12-month follow-up in reducing substance use (effect size: substance use frequency, d = 0.77; substance use problems, d = 0.74), delinquency (d = 0.31), and internalized distress (d = 0.54), and in reducing risk in family, peer, and school domains (d = 0.27, 0.67, and 0.35, respectively) among young adolescents.
Journal of Consulting & Clinical Psychology, 77(1) : 12-25
- Year: 2009
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy
Johnson, Knowlton W., Shamblen, Stephen R., Ogilvie, Kristen A., Collins, David, Saylor, Brian
This study tests for the efficacy of a school-based drug prevention curriculum (Think Smart) that was designed to reduce use of Harmful Legal Products (HLPs, such as inhalants and over-the-counter drugs), alcohol, tobacco, and other drugs among fifth- and sixth-grade students in frontier Alaska. The curriculum consisted of 12 core sessions and 3 booster sessions administered 2 to 3 months later, and was an adaptation of the Schinke life skills training curriculum for Native Americans. Fourteen communities, which represented a mixture of Caucasian and Alaska Native populations in various regions of the state, were randomly assigned to intervention or control conditions. Single items measuring 30-day substance use and multi-item scales measuring the mediators under study were taken from prior studies. Scales for the mediators demonstrated satisfactory construct validity and internal reliability. A pre-intervention survey was administered in classrooms in each school in the fall semester of the fifth and sixth grades prior to implementing the Think Smart curriculum, and again in the spring semester immediately following the booster session. A follow-up survey was administered 6 months later in the fall semester of the sixth and seventh grades. A multi-level analysis found that the Think Smart curriculum produced a decrease (medium size effect) in the proportion of students who used HLPs over a 30-day period at the 6 month follow-up assessment. There were no effects on other drug use. Further, the direct effect of HLPs use was not mediated by the measured risk and protective factors that have been promoted in the prevention field. Alternative explanations and implications of these results are discussed.
Prevention Science, 10(4) : 298-312
- Year: 2009
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
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Stage: Universal prevention
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Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Skills training
Findling, R. L., Pagano, M. E., McNamara, N. K., Stansbrey, R. J., Faber, J. E., Lingler, J., Demeter, C. A., et-al
Background: The objective of this study was to examine whether fluoxetine was superior to placebo in the acute amelioration of depressive symptomatology in adolescents with depressive illness and a comorbid substance use disorder. Methods: Eligible subjects ages 12-17 years with either a current major depressive disorder (MDD) or a depressive disorder that were also suffering from a comorbid substance-related disorder were randomized to receive either fluoxetine or placebo in this single site, 8-week double-blind, placebo-controlled study. The primary outcome analysis was a random effects mixed model for repeated measurements of Children's Depression Rating Scale-Revised (CDRS-R) scores compared between treatment groups across time. Results: An interim analysis was performed after 34 patients were randomized. Based on the results of a futility analysis, study enrollment was halted. Twenty-nine males and 5 females were randomized to receive fluoxetine (n = 18) or placebo (n = 16). Their mean age was 16.5 (1.1) years. Overall, patients who received fluoxetine and placebo had a reduction in CDRS-R scores. However, there was no significant difference in mean change in CDRS-R total score in those subjects treated with fluoxetine and those who received placebo (treatment difference = 0.19, S.E. = 0.58, F = 0.14, p = .74). Furthermore, there was not a significant difference in rates of positive urine drug toxicology results between treatment groups at any post-randomization visit (F = 0.22, df = 1, p = 0.65). The main limitation of this study is its modest sample size and resulting low statistical power. Other significant limitations to this study include, but are not limited to, the brevity of the trial, high placebo response rate, limited dose range of fluoxetine, and the inclusion of youth who met criteria for depressive disorders other than MDD. Conclusion: Fluoxetine was not superior to placebo in alleviating depressive symptoms or in decreasing rates of positive drug screens in the acute treatment of adolescents with depression and a concomitant substance use disorder. (copyright) 2009 Findling et al; licensee BioMed Central Ltd.
Child & Adolescent Psychiatry & Mental Health, 3 :
- Year: 2009
- Problem: Depressive Disorders, Substance Use Disorders (any)
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Griffin, James P., Jr., Holliday, Rhonda C., Frazier, Emma, Braithwaite, Ronald L.
This article examines the effectiveness of a career-oriented intervention for preventing involvement with alcohol, tobacco, and other drugs (ATODs) and violence and for promoting resilient behavior among eighth-grade, African American middle school students (N=178; n=92 intervention and n=86 comparison) through the implementation of the Building Resiliency and Vocational Excellence (BRAVE) Program. Students were randomly assigned to either the intervention or control group. Students in the evaluation participated in the school-based BRAVE Program intervention and the standard public school curriculum. Comparison students participated only in the standard curriculum. Alcohol, tobacco, and other drug use and violent behavior were assessed for 178 students at baseline, post-test, and one-year follow up (one year after baseline). Results revealed a beneficial effect of the intervention on participants' frequency of use of alcohol (p<.04) and marijuana (p<.05), but no effect for violent behavior.
Journal of Health Care for the Poor & Underserved, 20(3) : 798-816
- Year: 2009
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
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Stage: Universal prevention
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Treatment and intervention: Psychological Interventions (any)
, Skills training
Hawkins, J. David, Oesterle, Sabrina, Brown, Eric C., Arthur, Michael W., Abbott, Robert D., Fagan, Abigail A., Catalano, Richard F.
Objective: Design: Setting: Participants: Main Outcome Measures: Results: Conclusion: To test whether the Communities That Care (CTC) prevention system reduces adolescent alcohol, tobacco, and other drug use and delinquent behavior communitywide.The Community Youth Development Study is the first randomized trial of CTC.In 2003, 24 small towns in 7 states, matched within state, were randomly assigned to control or CTC conditions.A panel of 4407 fifth-grade students was surveyed annually through eighth grade. Intervention A coalition of community stakeholders received training and technical assistance to install the CTC prevention system. They used epidemiological data to identify elevated risk factors and depressed protective factors in the community, and chose and implemented tested programs to address their community's specific profile from a menu of effective programs for families, schools, and youths aged 10 to 14 years.Incidence and prevalence of alcohol, tobacco, and other drug use and delinquent behavior by spring of grade 8.The incidences of alcohol, cigarette and smokeless tobacco initiation, and delinquent behavior were significantly lower in CTC than in control communities for students in grades 5 through 8. In grade 8, the prevalences of alcohol and smokeless tobacco use in the last 30 days, binge drinking in the last 2 weeks, and the number of different delinquent behaviors committed in the last year were significantly lower for students in CTC communities.Using the CTC system to reduce health-risking behaviors in adolescents can significantly reduce these behaviors communitywide.
Archives of Pediatrics & Adolescent Medicine, 163(9) : 789-798
- Year: 2009
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
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Stage: Universal prevention
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Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Engle, Bretton, Macgowan, Mark J.
Objective: Method: Results: Conclusion: Evidence-based social work requires the use of interventions that are supported by good research evidence. This article reviews the empirical research on adolescent alcohol and other drug (AOD) abuse group treatments. Despite the popularity of group work, searches of the academic literature yielded only 13 adolescent group treatments for which AOD use outcomes have been reported. These treatments and the studies that evaluated them are systematically reviewed.Methodological, efficacy rating, and treatment factor criteria are applied to these studies.Statistically significant reductions in pre-, post-, and/or follow-up use rates of one or more substances were reported for 10 of the 13 reviewed treatments, but only two met Chambless and Hollon's (1998) criteria for "possible efficacy." Similarities between the two possibly efficacious treatments, as well as among the three treatments with no indication of positive outcomes are described. A major limitation of the studies overall was the lack of group treatment factor descriptions and analyses.If the state of the science is to advance, adolescent AOD group treatment researchers must improve study designs and reporting on group-related treatment factors. Based on the limited information provided, treatment factors and/or active ingredients that may distinguish effective vs. ineffective group work are discussed. Finally, the evidence suggests that group work is a viable modality for treating adolescent AOD abuse despite recent concerns to the contrary. Recommendations for advancing the state of the science are made.
Journal of Evidence-Based Social Work, 6(3) : 217-243
- Year: 2009
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
DeGarmo, David S., Eddy, J. Mark, Reid, John B., Fetrow, Rebecca A.
Substance use outcomes were examined for 351 youth participating in a randomized controlled trial designed to assess the efficacy of a school-based multimodal universal preventive intervention, Linking the Interests of Families and Teachers (LIFT). Frequency of any use of tobacco, alcohol, and other drugs was assessed via self-report from grades 5 through 12. Latent variable growth models specified average level, linear growth and accelerated growth. The LIFT intervention had a significant effect on reducing the rate of growth in use of tobacco and illicit drugs, particularly for girls, and had an overall impact on average levels of use of tobacco, alcohol, and illicit drugs. Average tobacco use reductions were mediated by increases in family problem solving. The intervention had significant indirect effects on growth in substance use through intervention effects on reduced playground aggression and increased family problem solving. The intervention was also associated with roughly a 10% reduced risk in initiating tobacco and alcohol use. Implications for future studies of multimodal preventive interventions are discussed.
Prevention Science, 10(3) : 208-220
- Year: 2009
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
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Stage: Universal prevention
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Treatment and intervention: Psychological Interventions (any)
, Skills training, Other Psychological Interventions
Brody, Gene H., Chen, Yi-Fu, Beach, Steven R. H., Philibert, Robert A., Kogan, Steven M.
Objective: The present research addressed the following important question in pediatric medicine: can participation in an efficacious preventive intervention ameliorate the risk that a genetic vulnerability factor is hypothesized to confer on increases in risk behaviors across preadolescence? Methods: As part of the Strong African American Families preventive intervention study, data were collected from 641 black families in rural Georgia, assigned randomly to the prevention or control condition. The prevention condition consisted of 7 consecutive meetings at community facilities, with separate parent and youth skill-building curricula and a family curriculum. Each meeting included separate, concurrent sessions for parents and youths, followed by a joint parent-youth session in which families practiced skills they learned in the separate sessions. Involvement in risk behaviors was assessed when the youths were 11 (pretest), 12 (posttest), and 14 (long-term follow-up) years of age. A genetic vulnerability factor, that is, a variable-nucleotide repeat polymorphism in the promoter region of the SLC6A4 gene (5HTT), was assessed 2 years after the long-term follow-up assessment. Results: Youths at genetic risk who were assigned to the control condition displayed greater increases in risk behaviors across the 29 months that separated the pretest and long-term follow-up assessments, compared with youths at genetic risk who were assigned to the Strong African American Families condition and youths without genetic risk who were assigned to either condition. Conclusion: This is the first study to demonstrate that participation in an efficacious preventive intervention can ameliorate a genetic risk for increasing involvement in health-compromising risk behaviors across preadolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Pediatrics, 124(3) : 911-917
- Year: 2009
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
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Stage: Universal prevention
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Treatment and intervention: Psychological Interventions (any)
, Skills training
Brown, Richard A., Strong, David R., Abrantes, Ana M., Myers, Mark G., Ramsey, Susan E., Kahler, Christopher W.
The purpose of this study was to compare substance involvement among psychiatrically hospitalized adolescent smokers who had received motivational interviewing (MI) versus brief advice (BA) for smoking cessation. One hundred and ninety-one (191) adolescent smokers (62.3% female; 15.4 years of age) were randomly assigned to MI (n=116) or BA (n=75). All patients were assessed at baseline, immediately after hospitalization, and at 1-, 3-, 6-, 9-, and 12-month follow-ups. Rates of substance use in the MI condition during follow-up increased from a low of 8.2% (SD=18.5) to a high of 15.4% (SD=30.0) substance use days, whereas in BA, substance use days increased from a low of 8.4% (SD=20.8) to a high of 21.4% (SD=35.2). The results of this study suggest that MI, relative to BA, for smoking cessation was associated with better substance use outcomes during the first 6 months following psychiatric hospitalization among adolescents. This finding is consistent with previous studies that have shown that smoking cessation does not have a detrimental effect on substance abuse treatment outcomes among youth.
Addictive Behaviors, 34(10) : 887-891
- Year: 2009
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy
Allahverdipour, Hamid, Bazargan, Mohsen, Farhadinasab, Abdollah, Hidarnia, Alireza, Bashirian, Saeed
The prevalence of substance abuse among adolescents from low- and middle-income countries is increasing drastically and requires immediate intervention. The objective of this longitudinal quasi-experimental panel study was to design and implement a skill-based intervention to prevent and reduce substance use among urban adolescents who attended 2 randomly selected high-schools in Tehran, Iran. One-year post intervention data show that substance abuse, knowledge, attitudes, peer resistance skills, level of self-control, self-efficacy, and perceived susceptibility among intervention group were significantly improved, whereas level of self control and attitudes against substance abuse among the control group deteriorated. To efficiently prevent substance abuse among youth primary preventive interventions should be implemented before onset of substance abuse to improve resistance skills and provide adolescents with information and skills needed to develop anti-drug norms.
Journal of Drug Education, 39(2) : 211-222
- Year: 2009
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
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Stage: Universal prevention
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Treatment and intervention: Psychological Interventions (any)
, Skills training
Beets, Michael W., Flay, Brian R., Vuchinich, Samuel, Snyder, Frank J., Acock, Alan, Li, Kin-Kit, Burns, Kate, et-al
Objectives: Methods: Results: Conclusions: We assessed the effectiveness of a 5-year trial of a comprehensive school-based program designed to prevent substance use, violent behaviors, and sexual activity among elementary-school students.We used a matched-pair, cluster-randomized, controlled design, with 10 intervention schools and 10 control schools. Fifth-graders (N = 1714) self-reported on lifetime substance use, violence, and voluntary sexual activity. Teachers of participant students reported on student (N = 1225) substance use and violence.Two-level random-effects count models (with students nested within schools) indicated that student-reported substance use (rate ratio [RR] = 0.41; 90% confidence interval [CI] = 0.25, 0.66) and violence (RR = 0.42; 90% CI = 0.24, 0.73) were significantly lower for students attending intervention schools. A 2-level random-effects binary model indicated that sexual activity was lower (odds ratio = 0.24; 90% CI = 0.08, 0.66) for intervention students. Teacher reports substantiated the effects seen for student-reported data. Dose-response analyses indicated that students exposed to the program for at least 3 years had significantly lower rates of all negative behaviors.Risk-related behaviors were substantially reduced for students who participated in the program, providing evidence that a comprehensive school-based program can have a strong beneficial effect on student behavior.
American Journal of Public Health, 99(8) : 1438-1445
- Year: 2009
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Teesson, M., Newton, N. C., Vogl, L. E., Andrews, G.
Aims: To establish the efficacy and feasibility of the Climate Schools: Alcohol and Cannabis course, an internet based prevention program for alcohol and cannabis use in adolescents. Design: A cluster randomised control trial. Intervention and control groups were assessed at baseline, immediately post and at six months follow-up. Participants: They were 764, 13-year old from ten secondary schools in Sydney, Australia. Half the schools were randomly allocated to the computerised prevention program (n=397 students), and half to their usual health classes (n=367 students). Intervention: Computerised, evidence based, curriculum consistent lessons were developed to reduce alcohol and cannabis use. The 6 lessons on alcohol were given at the beginning of the year and the 6 lessons on alcohol and cannabis use were given 6 months later. Measures: Alcohol and cannabis knowledge, expectancies and attitudes, alcohol consumption (frequency, quantity and binging), frequency of cannabis use, and harms associated with one's use of alcohol and cannabis were assessed at baseline, the end of the course and six month follow-up. Results: There were significant improvements in knowledge regarding alcohol and cannabis use at end of course and at the 6 month follow-up. Frequency of drinking to excess was reduced immediately after the intervention, and average weekly alcohol consumption and frequency of cannabis use was reduced at the 6 month follow-up. No differences between groups were found on alcohol expectancies, cannabis attitudes, or harms related to alcohol and cannabis use. Conclusions: The Climate Schools: Alcohol and Cannabis course is acceptable and scalable, and fidelity is ensured. It increased knowledge regarding alcohol and cannabis, and decreased use of these drugs. Support: The development of the Climate Schools: Alcohol and Cannabis course was funded by the Australian Government Department of Health and Ageing, and the Alcohol Education and Rehabilitation Foundation.
Alcoholism: Clinical & Experimental Research, 33 : 43A
- Year: 2009
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
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Stage: Universal prevention
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Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Psychoeducation, Skills training, Technology, interventions delivered using technology (e.g. online, SMS)