SAMHSA Creates Resources for Teen Substance Abuse Treatment
By Rebecca A. Clay
The idea that adolescents need specialized substance abuse treatmenttreatment
different from that offered to adultsemerged from the field
only within the past 20 years. Since then, many programs for treating
adolescents have been established. But which ones work?
"In the past, these programs haven't had the money for evaluation,"
said Randolph D. Muck, M.Ed., Team Leader for Adolescent Programs
in the Division of Services Improvement at SAMHSA's Center for Substance
Abuse Treatment (CSAT). "They've had no way of knowing whether they
were doing any good and neither did anyone else. They might claim
success, but those claims were mostly based on anecdotal evidence."
To address this lack of information, CSAT launched the Adolescent
Treatment Models (ATM) project in 1998 to identify promising programs
at 10 sites and evaluate their effectiveness. Although the project
is not yet completed, the programsbased on a wide variety
of modelsall show positive preliminary results.
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A Research Gap
Adolescents have special needs that differ from adults. Motivation,
for instance, can be a special problem for adolescents. They're
much more likely than adults to be in treatment under duress and
less likely to see their substance use as a problem.
In the late 1990s, practitioners started developing programs designed
to meet these and other challenges. However, there were few evaluations
of these programs. Those that did exist were marred by unstandardized
approaches, small sample sizes, and inadequate followup.
That started to change in 1997 with CSAT's Cannabis Youth Treatment
(CYT) study. This large-scale program took five theory-based outpatient
models for treating adolescent marijuana use, put them into practice,
and evaluated their effectiveness. CSAT found that these models
reduced adolescent substance abuse dramatically.
Following this study, CSAT staff decided to test and compare the
effectiveness of several already existing treatment programs for
adolescent drug use, including drugs other than marijuana. The result
was the ATM project. Collecting a core set of the same data as the
CYT study, the ATM project evaluated a wide range of existing programs
that appeared promising. Models included inpatient and residential
treatment programs as well as outpatient programs.
Drawing on the experience of approximately 2,000 adolescents,
grantees collected data about substance abuse and other areas of
interest at baseline, 6 months, and 12 months after the initial
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To the researchers' surprise, the ATM programs were just as effective
as the CYT programs.
"Programs already in use typically have limited resources, haven't
gone through a lot of rigorous evaluation, and are loosely based
on theory," said Mr. Muck. "We figured that CYT would have better
outcomes than the ATM projects, but that didn't turn out to be the
Overall, the ATM programs produced fairly substantial reductions
in adolescents' substance use, emotional problems, and illegal activities
in the year following intake, according to Michael L. Dennis, Ph.D.,
Director of the project's Data Coordinating Center and senior research
psychologist at Chestnut Health Systems. There was a 50- to 60-percent
reduction in the number of days adolescents used drugs, for example.
That's good news, according to Dr. Dennis. Although most parents
and policymakers hope for zero drug use post-treatment, he explained,
complete recovery isn't a very realistic goal without lots of aftercare.
"Many people evaluate treatment as if substance abuse is an acute
problem like a broken leg," he said. "What we need to do is switch
to a chronic disease model. We'll see, as with cancer or hepatitis,
that they're moving in and out of recovery."
That's especially true for adolescents, who tend to cycle in and
out of recovery more than adults. In the ATM project, 20 to 30 percent
of the adolescents were in recovery at the 1-year point, but more
than two-thirds had periods of recovery during the year.
The project also found that different levels of treatment intensity
produced different patterns of recovery. For adolescents in residential
programs, drug use tended to drop off quickly and then start climbing
again. Adolescents in outpatient treatment didn't see that kind
of dramatic short-term reduction but instead reduced their use gradually.
However, all the adolescentswhether in short-term residential,
long-term residential, or outpatient treatmentultimately achieved
a similar level of recovery at the 1-year point.
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While awaiting additional analysis and additional data, CSAT already
is supporting efforts to make information about these models available
to the field.
Two of the ATM principal investigators have edited a book called
Adolescent Substance Abuse Treatment in the United States: Exemplary
Models from a National Evaluation Study.
"All of us were struck by how little information there was about
the real nuts and bolts of [adolescent treatment] programs," said
co-editor Andrew R. Morral, Ph.D., principal investigator for the
Phoenix Academy project and senior behavioral scientist at RAND's
Drug Policy Research Center in Arlington, VA. "You could find programs'
names in directories, but you wouldn't know what was in them." The
book addresses this paucity of information by offering detailed
descriptions of the ATM projects. Grantees are also preparing manuals
describing their models so that other programs can replicate them.
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The ATM results are also prompting new avenues of inquiry. "Now
that we recognize that adolescents aren't just little adults, we
need to recognize that not all adolescents are alike," emphasized
co-editor Sally J. Stevens, Ph.D., principal investigator of the
two Arizona sites and research professor at the University of Arizona's
Southwest Institute for Research on Women. For example, drug use
and treatment needs of girls differ from those of boys; some adolescents
come from relatively supportive families and others do not; and
the developmental level of adolescents even between ages 13 and
17 can differ tremendously. Moreover, treatment providers need to
recognize that many adolescents live in chaotic, violent circumstances
or environments in which drug use is only one of many problems,
Dr. Stevens said.
An e-mail discussion group called the Society for Adolescent Substance
Abuse Treatment Effectiveness listservan outgrowth of the
ATM projectfacilitates ongoing conversation and sharing of
information. The listserv is open to anyone in the field.
"The adolescent treatment field is coalescing into a national group,"
said Mr. Muck. "Adolescent treatment providers and researchers weren't
really organized before. Now we have a kind of learning community
around the country."
To obtain a copy of Adolescent Substance Abuse Treatment in
the United States contact Haworth Press at 1 (800) 429-6784
weekdays between 9 a.m. and 5 p.m., est. Or visit www.HaworthPress.com.
To learn more about the listserv for the Society for Adolescent
Substance Abuse Treatment Effectiveness, e-mail Donna Williams at
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