ABSTRACT
The veterinary clinic plays a critical role in the prevention and treatment of behavior problems. If behavior problems do begin to emerge, the veterinary clinic can help determine who can advise and guide the owners most practically to improve or resolve the problem. This help might involve the veterinarian, a behavioral technician, a trained staff member, an appropriate trainer, or some combination of these persons. This article reviews how these professional roles might be integrated, depending on the complexity of the problem.
Subject(s)
Behavior Therapy/methods , Behavior, Animal , Dogs , Veterinarians/psychology , Veterinary Medicine/methods , Animals , Animals, Newborn/physiology , Animals, Newborn/psychology , Dogs/physiology , Dogs/psychology , Humans , Physician's Role , Veterinary Medicine/standardsABSTRACT
This article presents the main outcome findings from two inter-related randomized trials conducted at four sites to evaluate the effectiveness and cost-effectiveness of five short-term outpatient interventions for adolescents with cannabis use disorders. Trial 1 compared five sessions of Motivational Enhancement Therapy plus Cognitive Behavioral Therapy (MET/CBT) with a 12-session regimen of MET and CBT (MET/CBT12) and another that included family education and therapy components (Family Support Network [FSN]). Trial II compared the five-session MET/CBT with the Adolescent Community Reinforcement Approach (ACRA) and Multidimensional Family Therapy (MDFT). The 600 cannabis users were predominately white males, aged 15-16. All five CYT interventions demonstrated significant pre-post treatment during the 12 months after random assignment to a treatment intervention in the two main outcomes: days of abstinence and the percent of adolescents in recovery (no use or abuse/dependence problems and living in the community). Overall, the clinical outcomes were very similar across sites and conditions; however, after controlling for initial severity, the most cost-effective interventions were MET/CBT5 and MET/CBT12 in Trial 1 and ACRA and MET/CBT5 in Trial 2. It is possible that the similar results occurred because outcomes were driven more by general factors beyond the treatment approaches tested in this study; or because of shared, general helping factors across therapies that help these teens attend to and decrease their connection to cannabis and alcohol.
Subject(s)
Ambulatory Care/economics , Health Care Costs/statistics & numerical data , Marijuana Abuse/rehabilitation , Psychotherapy, Brief/economics , Adolescent , Alcoholism/economics , Alcoholism/rehabilitation , Cognitive Behavioral Therapy/economics , Combined Modality Therapy , Family Therapy/economics , Female , Humans , Length of Stay/economics , Male , Marijuana Abuse/economics , Motivation , Outcome and Process Assessment, Health Care/statistics & numerical data , Randomized Controlled Trials as Topic , Reinforcement, Psychology , Reinforcement, Social , United StatesABSTRACT
During the late 1960s, cannabis emerged from relative obscurity to become the most common illicit drug used in the United States, and has remained so ever since. From an epidemiological perspective, three major waves of successively younger new users can be identified during the past 40 years. Contrary to popular opinion, cannabis use can be problematic for many people (particularly adolescents). Moreover, the drug has become increasingly more potent. Cannabis is currently one of the leading substances reported in arrests, emergency room admissions, autopsies and treatment admissions. Like alcohol and tobacco, the need for effective approaches to treating cannabis use disorders transcends debates about whether it should be legal. Moreover, the costs to society are continuing to mount from past neglect of this continuing public health problem. This paper provides background on the need to develop effective models for treating cannabis use disorders.
Subject(s)
Marijuana Abuse/therapy , Adolescent , Adolescent Behavior , Adult , Age of Onset , Attitude to Health , Cannabis/adverse effects , Child , Crime , Female , Humans , Male , Marijuana Abuse/complications , Marijuana Abuse/epidemiology , Mental Disorders/chemically induced , Patient Acceptance of Health Care , United StatesABSTRACT
AIMS: This paper provides a description of the rationale, study design, treatments and assessment procedures used in the Cannabis Youth Treatment (CYT) experiment. DESIGN: CYT was designed to (a) test the relative effectiveness, cost and benefit-cost of five promising treatment interventions under field conditions and (b) provide evidence based manual-guided models of these interventions to the treatment field. SETTING: The study involved two community-based treatment programs and two major medical centers. PARTICIPANTS: Participants were 600 adolescents recruited from the regular intake who were between the ages of 12 and 18, had used marijuana in the past 90 days, and met one or more criteria of dependence or abuse. INTERVENTIONS: Participants were randomly assigned to one of five interventions: Motivational Enhancement Therapy (MET), Cognitive Behavioral Therapy (CBT), Family Support Network (FSN), Adolescent Community Reinforcement Approach (ACRA), or Multidimensional Family Therapy (MDFT). MEASUREMENTS: Self-report data were collected at intake, 3, 6, 9 and 12 months post discharge using the Global Appraisal of Individual Needs (GAIN), as well as several supplemental self-reports, collateral reports, urine testing, and service logs. FINDINGS: This paper reports on the study's implementation including the psychometric properties of the measures (alphas over 0.8), validity of self-report (kappa over 0.6), high rates of treatment completion (81% completed two or more months), and high rates of follow-up (over 94% per wave). CONCLUSIONS: The feasibility of implementing the CYT manual-guided treatment and quality assurance model in community-based adolescent treatment programs is discussed.
