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CORK Bibliography: Adolescent Treatment Programs

65 citations. 2003 to present

Prepared: June 2009

Anderson RL; Gittler J. Unmet need for community-based mental health and substance use treatment among rural adolescents. Community Mental Health Journal 41(1): 35-49, 2005. (37 refs.)

This research assessed the extent of unmet service need for rural youth with mental health (MH) and/or substance use (SU) problems. All adolescents (1218 years old) living in a three-county region of Iowa and discharged from outpatient MH or SU treatment were included (n = 177). Chart review was used to retrospectively assess service utilization and clinical characteristics at time of admission and discharge. Two-thirds (64%) of adolescents with co-occurring disorders did not receive treatment consistent with widely supported guidelines recommending that individuals with co-occurring disorders receive treatment for both their MH and SU problems. Higher severity of depression, more supports, prior MH service utilization and lower prevalence of prior abuse predicted the receipt of dual services. Finally, adolescents with co-occurring problems who received only MH treatment showed improvement on MH needs at discharge but no improvement on SU needs. Similarly, adolescents with co-occurring problems who received only SU treatment showed improvement on SU needs but not on MH needs. There is considerable unmet treatment need among rural adolescents with co-occurring disorders. Efforts to improve care must focus on adolescent, familial, program, funding and policy factors that act as barriers to unifying philosophies and practices needed to advance appropriate care.

Anderson RL; Huffine C. Child & adolescent psychiatry: Use of community-based services by rural adolescents with mental health and substance use disorders. Psychiatric Services 54(10): 1339-1341, 2003. (14 refs.)

This column deals with the conundrum of dual diagnosis among adolescents. The problems described are all the more daunting because of the problems of finding services in a rural setting. Her paper, which represents an overview of mental health, substance abuse, and public health, fits well with the column's theme of collaboration and building systems of care.

Ballon B; Chaim G. HELP!!! An interactive experiential simulation of youth with concurrent disorders accessing help from "the system''. Addiction Research & Theory 14(6): 603-617, 2006. (8 refs.)

HELP!!! is an interactive, experiential simulation of the health care system that youth with concurrent mental health and addiction issues need to access for help. Using this exercise after a didactic teaching session reinforces the learning, synthesizes the knowledge for application and encourages group discussion and the sharing of participants' knowledge. This exercise was originally developed to create an opportunity for interprofessional learning groups to experience the gaps and barriers youth encounter as they attempt to navigate the system and to act as a catalyst for creative problem solving and system change. By participating, learners experience a simulation of what youth, family members, and various professionals usually encounter in the system. This exercise elicits key issues for discussion and provides a forum for networking and the initiation of collaborative ventures for healthcare providers.

Bell E. Self, meaning, and culture in service design: Using a hermeneutic technique to design a residential service for adolescents with drug issues. International Journal of Drug Policy 17(5): 425-435, 2006. (69 refs.)

This paper aims to contribute to a relatively untheorised and unresearched area of adolescent drug and alcohol literature-designing residential services. In a context in which the researcher was given the 'hands on' task of designing a model residential service for adolescents with drug issues in the Australian state of Tasmania, it explores techniques that might be useful to understanding and placing young people's views at the centre of service design. The paper begins with discussion of the international literature on residential service design for adolescents with drug issues, and the nature of a Tasmanian service design project. It then explores young Tasmanians' idealisations of residential services needed for youth with drug issues. These young people offered their thoughts along five major dimensions of the operationalisation of a residential service: service mission, activities and programs, location of the service, nature of staff, and service rationale or benefits. Their comments were analysed using a hermeneutic technique exploring the 'life-worlds' suggested by their vision of the ideal residential service. Youth data are contrasted with the broad findings of interviews with adult professionals in Tasmanian youth services to question the assumptions implicit in research, policy and practice at the international level.

Bell E. Time, space and body in adolescent residential services: Re-imagining service research. (review). Addiction Research & Theory 15(1): 97-111, 2007. (70 refs.)

The objective of this article, which emerges from the pragmatic dissatisfactions of a service designer, is to explore the way forward for developing more socially useful research evidence for adolescent substance abuse services. Analysis is made of the limitations of existing substance abuse research, driven by classical experimental models that rely on traditional quantitative techniques. Theoretical propositions about the nature of an ideal service are developed from interviews with professionals in twenty of Australia's twenty-three adolescent residential services. These suggest the configurational nature of the service, arising from its multi-dimensional temporal, spatial and material properties, and the importance of the service's capacity to combine diverse service elements in complementary ways to meet individual client needs. A social sciences methodology - qualitative comparative analysis (QCA) - has the potential to better analyse the configurational nature of such services, allowing identification of effective service element combinations, especially in small-N studies.

Brannigan R; Schackman BR; Falco M; Millman RB. The quality of highly regarded adolescent substance abuse treatment programs: Results of an in-depth national survey. Archives of Pediatrics & Adolescent Medicine 158(9): 904-909, 2004. (24 refs.)

Background: Drug and alcohol abuse and dependence are the most prevalent causes of adolescent morbidity and mortality in the United States. Effective, accessible treatment for adolescents with substance abuse problems is urgently needed. Objective: To conduct the first systematic evaluation of the quality of highly regarded adolescent substance abuse treatment programs in the United States. Methods: An advisory panel of 22 experts defined 9 key elements of effective treatment for adolescent substance abuse based on a review of the literature. In-depth telephone and written surveys were conducted with 144 highly regarded adolescent substance abuse treatment programs identified by panel members and by public and private agencies. There was a 100% response rate to the initial interviews, and a 65% response rate to the follow-up surveys. The open-ended survey responses were coded by defining 5 components deemed to be crucial in addressing each of the 9 key elements, and quality scores were calculated overall and for each of the 9 key elements. Results: Out of a possible total score of 45, the mean score was 23.8 and the median was 23. Top-quartile programs were not more likely to be accredited. The majority of programs scored at least 4 of a possible 5 on only 1 of the 9 key elements (qualified staff). The elements with the poorest-quality performance were assessment and treatment matching, engaging and retaining teens in treatment, gender and cultural competence, and treatment outcomes. Conclusions: Most of the highly regarded programs we surveyed are not adequately addressing the key elements of effective adolescent substance abuse treatment. Expanded use of standardized assessment instruments, improved ability to engage and retain youths, greater attention to gender and cultural competence, and greater investment in scientific evaluation of treatment outcomes are among the most critical needs. Expanding awareness of effective elements in treating adolescents will lead the way to program improvement.

Burke AC; Early TJ. Readiness to adopt best practices among adolescents' AOD treatment providers. Health & Social Work 28(2): 99-106, 2003. (22 refs.)

Social work, along with other human services professions, is increasingly moving to establish guidelines for treatment interventions that are based on empirical knowledge about populations needs, and treatment effectiveness. This work, however, is in the beginning stages. This article explores how substance abuse treatment providers for adolescents attempt to obtain and use information to guide a "best practices" approach to treatment. Focus group data were analyzed for themes indicating supportive attitudes toward adopting and evidence of capacity to implement an evidence-based approach. Although support was fairly strong, capacity was relatively weak.

Cavanaugh DA; Doucette A. Using administrative data to assess the process of treatment services for adolescents with substance use disorders. Journal of Psychoactive Drugs 36(4): 473-481, 2004. (41 refs.)

In 1998, the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA) convened an expert panel comprised of a multidisciplinary group of providers, researchers, managed care representatives and public policymakers known as the Washington Circle (WC) to improve the quality and effectiveness of treatment for substance use disorders through the use of performance measures. The initial goals of the panel included developing, testing and implementing performance measures in health plans and encouraging collaboration with key stakeholders to ensure widespread adoption of the measures. The WC focused its initial efforts on the prevention, recognition and treatment of adults with alcohol and other drug (AOD) disorders who receive health care through private and/or public sector health plans (McCorry et al. 2000). In 2002, CSAT, aware of the need to improve access and quality of treatment for adolescents, supported the Washington Circle in the establishment of a special subcommittee focused specifically on adolescent treatment issues. This article introduces the work of the Washington Circle and describes the Adolescent Subcommittee's progress in developing performance measures for the treatment of adolescents with substance use disorders.

Center for Substance Abuse Treatment; Forman RF; Nagy PD. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series 47. Rockville MD: Center for Substance Abuse Treatment, 2006. (640 refs.)

This Treatment Improvement Protocol was prepared to assist clinicians involved in intensive outpatient treatment programs. It describes the core services such programs should include, the process of assessment and treatment planning, entry and engagement in treatment, common clinical approaches, including family services, as well as the considerations with special groups of clients: women, adolescents, those involved in the criminal justice system, persons with co-occurring psychiatric disorders, racial and ethnic minorities, lesbian, gay and bisexual individuals, the elderly, the homeless, those with HIV/AIDS, and persons with physical or cognitive disabilities. The TIP also outlines 14 principles of intensive outpatient treatment: making treatment readily available, easing treatment entry, building on existing motivation, enhancing the therapeutic alliance, making retention a priority, assess and addressing individual treatment needs, providing ongoing care, monitoring abstinence, using mutual-/self-help and community resources, using medications if indicated, providing education about substance abuse, recovery and relapse, engaging families, employers and significant others, incorporating evidence-based approaches, and improving program administration. There are 11 appendices that provide additional resources such as screening instruments, protocols, sample history forms. There are also 34 "exhibits", e.g. check lists, sample documents, suggested sequence of topics for groups therapy sessions.

Public Domain

Chassin L. Juvenile justice and substance use. Future of Children 18(2): 165-183, 2008. (63 refs.)

This paper focuses on the elevated prevalence of substance use disorders among young offenders in the juvenile justice system and on efforts by the justice system to provide treatment for these disorders. She emphasizes the importance of diagnosing and treating these disorders, which are linked both with continued offending and with a broad range of negative effects, such as smoking, risky sexual behavior, violence, and poor educational, occupational, and psychological outcomes. The high rates of substance use problems among young offenders suggests a large need for treatment. Although young offenders are usually screened for substance use disorders, the author notes the need to improve screening methods and to ensure that screening takes place early enough to allow youths to be diverted out of the justice system into community-based programs when appropriate. Cautioning that no single treatment approach has been proven most effective, Chassin describes current standards of "best practices" in treating substance use disorders, examines the extent to which they are implemented in the juvenile justice system, and describes some promising models of care. The author highlights several treatment challenges, including the need for better methods of engaging adolescents and their families in treatment and the need to better address environmental risk factors, such as family substance use and deviant peer networks, and co-occurring conditions, such as learning disabilities and other mental health disorders. The author advocates policies that encourage wider use of empirically validated therapies and of documented best practices for treating substance use disorders. High relapse rates among youths successfully treated for substance use disorders also point to a greater need for aftercare services and for managing these disorders as chronic illnesses characterized by relapse and remission. A shortage of aftercare services and a lack of service coordination in the juvenile justice system suggests the need to develop treatment models that integrate and coordinate multiple services for adolescent offenders, particularly community-based approaches, both during and after their justice system involvement.

Chun J; Guydish J; Chan YF. Smoking among adolescents in substance abuse treatment: A study of programs, policy, and prevalence. Journal of Psychoactive Drugs 39(4): 443-449, 2007. (31 refs.)

The study was designed to: (1) identify smoking policies and interventions in adolescent residential treatment settings; (2) examine the prevalence of smoking among adolescents in these settings; and (3) assess relationships between program-level smoking policies and client-level smoking. The Center for Substance Abuse Treatment funded 17 sites to evaluate the effectiveness of Adolescent Residential Treatment (ART) programs for substance abuse. To describe program smoking policies and interventions, we conducted phone interviews with one key informant at each program (N = 12). To describe client smoking behaviors, we conducted a secondary data analysis of baseline data for adolescents (N = 912) entering ART programs. All sites had no smoking indoors and 75% of the site had tobacco-free grounds for adolescents. Forty-two percent provided their youth with nicotine replacement therapy, and 42% provided counseling for smoking cessation. Also, 33% did not allow staff smoking on and off campus. The prevalence of any smoking in the-past month was 66%, and 22% of current smokers were daily smokers at admission. Where smoking was allowed on grounds, adolescents more often reported recent smoking. Smoking behavior is prevalent among adolescents in residential drug treatment, and should be addressed in all such programs through policy implementation and client-level smoking cessation intervention.

Collins MH; Ready J; Griffin JB; Walker KG; Mascaro N. The challenge of transporting family-based interventions for adolescent substance abuse from research to urban community settings. American Journal of Family Therapy 35(5): 429-445, 2007. (54 refs.)

Motivated by concerns about the extent to which urban African American youth under-report substance abuse, the extent to which they are over-represented in drug-related criminal justice settings, and the extent to which research on adolescent substance abuse treatment has lagged in settings serving urban minority populations, the authors comment on some factors to consider when conducting family-based interventions and research with such populations. They offer recommendations based on experience implementing a community-based treatment program for urban substance-abusing adolescents, patient demographic data gathered from the program, and their attempt at adding a family-based treatment component to the program.

Crome IB. Comorbidity in young people: Perspectives and challenges. Acta Neuropsychiatrica 16(1): 47-53, 2004. (46 refs.)

Trends in prevalence in substance misuse in young people in the UK are described: increased use over the last decade, the tendency to polydrug use, the narrowing of the gender gap. The complex issues relating to the description, definition and classification, and diagnosis of psychiatric comorbidity and substance misuse are outlined. The fact that there is no uniformly accepted definition of what constitutes 'dual diagnosis' or 'psychiatric comorbidity' in young people is highlighted: this variability impacts upon clinical assessment and study design. Despite these considerable drawbacks, a degree of consistency is beginning to emerge in the co-occurrence of some conditions, e.g. disruptive and suicidal behaviours. It is recognized that psychological distress and substance misuse are also associated with multiple social and physical complications. The rapid advances in treatment options are presented. At present the 'best practice' is implementation of what works for adults with addiction and young people with psychiatric disorder. This includes psychosocial interventions such as motivational enhancement techniques and cognitive behavioural treatment, as well as appropriate safe (usually), short-term use of a range of pharmacological agents. Very few comprehensive designated adolescent addiction services exist, while child and adolescent mental health services are under serious pressure. Thus the need for a longitudinal and multidisciplinary approach, with appropriate assessment instruments in young people, is required to further explore diagnostic classification which will classify the degrees and patterns of relationships between disorders. In this way it may be possible to build up a picture of the nature and extent of numerous complex, and sometimes overlapping, problems and needs in children and adolescents in a variety of settings: primary and secondary care, the criminal justice system and educational establishments. This might strengthen the development of innovative treatment services where novel interventions are tested as a priority.

Dembo R. Special Issue on Innovative Strategies in Working with High Risk Youth. (editorial). Substance Use & Misuse 40(7 Special Issue): 879-885, 2005. (16 refs.)

Dembo R; Walters W. Innovative approaches to identifying and responding to the needs of high risk youth. Substance Use & Misuse 38(11/13): 1713-1738, 2003. (62 refs.)

Following a critical review of key issues facing the delivery of effective, cost-attractive services to high-risk youth, and research addressing these experiences, we identify some innovative approaches to identify and respond to the multiple needs of these youth. The importance of providing family services with an ecological focus is stressed. Further, some exciting developments occurring in juvenile assessment centers, involving screening and in-depth assessment, as well as intervention strategies are presented. These innovative developments include for the Tampa Juvenile Assessment Center: 1) a family empowerment intervention service for arrested youth; 2) a family focused early-intervention, intensive case management service for youth entering a diversion program; and 3) for the Miami-Dade Juvenile Assessment Center, the comprehensive program of research and program development occurring in the context of the National Demonstration Project. We conclude with a discussion of major issues facing the field and the continuing need for a national commitment to help the many troubled youths entering the juvenile justice system.

Dennis ML; Ives ML; White MK; Muck RD. The Strengthening Communities for Youth (SCY) initiative: A cluster analysis of the services received, their, correlates and how they are associated with outcomes. Journal of Psychoactive Drugs 40(1): 3-16, 2008. (35 refs.)

This article describes the Strengthening Communities for Youth (SCY) initiative using data from 1,297 adolescents in eight U.S. cities (Oakland, CA; Tucson, AZ; Iowa City, IA; Bloomington, IL; St. Louis, MO; Cleveland, OH; Louisville, KY, New York, NY) to better understand the pattern of services they received, how these services varied by need, and how services were associated with initial treatment outcomes. Data include adolescent reports collected with the Global Assessment of Individual Needs (GAIN) at treatment intake and 90 days post-intake, information on early therapeutic alliance using a modified Working Alliance Inventory (WAI), and staff reports from service logs. Cluster analysis identified four patterns of treatment received: (1) substance abuse and mental health treatment, (2) primarily residential treatment, (3) interrupted treatment, and (4) primarily outpatient treatment. Outcomes examined included changes in substance use, substance abuse/dependence problems, recovery environment risk, as well as risk from social peers, illegal activity and emotional problems. Overall and for most groups, treatment was associated with reduced or unchanged problems in each of these areas. The exception was for cluster 1, for whom emotional problems actually increased. Implications for placement, treatment planning and future research are discussed.

Diamond G; Panichelli-Mindel SM; Shera D; Dennis M; Tims F; Ungemack J. Psychiatric syndromes in adolescents with marijuana abuse and dependency in outpatient treatment. Journal of Child & Adolescent Substance Abuse 15(4): 37-54, 2006. (40 refs.)

Objective: The purpose of the current study to assist in understanding the prevalence and clinical correlates of psychiatric distress in adolescents seeking outpatient services for marijuana abuse or dependency. Methods: In a multi-site randomized clinical trial, 600 adolescents and their parents were assessed at intake using the Global Appraisals of Individual Needs. DSM-IV criteria were used to diagnose marijuana use disorders, and a symptom check list was used to measure symptoms on five syndromes: conduct disorder, ADHD, depression, anxiety, and disorders of traumatic distress. Results: Patients endorsed acute levels of conduct disorder (74%), ADHD (77%), depression (37.7%), anxiety (28.8%), and traumatic distress (13.8%), and 72% endorsed acute levels on two or more syndromes. Adolescents with a diagnosis of dependency and females evidenced the greatest severity of mental health distress, and minimal differences were found between racial groups. Patients with acute levels of both internalizing and externalizing syndromes reported problems with substance use, criminal activities, trauma experience, and family environments. Conclusion: Co-occurring psychiatric distress is the norm for adolescents seeking outpatient services for marijuana disorders. Better integration of substance use and mental health services would likely improve the quality of care for these troubled youth.

Duroy TH; Schmidt SL; Perry PD. Adolescents' and young adults' perspectives on a continuum of care in a three year drug treatment program. Journal of Drug Issues 33(4): 801-832, 2003. (12 refs.)

Recent discussion in the adolescent treatment community has centered on the therapeutic merits of continuum of care treatment for adolescent and young adult substance abusing populations. However, despite this discussion, few studies to date have actually looked at how adolescents and young adults view continuum of care treatment in practice. In this paper a continuum of care offered within a single treatment approach will be addressed from the perspectives of youths participating in treatment at a three year step-down therapeutic community program with four distinct levels of care: residential treatment, intensive day treatment, day treatment with work/school release, and ambulatory meetings. Adolescents and young adults attending this program must complete all four levels of care before they are eligible for program graduation. Data from 53 qualitative semistructured and open-ended interviews (conducted with 45 adolescents and young adults) indicate that treatment experiences were marked by significant program transition points, during which clients stepped down from one level of care to another. Adolescents and young adults reported experiencing distress at and during these transition points. However they also indicated that overall emotional and psychological stress was minimized due to the following: (1) these transitions were experienced within a single program structure, (2) youths transitioned through a continuum of care with program peers and friends, and (3) the program staff was perceived by adolescents and young adults to be compassionate and encouraging.

Faw L; Hogue A; Liddle HA. Multidimensional implementation evaluation of a residential treatment program for adolescent substance abuse. American Journal of Evaluation 26(1): 77-94, 2005. (39 refs.)

The authors applied contemporary methods from the evaluation literature to measure implementation in a residential treatment program for adolescent substance abuse. A logic model containing two main components was measured. Program structure (adherence to the intended framework of service delivery) was measured using data from daily activity logs completed by program staff. Treatment process, conceptualized as therapeutic milieu, was measured using an adapted version of a scale used to measure implementation in therapeutic communities. In addition, variability in implementation was measured using statistical process control (SPC) procedures. Adolescents completed, on average, 50% of the weekly prescribed services. The milieu of the program was rated by the adolescents as highly therapeutic. Moreover, preliminary psychometrics suggest therapeutic milieu can be measured reliably in adolescents. These two main variables were implemented with consistency across adolescents. These findings are discussed along with implications for evaluation work in similar fields.

Flanzer JP. Health services with drug-abusing adolescents: The next frontier of research. IN: Liddle HA; Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006. pp. 204-220. (58 refs.)

This is one of five chapters in Part II, dealing with practice and policy trends in adolescent substance abuse treatment. Within the broad public health system there has been a trend to focus upon care of chronic conditions, rather than acute, episodic care. Drug misuse, in general, and among adolescents, is discussed as a condition which would benefit from a chronic disease approach. This chapter reviews the work that has been undertaken, and the further health-service research that is required. The authors adopt the frameworkset forth by the Institute of Medicine, the key principles being effective, patient-centered, timely, efficient, equitable, and designed around these principles.

Gil AG; Wagner EF; Tubman JG. Culturally sensitive substance abuse intervention for Hispanic and African American adolescents: Empirical examples from the Alcohol Treatment Targeting Adolescents in Need (ATTAIN) Project. Addiction 99(Supplement 2): 140-150, 2004. (58 refs.)

Aims: This study presents preliminary analyses examining the effects of an alcohol and other drug use (AOD) intervention with minority juvenile offenders. Furthermore, the study investigates the impact of cultural factors on baseline AOD use among Hispanic and African American youth, as well as on treatment outcome. Design, setting and participants: Participants were 213 juvenile offenders referred for treatment (mean age = 15.7 years), 97 of whom have completed treatment to date. The intervention was carried out in clinics placed within the neighborhoods in which the participants resided. Intervention: Alcohol Treatment Targeting Adolescents in Need (ATTAIN) is a controlled clinical trial evaluating the effectiveness of a brief motivational, cognitive behavioral intervention, guided self-change (GSC). Participants are assigned randomly to the individual format of guided self-change (I-GSC), the family involved format of guided self-Change (F-GSC), choice of one of these two, or a waiting list control condition. Only participants involved in active intervention are included in the present report. Measurements: Data were collected via structured face-to-face interviews. Alcohol and marijuana use measures were collected using the Time-line Follow-back interview (TLFB). Findings: There were significant reductions in alcohol and marijuana use for all ethnic groups from baseline to post-intervention. Cultural factors (discrimination, acculturation, ethnic pride and cultural mistrust) were associated with pre-intervention levels of alcohol and marijuana use. Among Hispanics, pre-intervention level of substance use were higher among foreign-born than US-born youth. Analyses conducted with the US-born Hispanic group showed that ethnic orientation and ethnic pride were associated positively with greater reductions in alcohol use. Conclusions: The intervention provided through ATTAIN appears to be effective with a multi-ethnic population of juvenile delinquents. Cultural factors, such as ethnic orientation and ethnic mistrust, appear to constitute amenability to treatment factors, with US-born Hispanic youth lower in acculturation responding better to the intervention.

Godley MD; White WL. A brief history and some current dimensions of adolescent treatment in the United States. IN: Galanter M, ed. Recent Developments in Alcoholism. Volume 17: Alcohol Problems in Adolescents and Young Adults -- Epidemiology, Neurobiology, Prevention, Treatment. New York: Kluwer Academic, 2005. pp. 367-382. (66 refs.)

This chapter provides a brief overview of the history of adolescent substance use and its clinical management. This includes an overview of the emergence of adolescent treatment system develpment in the United States. It descirbes the characteristics of substance-involved adolescents entering speciality treatment and the levels of care within which are treated. Also it discusses the way in which recent research findings have begun to influence clinical responses to alcohol and other drug problems among adolescents.

Godley SH; Adams L; Risberg R; Sodetz A. Chestnut Health Systems' Bloomington outpatient and intensive outpatient program for adolescent substance abusers. IN: Steven SJ; Morral AR, eds. Adolescent Substance Abuse Treatment in the United States: Exemplary Models from a National Evaluation Study. Binghamton NY: Haworth Press, 2003

This chapter is from Section II which deals with outpatient treatment models. It addresses the Chestnut Health system's adolescent model. It provides information of the recruitment, assessment and placement of clients, the profile of clients, a description of treatment components, criteria for determining readinessfor discharge or transfer. It also deals with critical issues central to treatment, as well as staffing and the process of clinical supervision.

Graham AW; Schultz TK; Mayo-Smith MF; Ries RK; Wilford BB, eds. Principles of Addiction Medicine. Chevy Chase MD: American Society of Addiction Medicine, 2003. (Chapter refs.)

This volume is a comprehensive text on addictions. It is organized into 14 major sections, each of which has multiple chapters. There are over 200 contributors. The sections deal with the following themes: basic science and core concepts; pharmcology; diagnosis, assessment and early intervention; overview of addiction treatment; management of intoxication and withdrawal; pharmacologic interventions; behavioral interventions; 12-step programs and other recovery-oriented interventions; alcohol and drug problems in the workplace; medical disorders and complications of addiction; co-occurring addictive and psychiatric disorders; pain and addiction; and children and adolescents. There are also six appendices.

Greenwood P. Prevention and intervention programs for juvenile offenders. Future of Children 18(2): 185-210, 2008. (50 refs.)

Over the past decade researchers have identified intervention strategies and program models that reduce delinquency and promote pro-social development. Preventing delinquency, says Peter Greenwood, not only saves young lives from being wasted, but also prevents the onset of adult criminal careers and thus reduces the burden of crime on its victims and on society. It costs states billions of dollars a year to arrest, prosecute, incarcerate, and treat juvenile offenders. Investing in successful delinquency-prevention programs can save taxpayers seven to ten dollars for every dollar invested, primarily in the form of reduced spending on prisons. According to Greenwood, researchers have identified a dozen "proven" delinquency-prevention programs. Another twenty to thirty "promising" programs are still being tested. In his article, Greenwood reviews the methods used to identify the best programs, explains how program success is measured, provides an overview of programs that work, and offers guidance on how jurisdictions can shift toward more evidence-based practices The most successful programs are those that prevent youth from engaging in delinquent behaviors in the first place. Greenwood specifically cites home-visiting programs that target pregnant teens and their at-risk infants and preschool education for at-risk children that includes home visits or work with parents. Successful school-based programs can prevent drug use, delinquency, anti-social behavior, and early school drop-out. Greenwood also discusses community-based programs that can divert first-time offenders from further encounters with the justice system. The most successful community programs emphasize family interactions and provide skills to the adults who supervise and train the child. Progress in implementing effective programs, says Greenwood, is slow. Although more than ten years of solid evidence is now available on evidence-based programs, only about 5 percent of youth who should be eligible participate in these programs. A few states such as Florida, Pennsylvania, and Washington have begun implementing evidence-based programs. The challenge is to push these reforms into the mainstream of juvenile justice.

Henderson CE; Young DW; Jainchill N; Hawke J; Farkas S; Davis RM. Program use of effective drug abuse treatment practices for juvenile offenders. Journal of Substance Abuse Treatment 32(3): 279-290, 2007. (89 refs.)

This study examined the extent to which organizational context predicted use of consensus-based elements of effective substance abuse treatment practices with juvenile offenders. Participants were either directors of substance abuse treatment programs located in residential facilities (institutional sample) or directors of community-based treatment agencies providing services to adolescents in their home communities (community sample). The two settings differed significantly in the number and types of effective practices they were using. Community programs were more likely to have staff qualified to deliver substance abuse treatment, involve families in treatment, and assess their treatment outcomes. In contrast, institutional programs were more likely to provide comprehensive services. Resources dedicated to training, internal support for new programming, and network connectedness with non-criminal-justice facilities were associated with greater use of effective practices. These findings highlight the importance of establishing corrections-community partnerships designed to promote continuity of care for juvenile offenders.

Husler G; Werlen E; Rehm J. The Action Plan: A new instrument to collect data on interventions in secondary prevention in adolescents. Substance Use & Misuse 40(6): 761-777, 2005. (35 refs.)

it is difficult to draw causal conclusions about the effectiveness of secondary prevention programs for adolescents at risk, when the programs use a variety of different interventions. The Action Plan is an instrument that is designed to make collection of such data possible. This allows calculating different kinds of intervention patterns for each participant and program, which, in combination with outcome measures, gives an estimate of successful v.s. less successful interventions. The study compared intervention patterns from 12 different sites in a national intervention program in Switzerland. The program, called supra-f (www.supra-f.ch), started in 1999 and will end in 2005. Results are presented from the ongoing study with approximately 600 adolescents. We calculated effect sizes (ES) to compare interventions with outcome measures. Effect sizes (ES) are presented on well being, coping, self-esteem, delinquency, and substance use (cigarettes, alcohol, cannabis) in relation to intervention packages, risk groups (low, moderate, high), and age (two groups: 11-15 and 16-20 years of age) using data collected from 1999-2002.

Jaffe SL; Solhkhah R. Substance abuse disorders. IN: Wiener, JM; Dulcan, MK eds. The American Psychiatry Publishing Textbook of Child and Adolescent Psychiatry, 3rd ed.. Washington DC: American Psychiatric Publishing, Inc, 2004. pp. 795-812. (111 refs.)

Adolescents with psychiatric disorders also frequently have substance abuse disorders, and because 40%-90% of adolescents with substance use disorders have comorbid psychiatric disorders -- specifically attention-deficit/hyperactivity disorder (ADHD), conduct disorders, anxiety disorders, and affective disorders -- the common practice of separating community psychiatric services from alcohol and drug services is inappropriate for adolescents. Substance abuse assessment and treatment services for adolescents need to be integrated with psychiatric services so that a higher level of therapeutic success can be attained.

Kaklamanos KW. An evaluation of an adolescent treatment program for alcohol and drug use. Dissertation Abstracts International: Section B 63(11-B): 5521, 2003

Adolescent substance use is a vast concern for many reasons. Due to the many challenges adolescents' face in their development and the difficult transition from childhood to adulthood, they are vulnerable to the misuse of substances. Early use interferes with emotional, psychological, and physical development. Although this problem is extensive, there is evidence that it can be successfully treated. Therefore, evaluation of current drug treatment programs and the design of new treatment strategies are critical. There is a need for evaluation of youth drug treatment programs to determine what types of programs, treatment philosophies, and counseling modalities are most effective and efficient with this population. The present research was conducted at Turn About, Inc., a non-profit agency that provides substance abuse and behavioral treatment to adolescents and their families. The goal of the research was to conduct a formal program evaluation of the agency's primary treatment program. This evaluation was conducted to determine the effectiveness of treatment, satisfaction, client outcomes, and to provide the initial steps towards equipping the organization with standardized evaluation tools. The participants were divided into two categories that were comprised of (1) former clients from the Day Treatment Program (DTP), and (2) their parents, (3) former clients from the Intensive Outpatient Program (IOP), and (4) their parents. The program evaluation performed on this agency's treatment program supports much of the reviewed literature. Overall, clients and parents appeared satisfied with the services they received. The DTP group appeared more satisfied with services than the IOP group. Results suggested that each respective program was perceived as overall effective in its treatment as well. Several "life areas" emerged as particularly effected by the treatment program. The "life areas" most positively effected by treatment were family relations and communication, peer associations, leisure activities for parents only, social skills such as assertiveness and self-confidence, ability to handle stress and anger, and self-esteem. The "life areas" that did not seem to be positively effected were peer associations for IOP clients, perceptions of school success for IOP clients, extracurricular involvement for all clients, and respect for authority for IOP clients. To conclude, it appears Turn About is able to produce evidence of positive change in adolescents following treatment in the program. This study also contributes to future evaluations of adolescent treatment programs.

Kamon J; Budney A; Stanger C. A contingency management intervention for adolescent marijuana abuse and conduct problems. Journal of the American Academy of Child and Adolescent Psychiatry 44(6): 513-521, 2005. (38 refs.)

Objective: To describe an innovative treatment for adolescent marijuana abuse and provide initial information about its feasibility, acceptability, and potential efficacy. Method: Provided an intervention composed of (1) a clinic-administered, abstinence-based incentive program; (2) parent-directed contingency management targeting substance use and conduct problems; (3) a clinic-administered incentive program for parent participation; and (4) individual cognitive-behavioral therapy for adolescents. Data are presented for 19 adolescents, age 15-18 years. Measures of substance use, psychopathology, and parenting were collected before and after the 14-week treatment. Substance use measures were also collected 1 month post-treatment. Substance use was monitored by twice-weekly urine and breath testing. An intent-to-treat model was used. Results: Adolescents and parents attended an average of 10.3 and 10.6 of 14 sessions, respectively. Substance use, externalizing behaviors, and negative parenting behaviors decreased by treatment end. Urine testing indicated that abstinence increased from 37% at intake to 74% at treatment end (z value = 2.28, p = .02) and that 53% of adolescents were abstinent 30 days post-treatment. Conclusions: Preliminary data provide support for the feasibility and acceptability of a family-based, contingency management model to treat adolescent substance use and conduct problems. Controlled efficacy studies with larger samples are needed.

Letters P; Stathis S. A mental health and substance abuse service for a youth detention centre. Australasian Psychiatry 12(2): 126-129, 2004. (10 refs.)

Objectives: To describe a new programme, the Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) at the Brisbane Youth Detention Centre, which aims to provide young people in detention with the same quality of mental health and substance dependency services that would normally be available to them in the community. Conclusions: Young people in detention suffer from considerable mental health and substance abuse problems. MHATODS seeks to address the specific needs of this group of young people. Its innovative structure recognizes the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has created an integrated treatment service for young people in detention.

Libby AM; Riggs PD. Integrated substance use and mental health treatment for adolescents: Aligning organizational and financial incentives. Journal of Child & Adolescent Psychopharmacology 15(5): 826-834, 2005. (44 refs.)

The high prevalence of the dual diagnosis of mental and substance use disorders (SUD) has been increasingly documented for both adolescents and adults. For more than a decade, the National Institute of Drug Abuse (NIDA) has included integrated treatment of comorbid psychiatric disorders as one of nine core treatment principles (National Institute on Drug Abuse 1999). Despite empirically supported practice guidelines, implementation of integrated treatment has been slow. In response to the growing call for integrated treatments and systems of care, this paper: (1) identifies systemic and economic barriers that have impeded widespread implementation of integrated care for adolescents with co-occurring SUD, specifically the supply of treatment providers, shifting priorities of gatekeepers to specialty care, and financing streams; and (2) describes possibilities for aligning economic incentives in order to facilitate the dissemination and implementation of integrated care for adolescents with co-occurring SUD.

Liddle HA; Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006. (Chapter refs.)

This volume covers a range of issues related to adolescent substance abuse, including empirically-based treatment development protocols; how to incorporate innovative treatment models into diverse clinical settings; research advances; interventions with special populations; culturally based intervention guidelines, and recommendations for practice and policy. This edited book has 21 chapter and 33 contributors. It is organized into five sections. Following an introduction and overview of the volume, Part I considers the theoretical, empirical and methodological foundation for research in adolescent substance abuse treatment. It deals with development issues, recent methodological and statistics advances that can underpin research, and highlights a major research initiative the Cannabis Youth Treatment Intervention, and the preliminary findings. Part II examines the practice and treatment policy trends. There is attention to European research, the Drug Abuse Treatment Outcomes Studies ducted at the UCLA Drug Abuse Research Center, contextual issues that are important in adolescent care, and examines the nature of service organization in England. Part III considers the importance and approaches to comprehensive assessment and integrated treatment planning. Individual chapters consider drug therapies, developmental issues in the diagnosis of co-occurring disorders, and HIV/AIDS prevention in adolescent substance abusers. Part IV addresses evidence-based interventions. Directed initiatives examined are adolescent therapeutic communities, school-based group treatment, family and behavioral interventions, as well as cognitive-behavioral therapy with adolescents substance abuse problems. Part V considers culturally based treatments that have been developed, with a focus on family centered programs created for Native Americans and family-based treatment of Hispanic adolescents. Part VI includes a concluding chapter that examines the strides that have been made while also noting important research questions.

Liddle HA; Rowe CL; Gonzalez A; Henderson CE; Dakof GA; Greenbaum PE. Changing provider practices, program environment, and improving outcomes by transporting multidimensional family therapy to an adolescent drug treatment setting. American Journal on Addictions 15(Supplement 1): 102-112, 2006. (21 refs.)

Effective interventions for drug abusing adolescents are underutilized. Using an interrupted time series design, this study tested a multicomponent, multi-level technology transfer intervention developed to train clinical staff within an existing day treatment program to implement multidimensional family therapy (MDFT), an evidence-based adolescent substance abuse treatment. The sample included 10 program staff and 104 clients. MDFT was incorporated into the program and changes were noted in the program environment, therapist behavior, and in most (e.g., drug abstinence, and out of home placements) but not all (e.g., drug use frequency) client outcomes. These changes remained after MDFT supervision was withdrawn.

Lubman D; Hides L; Elkins K. Developing integrated models of care within the youth alcohol and other drug sector. Australian Psychiatry 16(5): 363-366, 2008. (18 refs.)

Objective: The aim of this paper is to describe an initiative in Victoria, Australia, aimed at improving the detection and management of co-occurring mental health issues within the youth Alcohol and Other Drug (AOD) sector. Conclusions: Over the past 4 years, in partnership with local youth AOD services, we have developed a successful service model that addresses co-occurring mental health issues within the youth AOD sector. However, such capacity-building requires the full support of workers and senior management, and a cultural shift whereby the assessment and management of mental health issues are seen as a priority and core service issue. The capacity-building process was facilitated by embedding experienced mental health clinicians within each service to support and implement the initiative. This model offered learning opportunities through the modelling of relevant skills and the provision of 'on-the-job' training. Such approaches demonstrate that integrated models of care can be delivered within youth AOD services, although further research is needed to determine their effectiveness.

MacDonald S; Rothwell H; Moore L. Getting it right: Designing adolescent-centred smoking cessation services. Addiction 102(7): 1147-1150, 2007. (25 refs.)

Aims: To demonstrate the importance of identifying adolescent preferences for smoking cessation in order to inform the design of effective adolescent cessation services. Design Structured qualitative interviews drawing on means-end theory. Setting Three youth-clubs and two secondary schools in south-east Wales. Participants: Twenty-five male and female 13-18-year-olds, mainly daily smokers. Findings Interviewees did not assume immediately that a smoking cessation service is something that will be available to them, and therefore they initially encountered difficulties in identifying attributes of such support. With further prompting interviewees were able to express a preference for support attributes, but these were not attributes that traditionally form part of cessation provision. Their main preference was for support from friends and family, access to nicotine replacement therapy and non-school-based, flexible support and guidance. Conclusion: The results re-emphasize the inadequacies of existing cessation provision for meeting adolescent preferences and suggest that developing more adolescent-appropriate support requires a reconceptualization of existing interventions, with service users situated at the core of intervention design. The study highlights a number of service development points for intervention planners including: rethinking the timing and location of provision; placing more emphasis on the selection of facilitators; harnessing support from friends and family; and rooting these developments in broader tobacco control strategies.

Mark TL; Song X; Vandivort R; Duffy S; Butler J; Coffey R et al. Characterizing substance abuse programs that treat adolescents. Journal of Substance Abuse Treatment 31(1): 59-65, 2006. (19 refs.)

Few systematic studies have examined the characteristics of substance abuse treatment programs serving adolescents. An expert panel recently identified nine key elements of effective adolescent substance abuse treatment. We measured the percentage of treatment programs in the United States with at least 10 adolescent clients on a given day that reported these elements using data from the 2003 National Survey of Substance Abuse Treatment Services. This first look into the characteristics of facilities serving significant numbers of adolescents indicates that many facilities may be lacking in components considered important. The most significant measured potential areas for improvement occurred in the areas of including mental health as well as medical issues in comprehensive assessments and developing curricula to meet the developmental and cultural needs of clients. On a more encouraging note, many facilities were conducting discharge planning and providing aftercare, although the specifics of these services were not determined.

McArdle P; Gilvarry. The principles of service organization and practice in England. IN: Liddle HA; Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006. pp. 189-203. (12 refs.)

This is one of five chapters in Part II, dealing with practice and policy trends in adolescent substance abuse treatment. It describes the common legal and policy context and the patterns of resources that determine how services in England respond to young people in difficulty. It also sets forth how apparently different organization can knit together to provide integrated services for youth with complex problems. It draws upon recent reports that deal specifically with substance use problems.

McWhirter PT. Enhancing adolescent substance abuse treatment engagement. Journal of Psychoactive Drugs 40(2): 173-182, 2008. (27 refs.)

Trends in adolescent drug use are encouraging and suggest the importance of preventative programs for youth. Yet, among those who become involved with illicit substances and seek treatment, only a fraction report positive outcomes. This article describes an approach to enhance adolescent participation in substance abuse treatment. Aspects of the transtheoretical model are integrated into a treatment program designed to meet the unique developmental needs of adolescent alcohol and marijuana abusers. The result is a treatment that better engages adolescents in participation, thereby increasing the likelihood for treatment success.

Meyers K; McLellan AT. The American treatment system for adolescent substance abuse: Formidable challenges, fundamental revisions, and mechanisms for improvements. IN: Evans DL; Foa EB; Gur RE; Hendin H; O'Brien CP; eds. Treating and Preventing Adolescent Mental Health Disorders: What we Know and What We Don't Know. New York: Oxford University Press, 2005. pp. 561-578. (book refs.)

The purpose of this chapter is to discuss an additional complicating factor that impacts adolescent treatment and goes beyond the individual youth and his or her family: the service delivery system. These systems (e.g., educational institutions, health care, juvenile justice, and mental health systems) are complex environments environments that offer opportunities to identify, treat, and monitor adolescent substance abusers. However, the architecture and operating procedures of these systems often serve to inhibit access to needed services and to confuse or confound coordination of complementary service delivery across systems. The result can be formidable challenges to the identification and subsequent intervention and treatment of the adolescent who uses, abuses, or is dependent upon substances. In the text that follows, we identify problems within the current "standard" system of care leading to failure to identify these adolescents, inadequate access to even basic substance abuse intervention for those identified, and failure to provide adequate amounts or types of services to those who do access the care system. We also present mechanisms for enhancements and conclude with a summary of three innovative approaches targeted to systems improvement.

Minugh PA; Janke SL; Lomuto NA; Galloway DK. Adolescent substance abuse treatment resource allocation in rural and frontier conditions: The impact of including organizational readiness to change. Journal of Rural Health 23(Supplement S): 84-88, 2007. (15 refs.)

Context: Rural and frontier states are significantly affected by substance abuse and poverty. The; high rate of substance abuse coupled with high levels of dependence on state funded treatment systems places a burden on rural treatment systems and makes resource allocation a central planning issue. Purpose: The goal of this study was to combine substance abuse treatment need data with organizational readiness to change data to create a rank-ordered listing of residential treatment, providers to answer the following questions: Do program priority rankings change when organizational readiness to change is included in a need-based resource allocation algorithm? Methods: Three methodological procedures were used to determine program priority rankings among 14 residential adolescent treatment programs in 8 Wyoming counties: (2) a social indicators analysis of crime data, (2) synthetic estimates of substance-abuse treatment need, and (3) analysis of organizational change data from the directors 3 and staff at adolescent residential treatment programs: Findings: Program need rankings based on crime data and synthetic estimates of substance abuse treatment need shifted when organizational readiness to change data was added to, the algorithm: Conclusions: There is much to be gained from considering organizational readiness to change when selecting programs for funding: It plays a central: role in the successful diffusion of evidence-based practices within and among programs. Including this measure in the resource allocation process can help. planners identify programs that will be more apt to adopt a best practice. This is critical for making decisions about where to allocate scarce treatment resources.

Myers MG; Brown SA. A controlled study of a cigarette smoking cessation intervention for adolescents in substance abuse treatment. Psychology of Addictive Behaviors 19(2): 230-233, 2005. (14 refs.)

Tobacco use is prevalent among youth with alcohol and other drug problems, yet this issue has received limited research and clinical attention. This study reports on a controlled evaluation of a cigarette smoking intervention with 54 adolescents in treatment for substance abuse, ages 13-18 (22% female). Participants were assessed at 4 time points. A greater proportion of participants in the treatment condition (n = 26) reported cessation attempts and point abstinence than did control participants (n = 28) at all time points. However, significant differences were found only for point abstinence at a 3-month follow-up. These findings provide initial support for the efficacy of a smoking cessation intervention delivered in the context of adolescent substance abuse treatment.

Nissen LB; Hunt SR; Bullman S; Marmo J; Smith D. Systems of care for treatment of adolescent substance use disorders: Background, principles and opportunities. Journal of Psychoactive Drugs 36(4): 429-438, 2004. (36 refs.)

Adolescent substance abuse is a serious social problem facing the United States. Despite numerous recent advances in the clinical effectiveness of treatment approaches for this population, not enough attention has been paid to the adolescent treatment and service delivery infrastructures. The right services must be delivered through carefully organized and systematic community partnerships among agencies that serve the youth and families most in need. This article provides a working definition for the systems of care approach, reviews the movement's history within children's mental health services, addresses the feasibility of using the systems of care model for adolescent substance use disorders, and discusses principles and elements essential for successfully implementing a system of care for treatment of adolescent substance use disorders.

Office of Applied Studies, Substance Abuse and Mental Health Administration. National Survey of Substance Abuse Treatment Services (N-SSATS): 2004. Data on Substance Abuse Treatment Facilities. DASIS Series S-34. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (0 refs.)

This report is one in an annual series on the characteristics of treatment facilities in the US. it is based on data for a single, index day. The report is organized in six chapters. The first chapters describes the Survey. Chapter 2 describes the trends found in facility characteristics, for example, in terms of number and type of care offered. Chapter 3 describes the trends in client characteristics -- the number of clients, type of care received, and the substances involved. Chapter 4 deals with the facility characteristics and services, size, utilization rates, programs offered for specific populations -- adolescents, those with co-occurring disorders, with criminal justice involvement, gays and lesbians, seniors, those HIV/AIDS, women, DWI offenders, and pregnant or postpartum women. Chapter 5 describes the client characteristics. Data is drawn from almost 14,000 facilities. Chapter 6 deals with state data. The highlights present trends in facility and client characteristics. Over 13,400 faculties reported, with over 1 million persons in treatment on the index date. About 55% were in treatment within private, non-profit programs. There was an increase in for-profit facilities, and represented about 27% of those in care. Eighty-nine percent of those in treatment were receiving outpatient care; 10% were in non-hospital residential care; and 1% in hospital inpatient care. Adolescents made up about 8% of all clients, and the majority were in special adolescent treatment programs. Of those providing substance abuse treatment, 62% of the facilities, representing 69% of clients, were primarily involved in substance abuse treatment. Twenty-seven percent of programs, representing 24% of those in care, were treated in combined mental health/substance abuse treatment. Outpatient care was provided by 72% of all programs, and had 53% of those in care. Outpatient/partial hospitalization was offered by 14% of facilities and was provided to 12% of all clients in the index date. Nearly half of clients (47%) were being treated for both alcohol and drug abuse. Nationally the rate for treatment was 431 clients per 100,000 population age 18 or over. The median number of clients was 40 persons. Data is summarized and presented in 88 figures and tables.

Office of Applied Studies, Substance Abuse and Mental Health Administration. The DASIS Report: Adolescent Treatment Admissions by Gender, 2005. (May 24, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (5 refs.)

Based on SAMHSA's Treatment Episode Data Set (TEDS), of the 142,600 adolescent admissions aged 12 to 17 in 2005, about 31% (44,600) were female. Adolescent female substance abuse treatment admissions were less likely than adolescent male admissions to report marijuana as their primary substance of abuse (51% vs. 72%) and more likely to report alcohol (23% vs. 16%) or stimulants (12% vs. 4%) as their primary substance of abuse. Adolescent females admissions were more likely than males to have a co-occurring psychiatric disorder (23% vs. 18%).

Public Domain

Olmstead T; Sindelar JL. To what extent are key services offered in treatment programs for special populations? Journal of Substance Abuse Treatment 27(1): 9-15, 2004. (29 refs.)

Many substance abuse treatment (SAT) facilities offer programs designed specifically for special populations such as women, adolescents, gays/lesbians and others. Previous research shows that there are specific services that are integral to the successful treatment of these populations (e.g., family therapy for adolescents, childcare and transportation assistance for women, and HIV testing and counseling for gays/lesbians). This study examines whether facilities that self-report having programs for special populations actually offer the recommended services. The data come from the 2000 National Survey of Substance Abuse Treatment Services, which contains information on service offerings, special programs and other characteristics for all SAT facilities in the USA. The results indicate that facilities with special programs are more likely to offer the recommended key services. However, often less than half of these facilities provide the key services. There are consistent differences by ownership status, with for-profit facilities less likely to offer many of the key services.

Pollio DE; McClendon J; Reid DL. Certification and program regulations for inpatient services to youth with addiction: A state-level analysis. Journal of Psychoactive Drugs 36(4): 499-509, 2004. (17 refs.)

Recent evidence has indicated that the prevalence of addiction in youth is far higher than previously expected. High demand for services to this population require attention to programs providing interventions, in particular to the regulations and structures that assure youth receive quality services. Thus, the current research examines state-level certification and program requirements for inpatient youth facilities. Current data (from August 2002 through July 2003) on state-level regulations was collected from a variety of sources. Wherever possible, confirmation was sought from multiple sources. Multiple authors interpreted information. Youth with addictions are currently being treated across a wide variety of governmental agencies. Level of detail and clarity of information varied widely, as did distinctness of youth requirements from adult ones. Adequate regulatory attention was evident in a minority of states, while a handful of states did little or nothing to distinguish youth from adult services. While it is undoubtedly the case that providers within each state offer outstanding services, there is often little or no available protection for these youth through governmental regulations. Attention is needed in almost all states to providing additional regulations and program requirements that assure youth consistency in service quality. Recommendations are made for standards of certification requirements.

Riggs PD. Treating adolescents for substance abuse and comorbid psychiatric disorders. Science & Practice Perspectives 2(1), 2003. (25 refs.)

Recent research has identified a cluster of standardized approaches that effectively treat adolescents with substance abuse disorders. Many of these approaches share elements that may be adopted to improve outcomes in substance treatment programs. In adolescents, treatment goals should be informed by a comprehensive assessment that includes the adolescent patient's developmental history and evaluation of psychiatric comorbidity. Treatment for behavioral, psychosocial, and psychiatric problems should be integrated with substance abuse interventions. The author describes practical clinical guidelines, grounded in current research, for providing integrated treatment services. Special emphasis is given to strategies for integrating the treatment of comorbid psychiatric disorders with substance use disorders in adolescents.

Public Domain

Robinson LA; Emmons KM; Moolchan ET; Ostroff JS. Developing smoking cessation programs for chronically ill teens: Lessons learned from research with healthy adolescent smokers. Journal of Pediatric Psychology 33(2): 133-144, 2008. (68 refs.)

Objective: Medically fragile teens who smoke need access to smoking cessation programs, because they are at even higher risk than their healthy peers for smoking-related complications. Methods To date, no studies on the outcome of smoking cessation programs for medically ill teens have been conducted. To suggest directions for future research, we turn to the literature on smoking cessation in the general population of teens and occasionally to the literature on adult smokers. Results Four areas are explored: (a) the prevalence of unaided cessation in healthy teens; (b) the outcomes of various treatments for smoking cessation in healthy adolescents; (c) special issues that should be considered when designing programs for medically ill teens; and (d) lessons learned from previous research. Conclusions: Medically ill teens face a number of medical, emotional, social, and developmental challenges that can affect the quitting process. Research is sorely needed to address the unique needs of this population.

Rogers N. From "Treatment" to "Care": Developing youth drug treatment services using a social model of health. Australian Journal of Primary Health 14(1): 52-58, 2008. (22 refs.)

The Youth Substance Abuse Service (YSAS) was conceived and developed as a youth alcohol and other drug (AOD) service when few adolescent treatment models existed. Although initially funded to provide drug support and treatment, our developing practice, training and research findings encouraged us to view our role more broadly. Now with 10 years' experience, YSAS increasingly draws on social health concepts and primary health practices to describe our work with young drug users. Through our growing practice and training experience we have developed services to meet client needs. Evaluation of these services and further research has refined our thinking and provided a theoretical basis for our work. This paper sets out to describe the evolution of a youth AOD service, and demonstrate how social health concepts and primary health practices have helped frame and facilitate our responses to young drug users during YSAS' first 10 years.

Santisteban DA; Mena MP; Suarez-Morales L. Using treatment development methods to enhance the family-based treatment of Hispanic adolescents. IN: Liddle HA; Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006. pp. 449-470. (76 refs.)

This is one of two chapters in Part V dealing with culturally based treatment development for adolescent substance abusers. Prior to the authors' description of their involvement in generating integrative family therapy approaches for Hispanic adolescents, they address the short-comings of current efforts to promote cultural competence. The chapter addresses the cultural related variables and processes, acculturation and its relationship to externalizing behaviors, to parenting practices, and to immigration experiences. The process of the development of the model is highlighted, with discussion of efforts to incorporate the relevant literature, the use of pilot cases, the creation of thematic modules, and a flexible manual design.

2006, Project Cork

Schroder R; Sellman D; Frampton C; Deering D. Profile of young people attending alcohol and other drug treatment services in Aotearoa, New Zealand: Clinical file search. Australian and New Zealand Journal of Psychiatry 42(11): 963-968, 2008. (16 refs.)

Objective: The aim of the present study was to provide a profile of young people attending alcohol and other drug (AOD) treatment services in Aotearoa, New Zealand. Method: Data were gathered from a clinical file search of 184 randomly selected young people aged 13-19 years who had attended one of eight youth AOD treatment services in New Zealand during 2003 or 2004. These services represented eight of the 11 youth-specific AOD services available to youth in New Zealand. Results: Young people who attend youth-specific AOD services in New Zealand present with a range of complex needs including substance use and mental health issues, criminality, family conflict and disengagement from school. A total of 62.0% were male, 56.4% had criminal convictions, 40.6% had spent some time in Child, Youth and Family Services care and 53.8% were reported to have a coexisting substance use and mental health disorder. Low rates of reporting of substance use and mental health diagnoses in treatment files suggest that substance use and mental health disorders among this population are likely to be higher than those reported. Conclusions: This paper provides a unique profile of young people attending youth-specific AOD treatments in New Zealand. Such information is useful in informing treatment planning and funding and ensuring that service development occurs to specifically meet the complex needs of this patient group.

Schubert K; Pond ANS; Kraft MK; Aguirre-Molina M. The adolescent addiction treatment workforce: Status, challenges, and strategies to address their particular needs. Journal of Psychoactive Drugs 36(4): 483-488, 2004. (5 refs.)

Treating youth with substance use problems presents unique challenges, distinct from those of adults, that add to the complexity of recruiting and retaining a qualified adolescent treatment workforce. Youth who need treatment are often involved in an array of systems (i.e., health, legal, and social) and use substances for a variety of reasons, requiring providers to have a unique set of treatment practices and proficiencies. The intent of this article is to highlight the current understanding of the issues facing the alcohol and other drug treatment workforce and to provide an overview of strategies people are or could be using to build and maintain a workforce that can effectively deliver care for adolescents.

Shillington AM; Clapp JD. Adolescents in public substance abuse treatment programs: The impacts of sex and race on referrals and outcomes. Journal of Child & Adolescent Substance Abuse 12(4): 69-91, 2003. (34 refs.)

Adolescent substance use continues to be a serious public health and social problem. However, very little research has been conducted to understand substance use treatment for adolescents during the past thirty years. This study reports on adolescents in publicly funded AOD treatment programs from 1997-1999 (N = 4,733). Analyses are presented examining sex and ethic differences within this population. Females were more likely to report methamphetamine and males reported marijuana use. Females were more likely to report injection drug use; males were more likely to be mandated to treatment. Hispanic and African American youth were referred into treatment from criminal justice; reported marijuana as the primary drug; much less likely to be IDUs; be mandated to treatment; and released unsatisfactorily compared to white adolescents. Implications for future research and substance abuse treatment are discussed.

Simmons R; Ungemack J; Sussman J; Anderson R; Adomo S; Aguayo J et al. Bringing adolescents into substance abuse treatment through community outreach and engagement: The Hartford Youth Project. Journal of Psychoactive Drugs 40(1): 41-54, 2008. (34 refs.)

While outreach and case management services have been shown to improve retention of at-risk youth in behavioral health treatment, these important support services are challenging to implement. The Hartford Youth Project (HYP), established by the Connecticut Department of Children and Families as a pilot for the state adolescent substance abuse treatment system, made outreach and engagement integral to its system of care. HYP brought together a network of stakeholders: referral sources (juvenile justice, schools, community agencies, child welfare, and families); community-based outreach agencies; treatment providers; and an administrative service organization responsible for project coordination. Culturally competent Engagement Specialists located in community agencies were responsible for: cultivation of referral sources; community outreach; screening and assessment; engagement of youth and families in treatment; case management; service planning; recovery support; and advocacy. This article describes HYP's approach to identifying and engaging youth in treatment, as well as its challenges. Use of family-based treatment models, expectations of referral sources, limited service capacity, youth and family problems, and staff turnover were all factors that affected the outreach and engagement process. Process, baseline assessment and case study data are used to describe the needs and issues specific to Hartford's substance-abusing Latino and African-American youth.

Stathis SL; Letters P; Doolan I; Whittingham D. Developing an integrated substance use and mental health service in the specialised setting of a youth detention centre. Drug and Alcohol Review 25(2): 149-155, 2006. (53 refs.)

This article describes the frequency of co-morbid substance use and mental health problems of young people within the youth justice system and demonstrates that mental health and drug and alcohol services can be integrated and work effectively. The establishment of an integrated Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) to juveniles in detention represents a shift away from the traditional paradigm of separate services frequently found throughout Australia. The development of referral procedures and adolescent-focused treatment programmes that are tailored to the specific needs of this disadvantaged population are discussed. A wide-ranging literature review illustrates the consequences of the high prevalence of co-morbid substance use and mental health problems in juveniles within the youth justice system. A retrospective and descriptive account is given of the expansion of the MHATODS, including the recruitment of an Indigenous health worker, the incorporation of an automatic referral process for young people with substance use problems and the development of a brief four-session drug and alcohol counselling programme and a group relapse prevention programme. The proportion of Indigenous clients referred to MHATODS is now equitable to referrals of non-Indigenous youth. The introduction of an automatic voluntary referral process resulted in an increase in referrals for drug and alcohol assessment and counselling from 17% to 64% of total referrals. Of those young people commencing the drug and alcohol programme, 32% completed all sessions. While young people reportedly enjoyed the group programme, feedback from participants indicated that they felt vulnerable in a group setting. MHATODS recognises the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has developed an integrated treatment service for juveniles in detention. The service has expanded its referral base for substance use problems by employing an Indigenous health worker, and initiating an automatic referral process for young people admitted into detention who have a history of significant substance use. Early evidence indicates increased utilisation of drug and alcohol services by young people in detention.

Stevens SJ; Morral AR, eds. Adolescent Substance Abuse Treatment in the United States: Exemplary Models from a National Evaluation Study. Binghamton NY: Haworth Press, 2003. (Chapter refs.)

This book describes exemplary drug treatment models serving adolescent substance users. It is organized into 11 chapters with 47 conributors. Following an overview introductory chapter outlining dimensions of substance use problems among adolescents, it addresses treatment of a number of special population groups: - African Americans, Hispanics, Whites, Native Americans, Russian Immigrants. Beyond addressing the needs of special populations, it also describes different treatment models: outpatient, residential, family-oriented, and modified therapeutic community programs.

Stiffman A; Striley C; Brown E; Limb G; Ostmann E. American Indian Youth: Who Southwestern urban and reservation youth turn to for help with mental health or addictions. Journal of Child and Family Studies 12(3): 319-333, 2003. (48 refs.)

Examined the addictions and mental health service use of American Indian (AI) adolescents. Interviews concerning mental health need and service configurations with 401 Southwestern American Indian youth used questions from the Diagnostic Interview Schedule and the Service Assessment for Children and Adolescents. 79% had mental health or addiction problems, with half meeting criteria for at least 1 diagnosis. One in 4 youth met criteria for drug dependence/abuse or conduct disorder, 1 in 5 for depression, and 1 in 8 for alcohol dependence/abuse. Most youth were helped by a combination of providers. Youth meeting more diagnostic criteria were increasingly likely to use service configurations with adults, nonspecialist professionals, and specialists, respectively. Regardless of disorder, youth were least likely to use configurations with traditional healers or specialists and there was little difference in rates of use between the two. The lack of services from specialist providers was potentially offset by use of an extensive range of informal adults, nonspecialist professionals, and peers. Since informal helpers, peers, and nonspecialist providers, but not specialists, are providing the bulk of services they must be given support and skills so they can function effectively.

Sussman S; Dent CW. Five-year prospective prediction of self-initiated quitting of cigarette smoking of high-risk youth. Addictive Behaviors 32(5): 1094-1098, 2007. (7 refs.)

This paper provides a 5-year replication-extension of a previous 1-year follow-up study of the same sample of southern California alternative high school youth. Demographic, behavioral, psychosocial, and emerging adult function predictors of adolescent self-initiated smoking cessation were investigated. Based on the first (1-year) prospective study and this follow-up, one may speculate that smoking cessation programs for adolescents should include counteraction of problem-prone attitudes, assistance with job aspirations and information about drug-free workplaces, motivation to quit strategies, and assistance with overcoming withdrawal symptoms.

Taxman FS; Young DW; Wiersema B; Rhodes A; Mitchell S. The National Criminal Justice Treatment Practices survey: Multilevel survey methods and procedures. Journal of Substance Abuse Treatment 32(3): 225-238, 2007. (87 refs.)

The National Criminal Justice Treatment Practices (NCJTP) survey provides a comprehensive inquiry into the nature of programs and services provided to adult and juvenile offenders involved in the justice system in the United States. The multilevel survey design covers topics such as the mission and goals of correctional and treatment programs; organizational climate and culture for providing services; organizational capacity and needs; opinions of administrators and staff regarding rehabilitation, punishment, and services provided to offenders; treatment policies and procedures; and working relationships between correctional and other agencies. The methodology generates national estimates of the availability of programs and services for offenders. This article details the methodology and sampling frame for the NCJTP survey, response rates, and survey procedures. Prevalence estimates of juvenile and adult offenders under correctional control are provided with extemally validated comparisons to illustrate the veracity of the methodology. Limitations of the survey methods are also discussed.

Trupin EW; Turner AP; Stewart D; Wood P. Transition planning and recidivism among mentally ill juvenile offenders. Behavioral Sciences and the Law 22(4): 599-610, 2004. (38 refs.)

Objectives: To determine the extent to which transition planning and community service would predict lower levels of recidivism among mentally ill juvenile offenders. Design: Review of legal, medical and social service records including examination of 3-month period following community release. Participants: juvenile offenders incarcerated for 6 months or more (N = 44) transitioning to community. Measures: Child and Adolescent Functional Assessment Scale (CAFAS), sum of different documented pre- and post-release discharge planning contacts, documented community service contacts. Outcomes: Re-offense during the first year post-release. Results: Documented community service contacts in the 3 months following discharge were rare for mental health (20.5%), substance abuse (38.6%), financial assistance (29.9%), and school placement (34.1%). The average number of different pre-release and post-release discharge planning contacts was also low, M(SD) = 1.86(1.68) and M(SD) = 2.34(1.71) respectively. Post-release discharge planning and the receipt of financial assistance and mental health services were all associated with lower levels of reoffending. Conclusions: Community transition planning, including the coordination and provision of community services, is an essential component of community reintegration for juvenile offenders and is associated with lower rates of recidivism during the first year post-discharge.

Weis R; Wilson NL; Whitemarsh SM. Evaluation of a voluntary, military-style residential treatment program for adolescents with academic and conduct problems. Journal of Clinical Child and Adolescent Psychology 34(4): 692-705, 2005. (53 refs.)

This study evaluated the effectiveness of a military-style residential treatment program for adolescents with academic and conduct problems. Two hundred twelve referred adolescents were separated into 3 groups for analyses: (a) adolescents who completed the 22-week program, (b) adolescents who prematurely withdrew, and (c) wait-list controls. Adolescents' socioemotional and behavioral functioning were measured at baseline and 6 months after treatment. Results showed statistically and clinically significant reductions in externalizing symptoms and increases in adaptive behavior associated with treatment. Treatment was also associated with increased likelihood of high school completion or employment and decreased likelihood of alcohol or drug problems and arrest. The relation between treatment participation and outcomes was moderated by adolescents' living environments after treatment, but it was not moderated by age of symptom onset. The benefits of treatment may be partially attributable to the voluntary nature of the intervention.

Withy KM; Lee W; Renger RF. A practical framework for evaluating a culturally tailored adolescent substance abuse treatment programme in Molokai, Hawaii. Ethnicity & Health 12(5): 483-496, 2007. (30 refs.)

Objective. Successful substance abuse treatment requires many changes in behavior, attitude and skills. Culturally tailored approaches to substance abuse treatment have shown initial success, but are not yet accepted as best practice models. In order to document programme effectiveness of a new culturally tailored substance abuse treatment programme on the rural island of Molokai, Hawaii, the authors worked to develop a multi- level evaluation plan to measure behavior changes occurring after participation in activities targeting identified causes of substance abuse in the population of interest. Methods. The authors compiled interview results to develop a map of identified causes of substance abuse in the community studied. Strategic planning then identified the specific activities aimed at impacting identified root causes. A literature review was performed to document the effectiveness of such activities. An evaluation plan was developed to measure programme impact on antecedent conditions contributing to substance use in this community. Results. Prioritized causes of substance abuse in the target group included low self esteem, lack of self identity and life plan, and limited communication and conflict resolution skills. Activities targeting these conditions included cultural activities, group counseling, and individual counseling. Literature to support the benefit of addressing these factors was uncovered, and evaluation methodology was developed to measure changes in behaviors, attitudes, and practices, as a measure of programme success. Discussion. While programme evaluation data is still being collected, the authors have demonstrated a sound foundation for programme activities, and designed methodology for collecting meaningful data to measure programme effectiveness at changing important root causes of substance abuse in a rural Native Hawaiian community.

Young DW; Dembo R; Henderson CE. A national survey of substance abuse treatment for juvenile offenders. Journal of Substance Abuse Treatment 32(3): 255-266, 2007. (61 refs.)

Despite consensus about the value of substance abuse treatment for delinquent youth, information about its prevalence and availability is inadequate and inconsistent. This article presents findings about treatment and other correctional service provision from a national survey of directors of 141 juvenile institutional and community corrections (CC) facilities. Educational/General Educational Development programming and drug and alcohol education were the most prevalent types of correctional and substance abuse services. Other common services included physical health services and mental health assessment, provided to about 60% of youth across facilities, and mental health counseling, life and communication skills, and anger management, provided to about half of the youth. Substance abuse treatment, as with most other services, were more prevalent in large, state-funded residential facilities (where 66% provided treatment) than in local detention centers (20%) and CC facilities (56%). More detailed data showed that the number of youth attending treatment in all types of facilities on any given day was very low.

Zheng H; Sussman S; Chen X; Wang Y; Xia J; Gong J et al. Project EX: A teen smoking cessation initial study in Wuhan, China. Addictive Behaviors 29(9): 1725-1733, 2004. (18 refs.)

The increasing smoking prevalence in China indicates a need for effective smoking cessation programs, yet, to our knowledge, no studies have evaluated the effects of smoking cessation programs among Chinese adolescents. A group of 46 10th-grade-level cigarette smokers from two schools in Wuhan, China, were provided with Project EX, an eight-session school-based clinic smoking cessation program developed in the United States. Efforts of translation of the Project EX curriculum, verification of translation, curriculum modification, and cultural adaptation were made to adapt the curriculum to the local culture. The 46 smokers represented 71% of all the self-reported 30-day smokers among 622 10th graders at these two schools. Only one student dropped out from the clinic program. Four-month follow-up data indicated a 10.5% 30-day quit rate and a 14.3% 7-day quit rate. The students who did not quit smoking reported a 16% reduction in daily cigarette consumption at posttest and a 33% reduction at 4-month follow-up. Use of a 2 1/2-week prebaseline-to-baseline clinic assessment indicated a clinic cohort nonassisted quit rate of 3%. These data provided evidence that Project EX can be adapted in another country, such as China; can be very well received; and can lead to promising results on cessation.