Challenges and Successes Treating Adolescent Substance Use Disorders Janet L. Brody, Ph.D. Center for Family and Adolescent Research (CFAR), Oregon Research Institute Child Health Research 3 x 5 x 5 Conference University of New Mexico July 15, 2008

Drug Use in New Mexico year olds * Source: Samhsa, survey results.  Risk Factors  Genetic Predisposition / Family History Poor parenting behavior, attitudes, values Behavior management problems Early history of anti-social behavior Negative peer influence Unsupportive school environment Academic failure or negative attitudes toward school  Protective Factors  Close interpersonal bonds Nurturing family environment Pro-social values Consistent behavior management High expectations for success Goal setting and mastery Meaningful participation at home and at school New Mexico Statistics Drug abuse or dependence: 5.7% (10,000) Needing/not receiving tx for drug use: 5.4 ( 9,000) Alcohol abuse or dependence 6.7% (12,000) Needing/not receiving tx for alcohol use: 6.6 (11,000) At least one Major Depressive episode 9.2% (16,000)

Recent History of Clinical Trials Evaluating Treatments for Adolescent SUD* Nationally: 17 published clinical studies over the past 10 years – 46 intervention conditions 07 Individual Cognitive Behavioral Therapy 13 Group Cognitive Behavioral Therapy 17 Family Therapy 09 Minimal treatment control – Total Combined Sample: 2,307 adolescents *Source: Waldron & Turner, in press. CFAR: 3 clinical efficacy trials conducted by CFAR over past 10 years - compared family therapy to individual/ and or group CBT. a. Marijuana abuse/dependence b. Alcohol abuse/dependence c. Ethnicity x therapy d. “Mechanisms of action”

Comparison of four cluster groupings for all substance use.

Consistency of Treatment Outcome Findings Treatment is associated with significant reductions in substance use for most youth Across studies, roughly 25% of youth do not improve Better outcome is associated with parental involvement, attendance in aftercare, and treatment completion Relapse rates for adolescent substance abusers greater than those for adults Greatest risk for relapse highest within first 3 months post- treatment Outcomes vary depending on measures used, length of follow-up, type of substance used

Current CFAR Studies Transitions: Relapse prevention – 12 weeks of family therapy followed by randomization to 1 of 3 aftercare programs Systems, Group or Phone follow-up Adaptive: Examining Decision rules to determine how much/which type of treatment is necessary. – Minimal use vs. abstinence – Individual CBT or Family therapy following group treatment failure Sequences: Dual diagnosis (SAD and Depression) to determine most effective order of treatment Aspen: Engaging treatment resistant youth through parent training.