Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments.

This randomized clinical trial evaluated individual cognitive-behavioral therapy (CBT), family therapy, combined individual and family therapy, and a group intervention for 114 substance-abusing adolescents. Outcomes were percentage of days marijuana was used and percentage of youths achieving minimal use. Each intervention demonstrated some efficacy, although differences occurred for outcome measured, speed of change, and maintenance of change. From pretreatment to 4 months, significantly fewer days of use were found for the family therapy alone and the combined interventions. Significantly more youths had achieved minimal use levels in the family and combined conditions and in CBT. From pretreatment to 7 months, reductions in percentage of days of use were significant for the combined and group interventions, and changes in minimal use levels were significant for the family, combined, and group interventions.

Ethical issues in research on the treatment of adolescent substance abuse disorders.

Treatment research on adolescent substance use disorders raises a number of important ethical and legal concerns which have not been widely acknowledged. This paper explores these concerns as they relate to fundamental ethical principles in the conduct of human research. The issues discussed include tensions between conflicting regulations governing informed consent for research and treatment of adolescents, the capacity of adolescents to give informed consent, potentially coercive elements related to research on substance use treatment, problems associated with confidentiality and release of information, research vulnerability associated with substance use, and ethical implications of distinctions between effectiveness and efficacy research. Suggestions for ways investigators may address these concerns are provided.

Innovations in adolescent substance abuse intervention.

Adolescent alcohol and other drug abuse is an important public health concern, and the past two decades has seen a dramatic increase in the demand for interventions to address substance use problems among teenagers. This demand has led to the development of multiple primary, secondary, and tertiary substance abuse prevention programs, some of which have little theoretical basis and most of which currently operate in the absence of data supporting their effectiveness. Very recently, there has been increased emphasis on the goal of developing and testing theoretically based and empirically supported intervention approaches for adolescent substance abuse. We describe five ongoing research programs devoted to meeting this goal. The background and rationale for each research program are discussed, and preliminary efficacy data concerning the specific interventions are presented.

Assessing adolescent substance use: a critique of current measurement instruments.

A variety of instruments are currently available to screen for and assess adolescent substance abuse and aid in planning appropriate interventions. Assessment practices in treatment facilities for adolescents have tended to rely on the use of unstandardized, local measures or on measures developed for adults with unknown reliability and validity for adolescents. This review is designed to serve as a resource for health professionals regarding the issues involved in assessing adolescent substance involvement and the types of instruments that are available for use. Conceptual issues relevant to the evaluation of adolescent substance use are discussed. Then, standardized, adolescent-specific assessment tools are briefly summarized, including screening questionnaires, comprehensive instruments, and several other substance-related instruments.

The minimizing of blaming attributions and behaviors in delinquent families.

Parents' data were evaluated in three studies of families with a delinquent adolescent. Families were provided with different forms of a positive versus negative interactional (attributional) context. Study 1 demonstrated that the negative context elicited significantly more negative behaviors than did the positive context when parents interacted with each other and with their delinquent adolescent. Study 2 demonstrated that the dispositional attributions of parents were influenced by the manipulation of set, with a dissatisfied set producing negative blaming attributions and a satisfied set producing nonblaming, positive attributions. Study 3 demonstrated that parents' negative sets regarding their adolescent's negative behaviors, once established and discussed by the family for 5 min, were unresponsive to a subsequent positive reattribution regarding those behaviors. Taken together, the data provide some support for reattribution techniques such as relabeling. Yet, the data question the ease with which such techniques can be successful and challenge proponents of such techniques to develop methodologically sound empirical demonstrations of their effectiveness.