Satisfaction of parents with their conduct-disordered and substance-abusing youth.

This study examined parental satisfaction (using the Parent Satisfaction With Youth Scale) in 132 parents of adolescents who were dually diagnosed with conduct disorder/oppositional defiant disorder and drug abuse/dependence. Results indicated parental satisfaction did not vary as a function of age, ethnic minority status, or gender. Parents of younger youth were generally more dissatisfied than parents of older adolescents although younger youth were no more delinquent than older youth. These results suggest that parents of delinquent youth become tolerant of their children's behavior problems with time. As expected, parents were most dissatisfied with their youth's use of drugs, illicit behavior, school performance, and response to discipline. Parents who endorsed lower levels of satisfaction reported their youth engaged in more pronounced levels of problem behavior and more drug use than did parents who were relatively more satisfied with their youth. Study implications and future directions are discussed.

Satisfaction of conduct-disordered and substance-abusing youth with their parents.

Conduct-disordered and substance-abusing adolescents (N = 132) completed the Youth Happiness With Parent Scale (YHPS). The YHPS measures youth happiness with parental behaviors across 11 domains (e.g., communication, chores, and discipline) as well as a single item reflecting overall happiness. Results indicated that youth satisfaction did not vary as a function of parents' or youths' age, ethnic minority status, or gender. Although youth were relatively dissatisfied with their parents across behavioral domains (particularly illegal behaviors, drug use, school conduct, and alcohol use), they were fairly satisfied with their parents overall. Youth happiness with parental behaviors was negatively related to externalizing but not internalizing behavioral problems of the youth. Study implications and future directions are discussed in light of the results.

Prevalence and treatment of substance abuse in the mentally retarded population: an empirical review.

This article presents the first comprehensive review of studies of alcohol and illicit substance use in mentally retarded individuals, including prevalence, and recommendations for assessment and treatment. Mentally retarded persons appear to use/abuse alcohol at about the same rate as their noncognitively-impaired counterparts, and illicit drugs at moderately lower rates. However, little is known regarding which assessments and interventions are most effective in this population, given the absence of published treatment outcome studies and case examples. This is particularly disconcerting as detrimental consequences resulting from substance use have been identified in mentally retarded samples. Anecdotal data suggests that treatment for these individuals require modifications of existing empirically-derived substance abuse interventions to accommodate their unique needs.

The relationship of neuropsychological functioning to measures of substance use in an adolescent drug abusing sample.

The purpose of this research was to investigate the relationship between recent and long term substance use on adolescents' neuropsychological functioning. Subjects were 77 adolescents who were referred for outpatient treatment for drug and conduct problems. Subjects were administered the Luria-Nebraska Neuropsychological Battery-III, structured interviews to assess substance use, and urine tests. Subjects were divided into neuropsychologically impaired and nonimpaired groups. Results indicated no significant group differences for: self-reports of lifetime use of alcohol, cannabis, and hard drugs; self or collateral reports of recent (past 30 days) use of alcohol, cannabis, and hard drugs; or urinalysis detection of alcohol, cannabis, and hard drugs. Correlations between these dependent measures of substance use and neuropsychological functioning were also nonsignificant (all ps > .05). Although neuropsychological impairment was observed for some subjects in this sample, it was unrelated to their cannabis, hard drug, or alcohol use. These results are consistent with those found in the adult literature, given the relatively short period of time that these youth have used such substances. However, given the severity of their absolute levels of substance usage, they may be at greater risk for developing future neuropsychological problems, related directly to the ingestion of alcohol and illicit drugs, and to their secondary effects (e.g., head traumas, malnutrition).

Identification of neuropsychological subtypes in a sample of delinquent adolescents.

Although research has long recognized a relationship between neurological dysfunction and delinquency, the nature of this relationship is unclear. Based on the theory that there may be clusters of delinquents with different types of neurological dysfunction which contribute to the delinquency in different ways, the present research attempted to identify these subtypes using neuropsychological testing. Seventy-seven such adolescents were administered the full Luria-Nebraska Neuropsychological Battery-III (LNNB-III) and a battery of assessments measuring behavioral functioning and substance use. A Hierarchical Cluster Analysis yielded four identifiable neuropsychological clusters: Verbal/Left-Hemispheric Deficits, Subcortical-Frontal Deficits, Mild-Verbal Deficits, and Normals. The distinctiveness of these subtypes was confirmed by univariate analyses. Results further indicated that the number of LNNB scales that were in the abnormal range differed per subtype, with each subtype differing significantly from one another. These neuropsychological subtypes were found to be associated with specific psychological and behavioral problems.

Evaluation of an instructional program for improving medication compliance for chronically mentally ill outpatients.

Outpatient medication adherence is a major problem, especially for patients repeatedly hospitalized for psychiatric disorders. This study included 39 such patients who were receiving case management services from a community mental health center. Patients were matched and randomly assigned to receive in a single session either (1) information regarding medication and its benefits, (2) guidelines for assuring adherence which encompassed all phases related to pill-taking including filling prescriptions, use of a pill container, transportation, self-reminders, doctor's appointments and so forth, or (3) the same guidelines as (2) above but given in the presence of a family member who was enlisted in support. The results showed that adherence increased to about 94% after the guidelines were given for both the individual and family guideline procedure, whereas adherence remained unchanged at 73% after the medication information procedure. These results suggest a practical means for assuring a high level of medication adherence for patients with psychiatric disorders.

Follow-up results of supportive versus behavioral therapy for illicit drug use.

Follow-up data (mean 9 months) were obtained for 74 subjects who had been treated for a mean of 8 months and 17 sessions in a controlled comparison of Behavioral vs Supportive Counselling for drug abuse. Based on urinalysis, self-report, and family report, all subjects (100%) were actively using drugs at pre-treatment. During the last month of treatment, 81% of the Supportive treatment subjects and 44% of the Behavioral treatment subjects were using drugs at least once. At the follow-up month, drugs were used at least once by 71% of the Supportive vs 42% of Behavioral subjects. When drug use was measured in terms of the number of days of use per month, Supportive counselled subjects did not decrease drug use either by the end of treatment or at follow-up; for Behavioral subjects, drug use decreased by 63% by the end of treatment and by 73% at follow-up. Alcohol use, and days worked/or in school showed a similar pattern of greater improvement for the Behavioral treatment being maintained at the follow-up. These results indicate a substantial treatment-specific reduction of drug usage that endures after treatment is discontinued. The present favorable results appear attributable to the inclusion of family/significant others in therapy and the use of reinforcement contingent on urinalysis results.

Behavioral and pharmacological treatments for tic and habit disorders: a review.

Children with tic and habit disorders are often seen by pediatricians, psychologists, or psychiatrists for evaluation and treatment. Current knowledge of the treatment-outcome research in these areas can serve as an important guide in the evaluation and treatment planning process. This article reviews the behavior therapy and pharmacological treatment of motor and vocal tic disorders, self-destructive oral habits, trichotillomania (hair pulling), onychophagia (nail biting), and thumb sucking. The research evidence indicates that all of these disorders can be effectively treated with behavioral or pharmacological approaches.

Behavior therapy for drug abuse: a controlled treatment outcome study.

82 Ss were studied in a comparative evaluation of a behavioral vs supportive treatment for illegal drug use. Behavioral treatment included stimulus control, urge, control, contracting/family support and competing response procedures for an average of 19 sessions. 37% of Ss in the behavioral condition were drug-free at 2 months, 54% at 6 months, and 65% at 12 months vs 20 +/- 6% for the alternative treatment during all 12 months. The behavioral treatment was more effective across sex, age, educational level, marital status and type of drug (hard-drugs, cocaine, and marijuana). Greater improvement for this condition was also noted on measures of employment/school attendance, family relationships, depression, institutionalization and alcohol use.

An evaluation of behavioral treatments for Tourette syndrome.

The present study evaluated the effectiveness of self-monitoring, relaxation training and habit reversal in the treatment of 6 Tourette Syndrome (TS) subjects with multiple motor and vocal tics. A counterbalanced design was employed and tic frequencies were measured in the clinic setting using videotapes taken through a one-way mirror. Tics were reduced by an average of 55% with habit reversal, 44% with self-monitoring, and 32% with relaxation training and each behavioral procedure was the most effective treatment for at least one subject. All three treatment approaches may have some utility in the behavioral treatment of TS.

Bulimia: a case illustration of the superiority of behavioral over cognitive treatment.

The present study compared the relative efficacy of two major clinical procedures previously used in multicomponent cognitive-behavioral programs for treating bulimia. A single-subject experimental design was used and the results showed that the behavioral procedure of exposure plus response prevention was more effective than the cognitive procedure in reducing binge and vomit episodes as well as the urges to binge-vomit. These results suggest that the exposure plus response prevention component is more relevant for cognitive as well as behavioral changes in treating bulimia.

Family-member involvement to initiate and promote treatment of problem drinkers.

The present study evaluated a method of teaching distressed family members of problem drinkers how to minimize their own distress, reduce the drinking, increase the motivation of the alcoholic to obtain formal treatment and assist in the treatment program. Twelve concerned family members were given either community-reinforcement counseling or a traditional type of counseling (control group). The reinforcement counseling resulted in more alcoholic persons obtaining treatment than did the traditional type and a greater reduction in drinking before the formal treatment was obtained; drinking was reduced further during the joint treatment of the family members and problem drinkers. These results suggest that the drinking of unmotivated alcoholic persons can be reduced by counseling concerned family members in the use of appropriate reinforcement procedures and can lead to the initiation of formal treatment.

Vomiting reduction by slower food intake.

Psychogenic vomiting of retarded persons might be partly the result of stomach overloading. A retarded male subject was treated by spacing the food intake and teaching him to eat more slowly. Vomiting decreased during the spaced food intake, resumed during normal intake, and decreased again during the reinstated spaced intake. These results indicate the importance of food-intake factors in psychogenic vomiting.

Alcoholism treatment by disulfiram and community reinforcement therapy.

Traditional disulfiram treatment has often been ineffective because of a failure to maintain usage. The present study with 43 alcoholics compared: (1) a traditional disulfiram treatment, (2) a socially motivated Disulfiram Assurance program and (3) a Disulfiram Assurance program combined with reinforcement therapy. About five sessions were given for each program. At the 6-month follow-up, the traditional treatment clients were drinking on most days and no longer taking the medication. The Disulfiram Assurance treatment resulted in almost total sobriety for married or (cohabitating) clients but had little benefit for the single ones. The combined program produced near-total sobriety for the single and married clients. These results indicate a promising integration of chemical, psychological and social treatment of alcoholism.

Habit reversal vs negative practice treatment of self-destructive oral habits (biting, chewing or licking of the lips, cheeks, tongue or palate).

Ten patients with oral habits such as biting, chewing licking, or pushing of the cheeks, lips, teeth, or palate were randomly assigned to either habit reversal treatment or to negative practice treatment. Treatment was given in a single 2-hr session. The patients receiving negative practice treatment showed a mean reduction of about 65%, those receiving the habit reversal treatment showed a mean reduction of about 99% during the 22-months of follow-up.