Transcript Insert Workshop Title

Implementing Evidenced Based
Substance Abuse Services for
Adolescents
Michael Dennis, Ph.D.,
Chestnut Health Systems,
Bloomington, IL
Presentation at “NEW DIRECTIONS TO HEALTHIER COMMUNITIES & METH SUMMIT”, September
28-30, 2005, Savannah Marriott Riverfront, Savannah, GA. Sponsored by the Georgia Council on Substance
Abuse and the Georgia Department of Juvenile Justice, Office of Behavioral Health Services. The content of
this presentations are based on treatment & research funded by the Center for Substance Abuse Treatment
(CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA) under contract 270-200300006 using data provided by the following grantees: (TI11320, TI11324, TI11317, TI11321, TI11323,
TI11874, TI11424, TI11894, TI11871, TI11433, TI11423, TI11432, TI11422, TI11892, TI11888, TI013313,
TI013309, TI013344, TI013354, TI013356, TI013305, TI013340, TI130022, TI03345, TI012208, TI013323,
TI14376, TI14261, TI14189,TI14252, TI14315, TI14283, TI14267, TI14188, TI14103, TI14272, TI14090,
TI14271, TI14355, TI14196, TI14214, TI14254, TI14311, TI15678, TI15670, TI15486, TI15511, TI15433,
TI15479, TI15682, TI15483, TI15674, TI15467, TI15686, TI15481, TI15461, TI15475, TI15413, TI15562,
TI15514, TI15672, TI15478, TI15447, TI15545, TI15671)). several individual grants. The opinions are those
of the author and do not reflect official positions of the consortium or government. Available on line at
www.chestnut.org/LI/Posters or by contacting Joan Unsicker at 720 West Chestnut, Bloomington, IL 61701,
phone: (309) 827-6026, fax: (309) 829-4661, e-Mail: [email protected]
Goals of this Presentation
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Provide a brief introduction on the move to evidenced
based practice (ECP)
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Summarize the recent growth in adolescent substance
abuse treatment and research
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Discuss the infrastructure and organizational changes
that are typically required to shift to evidence based
practice
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Review the materials that are currently available to
support evidence based practice,
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Introduce a common data set of adolescent treatment
programs using the Global Appraisal of Individual
Needs (GAIN) that is being used by CSAT’s adolescent
grantees and which has provided data to support the
planning of many of recent papers and presentations
Context
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The field is increasingly facing demands from payers,
policymakers, and the public at large for “evidence-based
practices (EBP)” which can reliably produce practical and
cost-effective interventions, therapies and medications
that will
– reduce substance use and its negative consequences
among those who are abusing or dependent,
– reduce the likelihood of relapse for those who are
recovering, and
– reduce risks for initiating drug use among those not yet
using,
NIDA Blue Ribbon Panel on Health Services Research
(see www.nida.nih.gov )
General Behavioral Health Practice
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Accumulating evidence indicates that most of the theories
and approaches that are used within the community of
practitioners are unsupported by empirical evidence of
effects
Various lists of 70 or so “proven” "empirically supported
therapies (ESTs) have proven to be relatively infeasible
because they have rarely been compared and generally have
not been tested with the clinically diverse samples found in
community based settings
Need for a new method of integrating scientific evidence
and the realities of practice is called for.
Source: Beutler, 2000
Problems and Barriers in SA Tx
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People with multiple substance use and multiple cooccurring problems are the norm of severity in practice,
but are often excluded from research
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Individualization of treatment content/duration is the
norm in practice, but research based protocols typically
involves fixed components/length that are not as
appropriate for heterogeneous problems
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No treatment is not considered a ethical or significant
option, practitioner’s are more interested in identifying
which of several treatments to use for a given type of
patient – but few such studies have been done
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When research practices have been identified, they are
often not adopted because practitioner’s often lack the
appropriate materials, training and resources to know
when or how to implement best practices
Randomized Clinical Trials (RCT) are to
Evidence Based Practice (EBP) like
Self-reports are to Diagnosis
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They are only as good as the questions asked (and
then only if done in a reliable/valid way)
They are an efficient and logical place to start
But they can be limited or biased and need to be
combined with other information
Just because the person does not know something
(or the RCT has not be done), does not mean it is
not so
Synthesizing them with other information usually
makes them better
So what does it mean to move the field
towards Evidence Based Practice (EBP)?
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Introducing reliable and valid assessment that can be used
– At the individual level to immediately guide clinical judgments
about diagnosis/severity, placement, treatment planning, and
the response to treatment
– At the program level to drive program evaluation, needs
assessment, and long term program planning
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Introducing explicit intervention protocols that are
– Targeted at specific problems/subgroups and outcomes
– Having explicit quality assurance procedures to cause
adherence at the individual level and implementation at the
program level
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Having the ability to evaluate performance and outcomes
– For the same program over time,
– Relative to other interventions
What are the pitfalls of EBP?
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EBP generally causes some staff turnover
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EBP often shines a light on staff or work place problems
that would otherwise be ignored
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EBP often impact a wide range of existing procedures and
policies – requiring modification and provoking resistance
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EBP (and most organizational changes) will fail without
good senior staff leadership
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EBP typically require going for more funds from grant or
other funders
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On-going needs assessment will create demand for more
change and more EBP
Growing Infrastructure
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Increasing availability and use of standardized
assessment to help focus and improve clinical practice
Growing number of manualized protocols designed for
replication and use in practice
CSAT increasingly encouraging and/or requiring the use
of standardized assessment, manuals, training, and
quality assurance practices to ensure adherence
ATTCs collaborating with CSAT, NIDA and NIAAA to
train individual staff
Growing Literature
GAIN/ JMATE workgroups (Gender, Spanish, African
American, Asian, LGBT, Juvenile Justice, Comorbidity,
Strength Based, Substance-specific, Interventionspecific, Trainers, Data Managers, MIS, Evaluators )
There is a list of above resources at the end of these handouts
How we are building a common knowledge
base about what is working for whom through
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Pooling data across multiple evaluations and
programs
Identifying common factors and principals that
appear to hold across interventions
Having peer reviewed panels review and rate the
strength of evidence on the effectiveness and
generalizability of specific interventions
Conducting formal meta analysis of a groups of
similar interventions that have been replicated and
evaluated several times
Reoccurring Themes…
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Severity and specificity of problem subgroup
Manualized and replicable protocols
Relative strength of intervention for a specific
problem
Adherence and implementation of intervention
Evaluation of outcomes targeted by the
intervention (a.k.a., logic modeling)
Global Appraisal of Individual Needs (GAIN)
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The GAIN family of instruments were developed
through a 10 year collaboration of researchers,
clinicians, policy makers, and IT specialists
They provide a standardized approach to measuring:
– Eligibility/need (i.e., screening),
– DSM/ICD Diagnosis,
– ASAM level of care Placement,
– Study/State/Federal Reporting,
– Treatment Planning,
– Severity/Case Mix,
– Change in Functioning, Service Utilization, and other
Outcomes, and
– Economic Cost and Benefits of treatment
Includes 103 scales and over 2000 created variables, had
good reliability/validity, 174 agencies and over four
dozen scientists working with it
More information is available at www.chestnut.org/li/gain
Adolescent and Adult Treatment Program
GAIN Clinical Collaborators
Number of
GAIN Sites
30 to 60
10 to 29
2 to 9
1
One or more state or county wide systems uses the GAIN
One or more state or county wide systems considering using the GAIN
07/05
The Current Renaissance of Adolescent
Treatment Research
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1994-2000 NIDA’s Drug Abuse Treatment Outcome Study of Adol. (DATOS-A)
1995-1997 Drug Abuse Treatment Outcome Study (DOMS)
1997-2000 CSAT’s Cannabis Youth Treatment (CYT) experiments
1998-2003 NIAAA/CSAT’s 15 individual research grants
1998-2003 CSAT’s 10 Adolescent Treatment Models (ATM)
2000-2003 CSAT’s Persistent Effects of Treatment Study (PETS-A)
2002-2007 CSAT’s 12 Strengthening Communities for Youth (SCY)
2002-2007 RWJF’s 10 Reclaiming Futures (RF) diversion projects
2002-2007 CSAT’s 12+ Targeted Capacity Expansion TCE/HIV
2003-2009 NIDA’s 14 individual research grants and CTN studies
2003-2006 CSAT’s 17 Adolescent Residential Treatment (ART)
2003-2008 NIDA’s Criminal Justice Drug Abuse Treatment Study (CJ-DATS)
2003-2007 CSAT’s 38 Effective Adolescent Treatment (EAT)
2004-2007 NIAAA/CSAT’s study of diffusion of innovation
2004-2009 CSAT 22 Young Offender Re-entry Programs (YORP)
2005-2008 CSAT 20 Juvenile Drug Court (JDC)
2005-2008 CSAT 16 State Adolescent Coordinator (SAC) grants
Full ( ) or Partial ( ) use of the Global Appraisal of Individual Needs (GAIN)
CSAT AT Program Common Data Set
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The 2004 CSAT adolescent treatment data set included data on
5,468 adolescents from 67 local evaluations (and is growing
exponentially in people, sites, and number of follow-ups)
All data collected with the Global Appraisal of Individual Needs
(GAIN) using centrally trained and certified staff
Outcome data through 12 months available on over 90% of CYT
and ATM clients and over 80% of others “due” in on-going
programs
Programs include several standardized protocols based on both
research and practice (ACC, ACRA, ATM, FFT, FSN, Matrix,
MET/CBT, MDFT, MST)
Local evaluations include several experiments and quasi
experiments, as well as up to 40 replications of the same
manualized protocol in different sites
Several workgroups working on common themes across
programs (African American, Co-morbidity, Family, Native
American/Indian, Spanish translation/workforce)
Data being shared for meta and several secondary analyses
CSAT Adolescent Treatment (AT) Programs
Reordered by Level of Care and Severity
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EAT: Effective Adolescent Treatment (2003-2007; n=975) replicating the CYT
MET/CBT intervention in early intervention, school and outpatient settings(22 of 36
grants: Bradley, Brown, Clayton,Curry, Davis, Dillon, Dodge, Kressler, Kincaid, Levine,
Levy, Locario, Mason, Moore, Rajaee-Moore, Paull, Payton, Rezende, Taylor, Tims,
Turner, Vincent)
CYT: Cannabis Youth Treatment (1997-2001; n=600) Experiments with adolescent
outpatient/intensive outpatient (5 grants: Babor, Dennis, Diamond, Godley, Tims)
TCE: Targeted Capacity Expansion (2002-2007; n=189) evaluation of intensive
outpatient programs and some residential treatment (2 of 12 grants: Tims, Lloyd)
SCY: Strengthening Communities-Youth (2002-2007; n=1120) evaluations of early
intervention, outpatient, intensive outpatient and some residential (11 of 12 grants:
Beach, Bolland, Dahl, Gerstel, Godley, Hall, Hutchinson, Keehn, Murphy, Noonan,
Panzarella)
ATM: Adolescent Treatment Model (1998-2002; n=1468) evaluations of outpatient,
short and long term residential (10 grants: Batttjes, Fishman, Godley, Liddle, Morral,
Perry, Sabin, Shane, Stevens-2)
ART: Adolescent Residential Treatment (2003-2006; n=1179) evaluations of
residential treatment enhancements and continuing care (17 grants: Beach, Fishman,
Flores, Gay, Gnazzo, Hatch, Hurtig, Lane, Law, Manov, May, Miley, Nordquist, Snipes,
Urquahart, Whitmore, Zammarelli)
Level of Care
100%
Other
Resid. Continuing Care
80%
Long Term Residential
60%
Med. Term Residential
Short Term Residential
40%
Intensive Outpatient
20%
Outpatient
Early Intervention
0%
EAT
CYT
TCE
SCY
ATM
Source: CSAT 2004 AT Common GAIN Data set
ART
Total
Gender
100%
90%
80%
Male
70%
60%
50%
40%
30%
Female
20%
10%
0%
EAT
CYT
TCE
SCY
ATM
Source: CSAT 2004 AT Common GAIN Data set
ART
Total
While few individual
studies can break out
females, this data set
has 1497
(so far)
Race
100%
Other
90%
Mixed
80%
Native American/
Alaskan
70%
60%
Hispanic
50%
Caucasian/White
40%
Asian/Pacific
Islander
30%
20%
African
American
10%
0%
EAT
CYT
TCE
SCY
ATM
Source: CSAT 2004 AT Common GAIN Data set
ART
Total
Across sites there are
300 or more for all
subgroups but Asian
(so far)
Age
100%
21-25
90%
80%
70%
18-20
60%
50%
40%
15-17
30%
20%
0-14
10%
0%
EAT
CYT
TCE
SCY
ATM
Source: CSAT 2004 AT Common GAIN Data set
ART
Total
921 Under 14 and
377 young adults
Single Parent
39%
34%
In School
86%
Juvenile Justice
Involvement
Recently in a
Controlled
Environment
Source: CSAT 2004 AT Common GAIN Data set
70%
45%
100%
90%
80%
70%
50%
Homeless or
Runaway
Employed
60%
50%
40%
30%
20%
10%
0%
Other Characteristics
Years of Use
100%
5+ Years
90%
80%
70%
3-4 Years
60%
50%
40%
1-2 Years
30%
20%
10%
Less than 1
0%
EAT
CYT
TCE
SCY
Source: CSAT 2004 AT Common GAIN Data set
ATM
ART
Total
Substance Use Severity (based on self-report)
100%
90%
Dependence
80%
70%
60%
50%
Abuse
40%
30%
20%
Subclinical
use/problems
10%
0%
EAT
CYT
TCE
SCY
ATM
Source: CSAT 2004 AT Common GAIN Data set
ART
Total
14 or more days in
Controlled Environment
100%
20%
Alcohol
Other Drugs
90%
52%
Marijuana
Heroin/Opioids
80%
65%
Any AOD Use
Cocaine/Crack
70%
60%
50%
40%
30%
20%
10%
0%
Weekly/Daily Substance Use Pattern
In our data and in TEDS, 1 in
5 did not use in the month
before intake – hence the use
of 90 day window and
measures of pre-CE use
5%
3%
8%
30%
Source: CSAT 2004 AT Common GAIN Data set
Prior Substance Abuse Treatment
100%
90%
Two or more
80%
70%
60%
50%
One
40%
30%
20%
None
10%
0%
EAT
CYT
TCE
SCY
Source: CSAT 2004 AT Common GAIN Data set
ATM
ART
Total
Acknowledges
AOD problem
Believes
treatment
needed
Self reports meets
abuse/dependence
criteria
Gives one or more
reasons to quit
Source: CSAT 2004 AT Common GAIN Data set
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Mixed Problem Recognition
35%
81%
92%
99%
Regular drug use
Regular alcohol use
In home
52%
among
social peers
61%
17%
among work/
school peers
among
social peers
Source: CSAT 2004 AT Common GAIN Data set
67%
79%
100%
90%
80%
70%
60%
50%
29%
among work/
school peers
In home
40%
30%
20%
10%
0%
High Risk Recovery Environments
Patterns of Co-Occurring Disorders
100%
Both Internal
& External
Disorders
90%
80%
70%
External
Disorder(s)
Only
60%
50%
Internal
Disorder(s)
only
40%
30%
20%
Neither
10%
0%
EAT
CYT
TCE
SCY
ATM
Source: CSAT 2004 AT Common GAIN Data set
ART
Total
Any Internal Disorder
Trauma Related Disorder
Any Self Mutilation
Any homicidal/
suicidal thoughts
Source: CSAT 2004 AT Common GAIN Data set
100%
90%
80%
70%
38%
21%
28%
32%
28%
67%
Any External Disorder
Conduct Disorder
Attention
Deficit-Hyperactivity
Disorder (ADHD)
60%
49%
Depressive Disorder
Anxiety Disorder
50%
40%
30%
20%
10%
0%
Interventions need to be more specific
59%
48%
Within a diagnosis
there are also mild to
severe subgroups
Lifetime
Victimization
57%
16%
Needle Use
Sexual Activity
Past 90 Days
61%
Sex Under
AOD Influence
Multiple
Sex Partners
Unprotected
Sex
51%
35%
29%
Victimization
23%
4%
Source: CSAT 2004 AT Common GAIN Data set
100%
90%
81%
Sexual Activity
Needle Use
80%
70%
60%
50%
40%
30%
20%
10%
0%
Also High Rates of HIV/STI risk behaviors
Severity of Victimization History
100%
High
90%
(4-15 on General
Victimization
Scale [GVS] *)
80%
70%
Moderate
60%
(Any Lifetime,
1-3 on GVS*)
50%
Low
40%
(No History)
30%
20%
10%
0%
EAT
CYT
TCE
SCY
ATM
Source: CSAT 2004 AT Common GAIN Data set
ART
Total
* Based on lifetime history and
current fear of 4 types of
victimization (attached with a
weapon, beaten, sexually
assaulted, emotionally abused),
and 8 trauma factors (under 18,
someone trusted, multiple
people, multiple times, sexual
penetration, fear for life, no one
believed when reported)
Victimization interacts with MH problems
100%
Both Internal
& External
Disorders
90%
80%
70%
External
Disorder(s)
Only
60%
50%
Internal
Disorder(s)
only
40%
30%
20%
Neither
10%
0%
Low
Moderate
High
Severity of Victimization
Source: CSAT 2004 AT Common GAIN Data set
Total
Intensity of Juvenile Justice System Involvement
100%
In detention/
jail 14+ days
90%
On prob./ parole
14+ days w/ 1+
drug screens
80%
70%
60%
50%
Other probation,
parole, detention
40%
Other JJ status
30%
Past arrest/
JJ status
20%
Past year illegal
activity/SA use
10%
0%
EAT
CYT
TCE
SCY
ATM
Source: CSAT 2004 AT Common GAIN Data set
ART
Total
Any violence or
illegal activity
86%
Physical Violence
72%
Property Crimes
58%
Drug Related Crime
57%
Interpersonal
Crimes
Source: CSAT 2004 AT Common GAIN Data set
51%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
Past Year
0%
It is NOT just about possession…
Need to focus on multiple problems clients
100%
Number of 12
Major Clinical
Problems*
90%
80%
70%
5 or more
Problems
60%
4 Problems
50%
3 Problems
40%
2 Problems
30%
1 Problem
20%
* (Alcohol, cannabis, or
other drug disorder,
depression, anxiety,
trauma, suicide, ADHD,
CD, victimization,
violence/ illegal activity)
10%
0%
EAT
CYT
TCE
SCY
ATM
Source: CSAT 2004 AT Common GAIN Data set
ART
Total
Generalizability of
research focused on a
single problem
Victimization is particularly intertwined
with the number of problems*
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1 Problem
Low
2 Problems
Mod.
High
3 Problems
4 Problems
5 or more
Problems
(117.2)
* (Alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization,
violence/ illegal activity)
Source: CSAT 2004 AT Common GAIN Data set (odds for High over odds for Low)
Victimization Also Interacts
with Outcomes
Marijuana Use (Days of 90)
40
CHS Outpatient
CHS Residential
Traumatized groups
35have higher severity
30
25
20
15
10
High trauma group
does not respond to OP
5
0
Intake
OP -High
6 Months
OP - Low/Mod
Source: Funk, et al., 2003
Both groups respond to
residential treatment
Intake
Resid-High
6 Months
Resid - Low/Mod.
How do CHS OP’s high GVS outcomes
compare with other OP programs on average?
Z-Score on Substance Frequency Scale (SFS)
1.00
0.80
0.60
0.40
CYT Total (n=217; d=0.51)
Other programs
serve clients who
have significantly
higher severity
ATM Total (n=284; d=0.41)
CHSOP (n=57; d=0.18)
0.20
0.00
And on average they have
moderate effect sizes even
with high GVS
-0.20
-0.40
-0.60
-0.80
-1.00
Green line is CHS OP’s High GVS adolescents;
they have some initial gains but substantial relapse
Intake
Mon 1-3
Source: CYT and ATM Outpatient Data Set
Mon 4-6
Mon 7-9
Mon 10-12
Which 5 OP programs did the best with
high GVS adolescents?
The two best were
used with much
higher severity
adolescents and
TDC was not
manualized
Z-Score on Substance Frequency Scale (SFS)
1.00
0.80
0.60
7 Challenges (n=42; d=1.21)
Tucson Drug Court (n=27; d=0.65)
MET/CBT5a (n=34; d=0.62)
MET/CBT5b (n=40; d=0.55)
0.40
FSN/MET/CBT12 (n=34; d=0.53)
0.20
CHSOP (n=57; d=0.18)
0.00
-0.20
-0.40
-0.60
-0.80
-1.00
Next we can check to see if they are
any more similar in severity
Intake
Mon 1-3
Source: CYT and ATM Outpatient Data Set
Mon 4-6
Mon 7-9
Mon 10-12
Which 5 OP Programs, of similar severity,
did the best with high GVS adolescents?
Z-Score on Substance Frequency Scale (SFS)
1.00
MET/CBT5a (n=34; d=0.62)
0.80
MET/CBT5b (n=40; d=0.55)
Trying MET/CBT5
because it is
stronger, cheaper,
and easier to
implement
0.60
0.40
0.20
FSN/MET/CBT12 (n=34; d=0.53)
Epoch (n=72; d=0.33)
TSAT (n=66; d=0.35)
CHSOP (n=57; d=0.18)
0.00
-0.20
-0.40
-0.60
-0.80
-1.00
Not much improvement and they do
not work quite as well
Intake
Mon 1-3
Source: CYT and ATM Outpatient Data Set
Mon 4-6
Currently CHS is doing an
experiment comparing its
regular OP with MET/CBT5
Mon 7-9
Mon 10-12
Areas where staff wanted more specific
knowledge and interventions
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Victimization, trauma and helplessness
Self mutilation, para-suicidal and suicidal behaviors
Anger management, violence and crime
How to help their kids access mental health services (typically
for internal disorders) when availability is limited
Managing ADHD and impulsivity
How to get parents involved in treatment and continuing care
Tobacco, opioids, and methamphetamine use,
Working with schools, probation, families
Females, Males, African Americans, Native Americans,
Spanish Speaking adolescents and their families
HIV, STI, and Liver risk
How to make interventions more assertive and strength based
Evaluation issues like follow-up, data management, & analysis
Workforce development, including peer-to-peer on specific
treatment approaches and other job functions like MIS
Common Strategies you can do NOW
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Standardize assessment and identify most common
problems
Pool knowledge about what staff have done in the past,
whether it worked, and what the barriers were
Identify system barriers (e.g., criteria to local access case
management, mental health) that could be avoided if
thought of in advance
Identify existing materials that could help and make sure
they are readily available on site
Identify promising strategies for working with the
adolescent, parents, or other providers
Develop a 1-2 page checklist of things to do when this
problem comes up
Identify a more detailed protocol and trainer to address the
problem, then go for a grant to support implementation
Resources
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Assessment Instruments
– CSAT TIP 3 at
http://www.athealth.com/practitioner/ceduc/health_tip31k.html
– NIAAA Assessment
Handbook,http://www.niaaa.nih.gov/publications/instable.htm
– GAIN Coordinating Center www.chestnut.org/li/gain
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Treatment Programs
–
–
–
CSAT CYT, ATM, ACC and other treatment manuals at
www.chestnut.org/li/apss/csat/protocols or
www.chestnut.org/li/bookstore
SAMHSA at
http://kap.samhsa.gov/products/manuals/cyt/index.htm or NCADI
at www.health.org
National Registry of Effective Prevention Programs
Substance Abuse and Mental Health Services Administration
(SAMHSA), Department of Health and Human Services :
http://www.modelprograms.samhsa.gov
Resources

Implementing Evidenced based practice
– Central East ATTC Evidence Based Practice Resource Page
http://www.ceattc.org/nidacsat_bpr.asp?id=LGBT
–
Northwest Frontier ATTC Best Practices in Addiction Treatment:
A Workshop Facilitator's Guide
http://www.nattc.org/resPubs/bpat/index.html
–
Turning Knowledge into Practice: A Manual for Behavioral Health
Administrators and Practitioners About Understanding and
Implementing Evidence-Based Practices
http://www.tacinc.org/index/viewPage.cfm?pageId=114
–
Evidence-Based Practices: An Implementation Guide for CommunityBased Substance Abuse Treatment Agencies
http://www.uiowa.edu/~iowapic/files/EBP%20Guide%20-%20Revised%205-03.pdf
–
–
–
National Center for Mental Health and Juvenile Justice Evidence Based
Practice resource list at http://www.ncmhjj.com/EBP/default.asp
2005 Joint Meeting on Adolescent Substance Abuse Treatment
Effectiveness http://www.mayatech.com/cti/csatsasatepost/
Society for Adolescent Substance Abuse Treatment Effectiveness
(SASATE) www.chestnut.org/li/apss/sasate
References Cited Here
Beutler, L. E. (2000). David and Goliath When empirical and clinical
standards of practice meet. American Psychologist, 55, 997-1007.
Dennis, M. L., Scott, C. K., Funk, R. R., & Foss, M. A. (2005). The duration
and correlates of addiction and treatment. Journal of Substance Abuse
Treatment, 28 (2S), S49-S60 .
Dennis, M.L., & White, M.K. (2003). The effectiveness of adolescent
substance abuse treatment: a brief summary of studies through 2001, (prepared
for Drug Strategies adolescent treatment handbook). Bloomington, IL:
Chestnut Health Systems. [On line] Available at
http://www.drugstrategies.org
Dennis, M. L. and White, M. K. (2004). Predicting residential placement,
relapse, and recidivism among adolescents with the GAIN. Poster presentation
for SAMHSA's Center for Substance Abuse Treatment (CSAT) Adolescent
Treatment Grantee Meeting; Feb 24; Baltimore, MD. 2004 Feb.
White, M. K., Funk, R., White, W., & Dennis, M. (2003). Predicting violent
behavior in adolescent cannabis users The GAIN-CVI. Offender Substance
Abuse Report, 3(5), 67-69.
White, M. K., White, W. L., & Dennis, M. L. (2004). Emerging models of
effective adolescent substance abuse treatment. Counselor, 5(2), 24-28.