Assessing Social Work's Contribution to Controlled Studies of Adolescent Substance Abuse Treatment

ABSTRACT

Findings from a review of social work's contribution to the adolescent substance abuse treatment outcome literature between 1990 and 2001 are presented. Social work involvement in adolescent substance abuse treatment was evaluated through a computerized bibliographic search of medical and social science databases and by a manual search of 13 core social work journals. Results indicate that social work has contributed little to knowledge development in adolescent chemical dependency treatment. Investigators affiliated with a department or school of social work accounted for three of 15 controlled treatment outcome studies. Only one report was published in a core social work journal. Efforts to develop clinical guidelines in this important practice domain will founder until a sufficiently directive body of practice-relevant research accumulates to guide evidence-based substance abuse treatment for adolescents.     

Psychiatric,Family, and Ethnicity-Related Factors That Can Impact Treatment Utilization Among Hispanic Substance Abusing Adolescents

SUMMARY

There is great significance to improving our understanding of predictors of treatment utilization among Hispanic substance abusing youth. One hundred and ten Hispanic substance abusing adolescents and their parents participated in a study of treatment utilization. Analyses showed that adolescents with lower numbers of externalizing disorders (χ² = 4.18, df = 1, p < .05) and parents with better parenting strategies (χ² = 8.73, df = 2, p < .05), predicted overall treatment utilization (residential + outpatient). Better parenting practices and higher parental years in the U.S. predicted more utilization of outpatient services and lower parenting stress predicted more utilization of residential services. Without specialized engagement strategies, adolescents and families most in need may be the least likely to engage in recommended treatment.     

The Seven Challenges: An Effective Treatment for Adolescents with Co-Occurring Substance Abuse and Mental Health Problems

ABSTRACT

Recent developments in the provision of the substance abuse treatment for adolescents has included a focus on age appropriate treatment with consideration for adolescents' relatively low level of motivation for treatment and high incidence of co-occurring substance use and mental health problems. This study examines 3- and 6-month substance use and mental health outcomes for youth (n = 36) participating in The Seven Challenges Program. Results indicate significant reductions in both substance use and mental-health-related measures at 3 months with all measures except substance abuse frequency continuing to improve at the most distal 6-month assessment. The Seven Challenges treatment model is presented along with a discussion of the findings.     

The Evolution of Substance Abuse Treatment in Juvenile Justice

ABSTRACT

This paper discusses the scope of substance abuse and related problems among juvenile offenders, and describes three models of addressing the problem based on a review of current approaches, ranging from Treatment Alternatives to Street Crimes programs (TASC), to juvenile drug courts, to an integrated treatment network model. The relevant strengths and weaknesses of each in supporting lasting change in substance-abusing juvenile offenders and their families are presented, and a call to action is offered for communities wishing to aim their interventions innovatively and precisely in the direction of substance abuse among their delinquent youth.     

Siblings’ Differential Treatment in Mexican American Families

We investigated the patterns and correlates of parents’ differential treatment of adolescent siblings in 246 two‐parent Mexican American families. In home interviews, siblings rated 7 domains of differential treatment (e.g., privileges, chores, warmth) as well as their adjustment and perceptions of parental acceptance and fairness, and both parents and adolescents reported on cultural dynamics. More gender‐typed patterns of differential treatment were evident when parents were more oriented to Mexican than Anglo culture. The links between differential treatment and youth reports of adjustment, parental acceptance, and parental fairness were moderated by adolescents’ familism values, particularly for older siblings: Differential treatment was linked more strongly to adjustment and parent‐youth relationship problems when youth reported lower levels of familism.     

Parent Marital Quality and the Parent–Adolescent Relationship: Effects on Adolescent and Young Adult Health Outcomes

Although a number of studies examined the implications of marital disruption for adolescent well-being, few studied the implications of marital relationship quality on health outcomes for children in married-couple families. The present study examines how parent marital quality among intact families interacts with the quality of parent–adolescent relationships to predict physical health, mental health, and substance use in middle adolescence and early adulthood. The study uses data from the NLSY97 cohort, a nationally representative sample of adolescents who are being followed into adulthood. Predictors include the quality of the parent marital relationship, the quality of the parent–adolescent relationship, marital structure, and a number of contextual covariates and control variables. Combined parent marital quality and parent–adolescent relationship groups were developed using latent class analyses and were used to predict positive and negative health behaviors during the teen and early adult years. Results indicate that adolescents in families experiencing poor marital quality fared worse on physical health, mental health, and substance use outcomes. In addition, adolescents who reported poor relationships with at least one of their parents fared worse on outcomes. Adolescents whose parents have low-quality relationships and also have poor parent–adolescent relationships tended to fare least well across health measures. Adolescents whose parents have a high-quality relationship and who have a good parent–adolescent relationship with both parents consistently had the best outcomes. Overall, poor relationships consistently undermine mental health, physical health, and substance use. Family religious activities also consistently predict better health outcomes.     

Gay Youth

Abstract

In recent years there has been a growing awareness among parents and social service professionals of the complex sexual identity development of adolescents. Despite this, adolescents continue to struggle to define their sexual identity. Gay and lesbian adolescents in particular are at risk for a host of problems, including substance abuse and suicide. In this context it is important for social service researchers to study adolescent sexual identity and to report their findings in such a way as to be accessible to professionals and to the public.     

Parent Psychological Distress: A Moderator of Behavioral Health Intervention Outcomes among Justice‐Involved Adolescents

We examined whether pre‐existing parent psychological distress moderated juvenile offenders’ substance use, sexual risk, and mental health outcomes in a randomized trial. Forty‐seven parent–adolescent dyads received either Family‐based Affect Management Intervention (FAMI) for adolescent substance use and HIV prevention or adolescent‐only Health Promotion Intervention (HPI). Parents’ self‐reported distress at baseline significantly moderated adolescents’ self‐reported marijuana use and alcohol use but not other outcomes at 3 months postintervention, producing crossover interactions. FAMI outperformed HPI when parents reported high‐level distress, whereas HPI outperformed FAMI when parents reported low‐level distress. This finding that the relative efficacy of interventions depends on the severity of parent psychological distress could inform efforts to match substance‐using, justice‐involved adolescents with the intervention most likely to benefit them.     

Do Actions Speak Louder Than Words? Adolescent Interpretations of Parental Substance Use

Parents are powerful socialization agents for children and as children reach adolescence parental role models, among other sources of influence, become particularly salient in adolescents’ decision-making regarding initiation of substance use. Open parent-adolescent communication about substances is associated with less substance use by adolescents; however, it is unclear how youth interpret antidrug use messages from their parents, especially if the parents engage in legal and/or illicit substance use themselves. Framed by social learning theory and social constructionism, this study analyzed in-depth interviews with 108 adolescents about personal experiences with substance use, family communication about substance use, and adolescent interpretations of parental use. Emergent themes in the data include: positive parental influence, parental contradictions, and negative outcomes of use. Prevalence of parental use—regardless of legality, rarity of explicit communication about parental use, and various interpretations of parental use are discussed.     

Substance Abuse Treatment with Adolescent African American Males

Abstract

The use of substances by adolescent African American males is of particular concern because of the damaging effect that drug abuse has not only on the individual and his family but also on the African American community. The literature is scant regarding treatment services and few therapeutic interventions have been specifically designed to holistically meet the needs of these youth. This article proposes the use of Afrocentricity and Reality Therapy as therapeutic bases for substance abuse treatment with this population.     

Best Practices in the Treatment of Substance-Abusing Women in the Child Welfare System

ABSTRACT

This paper reviews the literature on women's chemical dependency and its effects on their children. Many risk factors (e.g., a history of traumatic exposure) and consequences (interference with parenting) of substance abuse are unique for women, giving rise to special treatment needs of substance-abusing women with children. Substance-abusing mothers also experience unique barriers to receiving the services they need to recover, such as absence of child care and lack of gender-specific treatment in their communities. Model programs are described and recommendations are offered for best treatment practices for women with chemical dependency who present in the child welfare system.     

Agency Practices Affecting Social Workers Who Treat Substance-Abusing Clients

Abstract

This study interviewed 115 MSWs with substance abuse training working in general social service agencies to determine if they viewed their settings as facilitating or hindering their work with substance-abusing clients. This study builds on the work of Lightfoot and Orford (1986) who found that social workers were more hindered than helped by their agencies' practices regarding substance-abusing clients.

Results: A majority of workers viewed their agencies as facilitating substance abuse-related work through support from supervisors and administrators, availability of substance abuse training, workers' freedom to choose clients, and opportunities to supervise others on substance abuse-related issues. Supervisor data corroborated these findings. This is a hopeful sign for the profession contrasting with considerable social work literature documenting the profession's historic ambivalence toward substance-abusing clients.     

Ethical Issues in the Mental Health Treatment of Gender Dysphoric Adolescents

SUMMARY

This paper will focus on ethical dilemmas that arise in the treatment of adolescents with gender dysphoria. We will begin with a discussion of ethical and legal issues pertinent to the treatment of any adolescent, and then proceed to the gender dysphoric adolescent, since there is a great deal of overlap between the two areas. The authors re-view legal decisions, the existing data on adolescent decision-making, and ethical principles that may help the clinician in resolving some very complex situations. Utilizing case vignettes of three gender dysphoric adolescents, the authors provide a pragmatic illustration of the ethical dilemmas involved in evaluation and treatment of these youth. It is the authors' belief that treatment interventions should be based on respect for the adolescent's autonomy and confidentiality where he or she is deemed competent to make decisions.     

Psychosocial Treatment of Oppositional Defiant Disorder

Abstract

Objective:To review and describe empirical outcome studies on the psychosocial treatment of children and adolescents meeting the criteria for Oppositional Defiant Disorder (ODD).Method:To locate these treatment outcome studies, an extensive review of the literature using the PsycINFO database was conducted. Results:Psychosocial treatments designed solely for youth meeting the criteria for ODD are rare. Rather, it seems that most of the intervention studies have involved youth with Conduct Disorder as well as ODD, even though these two disorders have distinct differences. Selected psychosocial interventions, including anger control and stress inoculation training, assertiveness training, multisystemic therapy, and rational emotive therapy, have produced favorable outcomes in the studies conducted and published to date. Conclusions:Social workers serving ODD youth should seek training in these provisionally supported evidence-based practices. Given the scarcity of treatments designed solely for ODD with adolescents, there is a need for more outcome studies on this specific population, and for more studies of social work practice involving such youth.     

Preparing and Partnering with Families to Support the Adoption of Children from Foster Care

ABSTRACT

This investigation evaluated the effectiveness of a pre-placement education and preparation curriculum (PREP) for prospective foster/adoptive parents in improving attitudes toward children with prenatal substance exposure and their substance-using birth parent and increasing willingness to adopt these children. Participants included 1,836 prospective parents seeking adoption through foster care who received three 3-hour sessions of PREP. Prospective parents completed questionnaires assessing their knowledge about important issues involved in adopting a child from foster care, attitudes, and willingness to adopt children with a variety of characteristics. Changes from pre- to post-intervention were examined. Results indicated significant increases in self-reported knowledge; significantly more positive attitudes toward substance-abusing parents and children with prenatal substance exposure; and significantly increased willingness to adopt children with a variety of potential difficulties, including children with serious behavior problems, attention deficit hyperactivity disorder, and a biological history of mental illness. In sum, findings suggest that prospective adoptive parents who attended the PREP sessions felt better prepared by the end of training with regard to issues related to adoption of high-risk foster children with special needs, particularly those with prenatal substance exposure.     

Family Communication and Adolescent Alcohol Use in Nicaragua,Central America: A Test of Primary Socialization Theory

ABSTRACT

Applying primary socialization theory to a sample of early adolescents from Nicaragua, this study examines direct and indirect associations between family bonding and adolescent alcohol use via substance specific prevention communication (SSPC) and adolescent efficacy. Early adolescents in 7th and 8th grades completed a self-report, cross-sectional survey. Structural equation modeling revealed that family expressiveness was significantly indirectly related to adolescent lifetime alcohol use through SSPC. Results are discussed in relation to primary socialization theory, family communication, and international substance use prevention efforts. This study provides supportive evidence for the important role of positive family communication as a protective factor for early adolescents in Nicaragua.     

Working with Parents to Reduce Juvenile Sex Offender Recidivism

SUMMARY

Although there is very little research in the area of including parents in juvenile sex offender treatment, one of the factors that might be worth exploring is how the parental relationship may aid in successful relapse prevention. Since the family environment is a potential risk factor for adolescent sex offenders, integration of relapse prevention into daily family life may be a significant part of these youths' success or failure in the community. This article focuses on the concept of including parents in juvenile sex offender treatment. Issues addressed include what treatment providers can do to involve parents in relapse prevention, treatment providers' misconceptions about the inclusion of parents in treatment, a rationale for including parents in treatment, and research regarding different parenting styles.     

Social Work Roles in Drug Treatment with Youth

ABSTRACT

Social workers working with youth, who are prescribed psychotropic medication, are routinely faced with tasks pertaining to psychopharmacologic treatment. Little is known, however, about how these workers contribute to the medication treatment process or the impact of their contributions. The purpose of this national survey of social workers practicing with youth was to explore three areas: (1) the frequency of medication-related functions with adolescent clients; (2) the worker, client, and contextual factors associated with greater involvement; and (3) social workers' perceptions of the effects of greater involvement on treatment processes and outcomes. Our findings suggested that in relation to medication treatment, social workers more frequently interfaced with clients than physicians, and that various treatment context and individual factors are associated with greater involvement. Social workers also perceived their involvement as associated with some desirable treatment processes/outcomes, especially the inclusion of adolescents in decision-making.     

A review of literature: An examination of the correlation between attachment styles and adolescent girls’ sexual behaviors

ABSTRACT

This literature review examines eight studies of parental attachment styles, sexual behavior, and health outcomes among adolescent girls. The review focuses on studies that analyzed the perceived relationships between parents and their adolescent daughters and whether instabilities of life experiences correlated with risky sexual behaviors and if high-risk sexual behaviors were associated with an increase of sexually transmitted infections, unplanned pregnancies, and other poor health outcomes in adolescent girls. Findings show adolescent girls with insecure parental attachment styles were at a higher risk of sexual behaviors, early pregnancies, and transmission of sexually transmitted infections (STI’s). The most common finding in the studies reviewed was the significant association of how higher parental communication and monitoring may prevent risky sexual behaviors at an earlier age. Recommendations for mental and health care providers include the development of treatment programs to address the importance of parent-attachment relationships and multifaceted health needs of adolescents girls. Programs can be strengthened by involving other family members, improving parent-daughter communication and relationships and emphasizing system-level change (policy, procedure, practice). Adding these elements may ultimately lead to sustained improvements over time. Future research on other family social factors (e.g., divorce and separation of attachment figure, poverty, and single-parent homes) associated with attachment and high-risk behaviors is warranted. More research is needed to exam how secure attachments among adolescent girls may prevent earlier sexual encounters, unplanned pregnancies, and STI’s.