Published in the July edition of the Archives of General Psychiatry, the study reports that adolescents who participated in community-based treatment programs in four U.S. cities significantly reduced drug use and criminal behavior, and improved academic performance during the year after treatment.
The study of 1,167 adolescents (ages 11-18) admitted to 23 community-based treatment programs in Chicago, Minneapolis, Pittsburgh, and Portland also linked longer stays in treatment with better results. The study was conducted by researchers at the Drug Abuse Research Center of the UCLA Integrated Substance Abuse Programs, National Development and Research Institutes, the National Institute on Drug Abuse (NIDA), and the University of North Carolina at Wilmington.
"Until now, little research has focused on the effectiveness of treatment for adolescent substance abuse, and large-scale studies of treatment results have focused on adult patients," said Yih-Ing Hser, an adjunct professor in the UCLA Department of Psychiatry and Biobehavioral Sciences and lead author of the paper. "Adolescents are in a distinct developmental phase. Their substance abuse patterns and other factors influencing their lives typically differ from those of adults; thus, adolescent substance abusers may require different treatment strategies. Providing adequate treatment at this age may prevent the development of long-term addiction."
The naturalistic study - an assessment of treatment results in a non-experimental setting - examined the cases of 418 adolescents in eight residential programs, 292 in nine outpatient drug-free programs, and 457 in six short-term inpatient programs.
Among participants in the study, 47 percent reported marijuana abuse as their primary drug problem, while 21 percent cited alcohol as the primary drug of abuse. In the year following treatment, 44 percent reported weekly marijuana use, compared with 80 percent in the year before treatment admission; 20 percent reported heavy drinking, compared with 34 percent before treatment; and 42 percent reported use of other illicit drugs, compared with 48 percent before treatment.
Adolescents admitted to treatment typically reported problems in addition to drug abuse, such as trouble with the legal system (58 percent) or a mental disorder (63 percent). Criminal involvement dropped to 53 percent in the year following treatment, compared with 76 percent in the year before treatment, and patients also reported improved psychological adjustment and school performance.
"Post-treatment improvements among adolescents in this study are particularly impressive considering most patients faced multiple challenges, such as abuse of more than one drug, mental disorders, and criminal involvement," said Christine Grella, an associate research psychologist in the UCLA Department of Psychiatry and Biobehavioral Sciences and co-author of the paper. "In addition, the marked reductions in substance abuse are encouraging because most surveys of the general population report an acceleration in alcohol and drug use for adolescents. The reversal of this trend following treatment demonstrates the effectiveness of these programs."
Adolescents who stayed in treatment longer were more likely to have more favorable outcomes. However, length of time in treatment was generally short, particularly in outpatient drug-free and short-term inpatient programs, which contributed to some of the exceptions to the general pattern of improvement. For example, there was an overall increase in cocaine use to 19 percent at follow-up from 16 percent before treatment; the increases were found among those enrolled in these outpatient drug-free and short-term inpatient programs. In addition, patients in outpatient drug-free programs showed no improvement in their use of hallucinogens and stimulants.
"Despite the good news, much more needs to be done by programs and governmental agencies to optimize the results of drug abuse treatment for adolescents, particularly in the areas of treatment retention and completion," said Douglas Anglin, a professor in residence in the Department of Psychiatry and Biobehavioral Sciences at UCLA. "Helping adolescent patients to address the multiple problems in their lives, particularly those involving close family members or friends, remains a continuing challenge in the treatment field."
Funding for the study was provided by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health in Bethesda, Md.
In addition to Hser, Grella and Anglin, researchers involved in the study were Shih-Chao Hsieh of UCLA; Robert L. Hubbard of the National Development and Research Institutes Inc.; Bennett W. Fletcher of NIDA; and Barry S. Brown of the University of North Carolina at Wilmington.
Journal
Archives of General Psychiatry