Transcript Challenges and Successes Treating Adolescent Substance Abuse

Challenges and Successes
Treating Adolescent
Substance Use Disorders
Janet L. Brody, Ph.D.
Child Health Research
3 x 5 x 5 Conference
University of New Mexico
July 15, 2008
Center for Family and Adolescent
Research (CFAR),
Oregon Research Institute
Drug Use in New Mexico
12-17 year olds
*
Source: Samhsa, 2004 -2005 survey results.
New Mexico Statistics
Drug abuse or dependence:
Needing/not receiving tx for drug use:
5.7%
5.4
(10,000)
( 9,000)
Alcohol abuse or dependence
Needing/not receiving tx for alcohol use:
6.7%
6.6
(12,000)
(11,000)
At least one Major Depressive episode
9.2%
(16,000)

Risk Factors

Genetic Predisposition / Family History

Poor parenting behavior, attitudes, values

Behavior management problems

Early history of anti-social behavior
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Negative peer influence
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Unsupportive school environment
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Academic failure or negative attitudes toward
school
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Protective Factors

Close interpersonal bonds

Nurturing family environment
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Pro-social values
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Consistent behavior management
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High expectations for success

Goal setting and mastery

Meaningful participation at home and at school
Recent History of Clinical Trials Evaluating
Treatments for Adolescent SUD*

Nationally: 17 published clinical
studies over the past 10 years
– 46 intervention conditions
 07 Individual Cognitive
Behavioral Therapy
 13 Group Cognitive
Behavioral Therapy
 17 Family Therapy
 09 Minimal treatment
control
– Total Combined Sample:
2,307 adolescents
*Source: Waldron & Turner,
in press.

CFAR: 3 clinical efficacy trials
conducted by CFAR over past 10
years
- compared family therapy to
individual/ and or group CBT.
a. Marijuana abuse/dependence
b. Alcohol abuse/dependence
c. Ethnicity x therapy
d. “Mechanisms of action”
All substances (% days)
Comparison of four cluster groupings
for all substance use.
100
90
80
70
60
50
40
30
20
10
0
0
2
4
6
8
10
12
14
16
18
Assessm ent Point (m onths after baseline)
im provers
slow im provers
relapsers
resistant
Consistency of Treatment Outcome
Findings
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Treatment is associated with significant reductions in substance
use for most youth
Across studies, roughly 25% of youth do not improve
Better outcome is associated with parental involvement,
attendance in aftercare, and treatment completion
Relapse rates for adolescent substance abusers greater than
those for adults
Greatest risk for relapse highest within first 3 months posttreatment
Outcomes vary depending on measures used, length of follow-up,
type of substance used
Current CFAR Studies

Transitions: Relapse prevention
–
12 weeks of family therapy followed by randomization to 1 of 3 aftercare
programs


Systems, Group or Phone follow-up
Adaptive: Examining Decision rules to determine how much/which type
of treatment is necessary.
–
–
Minimal use vs. abstinence
Individual CBT or Family therapy following group treatment failure

Sequences: Dual diagnosis (SAD and Depression) to determine most
effective order of treatment

Aspen: Engaging treatment resistant youth through parent training.