Citation: Outpatient interventions for adolescent substance abuse: A quality of evidence review. Journal of Consulting and Clinical Psychology. Vol 76(4) Aug 2008, 531-543. Authors: Becker, Sara J; Curry, John F.
This review compared 31 randomized clinical trials of teen drug abuse treatments on the basis of the research methods used in the studies. The authors evaluated the studies based on a number of attributes that they consider to be established methods of preventing bias, and noted that most of these bias-preventing attributes were neglected in the majority of clinical trials under review.
Problems With The Current Studies On Teen Drug Abuse Treatment
The authors are highly critical of the methods of all of the studies under consideration. For example, while randomization of study participants was a prerequisite for inclusion in their review, they found that few of the studies reported on the measures that had been taken to ensure random assignment of the teen drug abusers involved. The authors report that the majority of the studies they looked at had used samples so small that they were at risk for failing to find positive treatment effects that a larger study would have found. They note that most studies failed to identify the primary hypotheses being tested, thereby putting the results at risk of overinterpreting the data through the analysis of multiple outcomes.
Fewer than 20% of the studies under review reported adequate blinding in the assessment of treatment outcomes, and fewer than 33% included all study participants in the final analysis. Nearly 20% of the studies billed as randomized clinical trials failed to use purely random methods to assign teenage drug abuse patients into treatment groups.
Effective Treatments for Teen Drug Abuse
Taking all of these methodological considerations into account, the authors state that the secondary goal of their study was to “evaluate the quality of evidence in support of different treatment models.” Some of the stronger teen drug abuse treatment modalities, picked from the most methodologically sound studies included in the review, included:
- Ecological Family Therapy
- Brief Motivational Intervention
- Cognitive Behavioral Therapy (CBT)
Of the treatment methods under review, teen drug abuse group therapy was the only one that was found to be ineffective in more than one of the better-quality studies under review.
The authors also note that research in the area of adolescent substance abuse is extremely challenging to perform, and that research methods in this area have improved over the past 2 decades. However, they assert that there is still a great deal of improvement to be made in this area in order that these studies can provide us with good quality information on the likelihood of teen drug abuse treatments to affect the desired outcomes.
Comments (0) • Drug Abuse, Teen Drug Abuse • August 2008
Citation: Amy A. Mericle, Ph.D.; Jennifer Alvidrez, Ph.D.; Barbara E. Havassy, Ph.D. Mental Health Provider Perspectives on Co-Occurring Substance Use Among Severely Mentally Ill Clients. Journal of Psychoactive Drugs, June 2007, 39(2), p.173-181
Although there is a well-established relationship between severe mental illness and substance abuse, few studies have directly addressed the practical issues that psychotherapists face in working with clients suffering from comorbid severe mental illness and alcohol or drug abuse disorders.
The studies that have been done have begun to explore clinicians’ perceptions of and attitudes toward the challenges of implementing drug abuse treatment strategies with these individuals, as well some of the administrative challenges that arise. These studies have found that clinicians’ tend to experience these clients as more challenging than simpler cases but no less rewarding, and that administrators rank social stigma and historical differences between treatment modalities for the two types of disorders as the greatest barriers to treatment.
However, the authors claim that the existing literature does not provide an adequate understanding of “what it is actually like for providers working directly with individuals with such disorders…” or the strategies that providers find success with. The authors’ interest in advancing this area of research is to expand the presently available knowledge of structural impediments to successful treatment of dual-diagnosis severe mental illness/substance abuse patients in order to suggest policy improvements. To that end, the authors conducted focus groups with service providers from public intensive case management (ICM) programs which provide intensive integrated services to “high users of county psychiatric services due to primary mental disorders.”
Strategies In Use For Drug Abuse Treatment With The Severely Mentally Ill
The authors identified a number of strategies that their participants use for alcohol and drug abuse treatment among severe mental illness clients and the perceived barriers to implementing those strategies. The primary strategies used in terms of direct therapeutic interventions were harm reduction techniques, confrontation, and motivational interviewing. The main strategy appeared to be “sheer persistence in bringing up the clients’ substance use over time.”
More indirect strategies that the providers were using revolved around basic psychotherapeutic strategies that a clinician would use with any client: building a trusting therapeutic relationship and strong working alliance. Study participants also reported capitalizing on external pressures, such as court mandates, and providing information and referrals to push their clients in the direction of recognizing and getting treatment for their drug and alcohol abuse disorders.
Barriers To Implementing Drug Abuse Treatment Strategies
The main barriers to implementing these strategies for treating drug and alcohol abuse occurred at the client level, the provider level, the system level, and the environmental level. Client-level barriers revolved around denial of substance abuse problems and lack of motivation to receive treatment. The main provider-level barriers were the need to address competing treatment demands, lack of training in addictions treatment, and the desire to preserve the therapeutic relationship in the face of strong resistance to recognition that substance abuse is a problem for the client at all.
Systemic barriers to alcohol and drug abuse treatment revolved around a lack of resources: lack of adequate case management resources and continuity of care, and lack of economic resources to provide treatment to all individuals in need of it. Finally, the study participants noted environmental barriers including severe poverty and isolation from healthy individuals and communities. severe mental illness substance abuse patients are frequently surrounded by other substance-users.
Comments (0) • Drug Abuse, Drug Alcohol Abuse, Substance Abuse Treatment • June 2008