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CORK Bibliography: Adolescent Treatment Programs

69 citations. January 1996 to present

Prepared: June 2007

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 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.

Balch GI. Exploring perceptions of smoking cessation among high school smokers: Input and feedback from focus groups. Preventive Medicine 27(5 Part 3 Supplement): A55-A63, 1998. (16 refs.)

Background: Despite many approaches to smoking cessation for youths, few programs have been thoroughly evaluated and found successful. To help the American Medical Association develop, implement, and evaluate an effective program, formative research was conducted. Methods: Four focus groups were conducted with high school smokers in the Chicago area to obtain input into interventions. Subsequently, five similar focus groups were conducted in Delaware and Denver, and a focus group of school health providers was conducted as well, to obtain feedback on a draft protocol and ideas. Results: Participants did not consider quitting smoking serious or urgent. They are unfamiliar with the idea of a smoking cessation program. People they would trust to help them quit include people who care about them, successful quitters, and psychologists. They had mixed reactions to physicians. They did not trust school personnel and locations. Participants found it hard to imagine what might draw them to a cessation program, except money, small enticements, and short sessions. They might keep coming to progress toward their own objectives or for interesting activities. Lecturing, nagging, and preaching would repel them. They doubted that a program would do anything else. They were highly sensitive about confidentiality. Conclusions: Attracting participants is critical. Program component ideas include personal physicians; adding other topics for a more attractive bundle; ensuring confidentiality; and ensuring no lecturing, preaching, or nagging.

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.

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; Denver Juvenile Justice Integrated Treatment Network. Strategies for Integrating Substance Abuse Treatment and the Juvenile Justice System: A Practice Guide. (Preview Copy). Rockville MD: Center for Substance Abuse Treatment, June 1999. (190 refs.)

This guide provides an overview of the range of alcohol and other drug treatment services provided in juvenile justice settings. It highlights approaches that have shown some evidence of producing positive results. Special attention is paid to integrating services across the substance abuse and juvenile justice systems, which typically have had separate and distinct professional mandates, areas of focus, and philosophies. The work is organized into five sections: (1) Introduction; (2) Overview of effective treatment practices; (3) Structural supports for effective treatment; and (4) Descriptions of CSAT-funded projects; and (5) References and further resources.

Public Domain

Crits-Christoph P; Siqueland L. Psychosocial treatment for drug abuse: Selected review and recommendations for national health care. (review). Archives of General Psychiatry 53(8): 749-756, 1996. (54 refs.)

Substance abuse and dependence remains an important public health concern because of health-related and other costs to our society. We review selected articles that address questions about the psychosocial treatment of substance abuse disorders; these articles could aid in setting the parameters of a national health care insurance. Data from major program evaluation studies of existing substance abuse treatment programs are presented, followed by reviews of controlled studies of opiate, cocaine, and marijuana abuse and dependence; particular attention is given to studies that have standardized treatment through the use of treatment manuals. Articles about the treatment of substance abuse in adolescents are also reviewed. The existing data suggest that substance abuse treatment should be intensive and should probably involve multiple modalities targeted to various problems encountered in patients with substance use disorders, including comorbid psychiatric problems. However, only a few well-controlled studies have been performed to date; therefore, substantial research is needed before a system truly informed by research can be designed. Suggestions for future research directions are provided.

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.

Crome IB. Treatment interventions: Looking towards the millennium. (review). Drug and Alcohol Dependence 55(3): 247-263, 1999. (181 refs.)

This contribution is focused around treatment interventions employed when dealing with young substance misusers. By necessity, it draws on effective interventions which are applied to adult substance abusers. Where possible, research data on the effectiveness of interventions in young people are outlined and reviewed. The components of a comprehensive service are delineated. Suggestions for a framework for research are discussed: paying particular attention to some methodological difficulties in previous research.

Crome IB; Christian J; Green C. The development of a unique designated community drug service for adolescents: Policy, prevention and education implications. Drugs: Education, Prevention and Policy 7(1): 87-108, 2000. (86 refs.)

This paper describes the initiation and development of the first designated service for adolescent drug misusers in the UK between 1995 and 1997. The priorities and objectives of the multi-agency partnership and multi-professional team were to provide the first recognized designated methadone service for adolescent drug misusers, to identify and treat psychiatric comorbidity and to co-ordinate and liaise with other agencies and professionals. The objectives to attract, engage and retain adolescent drug misusers into treatment were achieved with 272 young people attending. The project has provided a service in an appropriate environment, staffed by personnel competent in responding effectively to the complex needs with which these young people present. Protocols have been developed which ensure a focused and timely response, and highlight the frustrations inherent in the absence of a designated service. Since there are few models of good practice nationally, and, as a result, even less outcome research, this paper outlines the characteristics of the first 48 (mean age=17.1 years at initial consultation) patients with severe heroin dependence who accessed the designated community drug service and were prescribed methadone. The early age of initiation into substance use (mean = 13.3 years) and heroin use (mean = 15.8 years), the development of heroin dependence within a year, and injecting in 70%, highlight the importance of addressing these young patients' needs as early as possible. Only 30% were living with both parents, and in only 25% were both parents employed. Only 16% had taken examinations, and 25% had been excluded from school. Despite this, none were referred via the educational system. Only 13% were referred via the criminal justice system, though 56% had drug-related offences. General practitioners were prescribing analgesics or psychotropics in 40%, yet referred only 10%. Likewise, though 33% had a history of deliberate self-harm, psychiatrists had referred only 4%. Thus, the lost opportunities for targeting treatment and prevention are multiple. However, even against the background of severe disadvantage, 80% of young people prescribed methadone were retained in the service. Almost 40% complied or completed the agreed treatment plan, and demonstrated improved psychosocial functioning. Predictors of good outcome included supportive parents, educational achievement, and no psychiatric or forensic history. The implications of these findings are discussed inl relation to service delivery, policy developments and research and educational activities.

Crome IB; Christian J; Green C. Tip of the national iceberg? Profile of adolescent patients prescribed methadone in an innovative community drug service. Drugs: Education, Prevention and Policy 5(2): 195-197, 1998. (5 refs.)

In 1996 an innovative multidisciplinary community, drug service for adolescents was established in Stoke on Trent, UK. For the first time the profile of adolescent heroin dependents who access the service is described. A picture of extreme vulnerability emerges: early age (mean = 11.8 years) of initiation into substance use, rapid development of heroin dependence, concurrent polydrug use, injecting behaviour and deliberate self-harm. Retention in treatment was achieved in 80%, despite a background of social deprivation and criminality. This local information extends and confirms national data. The policy response must be the establishment and outcome evaluation of a few pilot projects.

Delany PJ; Broome KM; Flynn PM; Fletcher BW. Treatment service patterns and organizational structures: An analysis of programs in DATOS-A. Journal of Adolescent Research 16(6): 590-607, 2001. (41 refs.)

The availability of a variety of treatment services was examined within a national sample of programs treating adolescent drug abuse patients. Treatment service delivery profiles were created and examined in the context of organizational variables such as program modality program directors' academic credentials, program capacity staff composition, accreditation, and patient problems. Results suggested that distinct profiles of services existed within residential and outpatient modalities and that these service profiles were related both to organizational factors and to patient problem profiles.

Dembo R. Problems among youths entering the juvenile justice system, their service needs and innovative approaches to address them. Substance Use & Misuse 31(1): 81-94, 1996. (90 refs.)

There is an urgent need to expand substance misuse and related services to address the multiple problems experienced by youths entering the juvenile justice system. In particular, innovative efforts are needed in which staff working with delinquent youths and their families are trained to provide treatment, and to link them with additional community services. The authors discuss a few of these programs and provide a focused bibliography for further use.

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.

Denver Justice Integrated Treatment Network; Burney-Nissen L. Strategies for Integrating Subsance Abuse Treatment and the Juvenile Justice System: A Practice Guide. Rockville MD: Center for Substance Abuse Treatment, 2000. (302 refs.)

This Guide provides an overview of the range of alcohol and other drug treatment services provided in juvenile justice settings. It highlights approaches that have shown promise of producing good outcomes. Special attention is paid to integrating services across the substance abuse and juvenile justice systems, which typically have had separate and distinct professional mandates, areas of focus, and philosophies. It is organized into five sections, moving from 1) introduction, to 2) an overview of effective treatment practices, through 3) structural supports for effective treatment, and 4) descriptions of SCAT-funded projects, to 5) references and resources.

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.

Dino G; Horn K; Goldcamp J; Fernandes A; Kalsekar I; Massey C. A 2-year efficacy study of "Not on Tobacco" in Florida: An overview of program successes in changing teen smoking behavior. Preventive Medicine 33(6): 600-605, 2001

Background. Adolescent smoking has been an issue of major concern in the United States. This has led to a need for the development, evaluation, and dissemination of effective youth cessation programs. The purpose of this paper is to report the results of a 2-year demonstration study (1999-2000) of the American Lung Association's teen smoking cessation program, the Not On Tobacco (NOT) program. Methods. The study used a "matched" design wherein each NOT school was matched to a brief intervention (BI) school. The study consisted of 20 NOT and 20 BI Florida high schools encompassing 627 students. The primary outcome measures were carbon monoxide-validated quit and reduction rates for NOT and BI schools at 5.2 months postprogram. Results. NOT smoking cessation and reduction outcomes were significantly better than those of the brief intervention. Further, data indicate that NOT was more effective than the brief intervention for females compared with males; males showed successful quit attempts in both intervention groups. Overall, more NOT youth either quit or reduced smoking than did BI youth. Conclusions. These positive smoking behavior changes suggest that NOT is an effective teen smoking cessation option.

Donatelle RJ; Prows SL; Champeau D; Hudson D. Randomised controlled trial using social support and financial incentives for high risk pregnant smokers: Significant Other Supporter (SOS) program. Tobacco Control 9(Supplement): 67-69, 2000. (12 refs.)

An intervention was conducted to determine whether the combination of bolstered social support and financial incentives had an effect in significantly reducing smoking behavior among low-income, high-risk, pregnant and postpartum women who participate in Oregon's Women, Infants, and Children (WIC) program. Participants completed written surveys and salivary specimen collections, analyzed for cotinine regardless of smoking status, at each of three assessments: baseline, eight months gestation, and two months postpartum. All participants received a five-dollar participation voucher at each assessment. All participants were telephoned monthly and asked to self-report their smoking status. Any participant who reported quitting returned to the WIC site for saliva specimen collection. The intervention strategy employed used a three-pronged approach to facilitate smoking cessation among pregnant and postpartum women: positive incentives; bolstered social supports; and community participation. The combination of bolstered social support and direct financial incentives significantly increased the likelihood of a higher than usual smoking quit rate among high-risk pregnant women who participate in WIC programs.

Donohue B; Azrin NH; Lawson H; Friedlander J; Teichner G; Rindsberg J. Improving initial session attendance of substance abusing and conduct disordered adolescents: A controlled study. Journal of Child & Adolescent Substance Abuse 8(1): 1-13, 1998. (43 refs.)

The present controlled study was the first to demonstrate a method of improving first session attendance in a population of conduct disordered and substance abusing adolescents. The results indicated that an intensive intervention involving the youth and parent was more effective in improving session attendance than a less intensive intervention that excluded the youth's involvement. The intensive intervention resulted in greater attendance to the first appointment (60% vs. 89%), greater attendance to appointments throughout the study (57% vs. 83%), and greater promptness to sessions that were attended (5.8 mins. vs. 0.8 mins.). Implications of this study are discussed in light of these results.

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.

Garner BR; Godley SH; Funk RR. Evaluating admission alternatives in an outpatient substance abuse treatment program for adolescents. Evaluation and Program Planning 25(3): 287-294, 2002. (16 refs.)

Streamlined admission procedures for adolescents entering outpatient substance abuse treatment were evaluated. A time cohort of 128 adolescents receiving existing admission procedures over a 12 month period were compared to a subsequent cohort of 149 who received same day assessments, same day treatment placement staffings, use of pre- set admission appointments, and admission tracking procedures. Measures included: (a) the length of time taken to complete assessments, (b) the length of time between the assessment and admission appointments, and (c) the percentage of clients admitted to treatment. Results revealed that each of the new admission procedures were implemented in at least 50% of the cases, adolescents who received them completed their assessments sooner, and time-to-event analysis demonstrated that this group was admitted to treatment sooner. However, the percentage of adolescents who entered treatment was not significantly different between cohorts.

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.

Green C. Current opinion: Providing treatment and care for adolescent substance users. Journal of Substance Use 4(4): 227-233, 2000. (17 refs.)

The provision of treatment and care for adolescent substance users is discussed with a focus on the difficulties with providing a package of care that would be effective with this population group. Section headings in this journal article include: (1) the assessment process; (2) treatment and care; (3) specialist service; (4) difficulties experienced; (5) outcomes; and (6) lessons learned. It is concluded that the treatment outcomes were better than anticipated, given the vulnerability of the population, and it does show that some substance-dependent young people can be assisted to detoxify in the community. The author notes that one of the most important lessons learned from this particular project is that working with young dependent substance users is usually a lengthy process, in which the outcome is often uncertain. However, the author has learned not to give up on young individuals, who when they are ready to, can make some astounding changes in their lives. It is noted that this practice may be frustrating for the practitioner, but only the young person him- or herself can make these changes.

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.

Jumper-Thurman P; Beauvais F. Treatment of volatile solvent abusers. Substance Use & Misuse 32(12/13): 1883-1888, 1997. (7 refs.)

The need for knowledge about solvent use treatment is reflected in the frequent appeals for information received from drug use treatment programs. Most treatment programs are not equipped to deal with the problems of solvent users. Adding to the difficulty is the lack of even a rudimentary treatment model. While treatment of solvent use has some overlap with drug use treatment in general, approaches used in most treatment programs do not address the unique issues related to solvent use treatment.

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.

Kaminer Y; Tarter RE. Adolescent substance abuse. IN: Galanter M; Kleber HD, eds. Textbook of Substance Abuse Treatment, Second Edition. Washington DC: American Psychiatric Press, 1999. pp. 465-474. (98 refs.)

This is one of 6 chapters, discussing special populations, in the sixth section, of a reference text on substance abuse.

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.

Kempf J; Stanley A. Impact of tobacco-free policy on recruitment and retention of adolescents in residential substance abuse treatment. Journal of Addictive Diseases 15(2): 1-11, 1996. (15 refs.)

As residential treatment programs consider adopting smoke-free policies, treatment providers question whether such policies interfere with patient recruitment and retention. This study assesses the effect of a smoke-free policy on retention using a sample of 155 low-income, mainly minority youth, randomly assigned to two long-term adolescent residential programs at the New Jersey Substance Abuse Treatment Campus. One of these programs has a smoke-free policy, the other does not. Smoking rates are high for the sample. Eighty-five percent of these adolescents smoke, on average half a pack daily, and 39% smoke a pack or more daily. Differential dropout rates between programs for key time periods related to tobacco withdrawal were analyzed to assess the potential effect of smoking policy on retention. Differential dropout rates at the point of program assignment, in the first two days of residency (p = .43), and for the first two weeks of residency (p = .37) show no differences between programs. While analyses showed heavy smokers are more likely than others to leave treatment early, they were likely to leave from either program regardless of smoking policy. As well, verbal expressions of dissatisfaction with smoking policy did not result in drop outs. These results indicate that smoke-free policies have no detrimental effect on program retention.

Kennedy M; Spingarn R; Stanton A; Rotheram-Borus M. A continuum of care model for adolescents living with HIV: Larkin Street Youth Center. Drugs & Society 16(1/2): 87-106, 2000. (45 refs.)

Overcoming barriers to delivering care to adolescents living with HIV, Larkin Street Youth Center (LSYC) has developed a comprehensive HIV service delivery program. This model coordinates services for adolescents living with HIV and includes five types of services: outreach, drop-in services, routine health and medical care, dependent care, and residential/catering services. Stable housing was made available to youth in two settings: (1) scattered site apartments and single rooms in hotels within a small geographic area; and (2) a residential care facility for disabled adolescents living with HIV. Case reports and summaries of assessments conducted with seven adolescents living with HIV are described. Clinical descriptions, health indices, and improvements in daily routines demonstrate the program's benefits; continued substance use and sexual risk acts demonstrate the need for disorders.

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.

Liddle HA; Rowe CL; Quille TJ; Dakof GA; Mills DS; Sakran E; Biaggi H. Transporting a research-based adolescent drug treatment into practice. Journal of Substance Abuse Treatment 22(4): 231-243, 2002. (26 refs.)

This article describes the key ingredients and processes in transporting an empirically supported, research-developed family therapy for adolescent drug abusers, Multidimensional Family Therapy (MDFT), into an intensive day treatment program. Using the same systems change principles that guide this treatment approach, the technology transfer process has been, from its inception, a collaborative, multidimensional, systemic intervention aimed at changing organizational structures, and attitudinal and behavioral patterns with multiple staff members at several levels of the program. This article describes: (1) the conceptual and empirical basis for these technology transfer efforts; (2) the technology being adapted and transferred; and (3) the critical events and processes that have shaped the transfer of MDFT into this program. We discuss this process and the outcomes thus far through the lens of Simpson's organizational change model and specify the implications of this experience for the expansion of current conceptualization of technology transfer.

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.

Marshall S. The multigenerational treatment setting for the chemically dependent adolescent: Impact on cost, quality and treatment outcomes. Journal of Addictive Diseases 18(4): 13-27, 1999. (69 refs.)

The treatment outcome from homogeneous age group substance abuse treatment centers, whose clientele consist of adolescent chemical dependents, has never clearly been demonstrated to be superior to heterogeneous age group treatment. An analysis of research in several disciplines concerning outcome studies related to adolescent chemical dependency and mental health treatment, demonstrates that heterogeneous (multigenerational) treatment settings may be superior to homogeneous age group treatment. Other adolescent issues in the family and society that directly affect treatment philosophies in centers directed toward youth are compared to the treatment philosophies of adult centers. It is suggested that multigenerational treatment facilities cost less, require less staff, are better received by the client, and produce higher abstinence rates than adolescent-specific centers.

Mears DP; Kelly WR. Linking process and outcomes in evaluating a statewide drug treatment program for youthful offenders. Crime & Delinquency 48(1): 99-115, 2001. (41 refs.)

Considerable attention recently has been given to the principles of effective intervention and their importance for reducing recidivism. By contrast, much less attention has been given to youth performance while in treatment or to program implementation, yet both are critical factors that also can affect recidivism. Using data on youthful offenders in the Texas Youth Commission (TYC), the authors examine rearrest patterns for youths in TYC's Chemical Dependency Treatment Program. Analyses focus on treatment performance and program implementation and their impact on rearrest, net of demographic, risk, and need factors. Policy and research implications of these analyses are discussed.

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.

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.

Nissen LB; Vanderberg J; Embree-Bever J; Mankey J. Strategies for Integrating Substance Abuse Treatment and the Juvenile Justice System: A Practice Guide. Executive Summary. Rockville MD: Center for Substance Abuse Treatment, 1999. (0 refs.)

Political and professional interest in providing services to adolescents and juvenile offenders has risen. This sparked the creation of a practice guide for those working in the Juvenile Justice System. Executive Summary of a Practice Guide is divided into three sections. The first is an introduction and background. It draws upon the experience of Treatment programs supported by the Center for Substance Abuse Treatment (CSAT) conducted over the past 8 years. Section II is directed to consideration of effective treatment practices and approaches. Attention is directed to providing treatment that is appropriate to the youth's age, developmental stage, and culture. It also emphasizes the importance of working with families in treatment and adopting a strengths-based approach. The third section focuses on treatment program design and structure and covers such topics as collaboration, strategic planning, program administration, and evaluation.

Novins DK; Fleming CM; Beals J; Manson SM. Commentary: Quality of alcohol, drug, and mental health services for American Indian children and adolescents. American Journal of Medical Quality 15(4): 148-156, 2000. (52 refs.)

American Indian children and adolescents suffer from a high prevalence of alcohol, drug, and mental (ADM) disorders. Unfortunately, the systems of services for these children and youth have never been able to address adequately their mental health needs. Thus, the revolutionary changes now taking place within these service systems, in particular the marked increase in the direct provision of services by Indian tribes and organizations, provides a unique opportunity to address these historical shortcomings. In this paper, we describe our existing knowledge concerning the quality of ADM services for American Indian children and adolescents and their critical sociodemographic, sociocultural, and epidemiologic contexts. We then consider the implications of these studies for improving the quality of care as well as its measurement and monitoring.

Office of Applied Studies. 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.

O'Leary TA; Brown SA; Colby SM; Cronce JM; D'Amico EJ; Fader JS et al. Treating adolescents together or individually? Issues in adolescent substance abuse interventions. Alcoholism: Clinical and Experimental Research 26(6): 890-899, 2002. (65 refs.)

This article summarizes the proceedings of a symposium, chaired by Peter Monti and cochaired by Tracy O'Leary, that was presented at the 2001 RSA Meeting in Montreal, Quebec. The aim of this symposium was to present data on group- and individual-based interventions for adolescent alcohol and substance abuse, with a discussion of the implications of research findings hearing on developmental considerations when working with adolescents and young adults. Elizabeth J. D'Amico, PhD, reviewed recent findings on adolescents' choice of type of substance abuse treatment, Jennifer L. Maggs, PhD, presented a developmental perspective on this issue. Tracy O'Leary, PhD, presented data on enhancing motivational interviewing with the presence of a supportive peer for college students cited for alcohol infractions. Mary E. Larimer, PhD, presented 1-year follow-up results of the Greeks 2000 Project, a 5-year longitudinal study designed to evaluate the efficacy of an alcohol abuse prevention program provided to college students who were entering a pledge class (first year) of Greek houses. Barbara McCrady, PhD, a noted expert on the treatment of couples for substance abuse problems, served as discussant.

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.

Palinkas LA; Atkins CJ; Noel P; Miller C. Recruitment and retention of adolescent women in drug treatment research. IN: Rahdert ER, ed. Treatment for Drug-Exposed Women and Their Children: Advances in Research Methodology. NIDA Research Monograph 166. Rockville MD: National Institute on Drug Abuse, 1996. pp. 87-109

This chapter examines the issues of recruitment and retention of adolescents in drug treatment studies, with a particular emphasis on the experience of one of the Perinatal-20 studies that deals exclusively with adolescent women between ages 14 and 19.

Public Domain.

Pernice C; Robinson GK; Bush S; Crow S. A Summary of Planned Mental Health and Substance Abuse Services and Activities in the State Children's Health Insurance Program (CHIP). Bethesda MD: Substance Abuse and Mental Health Services Administration, 1999. (0 refs.)

This report consists primarily of charts and tables, organized by State, that describe the impact of Children's Health Insurance Program (CHIP) on children with mental health and substance abuse treatment needs. The CHIP plans are structured to provide a wide range of services.) This program is also know an Title XXI (of the Social Security Act.) The information in the report was obtained from the Title XXI applications submitted by each State to the Health Care Finance Administration (HCFA). These applications provided information on the following: (1) which type of CHIP a State would implement; (2) what population would be eligible for expanded coverage; (3) which benefits would be offered; (4) how each State would conduct outreach and enroll individuals; (5) how effectiveness would be measured; and (6) how States would involve the public in determining the CHIP plan design, implementation, and, as required, modification. Tittle XXI allows States to choose one of three options: Medicaid expansion, separate State designed CHIP; or a combination of these. (Vermont has a separate system model). The information is provided for each State.

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.

Pressman MA; Brook DW. A multiple group psychotherapy approach to adolescents with psychiatric and substance abuse comorbidity. International Journal of Group Psychotherapy 49(4): 486-512, 1999. (26 refs.)

Multiple group psychotherapy was employed as the primary treatment modality in a day-treatment program as an innovative multifaceted approach to treating adolescents comorbid for psychiatric and substance abuse diagnoses. The concurrent educational program included a high school on site. The groups included Substance Abuse Group, which promoted the 12-step model; Health Group; Psychotherapy Group; Leisure Time Group; Self-Awareness Group; and Multiple Family Group. The effect of the multiple groups was to provide a variety of experiences focusing on varied aspects of normal and dysfunctional adolescent development. Together the combination of groups served to strengthen the participants' cohesiveness, communicating skills, and hopefulness.

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

Riggs PD; Davies RD. A clinical approach to integrating treatment for adolescent depression and substance abuse. Journal of the American Academy of Child and Adolescent Psychiatry 41(10): 1253-1255, 2002. (16 refs.)

Despite both clinical and empirical support for integrating treatment for depression (and other comorbid disorders) and SUD, several barriers impede progress toward implementing truly integrated treatment models into clinical practice. These barriers include the following: (1) the historical separation of substance and mental health treatment programs, coupled with the paucity of integrated clinical and research training programs, has resulted in an extremely limited workforce of highly trained researchers and clinicians who are experienced in integrated treatment models for adolescent SUD and comorbid psychiatric disorders; (2) the exclusion of substance-involved adolescents from controlled pharmacotherapy and psychotherapy trials for psychiatric disorders has led to a serious gap in our knowledge of treatment safety and efficacy for adolescents with SUD and comorbid psychiatric disorders; and (3) similarly, controlled clinical trials demonstrating the efficacy of several treatment modalities for adolescent SUD have not given attention to comorbid psychiatric disorders such as depression, resulting in a lack of knowledge about which substance treatment approaches might be most effective in adolescents with dual diagnoses. To date, only two adequately powered placebo-controlled pharmacotherapy trials have targeted the treatment of any comorbid disorder in nonabstinent adolescents with SUD, but neither of these targeted MDD. Despite the paucity of pharmacotherapy trials in adolescents with SUD, several controlled clinical trials have demonstrated the efficacy of psychosocial treatment interventions for adolescent SUD, including family-based, behavioral, and cognitive-behavioral therapies. Therefore, it is important that we at least begin to derive a more standardized clinical treatment algorithm to guide our approach to integrated treatment from the current empirical base. A six step algorithm is then set forth. (1) establish a strong treatment alliance and patient-generated goals regarding his/her substance use. With comorbid depression, clinicians will want to emphasize the importance of rapidly reducing or discontinuing substance use (2) Once the adolescent is engaged in substance treatment, and if both self-report and urine toxicology results indicate abstinence or significant reduction in substance use, then carefully monitored pharmacotherapy for depression may be initiated-even within the first 2 weeks of treatment; current research would support the use of serotonin reuptake inhibitors (3) If pharmacotherapy is initiated, clinicians must closely monitor substance use, urine toxicology results, side effects, medication compliance, motivation, and target symptom response as well as behavior change and psychosocial functioning (4) If pharmacotherapy is clinically contraindicated, for example by ongoing heavy substance use, then psychotherapy for depression such as cognitive-behavioral therapy or interpersonal psychotherapy may be initiated without pharmacotherapy. Use of 12-step programs; (5) If depression and substance use do not significantly improve within the first 2 months after initiating treatment (or if functioning deteriorates), this may be an indication that a more intensive level (6) The potential for relapse after achieving abstinence should be openly discussed and anticipated, both during and after successful treatment. A detailed plan should be developed to intensify treatment and family involvement

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.

Stanton A; Kennedy M; Spingarn R; Rotheram-Borus MJ. Developing services for substance-abusing HIV-positive youth with mental health disorders. Journal of Behavioral Health Services & Research 27(4): 380-389, 2000. (14 refs.)

Models of program development have primarily focused on the internal organizational processes needed to plan, implement, and evaluate new service programs. However creating an external demand for new programs by policy makers, administrative bureaucracies, public health officials, and funders is critical to establishing new programs. A series of deaths of seropositive youth and an absence of local service settings with staff trained to address the needs of youth living with HIV provided the impetus for Larkin Street Youth Center In particular; the agency had to overcome stigma associated with having both substance use and mental health disorders to establish service programs to recruit and mobilize staff within the agency and the local community and to establish a comprehensive housing program for symptomatic HIV-infected adolescents. This article examines how a residential assisted care facility for HIV-seropositive adolescents was established using organizational strategic planning processes, problem solving, and social marketing frameworks.

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.

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.

Terry YM; VanderWaal CJ; McBride DC; Van Buren H. Provision of drug treatment services in the juvenile justice system: A system reform. (review). Journal of Behavioral Health Services & Research 27(2): 194-214, 2000. (116 refs.)

This article proposes a systemic reform of the organizational structure and delivery of substance abuse services for adolescents within the juvenile justice system. It first discusses the impact of substance use on the juvenile justice system and then reviews which drug treatment programs and services are currently available. Following an evaluation of the most effective drug treatment programs and modalities, recommendations for system reform are given. The recommendations are based on a graduated sanctions framework, supported by systems collaboration and comprehensive case management. Systems collaboration between service providers must exist for juvenile; to receive appropriate and comprehensive services. Case managers (CMs) both assess juveniles and help them move through and between judicial, drug treatment, and social service systems. lit this way, juveniles receive the most suitable and complete services a community can offer while remaining firmly under juvenile justice system supervision.

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.

Winters KC; Stinchfield RD; Opland E; Weller C; Latimer WW. The effectiveness of the Minnesota Model approach in the treatment of adolescent drug abusers. Addiction 95(4): 601-612, 2000. (51 refs.)

Aims. The treatment outcome of drug-abusing adolescents treated with a 12-Step approach. Design. The study compares drug use outcome data at 6 and 12 months post-treatment among three groups of adolescents: those who completed treatment, those who did not and those on a waiting fist. Also, among treatment completers, residential and outpatient samples were compared on outcome. Setting. The treatment site is located in the Minneapolis/St Paul area of Minnesota. Participants. Two hundred and forty-five drug clinic-referred adolescents (12-18 years old), all of whom met at least one DSM-III-R substance dependence disorder. One hundred and seventy-nine subjects received either complete or incomplete 12-Step, Minnesota Model treatment and 66 were waiting list subjects. Measurements. In addition to demographics and clinical background variables, measures included treatment involvement, treatment setting and drug use frequency at intake and follow-up. Findings. Absolute and relative outcome analyses indicated that completing treatment was associated with far superior outcome compared to those who did nor complete treatment or receive any at all. The percentage of treatment completers who reported either abstinence or a minor lapse for the 12 months following treatment was 53%, compared to I5 and 28% for the incompleter and waiting list groups, respectively. Conclusions. Favorable treatment outcome for drug abuse was about two to three times more likely if treatment was completed. Also, there were no outcome differences between residential and outpatient groups. Alcohol was the most common drug used during the follow-up period, despite cannabis being the preferred drug at intake.

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.