Tamara Fahnhorst

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.

Assessment Issues in Adolescent Drug Abuse Treatment Research

Experimentation with alcohol and other drugs (AOD) is commonplace among American adolescents. Despite reduction efforts, the use of AOD by adolescents has increased over the past decade. A number of youth experience significant negative personal, societal, economic, and health ramifications, but continue to abuse AOD and develop substance use disorders (SUD). Accurate assessment of adolescent AOD use is essential in determining the prevalence of SUDs, the development of effective interventions, and the implementation of beneficial prevention initiatives. Developmental considerations are significant factors in the validity of youth AOD assessment and are detailed in this chapter.

The Association Between Attention-Deficit Hyperactivity Disorder and Nicotine Use Among Adolescents and Young Adults

Previous research indicates that youths with attention deficit hyperactivity disorder (ADHD) are more susceptible to nicotine use compared to those without ADHD, and one explanation for this association is the self-medication theory. The present study examines nicotine use in a prospective sample derived from a community sampling procedure rather than a clinical setting. Nicotine use was measured through young adulthood (mean ages: 18, 20, and 22), and three groups were compared based on childhood status: ADHD only, ADHD externalizers, and control groups. Results indicated that at all three data points, individuals with childhood ADHD plus an externalizing disorder reported higher nicotine use on all variables compared to the ADHD group absent of an externalizing disorder and the comparison group of non-ADHD youths. The group differences were significant even after controlling for possible confounding variables (age, gender, and current treatment with psychostimulant medication). Study results are discussed in light of the self-medication hypothesis and of the importance of including nicotine prevention programs for adolescents and young adults with ADHD and externalizing problems.

Data Collection Strategies and Measurement Tools for Assessing Academic and Therapeutic Outcomes in Recovery Schools

Accurate evaluation and documentation of the efficacy of recovery schools can be vital to the continuation and expansion of these beneficial resources. A very limited data set currently exists that examines the value of specific schools established to support adolescents and young adults in recovery; additional research is necessary. The following article outlines the methodology utilized in a current quasi-experimental study evaluating both academic and therapeutic outcomes of adolescents attending recovery high schools as compared to traditional (non-recovery-based) high schools. The developmental considerations in assessing adolescents in recovery and their parents is delineated in this article, which underscores the need for extensive knowledge of adolescent substance abuse and other mental health issues. In addition, sensitivity around privacy among adolescents, parents, schools, and health providers is highlighted, as well as the validity of assessment. Key assessment strategies, including protocol of recruitment and interviewing techniques, are also presented along with a list of parent and adolescent assessment instruments and their corresponding interpretive variables. Protocol recommendations for future research are also outlined.