Advances in Adolescent Substance Abuse Treatment

Alcohol and other drug use among adolescents has been a public health problem for decades. Although some substance use may be developmentally routine, a concerning number of adolescents meet criteria for a substance use disorder and could greatly benefit from a quality treatment experience. However, parents and health care providers want evidence of the efficacy of adolescent-specific treatment programs. This review summarizes four factors surrounding the efficacy of current adolescent treatment programs: 1) adolescent-specific treatment services; 2) the variety of therapeutic modalities; 3) relapse and recovery rates; and 4) the need for evidence-based, quality assessments and research. Current adolescent treatment efforts are summarized, and the recent literature regarding the efficacy of adolescent treatment and recovery rates is discussed.     

Substance Abuse in an Adolescent Boy: Waking the Object

The analysis of an adolescent boy abusing alcohol, marijuana, and other drugs is used to discuss unconscious object relationships that can underlie substance dependence. Differentiating experimental from dangerous substance use is particularly challenging in the treatment of adolescents. The boy's escalating substance use is viewed both as an effort to numb himself and to “speak” through symptoms of problems he could not yet name. I utilize Rosenfeld's (1960/1966) view of the relationship of drug addiction to an identification with an ill or dead object to explicate the boy's psychodynamics. In this case, my patient was identified with both an ill mother and a neglectful father. Aspects of containment by the analyst that contribute in different ways to an adolescent's capacity to think about their self-destructiveness are discussed, along with the need for confrontation and the meaning of ancillary care when an adolescent's substance abuse become life threatening.     

Principles of Family Therapy for Adolescent Substance Abuse

Summary

The primary purpose of this article is to provide the therapist with general guidelines for conducting treatment with families of adolescent substance abusers from a structural-strategic orientation. After a brief review of the general literature and research on family therapy with adolescent substance abuse, an outline of the structural-strategic model will be presented, followed by specific modifications for treatment of substance abuse with adolescents.     

Gender Differences in Homeless Persons with Schizophrenia and Substance Abuse

The purpose of this study was to test thegeneralizability of previous research on genderdifferences between men and women with co-occurringschizophrenia and substance abuse. One hundred eightpatients with schizophrenia or schizoaffective disorderinvolved in a study of treatment for homeless personswere interviewed for information regarding substanceuse, social functioning and support, comorbid disorders, victimization, medical illness, and legaltroubles. We found that women had more children and weremore socially connected than men. Women also had higherrates of sexual and physical victimization, comorbid anxiety and depression, and medical illnessthan men. We conclude that homeless women with dualdisorders, like women with substance use disorders inthe general population, have distinct characteristics, vulnerabilities, and treatment needs comparedwith men. In addition to comprehensive treatment ofpsychiatric and substance use disorders, gender-specificservices should be developed, including prevention and treatment of victimization and relatedproblems as well as help with accessing medicalservices.     

Brain Structure Linking Delay Discounting and Academic Performance

As a component of self‐discipline, delay discounting refers to the ability to wait longer for preferred rewards and plays a pivotal role in shaping students’ academic performance. However, the neural basis of the association between delay discounting and academic performance remains largely unknown. Here, we examined the neuroanatomical substrates underlying delay discounting and academic performance in 214 adolescents via voxel‐based morphometry (VBM) by performing structural magnetic resonance imaging (S‐MRI). Behaviorally, we confirmed the significant correlation between delay discounting and academic performance. Neurally, whole‐brain regression analyses indicated that regional gray matter volume (rGMV) of the left dorsolateral prefrontal cortex (DLPFC) was associated with both delay discounting and academic performance. Furthermore, delay discounting partly accounted for the association between academic performance and brain structure. Differences in the rGMV of the left DLPFC related to academic performance explained over one‐third of the impact of delay discounting on academic performance. Overall, these results provide the first evidence for the common neural basis linking delay discounting and academic performance. Hum Brain Mapp 38:3917–3926, 2017. © 2017 Wiley Periodicals, Inc.     

Mindfulness: Implications for Substance Abuse and Addiction

Mindfulness is a concept that has taken quite a hold on the therapeutic world in recent years. Techniques that induce “mindfulness” are increasingly being employed in Western psychology and psychotherapy to help alleviate a variety of conditions. So while mindfulness has its conceptual roots in Buddhism it has been translated into a Western non-religious context. Mindfulness skills are now included as a technique for coping with urges to engage in substance use and relapse in addiction. The research at this date has not revealed the ultimate effectiveness of mindfulness for substance abuse and addiction. It might be that mindfulness is a helpful, but not a sufficient factor as a means to address substance abuse. The relationship between spirituality and mindfulness should be explored further.     

青少年物质滥用与父母物质滥用及精神疾病的关系

目的　分析青少年药物滥用及其他精神行为问题与父母药物滥用及共患精神疾病的关系。方法　研究对象为 181名药物滥用青少年和及其父母 ,根据父母的药物滥用和精神疾病史将青少年分成父母对照组、父母药物滥用组和父母共患组 ,比较了青少年物质滥用及其他精神行为问题和家庭环境在三组间的差异。结果　与父母对照组和父母药物滥用组青少年相比 ,父母共患组青少年行为问题问卷各量表分均大于其他两组 (P <0 .0 1) ,父母共患组家庭矛盾较多、家庭组织性较差 (P <0 .0 1)。结论　父母共患药物滥用和精神疾病的青少年药物滥用者可能属于不同亚群 ,其家庭矛盾较多、家庭组织性较差 ,青少年具有更多的精神行为问题 ,应加强相应的治疗和干预措施。     

Delay Discounting Interacts with Distress Tolerance to Predict Depression and Alcohol Use Disorders among Individuals Receiving Inpatient Substance Use Services

International Journal of Mental Health and Addiction -     

Hope-Focused Interventions in Substance Abuse Counselling

Hope is a vital component of psychological healing and plays a critical role in counselling. With despair so prominent for individuals with serious substance abuse problems, the question arises as to how to foster hope in such clients. There are recent suggestions in the general counselling literature that some of the work in counselling involve moving the topic of hope to the forefront and openly approaching the concept of hope with clients. This article describes several hope-focused interventions that can be used to explicitly explore hope in substance abuse counselling.     

Integrating Services for Schizophrenia and Substance Abuse

Over the past decade, several studies have attempted to determine whether integrating psychiatric and substance abuse treatment leads to better outcome for patients with comorbid schizophrenia and substance use disorders. A recent (1999) Cochrane Review (1) analyzed the effectiveness of prospective randomized studies of integrated treatment approaches, and concluded that there was no clear evidence for superiority of integrated treatment. This paper describes one such integrated treatment approach, in Beth Israel Medical Center's COPAD (Combined Psychiatric and Addictive Disorders) program. We summarize findings from an initial outcome study and a recent replication study; and describe clinical and research issues relevant to this population. Our data suggests the benefits of integrated treatment for patients with addictive disorders and schizophrenia, at least with regard to treatment retention. Clinical issues for such patients include identification of patients at risk, proper assessment and treatment planning, decision-making about mainstreaming vs. referral to specialized programs, and the importance of initial engagement and ongoing reengagement in successful treatment.