The effects of family therapies for adolescent delinquency and substance abuse: a meta-analysis

This meta-analysis summarizes results from k = 24 studies comparing either Brief Strategic Family Therapy, Functional Family Therapy, Multidimensional Family Therapy, or Multisystemic Therapy to either treatment-as-usual, an alternative therapy, or a control group in the treatment of adolescent substance abuse and delinquency. Additionally, the authors reviewed and applied three advanced meta-analysis methods including influence analysis, multivariate meta-analysis, and publication bias analyses. The results suggested that as a group the four family therapies had statistically significant, but modest effects as compared to treatment-as-usual (d = 0.21; k = 11) and as compared to alternative therapies (d = 0.26; k = 11). The effect of family therapy compared to control was larger (d = 0.70; k = 4) but was not statistically significant probably because of low power. There was insufficient evidence to determine whether the various models differed in their effectiveness relative to each other. Influence analyses suggested that three studies had a large effect on aggregate effect sizes and heterogeneity statistics. Moderator and multivariate analyses were largely underpowered but will be useful as this literature grows.     

The impact of schools self-administering substance abuse surveys: an evaluation

The literature suggests that administering drug surveys to public school students is best done by persons outside of the school system (or at least unfamiliar to the students). This is the approach used by the long-time Monitoring the Future project. Because of the increased costs that administration by outside research associates requires (both time and transportation), we decided to design an experiment that would compare it to administration by school personnel. Six school systems were split, and 3756 surveys were administered, about half by outside research associates and half by school personnel. The results indicate that there were minimal and non-significant differences between the two groups. On the basis of these results, we draw the conclusion that school personnel are able to administer survey instruments without affecting the quality of the results and, thus, that school districts may safely use such data in the evaluation of their drug education and drug prevention programs.     

Physical fitness effects on substance abuse risk factors and use patterns

In this study, seventy-four adolescents in either a school, community or hospital based drug intervention program received and eight to nine week structured fitness activity class as an integrated element of their respective prevention or treatment program. Prepost assessments indicated significant gains in the field fitness tests of one mile run, 1 minute situp, 1 minute pushup, percent fat and flexibility for the total sample. Based upon prepost change on the one mile run time (less than 1:00) subjects were categorized as improvers (n = 38) and non-improvers (n = 36). Improvers demonstrated a significant increase in the self concept risk factor (Piers Harris Self Concept Scale) and a significant decrease in anxiety and depression risk factors (General Well-Being Scale) compared to the non-improvers. At posttest, the improvers self reported substance use patterns were significantly lower compared to the non-improvers for percentage of the sample who were multiple drug users and alcohol uses per week and were significantly higher for the percentage of the sample demonstrating total abstinence. These findings are suggestive of the usefulness of physical training as a supplemental intervention for adolescent substance abusers.     

Disability and abuse in relation to substance abuse: a descriptive analysis

This analysis reviewed five years of a state's substance abuse treatment admissions and discharges in order to identify specific patterns among persons who had a disability. Using a series of group comparisons, Chi-squares, and logistic regressions, specific patterns of violence and abuse to this population were identified. Results indicate that persons who had a disability and abused substances were more likely to be victimized by physical abuse and domestic violence when compared with their peers without a disability. A person with a disability had about one-half to one-third the odds of receiving long-term residential, short-term residential and intensive outpatient care when compared with persons without a disability.     

Cost-effectiveness of family-based substance abuse treatment

In order to compete in a financially sensitive health care system, family systems-based treatments must demonstrate effective clinical results as well as cost-effectiveness. Cost-effectiveness research can demonstrate to health care insurers and policy makers which treatments are viable options for implementation. The present literature review identified eight cost-effectiveness family-based substance abuse treatment studies. The results suggest that certain family-based treatments are cost-effective and warrant consideration for inclusion in health care delivery systems.     

Use of computer-assisted instruction in the prevention of alcohol abuse

Recent critiques of and research with traditional alcohol prevention programs have revealed serious problems. Prevention programs typically increase knowledge and appropriate attitudes about alcohol while having little effect on drinking behavior. In this article several concepts are introduced in support of a technology which has the potential to revitalize alcohol education efforts. First, Bandura's self-efficacy theory offers a direction for re-conceptualizing the design of prevention programs as well as the measurement of their effects. Second, computer-assisted instruction (CAI) programs may provide a means for capturing attention, effectively educating about alcohol, and supplementing traditional approaches. One current CAI program is described in detail. Implications for research and practice and obstacles to effective CAI use are also discussed.     

Treatment outcomes among adolescents with substance abuse problems: the relationship between comorbidities and post-treatment substance involvement

This study examines comorbid mental disorders in relation to post-treatment outcomes (12 months post-intake) among adolescents (N=419) who entered three residential drug treatment programs. When contrasted with youths who had no comorbid mental disorders or youths with a single comorbid condition, those with combined internalizing and externalizing disorders (mixed comorbidity) had higher levels of substance-related problems and poly-drug use at entry to treatment, and poorer outcomes, e.g. relapse, particularly evident for drugs other than alcohol or marijuana. A significantly higher proportion of those with mixed comorbidity were admitted to short term residential treatment, as compared to long term residential care. However, the effects of comorbidity were independent of both planned and actual length of stay, suggesting that comorbidities can negatively impact treatment outcome in multiple ways, apart from length of stay. Since co-occurring problems appear to profoundly limit treatment effectiveness, treatment strategies that address comorbidity are needed to improve outcomes.     

A model of substance abuse risk: adapting to the Sri Lankan context

This study translated and validated the Substance Use Risk Profile Scale (SURPS) among 13 to 18 year old Sri Lankan adolescents attending school. A standard systematic translation procedure was followed to translate the original SURPS into Sinhala language. A Delphi process was conducted to determine judgmental validity of Sinhala SURPS. Confirmatory factor analysis was performed to test the translated version against the original theoretical model of the SURPS. Test-retest and internal consistency were used to ensure reliability. A few terms in one of the items posed some difficulty in translating into Sinhala. Adequate judgmental validity was determined except for one item, which was modified to suit the Sri Lankan setting. The four subscales introversion/ hopelessness, impulsivity, sensation seeking and anxiety sensitivity showed satisfactory test-retest reliability estimates of .74, .68, .76, and .88, respectively. The Sinhala SURPS is applicable in Sri Lankan context. Several implications based on the results are discussed.     

From social workers to socio-therapists: the transformative journey of substance abuse therapists

ABSTRACT

The efficiency of interventions in addiction is associated with the processes of practitioners’ professional development. Identity formation is studied extensively for clinical professions but little research focuses on social workers working in addiction settings. This study examined the experience of social workers working in a community treatment network in Greece. Fifteen interviews were conducted with 11 women and 4 men, ranging between 29 and 47 years οf age, who worked in different centers within the network. Data were analyzed following the guidelines of Interpretative Phenomenological Analysis, offering in-depth examinations of people’s lived experience. The results delineate a series of transformations in professional identity comprising a process of biographization. The participants highlighted intrapersonal and relational factors that influence this process which leads to self-understanding and engagement with the therapeutic community. The results contribute to deciphering the factors that influence social workers’ experience in their professional identity formation in substance abuse treatment contexts.     

The Doubles: a case study on developing a technology-based substance abuse education curriculum

The Doubles, funded by the National Institute on Drug Abuse, is a seven-episode series of media tools designed to teach third and fourth grade students about the science of drug addiction. The program's curriculum is delivered via a set of videos, interactive CD-ROMs, workbooks, or an Internet site. This article examines the process used to develop The Doubles and argues that its success stems from the careful balancing of the needs of the funding agency, state and national curricular guidelines, and the target audience.     

Pulsar: a qualitative study of a substance abuse prevention program

The purpose of this study was to explore the risk, protective factors, and resiliency characteristics of students selected to participate in the Police, Public Educators and Peers Utilizing the Leadership Skills of Students At Risk/As Resources (PULSAR) program. The study is significant as it employed qualitative methods and a resiliency-focused framework to evaluate a substance abuse prevention program. Findings revealed that the PULSAR program: facilitated self-reflection on student negative attitudes toward substance abuse and positive attitudes toward school; allowed students to gain skills that addressed individual needs; and fostered relationships between the students and adult facilitators in a safe environment. These results speak to increased protective factors and resiliency characteristics, but were not found to be constant with each student. Implications for continued research on the PULSAR program are addressed.     

Predictors of substance abuse treatment outcomes in Tennessee

In planning and implementing programs to treat substance abuse, it is important to understand which factors influence post-treatment abstinence.This article identifies and analyzes several variables important in predicting the likelihood of abstinence among substance abuse clients. The data used in this study was collected from 1,350 clients treated for alcohol or drug abuse in residential, halfway house, or outpatient facilities in Tennessee. We analyzed 22 variables as possible treatment outcome predictors by using two statistical procedures: stepwise logistic regression analysis and Quick, Unbiased, Efficient, Statistical Tree (QUEST) analysis, a tree-structured classification algorithm analysis. We found one pretreatment, five in-treatment, and three post-treatment variables to be significant predictors of treatment outcome: previous treatment history, perceived helpfulness of the treatment, simultaneous treatment for mental health, number of days in treatment,completion of treatment, special skills training during treatment, obtaining healthcare services for major physical health problem after treatment, living with someone using alcohol or drugs post treatment, and arrest record since treatment.     

Need-service matching in substance abuse treatment: Racial/ethnic differences

This study examines the impact of ancillary health and social services matched to client needs in substance abuse treatment for African Americans, Latinos and Whites. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3142 clients (1812 African Americans, 486 Latinos, 844 Whites) from 59 treatment facilities. Results show that racial/ethnic minorities are underserved compared to Whites in the substance abuse service system. Different racial/ethnic groups come into treatment with distinct needs and receive distinct services. Although groups respond differentially to service types, substance abuse counseling and matching services to needs is an effective strategy both for retaining clients in treatment and for reducing post-treatment substance use for African Americans and Whites. Receipt of access services was related to reduced post-treatment substance use for Latinos. Study findings are relevant to planning special services for African Americans and Latinos.     

The efficacy of the social norms approach to substance abuse prevention applied to fraternity men

Students tend to overestimate the amount of alcohol consumed among their peers and often drink to that imaginary level. The social norms strategy, designed to correct norm misperceptions, has been correlated with a decrease in reported consumption in the general college population. However, it has had little or no impact among Greek students, the group that consumes the most alcohol. The authors investigated and subsequently found three possible flaws in the application of the social norms strategy that may account for the failure to decrease binge drinking among fraternity men: there is no predominant, healthy drinking norm in this population; students are influenced more by people within their network(s) than by others; and binge drinking is the norm in this group and may serve to perpetuate the problem. The findings, though preliminary, provide the first step in developing interventions beyond the social norms approach to address binge drinking among fraternity men.     

Zero effects in substance abuse programs. Avoiding false positives and false negatives in the evaluation of community-based programs

The evaluation of community-based programs poses special design and analysis problems. The present article focuses on two major types of errors that can occur in such evaluations: false positive--incorrectly declaring a program to be effective--and false negatives--incorrectly declaring a program to be ineffective. The evaluation of a national demonstration of community-based programs to reduce substance abuse, Fighting Back, is used to illustrate several approaches to reduce the probability of errors. Both those errors that are affected by the design and those by analytic approaches are considered. Ways to assess multiple outcomes and to match the complexity of the program with design and analytic strategies are proposed. Community trials are complex interventions, and, although they can provide very useful information, their outcomes have to be understood in terms of the constructs they test and the contexts within which they are carried out.     

The use of antidepressant medications in substance abuse treatment: the public-private distinction, organizational compatibility, and the environment

Many studies of innovation adoption in health care organizations focus either on organizational characteristics or the institutional environment, but not both. Furthermore, these perspectives are rarely employed simultaneously in both public and private health care organizations. This research considers the public-private distinction, organizational compatibility, and interorganizational referral relationships in the use of selective serotonin reuptake inhibitors (SSRIs) by substance abuse treatment organizations. Using data from nationally representative samples of 363 publicly funded and 403 privately funded substance abuse treatment centers, a four-category typology of public and private organizations initially predicted variation in SSRI use. However some differences were no longer significant once organizational and environmental characteristics were added to the statistical model. These data support hypotheses about the associations between organizational characteristics and SSRI use as well as hypotheses regarding the external environment. Future research should continue to integrate both internal and external factors in theoretical explanations of innovation adoption.