By Kimberly R. Martin, NIDA NOTES Contributing Writer
In the first large-scale study designed to evaluate drug abuse
treatment outcomes among adolescents in age-specific treatment
programs, NIDA-supported researchers have found that longer stays in
these treatment programs can effectively decrease drug and alcohol use
and criminal activity as well as improve school performance and
psychological adjustment.
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| An evaluation of more than 1,100 adolescents who received substance abuse treatment in residential, short-term inpatient, or drug-free outpatient programs found improvement in rates of drug use and social behavior. Some 53 percent of those treated met or exceeded the minimum recommended stay in treatment. |
The study, part of NIDA's ongoing Drug Abuse Treatment Outcome Studies for Adolescents (DATOS-A), analyzed data from 23 community-based adolescent treatment programs that addressed peer relationships, educational concerns, and family issues such as parent-child relationships and parental substance abuse. Successful elements of adult treatment programs, such as participation in group therapy and participation in a 12-step program, were also included in treatment plans.
"The results of this study are particularly impressive in light of the
fact that the adolescents had multiple problems," says Dr. Christine
Grella of the University of California, Los Angeles (UCLA), Drug Abuse
Research Center, one of the study's investigators. "Although this is
also typical of many adults in treatment, timely resolution of these
problems is even more critical for adolescents. These young people are
in the process of developing values, making lifestyle decisions, and
preparing to assume adult roles and responsibilities, such as family
and work; whereas when many adults enter treatment, they have completed
this process."
Dr. Yih-Ing Hser, also of UCLA, led the research team that evaluated
the treatment outcomes for 1,167 adolescents, age 11 to 18, who were
admitted to one of the treatment programs between 1993 and 1995. The
treatment centers, located in Pittsburgh, Pennsylvania; Minneapolis,
Minnesota; Chicago, Illinois; and Portland, Oregon, included eight
residential programs, nine outpatient drug-free programs, and six
short-term inpatient programs.
The 418 adolescents in the residential treatment programs received
education, individual and group counseling, and interventions to
develop social responsibility. The 292 adolescents in the outpatient
drug-free programs received education, skills training, and individual
and group counseling. The 467 adolescents in short-term inpatient
programs received counseling and a 12-step program. Family therapy was
strongly emphasized, and adolescents in these programs were referred to
continued outpatient treatment. The average length of treatment for
adolescents in the residential, outpatient drug-free, and short-term
inpatient programs was 5 months, 1.6 months, and 18 days, respectively.
The adolescents were interviewed when they began treatment and again 1
year after discharge by professional interviewers who were not employed
by the treatment centers. Problem severity was determined at the
initial interview according to a number of criteria. Dependence on
drugs or alcohol was determined from standardized diagnostic measures.
To validate self-reports of drug use, one-quarter of the participants
were selected randomly to submit urine samples during the post
treatment interview.
Before treatment, 25 percent of the participants used three or more
drugs, 36 percent were dependent on alcohol, 64 percent were dependent
on marijuana, and 10 percent were dependent on cocaine. In addition to
substance abuse problems, 63 percent were diagnosed with a mental
disorder and 67 percent were criminally active.
| In the year following treatment, more adolescents attended school and reported average or better-than-average grades. |
Research has indicated that in general the rate of drug and alcohol use
tends to increase during adolescence. In the present study, however,
improvements were observed in many of the areas evaluated, although
some of the participants did not complete their treatment program.
Comparing the year before treatment to the year after treatment, the
adolescents showed significant declines in the use of marijuana and
alcohol, which are considered to be the major drugs of abuse for this
age group. Weekly or more frequent marijuana use dropped from 80
percent to 44 percent, and abstinence from any use of other illicit
drugs increased from 52 percent to 58 percent. Heavy drinking decreased
from 34 percent to 20 percent, and criminal activity decreased from 76
percent to 53 percent. Adolescents also reported fewer thoughts of
suicide, lower hostility, and higher self-esteem. In the year following
treatment, more adolescents attended school and reported average or
better-than-average grades. Some exceptions to the general pattern of
improvement were that overall, cocaine and hallucinogen use did not
improve during the year after treatment.
Previous research indicates that a minimum of 90 days of treatment for
residential and outpatient drug-free programs and 21 days for
short-term inpatient programs is predictive of positive outcomes for
adults in treatment. Better treatment outcomes were reported among
adolescents who met or exceeded these minimum lengths of treatment than
for those who did not. Among the treatment participants, 58 percent of
those in residential programs, 27 percent in outpatient drug-free
programs, and 64 percent in short-term inpatient programs met or
exceeded the minimum stay. In the year following treatment, those who
met or exceeded the minimum treatment were 1.52 times more likely to
abstain from drug and alcohol use and 1.2 times more likely to not be
involved in criminal activity. In addition, these adolescents were 1.34
times more likely to have average or better-than-average grades.
This study confirms that community-based drug treatment programs
designed for adolescents can reduce substance abuse and have a positive
impact on many other aspects of their life, says Dr. Tom Hilton of
NIDA's Division of Epidemiology, Services and Prevention Research.
These results justify new research to identify the key elements common
to effective treatment programs for adolescents, he noted.
Source
· Hser, Y-I.; Grella, C.E.; Hubbard, R.L.; et al. An evaluation
of drug
treatment for adolescents in four U.S. cities. Archives of General
Psychiatry 58(7):689-695, 2001.
Volume 17, Number 1 (April 2002)