No abstract

Reconciling urine results and self-reports is a classic challenge in substance abuse treatment research in general. For adolescents, the problems are compounded by the facts that they are more likely to use marijuana (which takes longer to metabolize) and to be coerced into treatment (which may increase lying). This article examines the construct and predictive validity of several different approaches for combining urine and self reported drug use including using common individual measures (urine tests and self-reported recency, frequency, and peak use), taking either as positive, using a summary scale, and using a latent model. Data are from 819 older adolescents 24 to 42 months after intake in seven sites. Days of use, the GAIN's substance frequency scale, and a latent model were the three best methods in terms of construct and predictive validity. Implications for treatment and longitudinal evaluation will be discussed.

Objectives-To determine the added risk of opioid problem use (OPU) in youth with marijuana/ alcohol problem use (MAPU).Method-475 youth (ages 14-21 years) with OPU+MAPU were compared to a weighted sample of 475 youth with MAPU only (i.e., no OPU) before and after propensity score matching on gender, age, race, level of care, and weekly use of marijuana/alcohol. Youth were recruited from 88 drug treatment sites participating in eight Center for Substance Abuse Treatment funded grants. At treatment intake, participants were administered the Global Appraisal of Individual Need to elicit information on demographic, social, substance, mental health, HIV, physical and legal characteristics. Odds ratios with confidence intervals were calculated.Results-The added risk of OPU among MAPU youth was associated with greater comorbidity: higher rates of psychiatric symptoms and trauma/victimization; greater needle-use and sex-related HIV-risk behaviors and greater physical distress. The OPU+MAPU group was less likely to be African American or other race and more likely to be age 15-17 years, Caucasian; report weekly drug use at home and among peers; engage in illegal behaviors and be confined longer; have greater substance abuse severity and poly drug use; and use mental health and substance abuse treatment services.Conclusions-These findings expand on the existing literature and highlight the substantial incremental risk of OPU on multiple comorbid areas, among treatment-seeking youth. Further evaluation is needed to assess their outcomes following standard drug treatment and to evaluate specialized interventions for this subgroup of severely impaired youth.

The purpose of this study was to evaluate the impact of an assessment training and certification program on the quality of data collected from clients entering substance abuse treatment. Data were obtained from 15,858 adult and adolescent clients entering 122 treatment sites across the United States using the Global Appraisal of Individual Needs-Initial (GAIN-I). GAIN Administration and Fidelity Index (GAFI) scores were predicted from interviewer certification status, interviewer experience, and their interactions. We controlled for client characteristics expected to lengthen or otherwise complicate interviews. Initial bivariate analyses revealed effects for certification status and experience. A significant interaction between certification and experience indicates interviewers attaining certification and having more experience far outperformed certified interviewers with low experience. Although some client characteristics negatively impacted fidelity, interviewer certification and experience remained salient predictors of fidelity in the multivariate model. The results are discussed with regard to the importance of ongoing monitoring of interviewer skill.

Youths are using emergency departments (EDs) for behavioral health services in record numbers, even though EDs are suboptimal settings for service delivery. In this article, the authors evaluated a mobile crisis service intervention implemented in Connecticut with the aim of examining whether the intervention was associated with reduced behavioral health ED use among those in need of services.