Listening to youth: Adolescents' reasons for substance use as a unique predictor of treatment response and outcome.

National efforts have focused on improving adolescent substance use disorder (SUD) treatment outcomes, yet improvements remain modest. Because adolescents are noteworthy for heterogeneity in their clinical profiles, treatment might be enhanced by the identification of clinical subgroups for which interventions could be more effectively tailored. Some of these subgroups, such as those based on abstinence motivation, substance involvement, and psychiatric status are promising candidates. This study examined the unique predictive utility of adolescents' primary reason for alcohol and other drug use. Adolescent outpatients (N = 109; 27% female, aged 14-19) were assessed at treatment intake on their reason for substance use, as well as demographic, substance use, and clinical variables, and reassessed at 3, 6, and 12 months. Reason for use fell into two broad domains: using to enhance a positive state (positive reinforcement [PR]; 47% of youth) and using to cope with a negative state (negative reinforcement [NR]; 53% of youth). Compared with PR patients, NR patients were significantly more substance involved, reported more psychological distress, and had a more extensive treatment history. It is important to note that NR patients showed a significant treatment response, whereas PR patients showed no improvement. PR-NR status also uniquely predicted treatment response and outcome independent of a variety of other predictors, including abstinence motivation, self-efficacy, coping, and prior treatment. Adolescents' primary reason for substance use may provide unique clinical information that could inform treatment planning and patient-treatment matching.

Ensuring Retention in Longitudinal Studies: A Practical Evaluation of an Intensive Follow-up Protocol and Suggested Adaptations.

Ensuring retention in longitudinal studies of individuals with substance use disorders (SUD) is a continual challenge for researchers. This study made several modifications to a highly intensive follow-up protocol (Scott, 2004), originally designed for adults with SUD, in order to adapt it to a group of adolescents in low-intensity outpatient SUD treatment (N = 127, M age 16.7 yrs) and to accommodate limitations in the financial resources available for study staffing and transportation. In the present sample, adolescent participants generally found it unreasonable for study staff to request to contact people outside their immediate family in order to locate them and to attempt to schedule interviews 3-6 months in advance, as specified in the original protocol. Changes were made to accommodate these concerns and follow-up rates remained high (85-91%). Even though this study is limited by its non-experimental nature, it provides a replicable example of a scaled-down, less costly version of a highly intensive follow-up protocol that can be used to achieve high follow-up rates in studies of adolescents with SUD. We hope this will be encouraging for researchers and program evaluators who have limited resources or who work with participants who express concerns about privacy or study burden.

How safe are adolescents at Alcoholics Anonymous and Narcotics Anonymous meetings? A prospective investigation with outpatient youth.

Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) have proven to be cost-effective recovery resources for adults and also appear helpful for youth. However, anecdotal concerns about adolescents' safety at meetings have dampened enthusiasm regarding youth participation. Unfortunately, little information exists to evaluate such concerns. Outpatients (N = 127; 24% female) were assessed at intake and at 3, 6, and 12 months regarding perceived safety at AA/NA, experience of negative incidents, and reasons for nonattendance/discontinuation. By 12-month follow-up, 57.5% reported some AA/NA attendance with a combined lifetime exposure of 5,340 meetings. Of these, 21.9% reported at least one negative experience, which was more common among NA than AA attendees. Overall, youth reported feeling very safe at meetings, and ratings did not differ by age or gender. Reasons for discontinuation or nonattendance were unrelated to safety or negative incidents. Weighing risks against documented benefits, these preliminary findings suggest that referral to AA/NA should not be discouraged, but, similar to adults, youth experiences at meetings should be monitored.

Can 12-step group participation strengthen and extend the benefits of adolescent addiction treatment? A prospective analysis.

BACKGROUND: Despite advances in the development of treatments for adolescents with substance use disorders (SUD), relapse remains common following an index treatment episode. Community continuing care resources, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), have been shown to be helpful and cost-effective recovery resources among adults. However, little is known about the clinical utility and effectiveness of AA/NA for adolescents, despite widespread treatment referrals. METHOD: Adolescents (N=127; 24% female, 87% White, M age=16.7 years) enrolled in a naturalistic, prospective study of community outpatient treatment were assessed at intake, and 3 and 6 months later using a battery of standardized and validated measures. RESULTS: Just over one-quarter of youth attended AA/NA meetings during the first 3 months, which was predicted by a goal of abstinence, prior AA/NA attendance, and prior SUD treatment experiences. Controlled multiple regression analyses revealed an independent effect of AA/NA on abstinence, in both contemporaneous and lagged models, which persisted over and above the effects of pre-treatment AA/NA attendance, prior treatment, self-efficacy, abstinence goal, and concomitant outpatient treatment. CONCLUSIONS: Results suggest that, similar to findings comparing adult outpatients to inpatients, AA/NA participation is less common among less severe adolescent outpatients. Nonetheless, attendance appears to strengthen and extend the benefits of typical community outpatient treatment. Given the dramatic increase in rates of substance use among same-aged peers in the population at this life-stage, and the relative dearth of abstainers and recovery-specific supports, these resources may provide a concentrated cost-effective social recovery resource for young people.