Adolescent Substance Abuse

Transcription

1 Adolescent Substance Abuse

2 Issue in Children s and Families Lives Series Editors: Thomas P. Gullota, Child and Family Agency of Southeastern Connecticut, New London, Connecticut Herbert J. Walberg, University of Illinois at Chicago, Chicago, Illinois Roger P. Weissberg, Univeristy of Illinois at Chicago, Chicago, Illinois For other titles in this series, go to A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher.

3 Carl G. Leukefeld Thomas P. Gullotta Michele Staton-Tindall Editors Jessica M. Ramos Research Assistant Adolescent Substance Abuse Evidence-Based Approaches to Prevention and Treatment

4 Editors Carl G. Leukefeld Department Behavioral Science Center on Drug & Alcohol Research University of Kentucky Lexington, KY USA Thomas P. Gullotta Child & Family Agency of Southeastern Connecticut, Inc., New London, CT USA Michele Staton-Tindall College of Medicine Department Behavioral Sciences University of Kentucky Lexington, KY USA A Sponsored Publication of the Child and Family Agency of Southeastern Connecticut, Inc. ISSN: ISBN: e-isbn: DOI: / Library of Congress Control Number: Springer Science+Business Media, LLC 2009 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed on acid-free paper springer.com

5 Preface This is a book about how some young people use substances to intensify or alter perceptions, feelings, and understandings. On one level, the purpose of this volume is straightforward. Identify and share those practices that appear to be most efficacious. To this end, we asked the respected and talented teams of scholars that worked on this project to identify evidence-based treatment and prevention practices that worked, might work, or did not work. These practices are found clearly in written papers that introduce the reader to the subject area before delving into the details of those treatment and prevention techniques. On another level, the editors of this volume want the reader to appreciate the need to be persistent in youthfocused substance misuse prevention and treatment activities as well as being mindful of changing adolescent needs. To that end, this volume opens with two foundational chapters that ground the uninitiated reader in the complexity of associated issues. In the first chapter, Gullotta makes it clear that the desire of humankind has always been to intensify or alter perceptions, feelings, and understandings to achieve some futile understanding of the unpredictable events surrounding them. With time these transporting means to other worlds lost their imagined foretelling, religious, or medicinal powers and entered the realm of personal recreational use. Every substance discussed in this book has at one time been legally used and at another time been prohibited from use including coffee! For example, King Charles II of England banned coffee houses in 1675 as did several other European monarchies. Those who ignored the royal decrees were beaten (Emboden, 1979). The kick in coffee is provided by caffeine that is commonly added to over the counter drinks in some beverages in outrageous amounts. Some of these substances like tobacco, alcohol, and coffee have reentered society with differing degrees of regulation. Presently, US drug policy is to deny legitimate access to tobacco and alcohol until youth reach the legal age when use is permitted. Other substances, some legal and others not, are more rigidly administered (prescription drugs) or prohibited (cocaine, for example). The difficulty becomes, as Kandel and her associates established decades ago (1975), that tobacco and alcohol can be the entry-level substances to other illegal drugs. The availability of these entry-level substances in most households in the Americas and the marketing of these substances by those v

6 vi Preface who profit from their sale is a guarantee that this book will not lose its usefulness anytime soon. In Chapter 2, Kelly and his colleagues expand on this point by providing the reader with a biological explanation for the power of caffeine, nicotine (tobacco), and alcohol on the individual. Their review clearly establishes the rewarding, calming, or numbing aspects these chemicals exert on the brain. With this knowledge as a backdrop, the reader is introduced by Dennis and his associates in Chapter 3 to those individual characteristics that appear to increase the susceptibility of some individuals to misuse substances. The availability of addictive drugs in society is not a guarantee that addiction will occur. Rather, there is a dynamic constant interplay between the specific chemical, the individual s genetic constitution, personality characteristics (locus of control, for example), and the larger environment and the stresses it exerts on the person. In Chapter 4, Winters et al. review the substance abuse treatment literature by identifying promising psychosocial and pharmacological interventions. Using a meta-analysis of the literature on substance use disorder treatment among adolescents, the authors examine research studies that focus on adolescents as the primary target of an intervention or treatment, includes drug use as an outcome, and incorporates a structured evaluation. From this review, recommendations are made. Continuing this effort, in Chapter 5, Dembo and Muck discuss the current state of knowledge about adolescent outpatient drug abuse treatment and describe promising interventions. Using the Treatment Episode Data Set (TEDS), the authors also examine the number of adolescents who received outpatient treatment in recent years, the primary substances of abuse leading to the treatment episode (alcohol and marijuana), the problem of co-occurring mental health issues among treated adolescent drug abusers, and the gap between those needing outpatient treatment and those youth actually receiving services. Calix and Fine follow this discussion with an examination of the differing degrees of success family-based treatment has in treating adolescent substance abuse and dependence. The authors provide detailed descriptions of family-based therapeutic interventions, guiding theoretical frameworks, components of the therapy, and research evidence in support of multisystemic therapy, multidimensional family therapy, and functional family therapy. The authors describe a promising family treatment approach that integrates cognitive-behavioral therapy with functional family therapy. An overview of brief strategic family therapy is provided with attention to the therapeutic process, components of treatment, and supporting research evidence. Family-based interventions that have not been supported by research literature are also described. Plant and Panzarella discuss adolescent residential evidence-based treatment approaches in Chapter 7. The authors point out that significant knowledge gaps exist in determining those interventions in residential treatment that matter. They highlight inconsistencies raised in the literature on the general effectiveness of residential treatment as a therapeutic milieu and limitations in the research on residential treatment outcomes which include low participation rates, low follow-up rates, and limited quality assurance. Despite these limitations, the emergence of some promising,

7 Preface vii evidence-based approaches for adolescent residential treatment in recent years including the Minnesota Model (12-steps), The Multidisciplinary Professional Model, The Seven Challenges, and the Therapeutic Community are discussed. In addition, evidence-based models that have demonstrated success in community and home settings such as cognitive-behavioral therapy, motivational enhancement therapy, and some family models are described for their potential application in residential settings. The next four chapters are concerned with prevention and health promotion approaches to substance use in childhood and adolescence. That is, how do we develop the capacity (promotion) of young people to resist the lure of drug misuse and how do we prevent that misuse. Bloom begins this discussion by providing the reader with an understanding of the concept and examples of how primary prevention and health promotion work. He describes five technologies as essential components of any effective prevention effort. These are education, promotion of self-competency, natural caregiving, impacting change at the community organization and systems level, and redesigning the social environment. An area with ties to competency enhancement and natural caregiving is spirituality discussed by Hill, Burdette, Weiss, and Chitwood in Chapter 9. Research suggests that religious involvement is associated with lower levels of alcohol consumption, tobacco smoking and illicit drug use, and more favorable substance use treatment outcomes. Hill et al. provide an overview of the theoretical and empirical explanations for the association between religious involvement and substance use which include religious factors (specific moral directives and general religious principles), social factors (social control, social learning, and social support), and psychological factors (positive self-concept, control beliefs, and psychological well-being). In Chapter 10 Sloboda emphasizes the importance of school prevention intervention programs for adolescent substance abuse. He states the need for these efforts by noting that the possession of tobacco and alcohol by persons under the age of 18 is illegal, and that research indicates that the use of tobacco and alcohol increases the risk for later, more extensive drug use. Sloboda reviews the historical context for the development of school-based prevention programs, the developing body of research on their effectiveness, and the impact of these approaches on adolescent use of tobacco, alcohol, and illicit substances. In Chapter 11 the prevention and health promotion approaches shift to a broader community focus. Namely, what larger community organization/system interventions might alter the availability of these to commonly available substances. D Amico, Chinman, Stern, and Wandersman provide the reader with valuable insights on ways to intervene in the system to achieve effective change. This volume concludes with the lessons we learned as editors in this process and as practitioners and scholars in this field for several decades. This volume contains both good and sobering news. The good news is that progress has been made to improve the likelihood that young people can be treated successfully. This book documents that fact and can be used by practitioners and program developers at local, county, and state levels to implement those practices. The good news is also that substance misuse can be prevented, and this book clearly demonstrates that

8 viii Preface fact. The prevention and health promotion examples provided and similar efforts should be copied and implemented elsewhere. The sobering news is that if we are correct and that humankind has forever sought the means to transport itself to altered states of consciousness then problems associated with substance misuse will remain. If we are correct in believing that tobacco and alcohol can be stepping-stone drugs to more serious drug misuse for some, then our society must continually reseed itself with new generations of evidence-based treatment and prevention interventions. This means that we cannot ignore promising treatment, health promotion, or prevention activities as they are developing. Drug misuse at any age by any group is a problem that if ignored will grow worse. It calls for a reconceptualization of the tactics to manage drug misuse and associated problems. The first step is to heed the advice of the talented scholars in this volume. The second step is returning the phrases harm risk reduction and distribution of consumption to our lexicon and expanding on the evidence-based interventions discussed in this book. References Emboden, W. (1979). Narcotic plants: Hallucinogens, stimulants, inebriants, and hypnotics, their origins and uses. NY: Macmillan. Kandel, D. B., & Faust, R. (1975). Sequence and stages in patterns of adolescent drug use. Archives of General Psychiatry, 32,

9 Contents 1 A Selected Social History of the Stepping-Stone Drugs... 1 Thomas P. Gullotta 2 A Biological/Genetic Perspective: The Addicted Brain Thomas H. Kelly, Alessandra N. Kazura, Karen M. Lommel, Shanna Babalonis, and Catherine A. Martin 3 Individual Characteristics and Needs Associated with Substance Misuse of Adolescents and Young Adults in Addiction Treatment Michael L. Dennis, Michelle K. White, and Melissa L. Ives 4 Adolescent Substance Abuse Treatment: A Review of Evidence-Based Research Ken C. Winters, Andria M. Botzet, Tamara Fahnhorst, Randy Stinchfield, and Rachel Koskey 5 Adolescent Outpatient Treatment Richard Dembo and Randolph D. Muck 6 Evidence-Based Family Treatment of Adolescent Substance Abuse and Dependence Shaun I. Calix and Mark A. Fine 7 Residential Treatment of Adolescents with Substance Use Disorders: Evidence-Based Approaches and Best Practice Recommendations Robert W. Plant and Peter Panzarella 8 Primary Prevention in Adolescent Substance Abuse Martin Bloom and Thomas P. Gullotta ix

10 x Contents 9 Religious Involvement and Adolescent Substance Use Terrence D. Hill, Amy M. Burdette, Michael L. Weiss, and Dale D. Chitwood 10 School Prevention Zili Sloboda 11 Community Prevention Handbook on Adolescent Substance Abuse Prevention and Treatment: Evidence-Based Practices Elizabeth J. D Amico, Matthew Chinman, Stefanie A. Stern, and Abraham Wandersman Epilogue: The Status of Knowledge Development and the Unknown Michele Staton-Tindall, Thomas P. Gullotta, William Walton Stoops, and Carl G. Leukefeld About the Editors About the Authors Index