Holly B. Waldron

Assessing adolescent substance use: a critique of current measurement instruments.

A variety of instruments are currently available to screen for and assess adolescent substance abuse and aid in planning appropriate interventions. Assessment practices in treatment facilities for adolescents have tended to rely on the use of unstandardized, local measures or on measures developed for adults with unknown reliability and validity for adolescents. This review is designed to serve as a resource for health professionals regarding the issues involved in assessing adolescent substance involvement and the types of instruments that are available for use. Conceptual issues relevant to the evaluation of adolescent substance use are discussed. Then, standardized, adolescent-specific assessment tools are briefly summarized, including screening questionnaires, comprehensive instruments, and several other substance-related instruments.

Ethical issues in research on the treatment of adolescent substance abuse disorders

Treatment research on adolescent substance use disorders raises a number of important ethical and legal concerns which have not been widely acknowledged. This paper explores these concerns as they relate to fundamental ethical principles in the conduct of human research. The issues discussed include tensions between conflicting regulations governing informed consent for research and treatment of adolescents, the capacity of adolescents to give informed consent, potentially coercive elements related to research on substance use treatment, problems associated with confidentiality and release of information, research vulnerability associated with substance use, and ethical implications of distinctions between effectiveness and efficacy research. Suggestions for ways investigators may address these concerns are provided.

Adolescent Substance Abuse and Family Therapy Outcome

Family therapy as a treatment for substance abuse was embraced in community mental health agencies and other clinical settings in the 1970s and came to be viewed as a viable treatment alternative for many at-risk populations, including adolescents (Coleman & Davis, 1978; Kaufman & Kaufman, 1992). In the clinical literature, the importance of family-based interventions for substance abuse has remained widely accepted (Craig, 1993), and family therapy is frequently implemented with adolescent abusers (cf. Selekman & Todd, 1991). As in the broader family therapy literature, however, treatment approaches have been derived primarily from theories of family functioning and clinical experience, rather independently from research (Bry, 1988), and with little attention to systematic evaluation.

Interpersonal problem-solving interactions of depressed adolescents and their parents

Research to date suggests that the family plays a significant role in the development, perpetuation, and relapse of depression in its members. This study examined the videotaped interactions of parents with a depressed adolescent and control parents and youth during a conflictual, problem-solving task. In comparison with parents of nondepressed adolescents, parents of depressed adolescents engaged in higher rates of incongruent communication in which aversive content behavior was linked with positive affective behavior. Adolescent depressed content behavior led to greater suppression of parent aversive content behavior in nondepressed families than in depressed families. The findings argue that dysfunctional family communication may be associated with the development or maintenance of depression in the child.

Coding defensive and supportive communications: discriminant validity and subcategory convergence

The Defensive and Supportive Communication (DSC) Interaction Coding System has been used frequently in the study of interactions in families with a juvenile delinquent. One limitation of the DSC system has been the lack of research examining the psychometric properties of the coding system. Discriminant analyses were used to examine the communication behaviors of members of 18 normal and 20 delinquent families and to determine the use of subcategories by different family members. Convergence among the subcategories for each of the main categories, defensiveness and supportiveness, was found.

Chapter 16 – Alcohol and Drug Abuse

Publisher Summary This chapter provides a theoretical rationale and practical suggestions for intervention with teens experiencing alcohol and other drug problems. It presents the theoretical rationale for two different treatment models and presents a case example to illustrate the subject. Two of the key developmental issues that must be considered when treating substance abusers are peer groups and identity formation. Adolescents with substance use problems are a heterogeneous group, with individual differences such as the anticipated effects and consequences resulting from substance use, the context and motivations in which use occurs, and the factors that contribute to or accompany substance use involvement. These differences also help explain the question that some substance-abusing adolescents respond to treatment, while others do not. The cognitive-behavioral and family treatments hold differing perspectives on the development and maintenance of substance use disorders, there is some procedural overlap between family and individual approaches. However, an integrative approach would allow for the flexible use of overlapping therapeutic interventions in a manner that is responsive to the needs of clients. And finally, therapists can schedule family and individual sessions as clinically appropriate to enhance positive outcomes.