Drug Abuse Treatment

Research Findings from February, 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.

Treatment of Adolescent Smokers with the Nicotine Patch

This study examined the effects of the nicotine patch on craving and withdrawal symptoms, safety, and compliance among adolescents. The secondary goal was to conduct a preliminary investigation of the effectiveness of the nicotine patch in helping adolescents quit smoking. The study design was a double-blind, placebo-controlled, randomized trial of the nicotine patch. The intervention also provided intensive cognitive-behavioral therapy and a contingency-management procedure. Participants (n=100) attended 10 treatment visits over 13 weeks. Compared with the placebo patch group, the active nicotine patch group experienced a significantly lower craving score and overall withdrawal symptom score (p=.011 and p=.025, respectively), as well as a time trend toward lower scores (p<.001) in craving only. Moreover, the nicotine patch appeared safe for adolescents to use. No differences by treatment group were found in experiencing adverse events, except that the participants in the placebo patch group reported more headaches than those in the active nicotine patch group. As another measure of safety, the overall mean salivary cotinine levels were significantly lower at 1, 6, 8, and 10 weeks post quit (all p<.05) compared with baseline levels, although these results were confounded by dropouts. Additionally, a significant number of participants were compliant with using the nicotine patch daily. Finally, point prevalence (7-day and 30-day abstinence rates) and survival analysis of participant abstinence indicated no significant differences between treatment groups. The results of this study suggest that the nicotine patch is a promising medication and a larger clinical trial of the nicotine patch among adolescents is warranted. Hanson, K., Allen, S., Jensen, S. and Hatsukami, D. Nicotine Tob Res., 5(4), pp. 515-526, 2003. Efficacy of Nicotine Patch in Smokers with a History of Alcoholism Smokers with a history of alcohol dependence may have more difficulty quitting, might relapse to alcohol use, and might especially benefit from nicotine replacement therapy for smoking cessation. One hundred fifteen smokers with a history of alcohol dependence (median of 5 years previously) were randomly assigned to either a 21-mg nicotine patch or placebo in a trial designed to be as similar as possible to a prior study that examined smokers with no history of alcoholism. Both studies were of heavy smokers with similar levels of nicotine dependence; thus, any differences in trials would be due to a history of alcohol problems per se. In the current trial, adjusted prolonged smoking abstinence in those with a history of alcohol dependence was higher in the active than the placebo group at end-of-treatment (28% vs. 11%; odds ratio, 3.2; p = 0.04) and at 6-month follow-up (24% vs. 6%; odds ratio, 4.9; p = 0.02). Among subjects not lost to follow-up, none reported drinking problems or increases in craving for alcohol. Smoking abstinence was not lower and the odds ratio for nicotine patch therapy was not greater in smokers with a history of alcohol dependence than in smokers with no such history. Heavy smokers with a history of alcoholism benefit from nicotine patch treatment. Hughes, J.R., Novy, P., Hatsukami, D.K., Jensen, J. and Callas, P.W. Alcohol Clin Exp Res., 27(6), pp. 946-954, 2003.

Maternal Vaccination Against Nicotine Reduces Nicotine Distribution to Fetal Brain in Rats

Vaccination of adult male rats against nicotine has been shown to reduce nicotine distribution to the brain. The current study examined whether vaccination of female rats before pregnancy would reduce the distribution to fetal brain of a single nicotine dose administered during gestation. Female rats immunized with a nicotine conjugate vaccine received a single dose of nicotine 0.03 mg/kg i.v. on gestational day 16 to 22. Five minutes later, vaccinated rats had substantially higher bound and lower unbound serum nicotine concentration and lower brain nicotine concentration than controls. Fetal brain nicotine concentration was reduced by 43% in vaccinated rats, comparable to the reduction in the maternal brain nicotine concentration. The whole-fetus nicotine concentration was not altered by vaccination. A similar experiment was performed in which pregnant rats were passively immunized with rabbit nicotine-specific IgG 7 or 21 mg/kg just before nicotine dosing. The effects of passive immunization on nicotine distribution in the mother were IgG dose-related and the higher dose reduced nicotine distribution to fetal brain by 60%. These data suggest that vaccine effects on nicotine distribution to serum and brain are similar in pregnant female rats to those previously reported in adult males. Vaccination of female rats before pregnancy, or passive immunization during pregnancy, can reduce the exposure of fetal brain to a single dose of maternally administered nicotine. Keyler, D.E., Shoeman, D., LeSage, M.G., Calvin, A.D. and Pentel, P.R. J Pharmacol Exp Ther., 305(2) pp. 587-592, 2003.

Prevalence of Alcohol and Drug Use in an Adolescent Training Facility

Dr. Lyn Stein and colleagues at the NIDA-funded Center for Alcohol and Addiction, Brown University, conducted a study of the substance use and crime histories of incarcerated male adolescents. Chart reviews of 186 adolescents indicated that drug use was highly prevalent, with 88.7% using alcohol and 95.7% using marijuana. Ethnic differences in drug use were found, with Caucasian, non-Hispanic adolescents significantly more likely to use cocaine, hallucinogens, and heroin than were adolescents of other ethnicities. Among the crimes committed, possession of a controlled substance was the most prevalent, with 31.8% of adolescents involved. These results provide important guidance for developing targeted behavioral treatments to reduce incarcerated adolescents' use of drugs and involvement in drug-related crimes. Lebeau-Craven, R., Stein, L., Barnett, N., Colby, S.M., Smith, J.L.and Canto, A.L. Substance Use & Misuse, 38(7), pp. 825-834, June 2003.

Some Substance Abuse Interventions for Adolescents Reduce Social Costs

An economic evaluation of five outpatient adolescent treatment approaches (12 total site-by-conditions) was conducted. The economic cost of each of the 12 site-specific treatment conditions was determined by the Drug Abuse Treatment Cost Analysis Program (DATCAP). Economic benefits of treatment were estimated by first monetizing a series of treatment outcomes and then analyzing the magnitude of these monetized outcomes from baseline through the 12-month follow-up. The average economic costs of treatment ranged from $90 to $313 per week and from $839 to $3,279 per episode. Relative to the quarter before intake, the average quarterly cost to society for the next 12 months (including treatment costs) significantly declined in 4 of the 12 site-by-treatment conditions, remained unchanged in 6 conditions, and increased in 2 treatment conditions (both in the same site). These results suggest that some types of substance-abuse intervention for adolescents can reduce social costs immediately after treatment. French, M.T., Roebuck, M.C., Dennis, M.L., Godley, S.H., Liddle, H.A., and Tims, F.M. Outpatient Marijuana Treatment for Adolescents: Economic Evaluation of a Multisite Field Experiment. Evaluation Review, 27(4), pp. 421-459, 2003.

Client-Level Predictors of Adherence to Multi-Systemic Family Therapy

This study seeks to examine factors that facilitate or impede the adoption of an evidence-based treatment for adolescent drug abusers and their families. Specifically, investigators examined client-level correlates of therapist adherence to Multi-systemic Therapy (MST) implemented in community practice settings. MST has received empirical support as an efficacious intervention for adolescents with serious antisocial and drug abuse problems and has been transported to treatment programs in over 30 states. Data for this study were derived using a non-experimental, short-term, prospective-longitudinal design. Families were nested within therapists and family, child, and caregiver data were collected at intake. Therapist adherence to MST was measured monthly. Study participants included 233 families referred to MST by juvenile justice and social services agencies. Youth were referred because of criminal behavior and/or drug abuse. Sixty-six MST therapists from nine treatment organizations participated in the study. Regression analyses were conducted to predict therapist adherence focusing on a different domain of family characteristics: demographic characteristics, referral characteristics, and pretreatment youth functioning. Variations in therapist adherence to MST were observed in relation to demographic and functioning variables at the client level. Caregivers experiencing educational and economic disadvantage report higher therapist adherence to MST than highly educated and economically advantaged caregivers. Therapist adherence to MST was higher when there was a match between the ethnicity of the therapist and caregiver. Finally, therapist adherence to MST was higher when youth were referred for status offenses and substance abuse and lower when youth were referred for a combination of criminal and substance abuse problems and when they had more arrests pre-treatment. Overall, the investigators suggest the current study demonstrates the complexity of implementing evidence-based practice in community settings. Schoenwald, S.K., Halliday-Boykins, C. and Henggeler, S.W. Family Process, 42(3), pp. 345-359, 2003.

Posttreatment Victimization and Violence Among Adolescents Following Residential Drug Treatment

This article examines the relationships among experiences of childhood abuse, psychiatric disorders, self-reported victimization, and violent behavior, with a focus on gender differences. Data were obtained from interviews at treatment entry and 5-year post-treatment for 446 adolescent clients in therapeutic community (TC) drug treatment programs throughout the United States and Canada. Fifty-eight percent of the sample indicated that they engaged in serious violent behaviors (e.g., beatings, threatening or using weapons against other people, or violent crimes such as assaults, rapes, murders) in the 5 years following their separation from TC treatment. Multivariate logistic regression analyses revealed that victimization in the posttreatment period was the most significant factor associated with violent behavior, and pretreatment childhood abuse experiences and psychiatric disorders were not significantly related to the odds of violent behavior. There were significant gender differences in self-reported victimization and violent behavior. The findings suggest that violence in young adulthood for males is related to increasing involvement in violent lifestyles that include drug trafficking, while violence among females is associated with the social and psychological consequences of drug involvement and victimization. High rates of violent involvement and victimization among former adolescent clients suggests the utility of incorporating interventions such as safety-oriented strategies for females or interventions that address involvement in the drug use lifestyles (i.e., use and dealing) for both males and females into residential treatment to reduce the likelihood of future violence. Hawke, J.M., Jainchill, N. and De Leon, G. Posttreatment Victimization and Violence Among Adolescents Following Residential Drug Treatment. Child Maltreatment, 8(1), pp. 58-71, 2003.