Drug Abuse Treatment

Research Findings from May, 2004 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the child and adolescent drug abuse treatment. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Psychiatric Co-morbidity Among Adolescent Substance Abusers Effects Response to Behavioral Treatment

Dr. Cindy Rowe of the University of Miami and colleagues continue their work to clarify the connection between psychiatric co-morbidity and treatment of adolescent substance abuse. Building on previous work highlighting the importance of both externalizing and internalizing disorders among adolescent substance abusers, this newest study examined whether adolescents with different psychiatric co-morbidities differed in clinical presentation and treatment response. Among 182 adolescent drug abusers in a randomized clinical trial comparing family and individual cognitive-behavioral therapy, more severe co-morbidity was associated with greater family dysfunction and being female and younger at intake. Regarding treatment response, adolescents with mixed externalizing and internalizing co-morbidities initially responded to treatment but returned to intake levels of substance use by 1 year post-discharge. Rowe, C.L., Liddle, H.A., Greenbaum, P.E. and Henderson, C. Impact of Psychiatric Comorbidity on Treatment Outcomes of Adolescent Drug Abusers. Journal of Substance Abuse Treatment, 26, pp. 1-12, 2004.

The Minnesota Multiphasic Personality Inventory-Adolescent Version (MMPI-A) Detected Under-Reporting of Teens' Substance Abuse

Drs. Lynda Stein and colleagues continue to tackle the difficult issue of accurate assessment of drug use among adolescents. Incarcerated, substance abusing (n = 67) and non-substance abusing (n = 59) adolescents completed the MMPI-A under two different sets of instructions. Assessments completed according to standard instructions correctly classified 60 - 85% of substance abusers. Assessments completed when adolescents were instructed to "fake good" produced lower scores on substance abuse overall, although the Lie scale detected over 75% of the under-reported profiles. Additionally, when used in combination with the best substance abuse scale, the Lie scale detected 82% of substance abusers. Given that accurate assessment is vital to effective treatment and treatment research, this study suggests that the MMPI-A may be a tremendously useful tool in adolescent substance abuse research. Stein, L.A.R.and Graham, J.R. Ability of Substance Abusers to Escape Detection on the MMPI-A in a Juvenile Correctional Facility. Paper presented at the 38th Annual Symposium on Recent Developments in the Use of the MMPI (MMPI-2 and MMPI-A), Minneapolis, MN, June 2003.

Advocacy Activities to Address Environmental Influences Led to Less Smoking among Teenagers

Most smoking prevention and cessation interventions for adolescents show little sustained effects on smoking behavior. Since behavior change is embedded in the social context, the authors designed an intervention that involved adolescents in advocacy about social and environmental factors that influence smoking as a way to test an alternative approach. Ten continuation high schools were randomized to receive an advocacy curriculum where 11th and 12th grade students carried out activities to counter environmental influences on smoking in their communities (i.e., the treatment) or a curriculum where students learned about drug and alcohol abuse prevention (control). Compared with control schools, students in treatment schools showed significant net changes from baseline to the end of the semester (post intervention) for regular smoking, involvement in community-advocacy activities. The findings were significant for students who were regular smokers but not for those who were non-smokers or light smokers. Regular smoking decreased 3.8% in treatment schools and increased 1.5% in control schools. Regular smoking continued to decrease at 6-months post-intervention in treatment schools, with a total change in prevalence from 25% to 20%. Involvement in community-advocacy activities and three measures related to social cognitive theory --- perceived incentive value, perceived self-efficacy, and outcome expectancies also showed significant net changes between treatment and control schools that were maintained at 6-months post-intervention. Winkleby, M.A., Feighery, E.C., Dunn M., Ahn, D. and Killen J. Effects of an Advocacy Intervention to Reduce Smoking Among Teenagers. Archives of Pediatric Adolescent Medicine, 158, pp. 269-275, 2004. Adolescent Substance Abuse: Under-reported or Under-detected by Health Plans? This article examines whether health plans are adequately identifying adolescents with substance use problems. Three measures developed by the Washington Circle, a group focused on the development of substance use performance measures, have been adapted for the 2004 Health Plan Employer Data and Information Set. One measure-the identification rate-can be used to examine the extent to which private health plans are able to identify adolescent enrollees with substance abuse problems. Using MarketScan, a database of private health plan claims for selected employers maintained by the MEDSTAT Group, researchers calculated a 0.5 percent rate of adolescents (ages 12-18 years) identified with substance abuse problems among those enrolled in 1997. This rate is low compared to the 6.8 percent rate of substance dependence reported by a subset of adolescents covered by commercial insurance who were included in the 1998 National Household Survey on Drug Abuse. Researchers detected no meaningful variation across health plan type. Researchers suggest that the low identification rate may be due to (a) providers' reluctance to record substance abuse diagnoses due to stigma or legal issues, or (b) providers' failure to identify substance abuse because they lack adequate training in or incentives for screening and diagnosis. Lee, M.T., Garnick, D.W., Miller, K. and Horgan, C.M. Adolescents with Substance Abuse: Are Health Plans Missing Them? Psychiatric Services, 55(2), p. 116, 2004.

Runaway Youth's Use of Federally-Funded Crisis Services Differs by Region

This study examined national and regional differences between runaway shelter users and national census norms on demographic and high-risk characteristics. Data collected from federally-funded youth shelters nationwide (n = 16,652) were compared with U.S. adolescent populations (n = 26,735,028). Runaway youth were more likely to be female, minority and older than respective national figures; ethnicity varied greatly from one region of the U.S. to another. Proportions of youth with high-risk characteristics, such as illicit drug use and selling, suicidal behaviors, and physical and sexual abuse were strikingly different across regions. Development of policies and services that target particular issues of youth in specific regions is needed. Thompson, S., Maguin, E., and Pollio, D. National and Regional Differences Among Runaway Youth Using Federally-Funded Crisis Services. Journal of Social Services Research, 30(1), pp. 1-17, 2003.