Use of the Internet to Obtain Drugs without a Prescription Among Treatment-involved Adolescents and Young Adults.

Nonmedical use of prescription drugs is common and poses risks such as injury, overdose, and development of abuse and dependence. Internet pharmacies offer prescription drugs without a prescription, creating a source of illicit drugs accessible to anyone with an Internet connection. We examined this issue in a convenience sample of 1,860 adolescents and young adults from 24 residential and outpatient treatment programs. Few individuals obtained drugs from the Internet (n = 26, 2.3%). Pain relievers were the most frequently purchased type of drug. The majority of adolescents and young adult online purchasers made the purchases from their own or a friend's house.

Independent Evaluation of Middle School-Based Drug Prevention Curricula: A Systematic Review.

IMPORTANCE: Lack of robust program evaluation has hindered the effectiveness of school-based drug abuse prevention curricula overall. Independently evaluated randomized controlled trials (RCTs) of universal, middle school-based drug abuse prevention curricula are the most useful indicators of whether such programs are effective or ineffective. OBJECTIVE: To conduct a systematic review identifying independently evaluated RCTs of universal, middle school-based drug abuse prevention curricula; extract data on study quality and substance use outcomes; and assess evidence of program effectiveness. EVIDENCE REVIEW: PsycInfo, Educational Resources Information Center, Science Citation Index, Social Science Citation Index, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched between January 1, 1984, and March 15, 2015. Search terms included variations of drug, alcohol, tobacco, and marijuana use, as well as school, prevention, and effectiveness. Studies included in the review were RCTs carried out by independent evaluators of universal school-based drug prevention curricula available for dissemination in the United States that reported alcohol, tobacco, marijuana, or other drug use outcomes. Two researchers extracted data on study quality and outcomes independently using a data extraction form and met to resolve disagreements. FINDINGS: A total of 5071 publications were reviewed, with 13 articles meeting final inclusion criteria. Of the 13 articles, 6 RCTs of 4 distinct school-based curricula were identified for inclusion. Outcomes were reported for 42 single-drug measures in the independent RCTs, with just 3 presenting statistically significant (P < .05) differences between the intervention group and the control group. One program revealed statistically significant positive effects at final follow-up (Lions-Quest Skills for Adolescence). CONCLUSIONS AND RELEVANCE: The results of our review demonstrate the dearth of independent research that appropriately evaluates the effectiveness of universal, middle school-based drug prevention curricula. Independent evaluations show little evidence of effectiveness for widely used programs. New methods may be necessary to approach school-based adolescent drug prevention.

An In-Depth Survey of the Screening and Assessment Practices of Highly Regarded Adolescent Substance Abuse Treatment Programs.

AIMS: To examine the quality of screening and assessment practices at some of the most highly regarded adolescent substance use treatment programs in the United States. METHODS: Between March and September 2005, telephone surveys were administered to directors of highly regarded programs. Several different publications and databases were then used to measure the quality of the screening and assessment instruments described by programs. RESULTS: For the 120 programs responding, 77 distinctly named instruments developed by outside sources were used at some point in the screening and assessment process, and the majority of programs also used instruments developed in-house. Fewer than half of these instruments were mentioned in the Substance Use Screening & Assessment Instruments Database. We were able to confirm that 87% of the instruments developed by others have a published manual, and 74% have been described in an article appearing in a peer-reviewed publication. Sixty-two percent were designed to be used with adolescents or adults and adolescents, while 19% were designed for adults only. CONCLUSION: Although adolescent substance abuse treatment programs recognized the importance of screening and assessment, the quality of such practices varied significantly. A large number of different tools were used by some of the most highly regarded programs in the country, and many used questionnaires developed in-house that may not have had high standards of reliability and validity. Furthermore, numerous programs were using assessment instruments that were not uniquely designed for adolescents. Encouraging the adoption of standardized assessment practices would help those involved in treatment to evaluate programs and to understand the assessment process.

Does higher cost mean better quality? evidence from highly-regarded adolescent drug treatment programs.

We conducted a survey to examine whether reimbursement levels are associated with the quality of adolescent substance use treatment programs in the United States. Between March and September 2005, telephone and written surveys were administered to program, clinical, and finance directors of previously surveyed highly regarded programs. Differences in quality scores were compared for programs with above versus below median reimbursement levels and examined in multivariate regression models constructed separately for programs offering residential and outpatient treatment. In residential treatment multivariate regression models, higher quality scores were associated with higher reimbursement, but this relationship was not observed for outpatient treatment. Even the highest level of outpatient reimbursement received may be too low to support quality improvement initiatives. Our results suggest that higher reimbursement may be a necessary component of quality improvement for residential adolescent drug treatment programs, and emphasize the need for further research to determine what levels of reimbursement and insurance coverage policies will encourage the expansion of high quality outpatient programs.

Quality of implementation: developing measures crucial to understanding the diffusion of preventive interventions.

As prevention programs become disseminated, the most serious threat to effectiveness is maintaining the quality of implementation intended by the developers. This paper proposes a methodology for measuring quality of implementation in school settings and presents data from a pilot study designed to test several of the proposed components. These methods included assessments of adherence, quality of process, the positive or negative valence of adaptations, teachers' attitudes and teachers' understanding of program content. This study was conducted with 11 teachers who had varying degrees of experience who taught Life Skills Training. Observation and interview data were collected during visits to schools. Results suggest that quality of implementation can be measured through observation and interview. Teachers varied in adherence and quality of program delivery. All teachers made adaptations to the program. Experienced teachers were more likely to adhere to the curriculum, deliver it in a way that was more interactive and engaging to students, communicate the goals and objectives better, and make positive adaptations. The field can use these findings as the basis for exploring strategies for measuring and improving quality of implementation.

The quality of highly regarded adolescent substance abuse treatment programs: results of an in-depth national survey.

BACKGROUND: Drug and alcohol abuse and dependence are the most prevalent causes of adolescent morbidity and mortality in the United States. Effective, accessible treatment for adolescents with substance abuse problems is urgently needed. OBJECTIVE: To conduct the first systematic evaluation of the quality of highly regarded adolescent substance abuse treatment programs in the United States. METHODS: An advisory panel of 22 experts defined 9 key elements of effective treatment for adolescent substance abuse based on a review of the literature. In-depth telephone and written surveys were conducted with 144 highly regarded adolescent substance abuse treatment programs identified by panel members and by public and private agencies. There was a 100% response rate to the initial interviews, and a 65% response rate to the follow-up surveys. The open-ended survey responses were coded by defining 5 components deemed to be crucial in addressing each of the 9 key elements, and quality scores were calculated overall and for each of the 9 key elements. RESULTS: Out of a possible total score of 45, the mean score was 23.8 and the median was 23. Top-quartile programs were not more likely to be accredited. The majority of programs scored at least 4 of a possible 5 on only 1 of the 9 key elements (qualified staff). The elements with the poorest-quality performance were assessment and treatment matching, engaging and retaining teens in treatment, gender and cultural competence, and treatment outcomes. CONCLUSIONS: Most of the highly regarded programs we surveyed are not adequately addressing the key elements of effective adolescent substance abuse treatment. Expanded use of standardized assessment instruments, improved ability to engage and retain youths, greater attention to gender and cultural competence, and greater investment in scientific evaluation of treatment outcomes are among the most critical needs. Expanding awareness of effective elements in treating adolescents will lead the way to program improvement.

A review of research on fidelity of implementation: implications for drug abuse prevention in school settings.

To help inform drug abuse prevention research in school settings about the issues surrounding implementation, we conducted a review of the fidelity of implementation research literature spanning a 25-year period. Fidelity has been measured in five ways: (1) adherence, (2) dose, (3) quality of program delivery, (4) participant responsiveness and (5) program differentiation. Definitions and measures of fidelity were found not to be consistent across studies, and new definitions are proposed. While there has been limited research on fidelity of implementation in the social sciences, research in drug abuse prevention provides evidence that poor implementation is likely to result in a loss of program effectiveness. Studies indicate that most teachers do not cover everything in a curriculum, they are likely to teach less over time and training alone is not sufficient to ensure fidelity of implementation. Key elements of high fidelity include teacher training, program characteristics, teacher characteristics and organizational characteristics. The review concludes with a discussion of the tension between fidelity and reinvention/adaptation, and ways of resolving this tension. Recommendations are made for developing a consistent methodology for measuring and analyzing fidelity of implementation. Further, researchers and providers should collaborate to develop ways of introducing flexibility into prevention programs.