Correlates of success following treatment for adolescent substance abuse

To date, little research is available examining the course and features of recovery from substance abuse following adolescent treatment. The current study evaluated the functioning of 142 teens for 2 years following treatment for substance abuse. Adolescent drug and alcohol outcome was examined in relation to functioning on five major life domains: academic involvement, interpersonal problems, emotional well-being, family relations, and social and occupational activities. Results of this investigation demonstrate that psychosocial functioning is associated with adolescent posttreatment drug and alcohol use. Teens who were abstinent and those with less substance use involvement generally displayed better functioning. The relationship between teen alcohol and drug use and improvement in functioning varied across psychosocial domains. Clinical implications of these findings are discussed along with advances in teen substance abuse research and treatment.     

The role of theory in treating adolescent substance abuse

The adolescent substance abuser, like adult addicts, is most commonly considered from the perspective of the disease model. The usefulness of the disease model in conceptualizing adolescent substance abuse is questioned, and an alternative view of the topic is set forth. Substance abuse, is regarded as an adaptive aspect of the ongoing interactive processes within the family. The developmental process of the adolescent substance abuser is seen as a functional dynamic in the family's preservation. Three characteristic elements of parental interaction common to the development of adolescent substance abuse are highlighted.An earlier version of this paper was presented at the Texas Association for Marriage and Family Therapy annual conference on January 28, 1993 in Houston Texas.a research associate and director of the Don D. Jackson Archive at the Mental Research Institute, Palo Alto, CA. Authors are listed alphabetically.     

Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research

This article provides an overview of controlled trials research on treatment processes and outcomes in family-based approaches for adolescent substance abuse. Outcome research on engagement and retention in therapy, clinical impacts in multiple domains of adolescent and family functioning, and durability and moderators of treatment effects is reviewed. Treatment process research on therapeutic alliance, treatment fidelity and core family therapy techniques, and change in family processes is described. Several important research issues are presented for the next generation of family-based treatment studies focusing on delivery of evidence-based treatments in routine practice settings.     

The therapeutic alliance: Adolescent perspectives

This paper presents a conceptualisation of the therapeutic alliance from the adolescent perspective and discusses implications for practitioners. The main aim of the study was to focus on the factors that participants identified as important in relationship formation and maintenance. Eighteen individuals were interviewed using a semi‐structured format. Three major themes were identified: therapeutic environment, uniqueness of the therapeutic relationship, and therapist characteristics. Participants identified both positive and negative aspects of the therapeutic relationship. A strong alliance was found to be necessary in that the perception of the therapist as accepting, supportive and trustworthy influenced the adolescent's evaluation of the appropriateness of therapeutic tasks and goals. Participants stressed the importance of the supportive nature of the relationship in their willingness to collaborate in therapeutic interventions.     

Child sexual abuse and adolescent prostitution: a comparative analysis

In several studies, child sexual abuse has been identified as a characteristic of adolescent prostitution. The implication of these findings, especially for girls, is that the two phenomena are related in that childhood sexual abuse perhaps leads to prostitution. The present study explored the relationship between sexual abuse and adolescent prostitution by comparing 70 sexually abused children with 35 prostitution-involved children on 22 variables. Findings suggest that the relationship is not directed, but involves runaway behavior as an intervening variable. It is not so much that sexual abuse leads to prostitution as it is that running away leads to prostitution. Implications for treatment of both sexually abused and prostitution-involved children also are discussed.     

Photography as a therapeutic tool for substance abuse clients who have a history of sexual abuse

Symptoms of sexual abuse among persons in substance abuse treatment facilities may be difficult to recognise since presenting symptoms frequently mirror those associated with substance abuse. Additionally, treatment may be difficult due to a lack of previous verbal processing and shared negative defence mechanisms that are resistant to traditional talking therapy. The use of photography is presented here as a method of treatment initiation and exploration for substance abuse clients who have a history of sexual abuse. The paper reviews rationale, advantages, current applications and practitioner concerns associated with the use of photography as a therapeutic tool.     

Dual diagnosis: Clinical issues in substance abuse treatment

Dual diagnosis within the context of alcohol and substance abuse has become the focus of considerable interest, particularly when related to anxiety and depression. Depressive symptomatology is frequently associated with substance abuse and chemical dependency and numerous studies report a high concordance with these diagnostic entities and major affective disorder (Galanter,Casteneda, & Ferman, 1988). Depressive symptoms are also related to post treatment of alcohol and substance abuse with reported occurrences of 75 percent occurring with patients who have experienced relapse (Biedermann, Newcome, & Sprich, 1991).     

Prevention education and substance abuse treatment

Relapse prevention is influenced by a number of variables including stress and negative mood states, motivation and commitment to abstinence, social support, physiological factors, withdrawal symptoms, and a repertoire of cognitive and behavioral strategies utilized in responding to the relapse process. Diverse theoretical approaches have emphasized conditioning models as well as information processing, cognitive and affective components of treatment, cognitive and behavioral coping responses, and a variety of other procedures. Outcome studies related to treatment have failed to consistently support the effectiveness of several of these components. To overcomes this, the authors advocate a single subject design in the study of these approaches. This article emphasizes the role of relapse prevention, and training and education in facilitating long-term abstinence, particularly with those intervention methods that are based on social learning theory and cognitive-behavioral models.     

Ethnic background, therapeutic alliance, and treatment retention in functional family therapy with adolescents who abuse substances

In this study, the authors examined the role of balance between adolescent-therapist and parent-therapist alliances in the retention of functional family therapy clients. Therapeutic alliances of mothers, fathers, and adolescents were assessed from videotapes of the 1st treatment session for 43 Hispanic and 43 Anglo families. Hispanic families who dropped out before completing the requisite number of sessions were found to have greater imbalance in alliance (parent-adolescent) than those who did complete therapy. However, this finding was not replicated with Anglo families. Results are interpreted in terms of previous research on family-level balanced alliance effects.     

Parent-adolescent relations and adolescent functioning: self-esteem, substance abuse, and delinquency

The present study examined parental support and monitoring as they relate to adolescent outcomes. It was hypothesized that support and monitoring would be associated with higher self-esteem and less risky behavior during adolescence. The diverse sample included 16,749 adolescents assessed as part of the National Educational Longitudinal Study. Both high parental support and parental monitoring were related to greater self-esteem and lower risk behaviors. The findings partially confirm, as well as extend, propositions in attachment theory.     

The therapeutic alliance in couples therapy: clinical considerations

This article presents clinical considerations about the therapeutic alliance in couples therapy, stimulated by pertinent new research findings reported in this issue. A loyalty dimension of the couple's relationship is described, as well as its influence on the therapeutic alliance in couples therapy. The therapist's establishment of a "meta-alliance" with the couple around their loyalty conflicts, avoidance of splits and disruptions, and prioritization of marital distress (versus individual symptoms) as the primary focus of treatment all serve to solidify the therapeutic alliance. In addition, identifying the partners' early family-of-origin distress can help predict and respond to strains in the therapeutic alliance that may occur later in therapy. Finally, the therapist helping the couple to balance their relational power differences in therapy and to address their concerns about the impact of the therapist's gender also strengthens their therapeutic alliance. A clinical case and vignettes are included to illustrate these issues.     

Cultural difference and the therapeutic alliance: an evidence-based analysis

The research on positive psychotherapy outcome consistently indicates that the quality of the alliance is important across different models of psychotherapy (D. E. Orlinsky, M. H. Ronnestad, & U. Willutzki, 2004; B. E. Wampold, 2000). Social psychological research has documented how "unintentional bias" can produce barriers to university admissions, employment, and advancement of well-qualified members of ethnic minority groups (J. F. Dovidio, S. L. Gaertner, K. Kawakami, & G. Hodson, 2002). Neuroscience is further confirming social psychological responses associated with race (J. L. Eberhard, 2005). Unintentional bias identified in social psychological research may be part of the psychotherapist/client interaction, interfere with the therapeutic alliance, and partly account for the high dropout rates and underutilization of psychotherapeutic services by people of color. The purpose of this article is to provide an evidence-based analysis of how psychologists in practice may unintentionally interfere with development of quality alliances with culturally different clients or patients and thus contribute to the barriers to effective multicultural counseling and psychotherapy. Principles from the American Psychological Association's (2003) multicultural guidelines and a review of relevant research are applied in suggesting strategies to reduce bias and to develop culturally appropriate skills in psychological practices.     

Understanding the online therapeutic alliance through the eyes of adolescent service users

Aims: The therapeutic alliance is a concept that has received a great deal of attention within face‐to‐face counselling. Furthermore, links have been made between the creation of strong alliances and successful therapeutic outcomes. This study examines the therapeutic alliance when counselling services are offered online to young people. Method: Fifteen young people took part in online interviews (utilising synchronous and asynchronous methods), and Grounded Theory techniques were utilised to analyse the data. Findings: A core category of ‘Client‐Service Match’ and three subcategories pertinent to the individuals’ experiences of creating good quality relationships with the counsellors were identified: (1) initial engagement, (2) developing rapport, and (3) establishing control. Discussion: The themes elicited are all relevant to the matching process and viewed as a chronological process similar to face‐to‐face counselling. However, unlike face‐to‐face work, specific nuances related to the online work arise that counsellors should be mindful of, including the rationale behind each individual's choice to approach services online, their own computer‐mediated communication skills, technical hurdles, and the perceived ‘power’ of the counsellor.     

MMPI profiles of adolescent substance abusers in treatment

The non-K-corrected MMPI profiles of 243 adolescents presenting themselves for chemical dependency treatment in a residential setting were examined. Results suggested a general lack of psychopathology in this population, although a significant elevation on the Pd scale did emerge. These data are compared to the findings of previous studies with both adolescent and adult populations.     

Patterns of adolescent psychoactive substance use and abuse in Benin City, Nigeria

The pattern of use and abuse of psychoactive substances by Nigerian adolescents is investigated. Unlike previous epidemiological studies that used questionnaires to investigate university or postprimary school students, the present study used unobtrusive methods for data collection. The observed pattern of use was not different from that found in previous research. Adolescents tended to use the following drugs in decreasing order of frequency: alcohol, cigarettes, stimulants, cannabis (Indian hemp) and sedative-hypnotics. Polydrug use, especially of alcohol, stimulants, and cigarettes, is common. The use of hard drugs was not reported in this study. The implications of the findings can be appreciated only against the background of the known sequelae (psychological, physical, and socioeconomic) of psychoactive drug abuse. Finally, recommendations for controlling adolescent drug use are offered.     

Diagnostic profiles of offenders in substance abuse treatment programs

This study examined the association of Axis I and Axis II disorders among offenders who were in prison-based substance abuse treatment in a national multi-site study. Participants (N = 280) received a psychosocial assessment and a structured diagnostic interview in two separate sessions. Logistic regression models examined the association between lifetime mood and anxiety disorders with two personality disorders, and the relationship of Axis I and Axis II disorders (alone and in combination) to pre-treatment psychosocial functioning. Over two-thirds of the sample met criteria for at least one mental disorder. Borderline personality disorder was strongly associated with having a lifetime mood disorder (odds ratio = 7.5) or lifetime anxiety disorder (odds ratio = 8.7). Individuals with only an Axis II disorder, or who had both Axis I and Axis II disorders, had more severe problems in psychosocial functioning than those without any disorder. Clinical treatment approaches need to address this heterogeneity in diagnostic profiles, symptom severity, and psychosocial functioning.     

Distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility

A large percentage of individuals who enter residential substance abuse treatment drop out before completing treatment. Given that early treatment dropout places individuals at an increased risk for relapse, identifying the mechanisms underlying treatment dropout would have several important theoretical and clinical implications. In the current study, the authors examined levels of psychological and physical distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. In a sample of 122 individuals entering a residential substance abuse treatment facility, level of psychological distress tolerance was predictive of early treatment dropout above and beyond relevant self-report variables. There was no relationship between physical distress tolerance and early treatment dropout. Implications for future studies and treatment development or modification are discussed.