Alfred S. Friedman

A Method for Diagnosing and Planning the Treatment of Adolescent Drug Abusers (The Adolescent Drug Abuse Diagnosis [ADAD] Instrument)

There is a need for a diagnostic method and an instrument appropriate for adolescent drug abuse clients, that permits the assignment of clients to the most appropriate treatment setting, provides the basis for individualized treatment planning, and facilitates comparability across research studies. The development of the Adolescent Drug Abuse Diagnosis (ADAD), a 150-item instrument with a structured interview format, modeled after the Addiction Severity Index (ASI) (which is for adults), is described. The ADAD produces a broad-spectrum comprehensive evaluation of the client, the interviewers ten-point severity ratings, and composite scores for each of nine life problem areas that are often relevant to the treatment needs of adolescent drug abuse clients. A series of validity and reliability tests are described. The characteristics of the standardization sample (N = 1,042), and the comparison of the characteristics of the three subsamples (outpatient, residential or non-hospital, and inpatient) are also presented.

Family therapy vs. parent groups: Effects on adolescent drug abusers

Abstract The families of adolescent drug abuse clients who were admitted to six outpatient drug-free (OPDF) treatment programs were randomly assigned to either a family therapy method or a parent group method. It was later found that in 93% of the family therapy families, one or both parents participated (N=85); but that in only 67% of the families assigned to a parent group did one or both parents participate (N=50). This is considered to be an important practical advantage for family therapy. At follow-up evaluation 15 months later (after a 6-month course of treatment and a 9-month follow-up period), the clients and their mothers in both groups reported significant improvement on numerous outcome criteria, including reduction in substance use. There was no significant difference between the two groups in degree of improvement.

Prediction to Successful Treatment Outcome by Client Characteristics and Retention in Treatment in Adolescent Drug Treatment Programs: A Large-Scale Cross Validation Study

NIDA–CODAP file data on adolescent clients admitted to thirty selected outpatient programs were available for calendar years 1979 (N = 2509) and 1980 (N = 3094). Two outcome criterion variables were utilized: 1) CODAPs “Reasons for Discharge” classification, and 2) a formula for “Reduction of Drug Use.” School grade, controlled for age, was the only client predictor variable found to account for more than 1 percent of the variance in the “Reasons for Discharge” outcome variable. Marijuana as the primary drug of abuse was the only client variable to account for more than 1 percent (4.4 percent) of the variance in the Reduction in Drug Use. The primary marijuana users showed less reduction in amount of drug use, and were less often considered to have completed the course of treatment. Time in treatment accounted for 1.6 percent in 1979 and 1.3 percent in 1980 of the variance in the “Reduction in Drug Use” criterion.

Violent Behavior as Related to Use of Marijuana and Other Drugs

Abstract The relationship of the degree of use of each of ten types of illicit drugs with each of eight types of violent criminal offenses, is reported for an African-American, inner-city, low SES, young adult study sample (N = 612). Prospective data from the time of birth was available for the statistical analyses, to provide 51 control variables on factors other than substance use which might predict to later violent behavior. Findings: Greater frequency of use of marijuana was found unexpectedly to be associated with greater likelihood to commit weapons offenses; and this association was not found for any of the other drugs, except for alcohol. Marijuana use was also found associated with commission of Attempted Homicide/Reckless Endangerment offenses. Cocaine/crack and marijuana were the only two types of drugs the frequency of use of which was found, for this sample, to be significantly related to the frequency of being involved in the selling of drugs. These findings may not apply to a middle-class African-American sample.

Effects of psychiatric symptomatology on treatment outcome for adolescent male drug abusers.

There is evidence that adult substance abusers tend to have high rates of psychiatric symptomatology and diagnosable psychiatric disorders and that those with more severe psychiatric problems show lower levels of improvement. This paper examines whether these same two findings also hold for adolescent substance abusers. The outcome of treatment, in a day treatment center in a private vocational high school setting, for 130 court-referred substance-abusing delinquent boys aged 14 to 18 years was studied in relation to their psychic symptomatology at admission, as measured by the Brief Symptom Inventory and the Emotional Reaction Inventory. The unexpected finding, although not conclusive, shows that there is a slight tendency among these young clients for those who report more psychiatric symptoms to improve more, rather than less, with treatment. For example, a greater score on the borderline psychotic subscale of the Emotional Reaction Scale predicted to more improvement as measured by reduction in drug use. A response set explanation was postulated for this finding: those clients who were more self-evaluative and more open and self-revealing about their disturbing inner thoughts and feelings might have been more trusting, more ready, and better motivated for counseling. The following are some possible explanations for the fact that the findings are different from those of some studies reported for adult substance abusers: (a) adolescent drug abusers have, or are aware of having, or report, less psychiatric symptomatology, than adult abusers or addicts; (b) our study sample included only court-referred delinquents; and (c) there are differences in research methodology, specifically in the types of instruments and measures used. In any event, further research with adolescent drug abusers on the relationships between psychiatric status at admission and treatment outcome is indicated.

The relationships of substance abuse to illegal and violent behavior, in a community sample of young adult African American men and women (gender differences)

In a longitudinal study of an African American young adult community sample (N = 380), prospective data on lifetime substance use/abuse from childhood up to age 24 were used as control variables in analyses to predict illegal and violent behavior during the ensuing 2 1/2-year period. Frequent earlier use of drugs predicted subsequent violent behavior for both men and women. Frequency of earlier use of alcohol predicted subsequent violent behavior for men but not for women. A weaker relationship was found between degree of psychopathology and degree of engaging in either illegal or violent behavior than between degree of psychopathology and degree of substance use/abuse. Comorbidity (the combination of earlier use/abuse of drugs with earlier psychopathology) was a stronger predictor, for women than for men, of later illegal and violent behavior.

Does drug and alcohol use lead to failure to graduate from high school

In a study of 526 students in two Philadelphia public high schools, the majority (135 of 265) who had been using drugs were found subsequently to have dropped out (failed to graduate) from high school, compared to only approximately one out of four (42 of 158) of the non-drug using students. In a multiple regression analysis, which controlled for twenty demographic, personal and family variables which had previously been found to have significant correlation with dropping out versus graduation from high school, the severity of the students earlier drug use was still found to predict to failure to graduate, to a significant degree (F = 6.03). While drug use may not be the main cause of dropping out of high school, but only a concomitant effect of earlier, more basic state of disaffection from school, it is nevertheless clear that drug use by adolescents interferes with academic progress in high school.

Psychopathology as an Antecedent to, and as a "Consequence" of, Substance Use, in Adolescence.

In this longitudinal study of 232 student-subjects in two public high schools, it was found, by a cross-lagged correlation method, that earlier psychopathology predicted to a statistically significant degree to substance use seventeen months later, and that earlier substance use also predicted to a statistically significant degree to later psychopathology. Thus it appears likely that there is an additive or cumulative interaction effect in which having psychiatric symptoms (psychopathology) contributes to the tendency to use drugs, and using drugs adds to the tendency to have psychiatric symptoms. Among the nine types of psychic symptoms measured, obsessive-compulsive symptoms, hostility, paranoid ideation and depression were found to be somewhat more predictive of later increase in substance use than the other types of psychic symptoms; and phobic anxiety was not predictive at all.

Family risk factors versus peer risk factors for drug abuse A longitudinal study of an African American urban community sample

This study compared the influence of family problems with influence of deviant and delinquent social behavior and peer relationships up to the time of the 16th birthday as risk factors for substance use, for lifetime up to age 26. Control variables for the analysis were available from the National Collaborative projects longitudinal data file, collected from time of birth, on the African American community study sample (N = 380). A key finding was that the social behavior and peer relationship problems accounted for 18.8% of the additional variance in later degree of substance use, whereas the family problems accounted for only 5.1% of the additional variance in later degree of substance use.

Multimodel Substance Use Intervention Program for Male Delinquents.

ABSTRACT In this prevention-early intervention project, for inner-city, low SES, court-adjudicated male adolescents, conducted in a residential treatment center, new admissions were randomly assigned to either a program participant group (in a triple-modality social learning program in the classroom), or to a control group. Results: The follow-up assessment (N = 251), at six months after discharge to home and community, showed that the program group reported a significantly greater degree of reduction in drug use/abuse, and in the selling of drugs, but not in alcohol use, or in illegal violent behavior, or in school problems. By means of dosage and process analyses, it was determined that (1) it was the Botvin LST program that was effective in reducing substance use/abuse and the selling of drugs; and (2) that those participants who participated more positively in the Prothrow-Stith Anti-Violence program reduced their violent behavior at follow-up to a significantly greater degree.