Disorders - Substance Use Disorders
Allen, M. L., Garcia-Huidobro, D., Porta, C., Curran, D., Patel, R., Miller, J., Borowsky, I.
CONTEXT: Parenting interventions may prevent adolescent substance use; however, questions remain regarding the effectiveness of interventions across substances and delivery qualities contributing to successful intervention outcomes. OBJECTIVE: To describe the effectiveness of parent-focused interventions in reducing or preventing adolescent tobacco, alcohol, and illicit substance use and to identify optimal intervention targeted participants, dosage, settings, and delivery methods. DATA SOURCES: PubMed, PsycINFO, ERIC, and CINAHL. STUDY SELECTION: Randomized controlled trials reporting adolescent substance use outcomes, focusing on imparting parenting knowledge, skills, practices, or behaviors. DATA EXTRACTION: Trained researchers extracted data from each article using a standardized, prepiloted form. Because of study heterogeneity, a qualitative technique known as harvest plots was used to summarize findings. RESULTS: A total of 42 studies represented by 66 articles met inclusion criteria. Results indicate that parenting interventions are effective at preventing and decreasing adolescent tobacco, alcohol, and illicit substance use over the short and long term. The majority of effective interventions required <12 contact hours and were implemented through in-person sessions including parents and youth. Evidence for computer-based delivery was strong only for alcohol use prevention. Few interventions were delivered outside of school or home settings. LIMITATIONS: Overall risk of bias is high. CONCLUSIONS: This review suggests that relatively low-intensity group parenting interventions are effective at reducing or preventing adolescent substance use and that protection may persist for multiple years. There is a need for additional evidence in clinical and other community settings using an expanded set of delivery methods. Copyright © 2016 by the American Academy of Pediatrics.
Pediatrics, 138(2) : e20154425
- Year: 2016
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Carney, T., Myers, B. J., Louw, J., Okwundu, C. I.
Background: Adolescent substance use is a major problem in and of itself, and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use. Objectives: To evaluate the effectiveness of brief school-based interventions in reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions. Search methods: We conducted the original literature search in March 2013 and performed the search update to February 2015. For both review stages (original and update), we searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to February 2015. We also contacted authors and organisations to identify any additional studies. Selection criteria: We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents. The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use. Data collection and analysis: We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence. Main results: We included six trials with 1176 adolescents that measured outcomes at different follow-up periods in this review. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. We generally found moderate-quality evidence that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short-, medium-, or long-term follow-up. They also did not have a significant effect on delinquent-type behaviour outcomes among adolescents. When compared to assessment-only controls, we found low- or very low-quality evidence that BIs reduced cannabis frequency at short-term follow-up in one study (standardised mean difference (SMD) -0.83; 95% confidence interval (CI) -1.14 to -0.53, n = 269). BIs also significantly reduced frequency of alcohol use (SMD -0.91; 95% CI -1.21 to -0.61, n = 242), alcohol abuse (SMD -0.38; 95% CI -0.7 to -0.07, n = 190) and dependence (SMD -0.58; 95% CI -0.9 to -0.26, n = 190), and cannabis abuse (SMD -0.34; 95% CI -0.65 to -0.02, n = 190) at medium-term follow-up in one study. At long-term follow-up, BIs also reduced alcohol abuse (SMD -0.72; 95% CI -1.05 to -0.40, n = 181), cannabis frequency (SMD -0.56; 95% CI -0.75 to -0.36, n = 181), abuse (SMD -0.62; 95% CI -0.95 to -0.29, n = 181), and dependence (SMD -0.96; 95% CI -1.30 to -0.63, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on adolescents' delinquent or problem behaviours, although the effect at long-term follow-up on these outcomes in the assessment-only comparison was significant (SMD -0.78; 95% CI -1.11 to -0.45). Authors' conclusions: We found low- or very low-quality evidence that brief school-based interventions may be more effective in r ducing alcohol and cannabis use than the assessment-only condition and that these reductions were sustained at long-term follow-up. We found moderate-quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high-quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low- and middle-income countries. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cochrane Database of Systematic Reviews, 2016(1) : CD008969
- Year: 2016
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Das, J. K., Salam, R. A., Arshad, A., Finkelstein, Y., Bhutta, Z. A.
Many unhealthy behaviors often begin during adolescence and represent major public health challenges. Substance abuse has a major impact on individuals, families, and communities, as its effects are cumulative, contributing to costly social, physical, and mental health problems. We conducted an overview of systematic reviews to evaluate the effectiveness of interventions to prevent substance abuse among adolescents. We report findings from a total of 46 systematic reviews focusing on interventions for smoking/tobacco use, alcohol use, drug use, and combined substance abuse. Our overview findings suggest that among smoking/tobacco interventions, school-based prevention programs and family-based intensive interventions typically addressing family functioning are effective in reducing smoking. Mass media campaigns are also effective given that these were of reasonable intensity over extensive periods of time. Among interventions for alcohol use, school-based alcohol prevention interventions have been associated with reduced frequency of drinking, while family-based interventions have a small but persistent effect on alcohol misuse among adolescents. For drug abuse, school-based interventions based on a combination of social competence and social influence approaches have shown protective effects against drugs and cannabis use. Among the interventions targeting combined substance abuse, school-based primary prevention programs are effective. Evidence from Internet-based interventions, policy initiatives, and incentives appears to be mixed and needs further research. Future research should focus on evaluating the effectiveness of specific interventions components with standardized intervention and outcome measures. Various delivery platforms, including digital platforms and policy initiative, have the potential to improve substance abuse outcomes among adolescents; however, these require further research. Copyright © 2016 Society for Adolescent Health and Medicine
Journal of Adolescent Health, 59(2 Supplement) : S61-S75
- Year: 2016
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
Gonzales, R., Hernandez, M., Murphy, D. A., Ang, A.
Background and Objectives: We examined youth recovery outcomes at 6- and 9-months post-participation in an aftercare pilot study called Educating and Supporting inQuisitive Youth in Recovery (ESQYIR) that aimed to investigate the utility of a 12-week mobile texting recovery support intervention. Methods: A total of 80 youth [Mage 20.4 (SD=3.5)] were randomized to a mobile texting aftercare intervention or an aftercare-as-usual control group. Both groups received identical data collection protocols with psychosocial and behavioral assessments occurring at baseline, during the trial (months 1 and 2), at discharge from the trial (month 3), and 3-, 6-, and 9-month post-intervention follow-ups. Results: Mixed modeling showed that youth who participated in the mobile texting aftercare intervention were less likely to test positive for their primary drug compared to youth in the aftercare-as-usual condition during 6- and 9-months follow-ups (p<.01). Additionally, youth in the aftercare intervention reported significantly higher selfefficacy/ confidence to abstain during recovery (p<.05) and were more likely to participate in recovery-related behaviors (self-help and goal-directed extracurricular activities; p<.05) than those in aftercare-as-usual at the 6- and 9-month follow-ups. Conclusions: Results suggest that delivering a structured, behavioralbased wellness aftercare intervention using mobile texting can be an effective for sustaining recovery outcomes in youth over time compared to youth who receive aftercare-as-usual. Scientific Significance: This study shows that a mobile-texting aftercare intervention sustained effects at 6- and 9-months post-intervention for young people in substance use recovery. Copyright © American Academy of Addiction Psychiatry.
American Journal on Addictions, 25(1) : 62-68
- Year: 2016
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Guo, Xiamei, Slesnick, Natasha, Feng, Xin
Eligible adolescents (12-17 years old) were recruited from a short-term crisis shelter for runaway adolescents in a large Midwestern city. Adolescents (N = 179) were randomly assigned to Ecologically-Based Family Therapy (EBFT, n = 61), the Community Reinforcement Approach (CRA, n = 57), or brief Motivational Enhancement Therapy (MET, n = 61) with the primary focus on substance abuse. A significant increase in perceived family cohesion and a significant reduction in perceived family conflict were found among all treatment conditions from baseline to the 24-month follow-up. Adolescents who received EBFT demonstrated more improvement in family cohesion after treatment than those who received CRA or MET, and more reduction in family conflict during treatment than those who received MET. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Journal of Marital and Family Therapy, 42(2) : 299-312
- Year: 2016
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions
Haggerty, Kevin P., Barkan, Susan E., Skinner, Martie L., Packard, W., Cole, Janice J.
Objective: This study aims to test the feasibility, usability, and proximal outcomes of Connecting, an adaptation of Staying Connected with Your Teen-a low-cost, self-directed, family-based substance-use prevention program-with foster families in a randomized, waitlist control pilot study. Method: Families (n = 60) fostering teens between 11 and 15 years of age were recruited into the study and randomly assigned into the self-administered program with telephone support from a family consultant (n = 32) or a waitlist control condition (n = 28). Results: Overall satisfaction with the program was high, with 100% of foster parents reporting that they would recommend the program to other caregivers and that they were "very satisfied" or "satisfied" with the program. Program completion was good, with 62% of families completing all 91 specified tasks. Analyses of proximal outcomes revealed increased communication about sex and substance use (posttest OR = 1.97, and 2.03, respectively) in the intervention relative to control condition. Teens in the intervention versus the waitlist condition reported lower family conflict (OR = .48), and more family rules related to monitoring (OR = 4.02) and media use (OR = 3.24). Caregivers in the waitlist group reported significant increases in the teen's positive involvements (partial eta-squared = 17% increase) after receiving the intervention. Conclusions: Overall, program participation appeared to lead to stronger family management, better communication between teens and caregivers around monitoring and media use, teen participation in setting family rules, and decreased teen attitudes favorable to antisocial behavior. This small pilot study shows promising results for this adapted program. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Journal of the Society for Social Work and Research, 7(4) : 639-659
- Year: 2016
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Henderson, C. E., Wevodau, A. L., Henderson, S. E., Colbourn, S. L., Gharagozloo, L., North, L. W., Lotts, V. A.
BACKGROUND AND OBJECTIVES: Substance use disorders among youth remain a serious public health problem. Although research has overwhelmingly supported the use of evidenced-based interventions, one of the primary limitations of the current evidence base is that for the vast majority of treatments, the developers of the treatments are also the ones conducting research on them, raising the possibility of allegiance bias.
METHODS: The present study was an independently conducted randomized controlled trial (n=126) comparing an evidenced-based treatment for adolescent substance use, Adolescent-Community Reinforcement Approach (A-CRA), and assertive continuing care (ACC), to services as usual (SAU) provided by a juvenile probation department. Latent growth curve modeling was used to compare the treatments on change in substance use assessed by the Global Appraisal of Individual Needs (GAIN) at baseline and 3, 6, and 12 months following treatment entry.
RESULTS: All youth evidenced a substantial reduction in substance use frequency and substance-related problems following treatment; however, youth treated with A-CRA/ACC evidenced a substantially greater decrease in substance-related problems.
CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Results are consistent with studies conducted by A-CRA/ACC model developers supporting the effectiveness of the clinical approach and, because the outcomes resulted from an independent replication, are encouraging for the transportation potential of A-CRA/ACC.
Copyright © 2016 American Academy of Addiction Psychiatry.
American Journal on Addictions, 25(3) : 233-40
- Year: 2016
- Problem: Substance Use Disorders (any), Alcohol Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions, Case management
Kelly, J. F., Cristello, J., Yeterian, J. D., Kaminer, Y., Kahler, C. W., Timko, C.
Background: A common clinical continuing care referral among alcohol/drug use disorder treatment programs for both adults and adolescents is to link patients to recovery supportive 12-step mutual-help organizations (MHOs) such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) in order to help prevent relapse and promote long-term recovery. While numerous treatments designed to link patients with these free community peer recovery resources have been developed and tested among adults (i.e., "Twelve-Step Facilitation [TSF]"), none have been developed and tested among young people. Specific development and testing of youth-focused TSF is necessary because young people face more developmentally-specific barriers to 12-step MHO engagement. The lack of any experimental research represents a notable gap in the evidence-base regarding the efficacy of TSF for young people. This study is the first to develop and experimentally test using a randomized controlled design an integrated TSF (iTSF) treatment for outpatient youths with SUD. Design: Randomized controlled trial testing iTSF against Motivational enhancement therapy (MET)/Cognitive Behavioral Therapy (CBT). Treatments consisted of two individual and eight group therapy sessions delivered over approximately 10 weeks. Validated measures assessed percent days abstinent, longest period of abstinence, proportion abstinent/mostly abstinent, alcohol/drug consequences, and psychiatric symptoms, with follow-ups at mid-treatment, end of treatment and at 6 and 9 months later. Results: Adolescents assigned to iTSF were significantly more likely to attend 12-step meetings during treatment (58%vs. 18%, p < 0.001). Accounting for baseline differences, patients assigned to iTSF had significantly fewer substance-related consequences during the follow up period relative to MET/CBT patients (p < 0.003). Findings also suggested longer periods of continuous abstinence favoring iTSF over time, but did not reach statistical significance. Conclusions: This integrated Twelve-step Facilitation (iTSF) treatment appears promising in the treatment of adolescents with alcohol/drug use disorders. Relative to current state-of-the-science treatments such as MET/CBT, iTSF may be particularly useful at helping young people participate in 12-step mutual-help meetings, reduce negative consequences related to their substance use, and possibly achieve longer periods of sustained abstinence.
Alcoholism: Clinical and Experimental Research, 40 : 307A
- Year: 2016
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions
Goense, P. B., Assink, M., Stams, G. J., Boendermaker, L., Hoeve, M.
This study meta-analytically examined the effect of treatment integrity on client outcomes of evidence-based interventions for juveniles with antisocial behavior. A total of 17 studies, from which 91 effect sizes could be retrieved, were included in the present 3-level meta-analysis. All included studies, to a certain level, adequately implemented procedures to establish, assess, evaluate and report the level of treatment integrity. A moderator analysis revealed that a medium-to-large effect of evidence-based interventions was found when the level of treatment integrity was high (d = 0.633, p < 0.001), whereas no significant effect was found when integrity was low (d = 0.143, ns). Treatment integrity was significantly associated with effect size even when adjusted for other significant moderators, indicating the specific contribution of high levels of treatment integrity to positive client outcomes. This implies that delivering interventions with high treatment integrity to youth with antisocial behavior is vital. Copyright © 2016 Elsevier Ltd
Aggression and Violent Behavior, 31 : 106-115
- Year: 2016
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
Goorden, M., Schawo, S. J., Bouwmans-Frijters, C. A. M., van-der-Schee, E., Hendriks, V. M., Hakkaart-van-Roijen, L.
Background: Family therapy and family-based treatment has been commonly applied in children and adolescents in mental health care and has been proven to be effective. There is an increased interest in economic evaluations of these, often expensive, interventions. The aim of this systematic review is to summarize and evaluate the evidence on cost-effectiveness of family/family-based therapy for externalizing disorders, substance use disorders and delinquency. Methods: A systematic literature search was performed in PubMed, Education Resource information Centre (ERIC), Psycinfo and Cochrane reviews including studies conducted after 1990 and before the first of August of 2013. Full economic evaluations investigating family/family-based interventions for adolescents between 10 and 20 years treated for substance use disorders, delinquency or externalizing disorders were included. Results: Seven hundred thirty-one articles met the search criteria and 51 studies were initially selected. The final selection resulted in the inclusion of 11 studies. The quality of these studies was assessed. Within the identified studies, there was great variation in the specific type of family/family-based interventions and disorders. According to the outcomes of the checklists, the overall quality of the economic evaluations was low. Results varied by study. Due to the variations in setting, design and outcome it was not feasible to pool results using a meta-analysis. Conclusions: The quality of the identified economic evaluations of family/family-based therapy for treatment of externalizing disorders, adolescent substance use disorders and delinquency was insufficient to determine the cost-effectiveness. Although commonly applied, family/family-based therapy is costly and more research of higher quality is needed. Copyright © 2016 The Author(s).
BMC Psychiatry, 16 (1) (no pagination)(237) :
- Year: 2016
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy
Knight, D. K., Joe, G. W., Crawley, R. D., Becan, J. E., Dansereau, D. F., Flynn, P. M.
Treatment engagement is a primary pathway to change. Because motivation consistently predicts engagement and sustained recovery following treatment, targeted efforts at improving problem recognition (i.e., a significant ingredient in motivation) during early weeks of treatment are critical. The purpose of this study is to compare the effectiveness of Standard Operating Practice (SOP) versus SOP plus an 8-session Treatment Readiness and Induction Program (TRIP; delivered in the first weeks of treatment) on cognitive indicators and treatment engagement among youth in 5 residential substance use treatment settings. Structural Equation Modeling (SEM) documented higher problem recognition, decision making, and treatment engagement (participation, satisfaction, counselor rapport) among youth receiving TRIP (compared to SOP only), even when controlling for background characteristics such as age, race-ethnicity, gender, baseline drug use severity, etc. Findings suggest that TRIP is an effective induction tool that directly impacts targeted constructs (i.e., problem recognition, decision making), and also directly affects indicators of engagement. Copyright © 2015 Elsevier Inc.
Journal of Substance Abuse Treatment, 62 : 20-27
- Year: 2016
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions
Lakshmana, Govindappa
This study assessed the efficacy of a 4-month program combining motivational interviewing and cognitive behavior intervention on substance-using street adolescents in India. The study followed classical experimental design and the subjects were randomly assigned to control and experimental groups. Readiness to change questionnaire and Adolescent Relapse Coping Questionnaire tools were used for the evaluation of the intervention program. At the baseline, majority of the respondents in both the groups were at the precontemplation stage of motivation. At the end of the 3rd month of the intervention, there was a significant difference, chi2 = 31.139, df = 2, p < .001, between the 2 groups on the stages of motivation. The study's limitations are noted. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Journal of Social Work Practice in the Addictions, 16(4) : 337-357
- Year: 2016
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Motivational interviewing, includes Motivational Enhancing Therapy