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See also:
Patient Characteristics and Treatment Outcomes for African American, Hispanic, and White Adolescents
The Effect of Drug Treatment on Criminal Behavior Among Adolescents in DATOS-A
 Sex-related HIV Risk Reduction Behavior among Adolescents in DATOS-A

Drug Treatment Outcomes for Adolescents with Comorbid Mental and Substance Use Disorders

The effectiveness of drug treatment was examined for adolescents with comorbid psychiatric disorders in comparison with non-comorbid adolescents across a wide range of outcomes (Grella, Hser, Joshi, & Rounds-Bryant, 2001). The study sample included 992 adolescent patients from 8 residential (RES) programs (n=362), 6 short-term inpatient (STI) programs (n=388), and 9 outpatient drug-free (ODF) programs (n=242).

Figure 1. Comorbidity among Adolescents in DATOS-A   Figure 2. Comorbid vs. Non-comorbid Adolescents
[Figure 1]             [Figure 2]

  • Conduct disorder was associated with being younger, being dependent on marijuana, having higher scores on the Negative Reference Group Scale, having a lower commitment to school and, as would be expected from the diagnostic criteria for conduct disorder, having a higher number of illegal acts in the year before treatment.

  • Adolescents in STI programs were about twice as likely as those in ODF to be diagnosed with conduct disorder.

  • Depression was associated with being female, white, and alcohol dependent; having more family problems; having a history of physical or sexual abuse; and having a lower commitment to school, as compared with non-depressed adolescents.

  • ADHD was associated with having more family problems and a history of physical or sexual abuse.

Figure 3. Logistic Regressions Predicting Comorbid Mental Disorders   Figure 4. Logistic Regressions Predicting Comorbid Mental Disorders
[Figure 3]             [Figure 4]

  • In general, there were significant reductions in marijuana use, hallucinogen use, stimulant use, heavy drinking, suicidal thoughts, hostility, family problems, illegal acts, and arrests from before to after treatment.

  • Improvements were found in levels of self-esteem and school commitment from before to after treatment.

  • Generally poorer posttreatment outcomes were found among the comorbid youth.

  • Comorbid adolescents had a higher likelihood of using marijuana weekly or more often, using hallucinogens, engaging in illegal acts, and having been arrested during the follow-up period.

Figure 5. Drug and Alcohol Use at Intake and Follow-up by Comorbidity    Figure 6. Suicidality, School Enrollment, and Criminal Behavior at Intake and Follow-up by Comorbidity   Figure 7. Odds Ratios for Comorbid vs. Non-comorbid Predicting Outcomes
[Figure 5]             [Figure 6]           [Figure 7]

In conclusion, comorbidity was associated with more severe substance use, and the findings underscore the need to incorporate diagnostic and treatment protocols that address both mental and substance use disorders among adolescents in drug treatment.

Reference

Grella, C. E., Hser, Y. I., Joshi, V., & Rounds-Bryant, J. L. (2001).  Journal of Nervous and Mental Disease, 189, 384-392.   [Abstract]

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Patient Characteristics and Treatment Outcomes for African American, Hispanic, and White Adolescents

Rounds-Bryant and Staab (2001) compared ethnic minorities and non-minorities to test the hypothesis that the characteristics and behaviors of African American, Hispanic, and White adolescents would be different from each other both at admission and 12 months after discharge. The study sample included 1,094 patients consisting of 213 African Americans, 108 Hispanics, and 773 White adolescents admitted to 23 drug abuse treatment programs between 1993 and 1995 in four cities, Chicago, Minneapolis, Pittsburgh, and Portland, Oregon.

Figure 1. Demographic and Pretreatment Characteristics by Ethnicity    Figure 2. Drug and Alcohol Dependence by Ethnicity   Figure 3. Mental Health Status by Ethnicity
[Figure 1]               [Figure 2]              [Figure 3]

Categorical and continuous data were analyzed using chi-square, analysis of variance, and paired t-test comparisons where appropriate, and logistic regression models were developed to examine relationships between race/ethnicity and treatment outcomes. Major findings included:

Similarities - all three groups were primarily male, 16 years old, and weekly or more frequent users of marijuana in the year before treatment.

Differences - African Americans and Hispanics were more frequently referred to treatment by and involved with the criminal justice system; Whites were mainly referred to treatment by family and friends and were engaged in serious illegal activity (e.g., crimes against persons) at greater rates than African Americans and Hispanics; African Americans were the least likely to meet diagnostic criteria for a mental disorder or substance dependence, but more likely to engage in sexual HIV-risk behavior.

Figure 4. Pretreatment Behavior by Ethnicity   Figure 5. Posttreatment Behavior by Ethnicity
[Figure 4]             [Figure 5]

In the context of the findings, suggestions for improving treatment access and tailoring treatment for unique needs are offered for minority patients.

Reference

Rounds-Bryant, J.L. and Staab, J. (2001). Patient characteristics for African American, Hispanic, and White Adolescents in DATOS-A. Journal of Adolescent Research, 16(6), 624-641. [Abstract]

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The Effect of Drug Treatment on Criminal Behavior among Adolescents in DATOS-A

The association between substance abuse treatment and subsequent criminal behavior was assessed to identify the adolescent patient characteristics that were most closely associated with reductions in crime during the posttreatment period (Farabee, Shen, Hser, Grella, & Anglin, 2001). Comparisons were made between adolescents who were and were not under criminal justice supervision (n = 1,167).

Figure 1. Percent of CJS-Supervised DATOS-A Clients Reporting Arrests during the past 12 months   Figure 2. Percent of Non-CJS-Supervised DATOS-A Clients Reporting Arrests during the past 12 months
[Figure 1]             [Figure 2]

Key findings included:

  • Pre-post treatment comparisons of criminal activity and arrests showed significant decreases in drug-related criminal activity for both CJS- and non CJS-supervised adolescents.

  • CJS-supervised adolescents accounted for the majority of the reduction of drug-related crime during the 12 months following treatment admission.

  • Pretreatment group differences showed that relative to non-CJS-supervised adolescents, CJS-supervised youth were more likely to have drug-using and criminally active family members and peers, and more likely to meet the diagnostic criteria for conduct disorder. Yet, in spite of the criminogenic characteristics of the CJS-supervised sample, CJS supervision was associated with improved outcomes on posttreatment criminal activity.

Reference

Farabee, D., Shen, H., Hser, Y.I., Grella, C.E., & Anglin, M.D. (2001). The Effect of Drug Treatment on Criminal Behavior Among Adolescents in DATOS-A. Journal of Adolescent Research, 16(6), 679-696.  [Abstract]

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Sex-related HIV Risk Reduction Behavior among Adolescents in DATOS-A

This study examined patient characteristics and treatment characteristics in relation to risk status and outcomes following treatment (Joshi, Hser, Grella, & Houlton, 2001). Subjects included 796 adolescent patients from 8 residential (n=352), 5 short-term inpatient (n=265), and 8 outpatient drug-free (n=179) programs. The sample included 70.5% males, 61.7% Whites, 22.5% African Americans, 9.7% Hispanic, and 6.2% "other" ethnic groups. The mean age was 15.7 years (SD = 1.5).

Figure 1. Posttreatment Outcomes by Improved HIV Risk Behavior
[Figure 1]

  • Over half of the adolescents who were sexually active at intake into DATOS-A treatment either improved their risky sex behavior or remained at a low level of risk 12 months after treatment.

  • There was no difference in rates of improvement between youth with and without conduct disorder, although there were differences between these two groups in the factors associated with risk reduction.

Conclusions

  • Findings from this study are consistent with others showing that a decline in one form of deviant behavior is associated with simultaneous declines in other deviant behaviors. Among the sample as a whole, adolescents who improved their risky sex behavior had higher rates of abstinence as well as less criminal involvement and negative peer influence following treatment.

  • Findings suggest that drug treatment can be most effective in reducing the HIV risk behaviors among adolescents when attention is focused on pretreatment risk factors, current levels of problem and deviant behaviors, response to treatment, and key personality characteristics.

Reference

Joshi, V., Hser, Y.I., Grella, C.E., & Houlton, R. (2001). Sex-related HIV Risk Reduction Behavior Among Adolescents in DATOS-A. Journal of Adolescent Research, 16(6), 642-660.  [Abstract]

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14 December 2001

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