Multidimensional family therapy for adolescent drug abuse: results of a randomized clinical trial.

Random assignment was made of 182 clinically referred marijuana- and alcohol-abusing adolescents to one of three treatments: multidimensional family therapy (MDFT), adolescent group therapy (AGT), and multifamily educational intervention (MEI). Each treatment represented a different theory base and treatment format. All treatments were based on a manual and were delivered on a once-a-week outpatient basis. The therapists were experienced community clinicians trained to model-specific competence prior to the study and then supervised throughout the clinical trial. A theory-based multimodal assessment strategy measured symptom changes and prosocial functioning at intake, termination, and 6 and 12 months following termination. Results indicate improvement among youths in all three treatments, with MDFT showing superior improvement overall. MDFT participants also demonstrated change at the 1-year follow-up period in the important prosocial factors of school/academic performance and family functioning as measured by behavioral ratings. Results support the efficacy of MDFT, a relatively short-term, multicomponent, multitarget, family-based intervention in significantly reducing adolescent drug abuse and facilitating adaptive and protective developmental processes.

Predictors of engagement in adolescent drug abuse treatment.

OBJECTIVES: To identify key demographic, parent, and adolescent characteristics that influence engagement in outpatient drug abuse treatment. METHOD: Youths aged 12 to 17 years (N = 224; 81% male and 72% African American) referred for drug treatment and their parents participated in this study. Marijuana was the primary substance of abuse. Data were gathered prior to treatment on demographic variables as well as on both parent and youth perspectives on youth, parent, and family functioning. RESULTS: A discriminant function analysis revealed that engagement in treatment was related to, in order of weighting, more positive parental expectations for their adolescent's educational achievement (standardized discriminant function coefficient [SDF] = 0.68), higher parental reports of youth externalizing symptoms (SDF = 0.59), and higher levels of family conflict perceived by the youth (SDF = 0.36). Family income, gender, juvenile justice status, minority group status, family structure, parental age and psychopathology, and treatment characteristics did not distinguish treatment-engaged from unengaged adolescents. CONCLUSIONS: The results suggest that both parent and youth perceptions are pivotal to whether or not adolescents are engaged in psychotherapy. These findings lead the authors to recommend adolescent engagement interventions focusing on both the youth and his or her parents and suggest a content focus for adolescent engagement interventions.

Understanding gender differences in adolescent drug abuse: issues of comorbidity and family functioning.

Female adolescent drug use has increased dramatically in the last 30 years, and there is a growing consensus that the syndrome of female adolescent substance abuse is different from the well-recognized male pattern. Gender differences in patterns of comorbidity and family functioning were investigated in a sample of 95 youths (42 girls and 53 boys) referred for substance abuse treatment. The findings indicate that male and female adolescent substance users differ in several clinically meaningful ways. The results from a discriminant function analysis indicate that substance-using adolescents referred to treatment are distinguished especially by the greater degree to which girls have internalizing symptoms and family dysfunction. The clinical implications of these gender differences are articulated.

Personality change in Parkinson's disease patients: chronic disease and aging.

Parkinson's disease patients (N = 41, mean age = 65 years) were described by themselves and their spouses as they were presently and before their illness using the Adjective Check List. Equivalent self- and spouse descriptions were obtained from the members of a matched community sample (N = 96). Descriptions of patients and their spouses converged, both reporting sharp, pervasive (e.g., on all of the Big Five dimensions), and uniformly negative change in personality. Similar, but much less marked change was found in the community sample. The data as a set suggest that the reported changes in the patients were veridical and that their magnitude was primarily the result of the disease rather than aging. Evidence of continuities in personality (for example, differential stability) was also noted. We argued that the illness accelerated and intensified changes normally expected in later life.

The affective consequences of social comparison: either direction has its ups and downs.

Research on social comparison processes has assumed that a comparison in a given direction (upward or downward) will lead to a particular affective reaction. In contrast, the present two studies proposed and found that a comparison can produce either positive or negative feelings about oneself, independent of its direction. Several factors moderated the tendency to derive positive or negative affect from upward and downward comparisons. In Study 1, cancer patients low in self-esteem and with low perceived control over their symptoms and illness were more likely to see downward comparisons as having negative implications for themselves. Those low in self-esteem were also more likely to perceive upward comparisons as negative. In Study 2, individuals with high marital dissatisfaction and those who felt uncertain about their marital relationship were more likely to experience negative affect from upward and downward comparisons. The implications of these findings for social comparison theory and for the coping and adaptation literature are discussed.

Victims' perceptions of social support: what is helpful from whom?

Although research has demonstrated that social interactions influence psychological well-being, little is known about what specific actions victims of stressful life events experience as helpful or unhelpful. Wortman and Dunkel-Schetter (1979) previously suggested that victims frequently experience rejection, withdrawal, and communication problems with those close to them. To address these issues, 55 cancer patients were interviewed concerning the specific actions they found to be helpful or unhelpful from several potential support providers: spouse, other family members, friends, acquaintances, others with cancer, physicians, and nurses. The data indicated that the Wortman and Dunkel-Schetter victimization model applied better to interactions with friends and acquaintances than to interactions with close family members. In addition, support was found to be partially dependent on the source: Particular actions were perceived to be helpful from some but not other network members. Implications for theory and research on social support are discussed.

Patterns of adaptation to Parkinson's disease.

Forty-four 50- to 80-year-old Parkinson patients were interviewed about the effects of the disease on their lives. The Q-sort technique was used to analyze the interview data. In addition, the Symptom Checklist 90, the Mini-Mental State, and physician ratings of disease severity were obtained. Four clusters of patients were identified. Cluster I patients were sanguine and engaged; Cluster III patients were depressed and apprehensive about the future; Cluster III patients felt depressed, ashamed, and misunderstood; and Cluster IV patients were passive and resigned. Disease severity, but not demographic or other health variables, discriminated the groups. Patients with a mild to moderate impairment who adjusted effectively to their illness (Cluster I) were distinguished by an ability to put negative thoughts out of mind, by their belief that there are worse fates than having Parkinson's disease, and by efforts to influence certain aspects of their illness. The particular patterns of adaptation of the patients who were depressed and misunderstood (Cluster III) and passive and resigned (Cluster IV) seemed primarily a function of physical condition. This suggest that the degree to which personal attitudes can influence adaptation to somatic disease is limited by specific realities of the disease.