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Prospective Risk Factors and Treatment Outcomes Among Adolescents in DATOS-A

An Evaluation of Drug Treatments for Adolescents in 4 U.S. Cities

A total of 1,732 consecutive adolescent admissions to 23 treatment programs in 4 major U.S. cities (Pittsburgh, PA; Minneapolis, MN; Chicago, IL; and Portland, OR) from 1993-1995 were interviewed and followed a year after discharge (Hser, Grella, Hubbard, Hsieh, Fletcher, Brown, & Anglin, 2001). Treatment modalities included residential (RES) programs, outpatient drug-free (ODF) programs, and short-term inpatient (STI) programs. The average patient age was 15 - 16 years, primary sources of treatment referral were by family or friends (41.6%) or the legal system (38.6%), and the majority were in trouble with the law (i.e., 58.4% were on parole, probation or awaiting trial).

Figure 1. Description of Adolescents in DATOS-A   Figure 2. Primary Drug Problems
[Figure 1]         [Figure 2]

  • Significant before to after treatment reductions were found in weekly or more frequent marijuana use, heavy drinking, use of other illicit drugs, criminal activities, and arrests.

  • Adolescents reported better psychological adjustment in terms of reduced suicidal thoughts and hostility and increased self-esteem, better school attendance, and average or better than average grades after treatment (as compared with the year before).

  • Longer time in treatment (greater than 90 days in RES and ODF programs and 21 days in STI programs) was significantly related to lower drug use and lower arrest rates following treatment.

Figure 3. Drug and Alcohol Use at Intake and Follow-up    Figure 4. Suicidality, School Attendance, and Criminal Behavior at Intake and Follow-up   Figure 5. Odds Ratios for Longer vs. Shorter Treatment Retention Predicting Outcomes
[Figure 3]         [Figure 4]         [Figure 5]

The DATOS-A study demonstrated many important behavioral and psychological improvements in the year following treatment discharge across the domains of alcohol and drug use, criminality, school performance, and psychological functioning. Poorer outcomes were associated with having shorter lengths of stay in treatment.

Reference

Hser, Y.I., Grella, C.E., Hubbard, R.L., Hsieh, S.C., Fletcher, B.W., Brown, B.S., & Anglin, M.D. (2001). An Evaluation of Drug Treatments for Adolescents in 4 U.S. Cities. Archives of General Psychiatry, 58(7), 689-695. [Abstract]

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Prospective Risk Factors and Treatment Outcomes Among Adolescents in DATOS-A

Problem behavior theory was used as a basis for testing the relationship between risk factors associated with drug use among adolescents and treatment outcomes (Galaif, Hser, Grella, & Joshi, 2001). The relationship of various risk factors, retention in DATOS-A treatment, and posttreatment outcomes among adolescents treated in outpatient drug-free (ODF; n=292) and residential (RES; n=418) programs were examined. Separate structural equation models were developed and tested for ODF and RES patients in the two modalities. Subjects were mostly male (74%), 58% were White, 24% Black, 13% Hispanic, and 5% of other ethnic groups.

  • For youth treated in ODF programs, severity of alcohol and marijuana use predicted lower rates of retention in treatment. Family drug and alcohol involvement predicted more alcohol use 1 year following treatment.

Figure 1. Outpatient Drug Free Structural Model

[Figure 1]

  • For youth treated in RES programs, family alcohol and drug involvement and criminal involvement predicted lower rates of retention in treatment. Conduct disorder predicted more marijuana use during the year after treatment.

 Figure 2. Residential Structural Model

[Figure 2]

Conclusion

  • Study findings indicate that adolescent treatment programs should specifically address adolescents' drug use and related problems (criminal activity, psychological problems), in addition to issues related to completing the stage-appropriate developmental tasks associated with adolescence.

Reference

Galaif, E., Hser, Y.I., Grella, C.E., & Joshi, V. (2001). Prospective Risk Factors and TreatmentOutcomes Among Adolescents in DATOS-A. Journal of Adolescent Research, 16(6), 661-678.  [Abstract]

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