Frank M. Tims

Outpatient marijuana treatment for adolescents. Economic evaluation of a multisite field experiment.

An economic evaluation of five outpatient adolescent treatment approaches (12 total site-by-conditions) was conducted. The economic cost of each of the 12 site-specific treatment conditions was determined by the Drug Abuse Treatment Cost Analysis Program (DATCAP). Economic benefits of treatment were estimated by first monetizing a series of treatment outcomes and then analyzing the magnitude of these monetized outcomes from baseline through the 12-month follow-up. The average economic costs ranged from

Early Therapeutic Alliance as a Predictor of Treatment Outcome for Adolescent Cannabis Users in Outpatient Treatment

90 to

Psychiatric syndromes in adolescents with marijuana abuse and dependency in outpatient treatment

313 per week and from

Alcohol and the Adult Brain: edited by J. Svanberg, A. Withall, B. Draper and S. Bowden, Hove, UK, Psychology Press, 236 pp.,

839 to

54.95 (softback), ISBN-13: 978-1848723085

3,279 per episode. Relative to the quarter before intake, the average quarterly cost to society for the next 12 months (including treatment costs) significantly declined in 4 of the 12 site-by-treatment conditions, remained unchanged in 6 conditions, and increased in 2 treatment conditions (both in the same site). These results suggest that some types of substance-abuse intervention for adolescents can reduce social costs immediately after treatment.

Alcohol and the Adult Brain

The association of early alliance to treatment attendance and longitudinal outcomes were examined in 356 adolescents participating in a randomized clinical trial targeting cannabis use. Both patient and therapist views of alliance were examined, and outcomes were evaluated over 12 months after numerous other sources of variance were controlled. Patient-rated alliance predicted a reduction in cannabis use at three and six months and a reduction in substance-related problem behaviors at six months. Therapist-rated alliance did not predict outcomes. Neither patient nor therapist alliance ratings were associated with attendance. The findings support the important and often overlooked role that alliance can play in treating substance abusing, often delinquent, adolescents.

The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized trials

ABSTRACT 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.

The Cannabis Youth Treatment (CYT) experiment: rationale, study design and analysis plans

Economists like to remind us that there is no free lunch —we might extend that observation to misuse of alcohol, and the failure of health policy to address it. In many societies, beverage alcohol is ubiquitous. Small amounts may be beneficial to health (e.g., neuroprotective at low levels), but consequences of hazardous use over time may include physical, psychological, economic, and social harm. The editors and authors of this volume focus on the brain and associated systems that are affected by hazardous drinking. Recent increases in high risk alcohol consumption make this volume especially timely. Svanberg, Withall, Draper, and Bowden have brought together a broad array of experts in twelve chapters to systematically examine the risks and consequences of alcohol misuse to the adult brain, and strategies to cope with a major public health problem. Their adult brain focus is useful since many of the syndromes addressed have a long causal trajectory, and the developmental risks in adolescents are a separate and complex area. Like other psychoactive substances, alcohol offers immediate rewards (e.g., self-medication of anxiety, relaxation, and even brief stimulation) but continued use at high levels can inflict lasting damage. The organization of the book, with its international range of contributors, explores key issues that set forth a wide agenda for further work in clinical, neurological, epidemiological, and health services research. It sets forth many factors that may inhibit early diagnosis and timely therapy, as well as help-seeking among the afflicted and their families. The first chapter presents a broad and useful overview. Major themes that run through this volume include long-term neurobiological effects of alcohol consumption, the role of nutrition and metabolism, structural and functional changes in different areas of the brain, complexity and comorbidity of alcohol-induced conditions, age-related issues associated with alcohol disorders, problems of under-diagnosis among clients, along with unreliability of prevalence estimates, improved assessment, challenges of treatment engagement in the presence of cognitive impairment, and services for the client with alcohol-related brain damage (ARBD). In Chapter 2, Scalzo, Bowden, and Hillbom examine Wernicke-Korsakoff Syndrome (WKS) in its development through the acute phase of Wernicke’s encephalopathy (WE) and Korsakoff Syndrome (KS), which presents as an amnesiac disorder and may be acute or chronic. WE neurological signs and symptoms (confusion, ophthalmoplegia and ataxia) involves CNS lesions that may result from alcohol’s effect on metabolism, especially involving thiamine deficiency, may be mild to moderate and may be missed in diagnosis. In addition to psychometric and MRI approaches to diagnosis of WKS, detection of thiamine deficiency is especially important, since this vitamin has a role in carbohydrate metabolism. WKS may vary in its dementia-like presentation, and prospects for recovery are not well understood. Thiamine dosing as part of the treatment regimen may bring about improvement. In Chapter 3, Ridley and Draper examine the epidemiology of alcohol-related dementia (ARD) and ARBD. Attempts to survey alcohol-related cognitive disorders are complicated by nosological issues and methodological differences, as well as mild to moderate cognitive impairment being frequently undetected in risk populations. A clear example of the magnitude of the under-diagnosis is underscored by the range of estimates (5 to 15%) of total dementia cases said to be related to alcohol. Under-diagnosis of WKS is borne out by post-mortem data. The authors expect new diagnostic approaches such as DSM-5 to provide better data on alcohol-related disorders, though this remains to be seen. In Chapter 4, Johnco and Draper address social and cultural factors that bear on problematic alcohol consumption and ARBD. Differing patterns in relation to local customs, socioeconomic development, employment, educational levels, minorities, migration, religion, and other factors are examined. Partially because there

Cannabis use: consistency and validity of self‐report, on‐site urine testing and laboratory testing

Economists like to remind us that there is no free lunch —we might extend that observation to misuse of alcohol, and the failure of health policy to address it. In many societies, beverage alcohol is ubiquitous. Small amounts may be beneficial to health (e.g., neuroprotective at low levels), but consequences of hazardous use over time may include physical, psychological, economic, and social harm. The editors and authors of this volume focus on the brain and associated systems that are affected by hazardous drinking. Recent increases in high risk alcohol consumption make this volume especially timely. Svanberg, Withall, Draper, and Bowden have brought together a broad array of experts in twelve chapters to systematically examine the risks and consequences of alcohol misuse to the adult brain, and strategies to cope with a major public health problem. Their adult brain focus is useful since many of the syndromes addressed have a long causal trajectory, and the developmental risks in adolescents are a separate and complex area. Like other psychoactive substances, alcohol offers immediate rewards (e.g., self-medication of anxiety, relaxation, and even brief stimulation) but continued use at high levels can inflict lasting damage. The organization of the book, with its international range of contributors, explores key issues that set forth a wide agenda for further work in clinical, neurological, epidemiological, and health services research. It sets forth many factors that may inhibit early diagnosis and timely therapy, as well as help-seeking among the afflicted and their families. The first chapter presents a broad and useful overview. Major themes that run through this volume include long-term neurobiological effects of alcohol consumption, the role of nutrition and metabolism, structural and functional changes in different areas of the brain, complexity and comorbidity of alcohol-induced conditions, age-related issues associated with alcohol disorders, problems of under-diagnosis among clients, along with unreliability of prevalence estimates, improved assessment, challenges of treatment engagement in the presence of cognitive impairment, and services for the client with alcohol-related brain damage (ARBD). In Chapter 2, Scalzo, Bowden, and Hillbom examine Wernicke-Korsakoff Syndrome (WKS) in its development through the acute phase of Wernicke’s encephalopathy (WE) and Korsakoff Syndrome (KS), which presents as an amnesiac disorder and may be acute or chronic. WE neurological signs and symptoms (confusion, ophthalmoplegia and ataxia) involves CNS lesions that may result from alcohol’s effect on metabolism, especially involving thiamine deficiency, may be mild to moderate and may be missed in diagnosis. In addition to psychometric and MRI approaches to diagnosis of WKS, detection of thiamine deficiency is especially important, since this vitamin has a role in carbohydrate metabolism. WKS may vary in its dementia-like presentation, and prospects for recovery are not well understood. Thiamine dosing as part of the treatment regimen may bring about improvement. In Chapter 3, Ridley and Draper examine the epidemiology of alcohol-related dementia (ARD) and ARBD. Attempts to survey alcohol-related cognitive disorders are complicated by nosological issues and methodological differences, as well as mild to moderate cognitive impairment being frequently undetected in risk populations. A clear example of the magnitude of the under-diagnosis is underscored by the range of estimates (5 to 15%) of total dementia cases said to be related to alcohol. Under-diagnosis of WKS is borne out by post-mortem data. The authors expect new diagnostic approaches such as DSM-5 to provide better data on alcohol-related disorders, though this remains to be seen. In Chapter 4, Johnco and Draper address social and cultural factors that bear on problematic alcohol consumption and ARBD. Differing patterns in relation to local customs, socioeconomic development, employment, educational levels, minorities, migration, religion, and other factors are examined. Partially because there