Andria Botzet

A prospective study of youth gambling behaviors

Little is known about the course and outcomes of adolescent gambling. This prospective study describes findings from a 3-wave (Time 1 [T1], Time 2 [T2], and Time 3 [T3]) assessment of gambling behaviors among youth (N = 305). Stable rates of any gambling and regular gambling (weekly or daily) were observed across T1, T2, and T3. The rate of at-risk gambling significantly increased at T3 (young adulthood), whereas the rate of problem gambling remained stable over time. Several adolescent risk factors were associated with either T3 at-risk or problem gambling, many of which are risk factors for adolescent substance abuse. Findings suggest that important to the origins of young adult gambling problems are risk factors associated with the problem behavior syndrome of adolescence.

Pathways of youth gambling problem severity

Prospective studies are needed to advance knowledge of the developmental features of gambling involvement and associated problems. Developmental pathways of youth gambling problem severity (no problem gambling, at-risk gambling, and problem gambling) are described on the basis of a 3-wave data set that spans midadolescence to young adulthood (N=305). The most prevalent group was the resistors (no problem gambling at all data points); 60% of study participants were in this group. New incidence cases (no problem gambling followed by at-risk or problem gambling) and desistors (at-risk or problem gambling followed by no problem gambling) were found among 21% and 13% of participants, respectively. Only 4% of cases were persistors, that is, at-risk or problem gambling at all 3 data waves. Findings are discussed in light of extant research on adolescent gambling that heretofore has not benefited from a developmental pathway perspective.

Brief intervention for drug-abusing adolescents in a school setting: Outcomes and mediating factors

This randomized controlled trial evaluated the use of two brief intervention conditions for adolescents (aged 12-18 years) who have been identified in a school setting as abusing alcohol and other drugs. Adolescents and their parents (N = 315) were randomly assigned to receive either a two-session adolescent-only (BI-A), two-session adolescent and additional parent session (BI-AP), or assessment-only control condition (CON). Interventions were manually guided and delivered in a school setting by trained counselors. Adolescents and parents were assessed at intake and at 6 months following the completion of the intervention. Analyses of relative (change from intake to 6 months) and absolute (status at 6 months) outcome variables indicated that for the most part, adolescents in the BI-A and BI-AP conditions showed significantly more reductions in drug use behaviors compared with the CON group. In addition, youth receiving the BI-AP condition showed significantly better outcomes compared with the BI-A group on several variables. Problem-solving skills and use of additional counseling services mediated outcome. The value of a school-based brief intervention for students is discussed.

Advances in Adolescent Substance Abuse Treatment

Alcohol and other drug use among adolescents has been a public health problem for decades. Although some substance use may be developmentally routine, a concerning number of adolescents meet criteria for a substance use disorder and could greatly benefit from a quality treatment experience. However, parents and health care providers want evidence of the efficacy of adolescent-specific treatment programs. This review summarizes four factors surrounding the efficacy of current adolescent treatment programs: 1) adolescent-specific treatment services; 2) the variety of therapeutic modalities; 3) relapse and recovery rates; and 4) the need for evidence-based, quality assessments and research. Current adolescent treatment efforts are summarized, and the recent literature regarding the efficacy of adolescent treatment and recovery rates is discussed.

Impulsivity and its Relationship to Risky Sexual Behaviors and Drug Abuse

We examined a mediational model of the interrelationship of drug use, sexual risk, and impulsivity in a sample of young adults (N = 89), of which almost half displayed highly disruptive behaviors as children. We chose a mediational model given the emerging evidence that impulsivity is an underlying risk factor for many youth health risk problems, including sexual risk behaviors. The findings supported a partial mediational model in that the three target variables were significantly related to one another, yet the association of drug use and sexual risk was significantly reduced (although not to zero) when controlled by impulsivity. The findings support the view that the association of drug use and sexual risk behaviors is partially mediated by impulsivity, as well as the broader theory that youths with deficits in self-regulatory behavioral systems confer a greater likelihood of engaging in risky behaviors. Study implications and limitations are discussed.

Adolescent Substance Abuse Treatment: A Review of Evidence-Based Research

Significant progress has been made since 1990 in the development and evaluation of treatments for adolescent drug abuse. This body of research reflects a greater focus on varying interventions using different theory-based psychotherapies, as well as a recognition of the unique developmental milestones specific to adolescents. Several modalities and approaches meet standards of evidence-based treatments, and that, in general, they are comparable in terms of outcomes.

One-year outcomes and mediators of a brief intervention for drug abusing adolescents

Two manually guided brief interventions were evaluated with a randomized, controlled trial. Adolescents (aged 13-17 years) suspected of abusing alcohol and other drugs and their parent were randomly assigned to receive either a 2-session adolescent only (BI-A), 2-session adolescent and additional parent session (BI-AP), or assessment only control condition (CON). Adolescents were identified in a school setting, and the intervention was delivered by trained counselors. Outcome analyses (N = 284; 90% of those enrolled) of relative change (from intake to 12 months) and absolute status (at 12 months) revealed a general pattern of reductions in drug use behaviors, particularly with the cannabis outcome measures, in both active conditions (BI-A and BI-AP). Students in the control condition showed worse outcome compared with the BI-A and BI-AP groups. Among the 4 mediating variables measured at 6 months, use of additional services, motivation to change, and parenting practices had significant influences on 12-month outcome; problem-solving skills approached significance as a mediator. The potential value of a brief intervention for drug abusing adolescents is discussed.

A Prospective Examination of the Association of Stimulant Medication History and Drug Use Outcomes among Community Samples of ADHD Youths.

A continuing debate in the child psychopathology literature is the extent to which pharmacotherapy for children with attention-deficit/hyperactivity disorder (ADHD), in particular stimulant treatment, confers a risk of subsequent drug abuse. If stimulant treatment for ADHD contributes to drug abuse, then the risk versus therapeutic benefits of such treatment is greatly affected. We have prospectively followed an ADHD sample (N = 149; 81% males) for approximately 15 years, beginning at childhood (ages 8 to 10 years) and continuing until the sample has reached young adulthood (ages 22 to 24 years). The sample was originally recruited via an epidemiologically derived community procedure, and all youths were diagnosed with ADHD during childhood. We report on the association of childhood psychostimulant medication and subsequent substance use disorders and tobacco use. The substance use outcomes were based on data collected at three time points when the sample was in late adolescence and young adulthood (age range approximately 18 to 22 years old). We did not find evidence to support that childhood treatment with stimulant medication, including the course of stimulant medication, was associated with any change in risk for adolescent or young adulthood substance use disorders and tobacco use. These results from a community-based sample extend the growing body of literature based on clinically derived samples indicating that stimulant treatment does not create a significant risk for subsequent substance use disorders.

Drug use and psychosocial functioning of a community-derived sample of adolescents with childhood ADHD

We describe the late adolescent psychosocial outcomes from a relatively large, community-identified sample of children with ADHD who have been assessed longitudinally from childhood through late adolescence. A range of outcomes were compared between ADHD (n = 119) and normal control (n = 93) groups, as well as ADHD subgroups that varied as a function of the course of externalizing predominantly ODD problems (persisters, desisters, escalaters, and resisters). ADHD youths that did not show externalizing problems during childhood (ADHD resisters) were associated with drug use outcomes generally comparable to the normal non-affected controls. All other ADHD groups with externalizing problems (ADHD persisters, ADHD escalaters, and ADHD desisters) consistently revealed worse drug use outcomes compared to controls/ADHD resisters. However, ADHD youths with or without externalizing problems showed worse outcomes compared to the control group on the non-drug, psychosocial functioning variables. The study highlights that ADHD with coexisting disruptiveness, whether the disruptiveness persists or remits before adolescence, is associated with an increased risk for drug involvement and that ADHD, regardless of the comorbid pattern, confers a poorer level of psychosocial functioning.

Development and psychometric evaluation of the gambling treatment outcome monitoring system (GAMTOMS).

This article describes the development and initial reliability and validity estimates of the Gambling Treatment Outcome Monitoring System (GAMTOMS), a multi-instrument and multidimensional outcome assessment battery designed to measure gambling treatment outcomes. Reliability methods included both internal consistency of scales and a 1-week test-retest temporal stability procedure. Validity was examined with procedures to estimate content, convergent, discriminant, predictive, and construct validity. Data were collected from 2 separate studies, 1 on the questionnaire version and 1 on the interview version. The questionnaire study included 46 female and 41 male gambling treatment clients and 22 female and 2 male nonclinical participants. The interview study included 88 female and 62 male gambling treatment clients and 16 female and 9 male nonclinical participants. The GAMTOMS was found to yield satisfactory estimates of internal consistency, and 1-week test-retest reliability and was also found to demonstrate satisfactory content, convergent, discriminant, predictive, and construct validity.