Recovery among adolescents: Models for post-treatment gains in drug abuse treatments

Abstract

Recovery among adolescents undergoing substance abuse treatment was modeled in terms of pre-treatment motivation, therapeutic relationships, psychological functioning, treatment retention, legal pressures, DSM diagnoses, and client demographics. To address between program differences, a within-covariance matrix, based on 547 youth, was used. Applicability of the results across treatment modalities was also examined. The data were from the NIDA-sponsored DATOS Adolescent study. Results from structural equation models (estimated using Mplus) indicated that higher pre-treatment motivation predicted stronger counselor and in-treatment peer relationships, better counselor relationships and retention predicted less illegal drug use at follow-up, and DSM diagnosis was important in the treatment process. Overall, illegal drug use at follow-up was associated with post-treatment alcohol consumption, cigarette use, condom nonuse, psychological distress, criminality, and school non-attendance. The results document the importance of motivation and therapeutic relationships on recovery, even when taking into account the relative effects of legal pressures, DSM diagnoses, and demographics.

Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change

“…For example, do clients who begin with highly experiential sessions (e.g., Downward Spiral) report greater gains on problem recognition than clients whose first sessions are more analytical in focus (e.g., Work It)? Studies are also needed to examine whether TRIP promotes engagement as a replication of the Treatment Process Model (Joe et al, 2014). All in all, interventions aimed at increasing motivation for change should have direct benefits in terms of treatment compliance and engagement because greater desire for help is related to increased compliance among adolescents (Wong, Hser, & Grella, 2002).…”

“…Values of .05 to .08 for the root mean square error of approximation (RMSEA) estimate, a value of less than .05 for the standardized root mean square residual (SRMR), along with a value close to 1 for the normed fit index (NFI), the goodness of fit index (GFI), and the comparative fit index (CFI) were used as criteria for good fit. Additional analyses using a within-covariance matrix to remove between treatment facility differences were used to test the structural equation model (Joe et al, 2014) and to provide generalizability of the findings.…”

“…Youth completing specialized treatment for their substance use show better follow-up outcomes (Williams, Chang, & Addiction Centre Adolescent Research Group, 2000; Winters, Latimer, & Stinchfield, 1999) in the areas of drug use, criminal activity, psychological adjustment, and school performance (Hser et al, 2001; Joe, Knight, Becan, & Flynn, 2014). While effective treatments exist, numerous studies have found that sizable individual differences in client responsiveness to treatment manifest even when administered with attention to protocol adherence (Dennis et al, 2004; Waldron, Slesnick, Brody, Turner, & Peterson, 2001).…”

“…Adolescents who do not acknowledge that negative consequences result from their substance use (i.e., in the lower pre-action stages of change) are more likely to drop out of treatment prematurely than youth in more advanced, action-oriented stages of change (Callaghan et al, 2005). Conversely, youth in the action stages who show a desire for help with their substance use and a high level of readiness and commitment to the therapeutic process are more likely to engage in meaningful interactions with the clinical staff and other youth receiving treatment (Joe et al, 2014). Further, the later stages of change interrelate to promote positive treatment outcomes.…”

Effectiveness of a Theoretically-Based Judgment and Decision Making Intervention for Adolescents

“…Improving problem recognition not only has implications for increasing internal motivation, but motivation to change is a consistent predictor of engagement in therapeutic activities (Joe, Knight, Becan, & Flynn, 2014). Thus, improving general thinking among adolescents should promote problem recognition and increase motivation to change.…”