TREATING TEENS

Methodology and Key to Abstracts
     The studies for this report were identified by examining 21 prior literature reviews and bibliographies (listed below), and then conducting electronic searches of medline, psychinfo, dialog, and google.  The initial list was also circulated on the list server for the Society of Adolescent Substance Abuse Treatment Effectiveness (SASATE) and expanded again based on feedback.  Studies were dropped if they:
• were not about formal adolescent substance abuse treatment (this includes a large number of prevention, early intervention, school, recreational, or camp type programs)
• did not report publicly available outcome data 
     Unlike many more formal meta analyses, we chose not to limit this review to controlled trials for two main reasons.  First, the field is still in its early stages of development and only had a total of 34 outcome studies of any kind.  Second, many of the early and experimental studies had few participants and major methodological flaws (e.g., low participation, unstandardized protocols, study-specific measures, high treatment drop out, high attrition) and were less informative than some of the larger multi-site observational studies.
     An unusual feature of this group of studies and documents is the relative age of the studies. Of the 34 studies, 21 (62%) were published within the past five years, and as of this writing we knew of more than 50 additional studies that were underway. (Due to literature review publication lag time even in the most recent lit reviews, the latest studies included were published in 1997.)  Moreover, this growth is only one aspect of the emerging renaissance of adolescent treatment, for this new generation of studies is more likely to have high inclusion rates (over 80%), experimental designs, manualized protocols, standardized measures, validation substudies, repeated measures, long term follow-up (e.g., 12 or more months), high follow-up rates (80-90% or more), and economic analysis of the cost and benefits to society. Thus in the past five years the field has grown and improved its scientific rigor significantly - and promises to continue doing so in the foreseeable future. 
     Section 3 of this report provides a list of 34 major studies that were identified and the primary reference used for the abstract.   We continue to expand this and welcome any comments or additions.
     Section 4 provides a crosswalk of the approaches that were evaluated in these studies.  The approaches have been divided into the following main levels of care (and types of treatment):  No/minimal treatment (including waiting lists, probation as usual, education only, and weak treatment conditions), Outpatient (12-Step Centered, Behavior Therapy, Family Therapy, Other Outpatient), Residential (12-Step Centered, Other Short Term Residential, Therapeutic Communities, Other Long Term Residential), and Other (Engagement, Psycho-pharmacology Continuing Care). Most studies compared types of treatment within levels of care, though some did go across them. Some approaches (e.g., 12 step) have also been studied in multiple levels of care.  Several studies compared multiple variations of a single type of treatment (e.g., types of family treatment), often where one was a "brand" name and the other was more generic or services as usual. Some studies also collected comparison data on adults with the same measures.  
     Section 5 provides a detailed abstract on each of the 34 studies (in columns).   For each study, we tried to abstract the following information: 
1 Study:  Abbreviation of Study Name (see list of studies)
2 Name:  Study Name (either given by authors, or assigned if not given)
3 Treatment Level of Care and Types ("Brand" names):  Separate rows are given for each level of care, followed by the types of treatment (and any specific "Brand" names evaluated). 
4 Sample Sizes:  The number of adolescents involved in the study.  If a subsample was drawn for follow-up or the follow-up rates dropped below 80%, these smaller sample sizes are noted as well. 
5 Follow-up Periods and Rates:  This is reported both as a percentage and a fraction (number done divided by number due). The follow-up percent is important for understanding generalizability, with rates below 80% having potential "bias" as large or larger than the treatment effects that are being evaluated. The actual fraction and/or size of the follow-up sample is important for two reasons: 1) If the follow-up rate is low, the sample size may be much smaller, and 2) several studies with large intake cohorts only attempted follow up on a much smaller subsample.
6 Design, Measures and Methodological Rigor:  Each study was coded in terms of its major design features (e.g., major multi-site study, experimental, repeated measures, long term follow-up), the kinds of comparison groups (e.g., no/minimal treatment, multiple protocols, across levels of care, to adults), use of study-specific vs. standardized measures (and the specific measures used - see glossary for full names), collection of validation measure (e.g., urine, hair, saliva, family/other collateral, pill counts, records) and whether the results of validation analyses were reported.  
7 Treatment Integrity, Manualization and Availability:  A summary of the procedures reported for ensuring the integrity and quality of the actual treatment that was delivered, whether it was based on a manualized protocol and information on any manuals that are publicly available for people interested in replicating the protocol. 
8 Initial Treatment Effects:  Change in use and abuse/dependence problems from intake to approximately the end of treatment (typically 3 to 9 months later). 
9 Long Term Treatment Effects:  Change in use and abuse/dependence problems from intake to 12 or more months after intake (or after discharge as noted). 
10 Economic Cost and Benefits:  Any references or reports giving approximate cost and/or benefits to society associated with the treatments being evaluated. 
12 Primary Source:  The primary source used for the abstract (typically the article reporting outcomes)
13 Additional References:  A list of other manuals, economic, outcome, or design articles related to the study.
While we have generally tired to spell out words associated with the specific treatment approaches, several have been abbreviated and we generally did not spell out common terms (e.g., instrument names) as it would have doubled the size of the report.  We have, however, provided a glossary of these abbreviations in section 6 
     Below is a list of the major literature reviews and bibliographies that were used in the first step of identifying the 34 studies.  The last one is actually a bibliography that contains all of the materials we identified and reviewed.  Moreover, we continue to update this document quarterly. 
       Beschner, G. M., & Friedman, A. S. (Eds.). (1979). Youth drug abuse: Problems, issues, and treatment. Lexington, MA: DC Heath.
       Brown, S. A., & D'Amico, E. J. (2001). Outcomes of alcohol treatment for adolescents. In Galanter, M (Ed.), Recent developments in alcoholism, Vol. 15: Research in the era of managed care (pp. 307-327). New York: Kluwer/Plenum.
       Bukstein, O. G. (1995). Adolescent substance abuse:  Assessment, prevention, and treatment. New York: John Wiley & Sons.
       Bukstein, O., Dunne, J. E., Ayres, W., Arnold, V., Benedek, E., Benson, R. S., Bernet, W., Bernstein, G., Gross, R. L., King, R., Kinlan, J. L. H., Licamele, W., McClellan, J., & Shaw, K. (1997). Practice parameters for the assessment and treatment of children and adolescents with substance use disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 140S-157S.
       Deas, D., & Thomas, S. E. (2001). An overview of controlled studies of adolescent substance abuse treatment. American Journal on Addictions, 10, 178-189. 
        Dennis, M. L., Dawud-Noursi, S., Muck, R., & McDermeit, M. (2002). The need for developing and evaluating adolescent treatment models. In S. J. Stevens, & A. R. Morral (Eds.), Adolescent drug treatment in the United States: Exemplary models from a National Evaluation Study (pp. 3-34). Binghamton, NY: Haworth Press.
        Friedman, A.S. & Beschner, G.M. (Eds.) (1985).  Treatment services for adolescent substance abusers (DHHS Publication No. ADM 85-1342m). Rockville, MD: National Institute on Drug Abuse.
       Friedman, A. S., & Granick, S. (Eds.) (1990).  Family therapy for adolescent drug abuse. New York: Lexington Books.
        Kaminer, Y. (2001). Adolescent substance abuse treatment: Where do we go from here? Psychiatric Services, 52, 147-149.
        Muck, R., Zempolich, K. A., Titus, J. C., Fishman, M., Godley, M. D., & Schwebel, R. (2001). An overview of the effectiveness of adolescent substance abuse treatment models. Youth & Society, 33, 143-168.
       Ozechowski, T. J., & Liddle, H. A. (2000). Family-based therapy for adolescent drug abuse: Knowns and unknowns. Clinical Child and Family Psychology Review, 3, 269-298. 
       Titus, J. C., & Godley, M. D. (1999, August). What research tells us about the treatment of adolescent substance use disorders. Presentation for the Governor’s Conference on Substance Abuse Prevention, Intervention, and Treatment for Youth, Chicago, IL.
       Prendergast, M. L., Podus, D., Chang, E. & Urada, D. (2002). The effectiveness of drug abuse treatment: A meta-analysis of comparison group studies. Drug and Alcohol Dependence, 67, 53-72.
       Stevens, S. J., & Morral, A. R. (Eds.). (2002). Exemplary models for adolescent substance abuse treatment in America. Binghamton, NY: Haworth Press.
       Wagner, E. F., Brown, S. A., Monti, P. M., Myers, M. G., & Waldron, H. B. (1999). Innovations in adolescent substance abuse intervention. Alcoholism: Clinical and Experimental Research, 23, 236-249. 
       Wagner, E. F. & Waldron, H. B. (Eds.). (2001). Innovations in adolescent substance abuse interventions. New York: Elsevier. 
       Waldron, H. B. (1997). Adolescent substance abuse and family therapy outcome: A review of randomized trials. In T. H. Ollendick, & R. J. Prinz (Eds.), Advances in Clinical Child Psychology Volume 19 (pp. 199-234). New York: Plenum Press.  
       Williams, R. J., Chang, S. Y., & Addiction Centre Adolescent Research Group. (2000). A comprehensive and comparative review of adolescent substance abuse treatment outcome. Clinical Psychology: Science and Practice, 7, 138-166.
       Winters, K. C. (1999). Treating adolescents with substance use disorders: An overview of practice issues and treatment outcome. Substance Abuse, 20, 203-225.
        Winters, K. C., Latimer, W. W., & Stinchfield, R. D. (1999). Adolescent Treatment. In P. J. Ott, R. E. Tarter, & R. T. Ammerman (Eds.), Sourcebook on Substance Abuse: Etiology, Epidemiology, Assessment, and Treatment (1st ed. pp. 350-361). Boston, MA: Allyn & Bacon.
       White, M.K., (2002).  Adolescent Substance Abuse Treatment Bibliography.  Bloomington, IL: Chestnut Health Systems.  [On Line] Available at: http://www.chestnut.org/LI/downloads/index.html#Bibliographies
 


Drug Strategies 1616 P Street, N.W. Suite 220, Washington, D.C. 20036 202-939-0664 drugstrategies@gmail.com