Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014–2017: Outcomes, Treatment Delivery, and Promising Horizons

Abstract

This article updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Hogue, Henderson, Ozechowski, and Robbins (2014). It first summarizes the Hogue et al. findings along with those from recent literature reviews and meta-analytic studies of ASU treatments. It then presents study design and methods criteria used to select 11 comparative studies subjected to Journal of Clinical Child and Adolescent Psychology level of support evaluation. These 11 studies are detailed in terms of their sample characteristics, methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach. These cumulative designations are virtually identical to those of the previous review: ecological family-based treatment, individual cognitive-behavioral therapy, and group cognitive-behavioral therapy remain well-established; behavioral family-based treatment and motivational interviewing remain probably efficacious; drug counseling remains possibly efficacious; and an updated total of 5 multicomponent treatments combining more than 1 approach (3 of which include contingency management) are deemed well-established or probably efficacious. Treatment delivery issues associated with evidence-based approaches are then reviewed, focusing on client engagement, fidelity and mediator, and predictor and moderator effects. Finally, to help accelerate innovation in ASU treatment science and practice, the article outlines promising horizons in improving youth identification and access, specifying and implementing pragmatic treatment in community settings, and leveraging emerging lessons from implementation science.

Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies

“…Family-based therapies engage parents, caregivers, and siblings in the treatment of adolescent SUDs. Family-based therapies are well-established interventions for treating adolescent SUDs, and are particularly effective at promoting treatment attendance and therapeutic alliance, whereas other treatment modalities have shown only mixed success in these areas [9]. Recent evidence has confirmed that utilizing strategies such as parental monitoring and behavioral management, promoting positive relationships, and encouraging self-regulation and stress management are effective in treating adolescent substance use through family-based approaches [12].…”

“…CBT is effective in that thoughts, behaviors, and moods are all interconnected, and by providing an adolescent tools to improve problematic thought processes or behaviors, improvements in mood and desirable substance use outcomes often follow. It is well-established as a treatment for adolescent substance use in both individual and group formats [9]. Recent work has focused on third-wave cognitive-behavioral therapies or personalized-delivery of CBT, discussed below in probably efficacious standalone treatments.…”

“…Recent evidence continues to support multicomponent psychosocial treatments, as combinations of family-based therapy, cognitive behavioral therapy, motivational interviewing, and contingency management can be effectively utilized to treat adolescent SUDs [9,[18][19][20][21][22][23]. Combinations of motivational enhancement therapy (MET; described below in more detail in section 2) and CBT are well-established interventions for treating adolescent SUD [9,21], and other studies have found that contingency management, an intervention in which an individual is rewarded for positive behavior, can be an effective supplement to MET, CBT, and family-based therapies [19,20].…”

Is fidelity to motivational interviewing associated with alcohol outcomes in treatment-seeking 60+ year-old citizens?

“…The effects of MI could be even better in combination with other treatment approaches (Hettema, Steele, and Miller, 2005; Spoelstra, Schueller, Hilton, and Ridenour, 2015; Westra, Aviram, and Doell, 2011; Westra, Constantino, and Antony, 2016), than as a standalone treatment, and combined treatment approaches which MI are advancing (Gates, Sabioni, Copeland, Le Foll, and Gowing, 2016;Hogue, Henderson, Becker, and Knight, 2018;Marker and Norton, 2018;Riper et al, 2014). Motivational Interviewing is often applied at the beginning of treatment and later combined with Cognitive Behavioral Therapies (CBT) as in the project COMBINE (Anton et al, 2006) and in the study reported on in this article: the Elderly study (Andersen et al, 2015).…”

The Volunteer Recovery Support for Adolescents (VRSA) experiment: Recruiting, retaining, training, and supervising volunteers to implement recovery monitoring and support services

“…Specifically, this model focuses on increasing prorecovery peers and activities in the community to compete with, reduce, and eventually replace substance use with constructive prosocial activities that support the development of recovery capital (Best et al, 2012;Cloud & Granfield, 2008;McKay, 2017). Research on A-CRA has demonstrated that it is effective as primary treatment for youth with substance use problems (Henderson et al, 2016;Hogue, Henderson, Becker, & Knight, 2018) and as continuing care recovery support following residential services (Garner, Godley, Funk, Lee, & Garnick, 2010;Godley et al, 2007Godley et al, , 2014.…”