One-year outcome of adolescent females referred for conduct disorder and substance abuse/dependence

We investigated whether substance abuse/dependence, conduct disorder, and other psychiatric disorders improved in adolescent females who were referred to outpatient treatment and which variables were related to 1-year outcome. Forty-six out of 60 conduct-disordered (CD) adolescent females with substance abuse or dependence were re-evaluated approximately 1 year after discharge. Treatment length averaged 16 weeks. Significant improvements were seen in three areas: (1) criminality and CD; (2) attention deficit hyperactivity disorder (ADHD); and (3) educational and vocational status. However, neither substance involvement nor depression improved, regardless of length of stay in treatment, and these females demonstrated significant risky sexual behaviors. In contrast to our previous work with adolescent males (Crowley, T.J., Mikulich, S.K., Macdonald, M., Young, S.E., Zerbe, G.O., 1998. Substance-dependent, conduct-disordered adolescent males: severity of diagnosis predicts 2-year outcome. Drug Alcohol Depend. 49, 225-237), we were not able to identify pre-intake variables, other than performance IQ, that were related to substance use and conduct outcomes. Only two post-treatment factors (peer problems and number of ADHD symptoms at follow-up) were found to be related to CD and substance use disorders outcomes. The overall lack of pre- and post-treatment predictors presents interesting challenges for future research on adolescent females with these disorders.     

Long-Term Outcome of a Brief Intervention to Address Adolescent Drug Abuse in a School Setting

The present study used data from a randomized controlled trial on brief interventions with adolescents to identify distinct longitudinal patterns of substance use and identify predictors, as well as outcomes associated with those use patterns. Data were originally collected for the purpose of evaluating two brief intervention conditions with adolescents who had been identified in a school setting as abusing alcohol or other drugs (total sample, N?=?315). Adolescents were randomly assigned to a two-session adolescent-only brief intervention (BI-A), a two-session adolescent-plus an additional parent session (BI-AP), or an assessment-only control session (CON). We located 74 participants to assess them at approximately 3.5 years post-intervention. Three distinct cluster patterns were identified, including a low decreasing, moderate increasing, and high decreasing pattern of use. The low decreasing cluster was associated with the BI-A condition, mono-substance use, and comorbid anxiety symptoms at baseline. The moderate increasing cluster was associated with the BI-AP condition, polysubstance use, and comorbid conduct disorder symptoms at baseline. No variables were found to be predictive of membership within the high decreasing cluster. There were also no differences found between clusters on adjustment outcomes in young adulthood. Overall findings from this study support the long-term efficacy of a brief intervention, without parent involvement, for adolescents experiencing mild to moderate substance abuse problems. Findings also highlight the importance of early intervention and the tailoring of interventions to meet the unique needs of adolescents.     

What came first,major depression or substance use disorder? Clinical characteristics and substance use comparing teens in a treatment cohort

This study utilized data on a treatment cohort from a randomized clinical trial that recruited adolescents with co-occurring major depression and substance use disorder (N=126). The purpose of this study was to compare adolescents for whom the onset of depression was first versus those for whom the onset of substance use disorder was first or in the same year as depression. Intake clinical evaluations were abstracted to yield common stressors that included childhood abuse, early loss or death, exposure to violence, and attachment problems. Tobacco, alcohol, and cannabis initiation and dependence were compared for the depression first and substance use disorder first groups, and within those groups by gender. Among the substances studied, only cannabis dependence was significantly more prevalent among those with depression first. Comparisons suggest some differences in the developmental path toward comorbid depression and substance use disorders, but remarkable similarity in measures of dependence and severity. Although small samples limited statistical significance, observed differences suggest possible avenues for prevention or intervention.     

Substance use disorder characteristics and externalizing problems among inpatient adolescent smokers

Attention deficit hyperactivity disorder (ADHD) and/or conduct disorder (CD) have been found to be associated with substance use disorders and cigarette smoking among adolescents. However, studies have often failed to explore these relationships among females from a dimensional perspective, taking into account comorbidity between ADHD and CD symptomatology, and examining ADHD symptom subtypes (i.e., inattention and hyperactivity/impulsivity) separately as they relate to substance involvement and smoking characteristics. This study takes each of the above into consideration when examining the relationship between externalizing symptomatology and substance involvement characteristics in a sample of 191 (62.3% female, mean age = 15.4 years) inpatient adolescent smokers. The results of this study suggest that ADHD and CD symptoms may be related to different types of substance use characteristics. CD symptoms were associated with early onset of substance involvement and ADHD symptoms were related to alcohol and marijuana frequency. ADHD inattention symptoms, but not hyperactivity/impulsivity symptoms, were associated with marijuana and nicotine dependence. Lastly, significant interactions suggested that ADHD symptoms among boys and CD symptoms among girls were related to frequency of any type of substance use prior to inpatient hospitalization. The results of this study point to potentially important clinical implications such as tailoring prevention and intervention efforts according to type of externalizing symptomatology and gender.     

Gender differences in psychiatric comorbidity among adolescents with substance use disorders

The authors examined gender differences in rates of comorbid psychiatric disorders among adolescents with I or more psychoactive substance use disorders. Baseline diagnostic data were obtained from 135 adolescents, ages 12 to 19, and their parents-guardians, who participated in a study to develop and efficacy test Integrated Family and Cognitive-Behavioral Therapy. Rates of attention-deficit/hyperactivity disorder and conduct disorder were higher among drug-abusing male adolescents compared with drug-abusing female adolescents. However, high rates of disruptive behavior disorders also characterized drug-abusing female adolescents. Similarly, drug-abusing female adolescents exhibited a higher rate of major depression compared with drug-abusing male adolescents. However, rates of dysthymia, double depression (i.e., major depression and dysthymia), and bipolar disorder were equivalent between genders.     

Moderators of fluoxetine treatment response for children and adolescents with comorbid depression and substance use disorders

Our recent 8-week, randomized, placebo-controlled trial of fluoxetine in adolescents (ages 12-17 years) with comorbid depression and substance use disorder (SUD) did not detect a significant antidepressant treatment effect. The purpose of this secondary analysis was to explore moderators of the effect of fluoxetine in this sample. Static moderators measured at baseline were depression chronicity and hopelessness severity; time-varying moderators measured at baseline and weekly during the 8-week trial period were alcohol and marijuana use severity. Treatment effects on depression outcomes were examined among moderating subgroups in random effects regression models. Subjects assigned to fluoxetine treatment with chronic depression at baseline (p = .04) or no more than moderate alcohol use during the trial (p = .04) showed significantly greater decline in depression symptoms in comparison to placebo-assigned subgroups. The current analysis suggests that youth with chronic depression and no more than moderate alcohol consumption are likely to respond better to treatment with fluoxetine compared with placebo than youth with transient depression and heavy alcohol use.     

The Role of Relationship Adjustment in an Integrated Individual Treatment for PTSD and Substance Use Disorders Among Veterans: An Exploratory Study

Objective: Identifying factors that influence treatment outcomes of emerging integrated interventions for co-occurring posttraumatic stress disorder (PTSD) and substance use disorder is crucial to maximize veterans' health. Dyadic adjustment suffers among individuals with PTSD and substance use disorder and may be an important mechanism of change in treatment. This exploratory study examined the association between dyadic adjustment and treatment outcomes in individual integrated treatment for co-occurring PTSD and substance use disorder. Methods: Participants were treatment-seeking veterans (N = 15) participating in a larger randomized controlled trial examining the efficacy of a novel integrated treatment for co-occurring PTSD and substance use disorder. Multiple regression analyses controlling for baseline symptom severity and independent sample t-tests were used to examine the relation between dyadic adjustment and treatment outcome variables including PTSD, substance use disorder, and depression symptom severity. Results: Baseline dyadic adjustment was associated with session 12 PTSD symptom severity as measured by both the Clinician-Administered PTSD Scale (CAPS) and PTSD Checklist (PCL), such that participants with high dyadic adjustment had significantly lower session 12 CAPS and PCL scores compared to participants with low dyadic adjustment. Baseline dyadic adjustment was not associated with session 12 depression symptoms or frequency of substance use. Conclusions: These findings suggest that while the primary determinant of treatment outcome in this sample is the application of an evidence-based intervention, dyadic adjustment may play a role in individual treatment outcome for some treatment-seeking veterans. Data from this study were derived from clinical trial NCT01365247.     

Substance Use Disorder Characteristics and Externalizing Problems Among Inpatient Adolescent Smokers

Abstract

Attention deficit hyperactivity disorder (ADHD) and/or conduct disorder (CD) have been found to be associated with substance use disorders and cigarette smoking among adolescents. However, studies have often failed to explore these relationships among females from a dimensional perspective, taking into account comorbidity between ADHD and CD symptomatology, and examining ADHD symptom subtypes (i.e., inattention and hyperactivity/impulsivity) separately as they relate to substance involvement and smoking characteristics. This study takes each of the above into consideration when examining the relationship between externalizing symptomatology and substance involvement characteristics in a sample of 191 (62.3% female, meanage = 15.4 years) inpatient adolescent smokers. The results of this study suggest that ADHD and CD symptoms may be related to different types of substance use characteristics. CD symptoms were associated with early onset of substance involvement and ADHD symptoms were related to alcohol and marijuana frequency. ADHD inattention symptoms, but not hyperactivity/impulsivity symptoms, were associated with marijuana and nicotine dependence. Lastly, significant interactions suggested that ADHD symptoms among boys and CD symptoms among girls were related to frequency of any type of substance use prior to inpatient hospitalization. The results of this study point to potentially important clinical implications such as tailoring prevention and intervention efforts according to type of externalizing symptomatology and gender.     

Testing the Effects of Peer Socialization Versus Selection on Alcohol and Marijuana Use Among Treated Adolescents

This study examined the relative influence of peer socialization and selection on alcohol and marijuana use among 106 adolescents who received a brief intervention. Adolescents were recruited between 2003 and 2007 and followed for 12 months as part of a SAMHSA-funded study. Cross-lagged panel models using four assessment points examined the longitudinal relationship between adolescent substance use and peer substance involvement separately for alcohol and marijuana. Consistent with community studies, there was evidence of both peer socialization and peer selection for alcohol use, and only evidence of peer selection for marijuana use. Implications for research and intervention are discussed.     

A parallel process growth mixture model of conduct problems and substance use with risky sexual behavior

Conduct problems, substance use, and risky sexual behavior have been shown to coexist among adolescents, which may lead to significant health problems. The current study was designed to examine relations among these problem behaviors in a community sample of children at high risk for conduct disorder. A latent growth model of childhood conduct problems showed a decreasing trend from grades K to 5. During adolescence, four concurrent conduct problem and substance use trajectory classes were identified (high conduct problems and high substance use, increasing conduct problems and increasing substance use, minimal conduct problems and increasing substance use, and minimal conduct problems and minimal substance use) using a parallel process growth mixture model. Across all substances (tobacco, binge drinking, and marijuana use), higher levels of childhood conduct problems during kindergarten predicted a greater probability of classification into more problematic adolescent trajectory classes relative to less problematic classes. For tobacco and binge drinking models, increases in childhood conduct problems over time also predicted a greater probability of classification into more problematic classes. For all models, individuals classified into more problematic classes showed higher proportions of early sexual intercourse, infrequent condom use, receiving money for sexual services, and ever contracting an STD. Specifically, tobacco use and binge drinking during early adolescence predicted higher levels of sexual risk taking into late adolescence. Results highlight the importance of studying the conjoint relations among conduct problems, substance use, and risky sexual behavior in a unified model.