Interventions and treatments for adolescent substance abuse: Publications guide

Annotated bibliography

Below are some citations and abstracts from publications about interventions and treatment for adolescent substance abuse.

Allen, M. L., Garcia-Huidobro, D., Porta, C., Curran, D., Patel, R., Miller, J., & Borowsky, I. (2016). Effective Parenting Interventions to Reduce Youth Substance Use: A Systematic Review. Pediatrics, 138(2), e20154425.

Context: Parenting interventions may prevent adolescent substance use; however, questions remain regarding the effectiveness of interventions across substances and delivery qualities contributing to successful intervention outcomes.

Objective: To describe the effectiveness of parent-focused interventions in reducing or preventing adolescent tobacco, alcohol, and illicit substance use and to identify optimal intervention targeted participants, dosage, settings, and delivery methods.

Data sources: PubMed, PsycINFO, ERIC, and CINAHL.

Study selection: Randomized controlled trials reporting adolescent substance use outcomes, focusing on imparting parenting knowledge, skills, practices, or behaviors.

Data extraction Trained researchers extracted data from each article using a standardized, prepiloted form. Because of study heterogeneity, a qualitative technique known as harvest plots was used to summarize findings.

Results: A total of 42 studies represented by 66 articles met inclusion criteria. Results indicate that parenting interventions are effective at preventing and decreasing adolescent tobacco, alcohol, and illicit substance use over the short and long term. The majority of effective interventions required ≤12 contact hours and were implemented through in-person sessions including parents and youth. Evidence for computer-based delivery was strong only for alcohol use prevention. Few interventions were delivered outside of school or home settings.

Limitations: Overall risk of bias is high.

Conclusions: This review suggests that relatively low-intensity group parenting interventions are effective at reducing or preventing adolescent substance use and that protection may persist for multiple years. There is a need for additional evidence in clinical and other community settings using an expanded set of delivery methods.

Becker, S., Hernandez, L., Spirito, A., & Conrad, S. (2017). Technology-assisted intervention for parents of adolescents in residential substance use treatment: protocol of an open trial and pilot randomized trial. Addiction Science & Clinical Practice, 12(1), 1-13.

Adolescents in residential substance use disorder (SUD) treatment have poor outcomes post-discharge, with follow-up studies suggesting that most adolescents relapse within 90 days. Parenting practices directly influence adolescent SUD outcomes, but parents of adolescents with SUDs are difficult to engage in traditional behavioral treatments. The current study adapts and evaluates a technology-assisted intervention for parents of adolescents in residential SUD treatment. Based on pilot qualitative data with parents, adolescents, and residential staff, we augment an existing computerized intervention (Parenting Wisely; PW) with four in-person coaching sessions, personalized text messages, and an expert-moderated online parent message board. We hypothesize that parents will find enhanced PW (PW+) both feasible and acceptable, and that adolescents whose parents receive PW+ will have better post-discharge outcomes than adolescents who receive standard care (SC) only. A two phase approach is used to adapt and evaluate PW+. Phase 1 consists of an open trial with 10 parents of adolescents (age 12–17) in residential SUD treatment. Post-discharge qualitative and quantitative data from parents and adolescents will support PW+ refinement. Phase 2 is a randomized pilot trial with 60 parents testing the effectiveness of adding PW+ to SC. Adolescents and parents will complete assessments at baseline, 6-, 12-, and 24-weeks post-discharge. Primary outcomes will be measures of feasibility and acceptability. Secondary outcomes will include adolescent substance use, truancy, high-risk sexual behavior, and criminal involvement. Two parenting processes (monitoring and communication) are examined as potential mediators of change. This study will adapt and evaluate a technology-assisted parenting intervention as a means of improving adolescent outcomes following residential SUD treatment. Results have the potential to advance the field by: addressing a high-risk population, improving parental engagement; targeting parenting practices (putative mediators of change) that have been linked to adolescent outcomes; and developing a highly disseminable approach.

Black, J. J., & Chung, T. (2014). Mechanisms of change in adolescent substance use treatment: How does treatment work?. Substance Abuse, 35(4), 344-351.

Background: Adolescent substance use treatment outcome research generally shows small to moderate effects in reducing substance use, with no specific “brand” of treatment emerging as clearly superior to any other, and treatment gains that fade over time. The relatively weak and temporary effects of treatment call for improving the potency and durability of intervention effects. In response to this call, this critical narrative review summarizes research on mechanisms of change for both adults and adolescents in substance use treatment, with a particular focus on reviewing what is known regarding “how” adolescent substance use treatment works.

Methods: A comprehensive review of the adolescent (ages 11–18) substance use treatment literature was conducted to identify empirical studies that examined mediators of intervention effects. Relevant databases (e.g., PsychINFO, Medline) were searched using key words (e.g., “mediator”), and relevant articles from reference sections of identified studies and review papers were considered.

Results: Studies of mechanisms of psychotherapy change are rare in the adult, and particularly adolescent, substance use treatment outcome literature. The four adolescent studies that examined substance use treatment mechanisms found that positive social support, motivation to abstain, and positive parenting behaviors mediated treatment effects. To date, research has not supported therapy-specific mechanisms of change, finding instead that “common” processes of change largely account for improvements in outcome across distinct “brands” of treatment.

Conclusions: The lack of empirical support for treatment-specific mechanisms of change may be due to the need for greater precision in defining and measuring treatment-specific causal chains. Future directions include neuroscience approaches to examining changes in brain functioning that are associated with treatment response and recovery and examining mechanisms in adaptive treatment designs, which can accommodate individual differences in targets for intervention and response to treatment.

Das, J. K., Salam, R. A., Arshad, A., Finkelstein, Y., & Bhutta, Z. A. (2016). Interventions for adolescent substance abuse: An overview of systematic reviews. Journal of Adolescent Health, 59(4), S61-S75.

Many unhealthy behaviors often begin during adolescence and represent major public health challenges. Substance abuse has a major impact on individuals, families, and communities, as its effects are cumulative, contributing to costly social, physical, and mental health problems. We conducted an overview of systematic reviews to evaluate the effectiveness of interventions to prevent substance abuse among adolescents. We report findings from a total of 46 systematic reviews focusing on interventions for smoking/tobacco use, alcohol use, drug use, and combined substance abuse. Our overview findings suggest that among smoking/tobacco interventions, school-based prevention programs and family-based intensive interventions typically addressing family functioning are effective in reducing smoking. Mass media campaigns are also effective given that these were of reasonable intensity over extensive periods of time. Among interventions for alcohol use, school-based alcohol prevention interventions have been associated with reduced frequency of drinking, while family-based interventions have a small but persistent effect on alcohol misuse among adolescents. For drug abuse, school-based interventions based on a combination of social competence and social influence approaches have shown protective effects against drugs and cannabis use. Among the interventions targeting combined substance abuse, school-based primary prevention programs are effective. Evidence from Internet-based interventions, policy initiatives, and incentives appears to be mixed and needs further research. Future research should focus on evaluating the effectiveness of specific interventions components with standardized intervention and outcome measures. Various delivery platforms, including digital platforms and policy initiative, have the potential to improve substance abuse outcomes among adolescents; however, these require further research.

Goorden, M., Schawo, S., Bouwmans-Frijters, C., van der Schee, E., Hendriks, V., & Hakkaart-van Roijen, L. (2016). The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review. BMC Psychiatry, 16(1), 1-22.

Family therapy and family-based treatment has been commonly applied in children and adolescents in mental health care and has been proven to be effective. There is an increased interest in economic evaluations of these, often expensive, interventions. The aim of this systematic review is to summarize and evaluate the evidence on cost-effectiveness of family/family-based therapy for externalizing disorders, substance use disorders and delinquency. A systematic literature search was performed in PubMed, Education Resource information Centre (ERIC), Psycinfo and Cochrane reviews including studies conducted after 1990 and before the first of August of 2013. Full economic evaluations investigating family/family-based interventions for adolescents between 10 and 20 years treated for substance use disorders, delinquency or externalizing disorders were included. Seven hundred thirty-one articles met the search criteria and 51 studies were initially selected. The final selection resulted in the inclusion of 11 studies. The quality of these studies was assessed. Within the identified studies, there was great variation in the specific type of family/family-based interventions and disorders. According to the outcomes of the checklists, the overall quality of the economic evaluations was low. Results varied by study. Due to the variations in setting, design and outcome it was not feasible to pool results using a meta-analysis. The quality of the identified economic evaluations of family/family-based therapy for treatment of externalizing disorders, adolescent substance use disorders and delinquency was insufficient to determine the cost-effectiveness. Although commonly applied, family/family-based therapy is costly and more research of higher quality is needed.

Liddle, H. A., Dakof, G. A., Rowe, C. L., Henderson, C., Greenbaum, P., Wang, W., & Alberga, L. (2018). Multidimensional Family Therapy as a community-based alternative to residential treatment for adolescents with substance use and co-occurring mental health disorders. Journal of Substance Abuse Treatment, 90(1), 47-56.

This randomized clinical trial (RCT) compared Multidimensional Family Therapy (MDFT) with residential treatment (RT) for adolescents with co-occurring substance use and mental health disorders on substance use, delinquency, and mental health symptoms. Using an intent-to-treat design, 113 adolescents who had been referred for residential treatment were randomly assigned to either RT or MDFT in the home/community. The sample was primarily male (75%) and Hispanic (68%) with an average age of 15.4 years. Seventy-one percent of youth had at least one previous residential treatment placement. Participants were assessed at baseline and at 2, 4, 12 and 18 months post-baseline. During the early phase of treatment (baseline to 2 months), youth in both treatments showed significant reductions in substance use [substance use problems (d = 1.10), frequency of use (d = 1.36)], delinquent behaviors (d = 0.18) and externalizing symptoms (d = 0.77), and youth receiving MDFT reported significantly greater reductions in internalizing symptoms than youth receiving RT (d = 0.42). In phase 2, from 2 to 18 months after baseline, youth in MDFT maintained their early treatment decreases in substance use problems (d = 0.51), frequency of use (d = 0.24), and delinquent behaviors (d = 0.42) more effectively than youth in RT. During this period, there were no significant treatment differences in maintenance of gains for externalizing and internalizing symptoms. Results suggest that Multidimensional Family Therapy is a promising alternative to residential treatment for youth with substance use and co-occurring disorders. The results, if supported through replication, are important because they challenge the prevailing assumption that adolescents who meet criteria for residential treatment cannot be adequately managed in a non-residential setting.

Stanger, C., Lansing, A. H., & Budney, A. J. (2016). Advances in research on contingency management for adolescent substance use. Child and Adolescent Psychiatric Clinics, 25(4), 645-659.

Multiple interventions for treating adolescents with substance use disorders have demonstrated efficacy, but the majority of teens do not show an enduring positive response to these treatments. Contingency-management (CM) based strategies provide a promising alternative, and clinical research focused on the development and testing of innovative CM models continues to grow. This article provides an updated review on the progress made in this area since we last commented on the published literature in 20101. Areas covered include: controlled trials of treatment for adolescents referred to substance use treatment, innovative applications of CM to tobacco cessation among youth, analyses of moderators and mechanisms of CM treatment outcomes, the emerging literature on dissemination and implementation, and other literature suggesting a growing acceptance of CM as viable and effective intervention. The literature in this area continues to progress at a moderate pace, with many indicators of budding interest in the application of CM, and in finding cost effective models to enhance dissemination and implementation. As with other types of substance use disorder treatments, we need to continue to search for more effective models, focus on post-treatment maintenance (reduce relapse), and strive for high levels of integrity and fidelity during dissemination efforts to optimize outcomes.

Stockings, E., Hall, W. D., Lynskey, M., Morley, K. I., Reavley, N., Strang, J., … & Degenhardt, L. (2016). Prevention, early intervention, harm reduction, and treatment of substance use in young people. The Lancet Psychiatry, 3(3), 280-296.

We did a systematic review of reviews with evidence on the effectiveness of prevention, early intervention, harm reduction, and treatment of problem use in young people for tobacco, alcohol, and illicit drugs (eg, cannabis, opioids, amphetamines, or cocaine). Taxation, public consumption bans, advertising restrictions, and minimum legal age are effective measures to reduce alcohol and tobacco use, but are not available to target illicit drugs. Interpretation of the available evidence for school-based prevention is affected by methodological issues; interventions that incorporate skills training are more likely to be effective than information provision—which is ineffective. Social norms and brief interventions to reduce substance use in young people do not have strong evidence of effectiveness. Roadside drug testing and interventions to reduce injection-related harms have a moderate-to-large effect, but additional research with young people is needed. Scarce availability of research on interventions for problematic substance use in young people indicates the need to test interventions that are effective with adults in young people. Existing evidence is from high-income countries, with uncertain applicability in other countries and cultures and in subpopulations differing in sex, age, and risk status. Concerted eff orts are needed to increase the evidence base on interventions that aim to reduce the high burden of substance use in young people.

Tanner-Smith, E. E., Wilson, S. J., & Lipsey, M. W. (2013). The comparative effectiveness of outpatient treatment for adolescent substance abuse: A meta-analysis. Journal of Substance Abuse Treatment, 44(2), 145-158.

Meta-analysis was used to synthesize research on the effects of outpatient treatment on substance use outcomes for adolescents with substance use disorders. An extensive literature search located 45 eligible experimental or quasi-experimental studies reporting 73 treatment–comparison group pairs, with many of the comparison groups also receiving some treatment. The first analysis examined 250 effect sizes for the substance use outcomes of adolescents receiving different types of treatment relative to the respective comparison groups. As a category, family therapy programs were found to be more effective than their comparison conditions, whereas no treatment programs were less effective. However, not all treatment types were compared with each other in the available research, making it difficult to assess the comparative effectiveness of the different treatments. To provide a more differentiated picture of the relative improvement in substance use outcomes for different treatments, a second analysis examined 311 pre–post effect sizes measuring changes in substance use for adolescents in the separate treatment and comparison arms of the studies. The adolescents in almost all types of treatment showed reductions in substance use. The greatest improvements were found for family therapy and mixed and group counseling. Longer treatment duration was associated with smaller improvements, but other treatment characteristics and participant characteristics had little relationship to the pre–post changes in substance use. Based on these findings family therapy is the treatment with the strongest evidence of comparative effectiveness, although most types of treatment appear to be beneficial in helping adolescents reduce their substance use.

Van Ryzin, M. J., Roseth, C. J., Fosco, G. M., Lee, Y. K., & Chen, I. C. (2016). A component-centered meta-analysis of family-based prevention programs for adolescent substance use. Clinical Psychology Review, 45, 72-80.

Although research has documented the positive effects of family-based prevention programs, the field lacks specific information regarding why these programs are effective. The current study summarized the effects of family-based programs on adolescent substance use using a component-based approach to meta-analysis in which we decomposed programs into a set of key topics or components that were specifically addressed by program curricula (e.g., parental monitoring/behavior management, problem solving, positive family relations, etc.). Components were coded according to the amount of time spent on program services that targeted youth, parents, and the whole family; we also coded effect sizes across studies for each substance-related outcome. Given the nested nature of the data, we used hierarchical linear modeling to link program components (Level 2) with effect sizes (Level 1). The overall effect size across programs was .31, which did not differ by type of substance. Youth-focused components designed to encourage more positive family relationships and a positive orientation toward the future emerged as key factors predicting larger than average effect sizes. Our results suggest that, within the universe of family-based prevention, where components such as parental monitoring/behavior management are almost universal, adding or expanding certain youth-focused components may be able to enhance program efficacy.

 

 

 

Annotated bibliography: Teenagers and substance use

Annotated bibliography

Annotated bibliography: Screen time and its impact on young people’s mental health.

Annotated bibliography

 

Babic, M. J., Morgan, P. J., Plotnikoff, R. C., Lonsdale, C., & Eather, N. (2015). Skinner, Geoff; Baker, Amanda L.; Pollock, Emma; Lubans, David R. “Rationale and study protocol for ‘Switch-off 4 Healthy Minds'(S4HM): a cluster randomized controlled trial to reduce recreational screen time in adolescents”. Originally published in Contemporary Clinical Trials Vol. 40, p. 150-158 (2015). Clinical Trials, 40, 150-158.

This paper describes a school-based strategy trialled in New South Wales to reduce screen time for adolescents in response to the known adverse effects high screen time can have on their mental and physical health. It uses self-determination theory and involves educating both the adolescent and their parents. Prompts were sent to the young via the social media platform of their choice and newsletters were sent to parents to raise awareness of screen time and its dangers. There wasn’t much detail in the paper about the interventions that would be employed in implementing the strategy.

Chassiakos, Y. L. R., Radesky, J., Christakis, D., Moreno, M. A., & Cross, C. (2016). Children and adolescents and digital media. Pediatrics, 138(5), e20162593.

This report provides a summary of the benefits and risks of childhood exposure to digital media. Social media can have beneficial effects to the mental health of LGBTIQ teenagers if they use it to engage with supportive communities. Similarly, individuals with mental illness may also benefit when using social media to share stories with others experiencing similar challenges. However, this can also leave them open to exposure, misinformation, negativity and hostility. Examples of digital media which may have adverse effects on the mental health of young people are pro-anorexia sites. Exposure to risky behaviour in media has been proven to increase teenage uptake of the behaviour and this exposure can be difficult to police on digital devices by parents. Social media has been shown to have both positive and negative effects on young people’s mental health. Used in moderation it can enhance their feelings of social connectedness. Passive use of social media or following attractive celebrities can increase depression and lower self-esteem, whereas engaging actively with family and friends has the opposite effect.

Gunnell, K. E., Flament, M. F., Buchholz, A., Henderson, K. A., Obeid, N., Schubert, N., & Goldfield, G. S. (2016). Examining the bidirectional relationship between physical activity, screen time, and symptoms of anxiety and depression over time during adolescence. Preventive Medicine, 88, 147-152.

This study was performed to establish relationships between low levels of physical activity, high screen time, depression and anxiety in adolescents. It took place over 11 years and took the form of four time specific questionnaires covering the ages from 10-21 years old (n= 1160, mean age = 13.54 years).  The results were controlled for variables such as gender, ethnicity, location and educational level of parents. A decrease in physical activity and increase in screen time, depression and anxiety over time was observed. Initial high anxiety was associated with higher screen time and lower physical activity independent of symptoms of depression. Higher initial levels of depression were also associated with higher screen time and predicted greater decreases in physical activity over time.  Limitations include the data collected was self-reported, type of screen time and type of physical activity was not identified and there was a high rate of attrition.

Hoare, E., Milton, K., Foster, C., & Allender, S. (2016). The associations between sedentary behaviour and mental health among adolescents: a systematic review. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 108.

This systematic review examined 32 papers, all of which reported the use of screen time for leisure amongst adolescents and two thirds identified depressive symptoms. Adolescence is a significant risk period for the development of mental health disorders and it is also a period when lifestyle behaviours are developed which can impact on mental health into adulthood. Depressive symptoms and length of  screen time for leisure use were consistently linked in the evidence. There was moderate evidence for an association between length of screen time and low self-esteem. More than 2-3 hours of screen time per day in adolescents is linked to poorer mental health status. It identified that the link may be in part due to the sedentary nature of screen time, as physical activity has been found to have a positive effect on mental health. Adolescents with poor mental health may lack motivation to exercise and instead opt for screen based activities. Young people who lead sedentary lifestyles are more likely to suffer from obesity, which can lead to stigmatisation and bullying resulting in adverse effects on their mental health.

Maras, D., Flament, M. F., Murray, M., Buchholz, A., Henderson, K. A., Obeid, N., & Goldfield, G. S. (2015). Screen time is associated with depression and anxiety in Canadian youth. Preventive Medicine, 73, 133-138.

Increased screen time has been linked to low physical activity and obesity in youth, factors that have been linked to an increase in depression and anxiety. The study aimed to examine the relationship between length of screen time and anxiety and depression in young people using a large community sample of Canadian adolescents (n=2482). They found that depression was associated with any type of screen behaviour except watching the TV, whereas anxiety was only associated with gaming. This is consistent with other large-scale studies including studies from the USA and Australia. They offer several explanations for this including social isolation and cyberbullying.  A limitation of the study was that they couldn’t conclude whether it was increased screen time that caused the depression and anxiety or whether the opposite was true that people with depression and anxiety spent more time on their electronic devices.

Przybylski, A. K., & Weinstein, N. (2017). A large-scale test of the Goldilocks Hypothesis: Quantifying the relations between digital-screen use and the mental well-being of adolescents. Psychological Science, 28(2), 204-215.

This study tested the Goldilocks Hypothesis for screen time in adolescents to try and ascertain the optimum amount of screen time that would benefit development without adversely affecting mental health. They studied 120115 British adolescents. They found the relationship between screen time and mental health was non-linear and a moderate time spent on screens was not harmful and may even have positive effects on wellbeing. There were differences in effect depending on the screen type, the type of activity, the day or time used and the level of engagement in the activity. They recommend studying the functionality of screen time against other daily pursuits in order to get a fuller understanding. Overall they concluded that moderate technology use was not intrinsically harmful and may prove beneficial in an increasingly digital world.

Saquib, N., Saquib, J., Wahid, A., Ahmed, A. A., Dhuhayr, H. E., Zaghloul, M. S., … & Al-Mazrou, A. (2017). Video game addiction and psychological distress among expatriate adolescents in Saudi Arabia. Addictive Behaviors Reports, 6, 112-117.

This study was conducted using a self-reported survey distributed to 276 students in expatriate schools in Saudi Arabia. The researchers use DSM-V criteria to diagnosed video game addiction and it was compared with other variables including screen time and psychological distress. The mean age of the participants was 15.3 years and nearly 75% reported screen time greater than 2 hours and 20% reported sleeping less than 5 hours a night. Those addicted to video games encompassed 15.8% of the sample and they were more likely to be boys, have higher screen time and less sleep. Addiction to video games was strongly related to psychological distress, as was screen time greater than 2 hours a day.  Psychological distress was also related to gender, with girls being more likely to experience it and inversely to sleep patterns. This study didn’t find any link between physical activity or BMI and psychological distress. The study concludes that screen time has an independent association with psychological distress even when other variables are taken into consideration.

Straatmann, V. S., Oliveira, A. J., Rostila, M., & Lopes, C. S. (2016). Changes in physical activity and screen time related to psychological well-being in early adolescence: findings from longitudinal study ELANA. BMC Public Health, 16(1), 977.

In this study, data was analysed from 526 adolescents in Brazil, assessing physical activity, screen time and psychological distress using a questionnaire. Psychological distress was associated with exceeding the recommended screen time of 4 hours per day in girls, although they questioned whether there was a negative causality impacting on this that is the psychological distress caused them to withdraw and spend more time on screen based activities. For boys, psychological distress was associated with a reduction in physical activity in this study. The study was limited in that the data collected was self-reported.

Trinh, L., Wong, B., & Faulkner, G. E. (2015). The independent and interactive associations of screen time and physical activity on mental health, school connectedness and academic achievement among a population-based sample of youth. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 24(1), 17.

The study aimed to establish the effects high screen time and physical activity had independently and together on the mental health of young people. Data was collected from 2660 adolescents using a survey. It found that high screen time is consistently associated with poorer mental health independent of the amount of physical activity. However, there may be reverse causality where depressed youth seek social isolation or comfort in their digital devices. The study also found that high screen time was associated with low self-esteem, which did not improve with physical activity.  Higher screen time was associated with lower physical activity. It concluded that screen time and physical activity had both independent and interactive effects on the mental health of young people. A limitation in the study was that the data was self-reported.

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2017). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among US adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 2167702617723376.

There was an increase in teenage depression and suicide in the USA between 2010 and 2015, which corresponded with the increased use of smartphones and other digital devices. This study analysed the data from two national surveys of high school students in the USA to establish if there was a link between screen time and depression and suicide.  There were 388275 respondents to the surveys, who completed them retrospectively. The study found a positive correlation between screen time and depression and suicide especially amongst females. No significant variation occurred in other variables such as socioeconomic status. Exercise and face-to-face social interaction negatively correlated with depression and suicide, but increased screen time was often associated with low physical activity and social interaction. Lack of sleep has also been identified in other studies as being linked to increased screen time and as a risk factor for depression and suicide. The study was unable to establish if screen time was the sole cause of increased incidence of depression and suicide, the joint cause or if the cause was one of the other factors. Another limitation was the surveys were completed retrospectively rather than in real time, which may have affected the answers given.

Wu, X., Tao, S., Zhang, Y., Zhang, S., & Tao, F. (2015). Low physical activity and high screen time can increase the risks of mental health problems and poor sleep quality among Chinese college students. PLoS One, 10(3), e0119607.

High screen time and low physical activity have been shown to interact to cause psychological problems. The study has suggested that high screen time is associated with a higher incidence of depression, anxiety, psychopathological symptoms and poor sleep quality. It is also associated with reduced physical activity. Physical activity has been shown to reduce symptoms of depression, anxiety and other mental health problems. The results of this study suggest that high screen time and low physical activity both increase psychological stress independently and synergistically. A limitation of the study is that it assessed self-reported symptoms and not clinically diagnosed disorders.

Wu, X., Tao, S., Zhang, S., Zhang, Y., Chen, K., Yang, Y., … & Tao, F. (2016). Impact of screen time on mental health problems progression in youth: a 1-year follow-up study. BMJ Open, 6(11), e011533.

This study examined the association between screen time and mental health in a group of Chinese university students (n=2521, mean age=18.43 years). Nearly all of the participants reported screen time of more than 2 hours per day. They found consistent associations with screen time and anxiety, depression or other psychopathology. The associations also remained after adjustments for other variables. Due to the small effects size it is unclear to what degree screen time effects mental health outcomes. The limitations of the study include that the data collected was self-reported and it doesn’t differentiate between different screen uses.

Annotated bibliography: Consumer participation in treatment programs

Annotated bibliography

Becan, J. E., Knight, D. K., Crawley, R. D., Joe, G. W., & Flynn, P. M. (2015). Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change. Journal of Substance Abuse Treatment, 50(1), 38-49.

The aim of this study was to assess the effectiveness of the Treatment Readiness and Induction Program (TRIP) for treating for motivating adolescents involved in treatment programs. Motivation is a crucial factor in the success of treatment for substance abuse and includes problem recognition, a desire to seek help and a readiness to change. The authors stated that interventions that facilitate this are particularly important for adolescents. The data was collected from 519 adolescents from six residential programs. They completed assessments at treatment intake and again 35 days after admission. The study included a control sample (n = 281) that had commenced treatment prior to the implementation of TRIP, which were compared against clients who received standard treatment enhanced by TRIP (n = 238). Motivational levels were conceptualised utilising statistical tools, which allowed for variables such as gender and drug use severity. The adolescents using TRIP demonstrated greater levels of gains in problem recognition and TRIP was linked indirectly with gains in the desire to seek help and readiness for treatment. Limitations include that the study was confined to those in residential care and were still in treatment 35 days after admission.

Durbeej, N., Palmstierna, T., Berman, A. H., Kristiansson, M., & Gumpert, C. H. (2014). Offenders with mental health problems and problematic substance use: Affective psychopathic personality traits as potential barriers to participation in substance abuse interventions. Journal of Substance Abuse Treatment, 46(5), 574-583.

Treatment for substance abuse may reduce recidivism in offenders as substance abuse has been linked to re-offending. Participation in substance abuse treatment programs by offenders may be associated with severity of substance use and social problems, violence risk and psychopathic personality traits. This study examined the relationships between these characteristics and participation in substance abuse programs in Swedish offenders with comorbid mental illness and problematic substance abuse. The data was collected by interviews on three occasions: at the beginning of the study, shortly before release and at the end of the treatment period (mean time = 20.8 months) and standard assessment tools were used including the Alcohol Use Disorders Identification Test (AUDIT). The data was collected from 134 offenders who voluntarily participated in the study. It indicated that problem severity predicted participation in intervention but that affective psychopathic personality traits were negatively associated with intervention participation. It concluded that psychopathic personality traits should be considered when planning interventions and that cognitive behavioral therapy and dialectical behavioral therapy may be more applicable for these offenders. One of the limitations of the study is that it utilised an observational study design so was reliant on observed associations between variables, which may result in researcher bias.

Garrett, S. B., Doyle, S. R., Peavy, K. M., Wells, E. A., Owens, M. D., Shores-Wilson, K., & … Donovan, D. M. (2018). Age differences in outcomes among patients in the “Stimulant Abuser Groups to Engage in 12-Step” (STAGE-12) intervention. Journal of Substance Abuse Treatment, 84(1), 21-29.

Young adults (aged 18-29 years) have the potential to benefit from participating in twelve-step programs, but their uptake in these programs is relatively low. The aim of this study was to examine if age did effect attendance at twelve-step interventions and how it affected substance use. Data was obtained using a multi-site randomised controlled trial with assessments performed at baseline, mid-treatment (week 4), end-of-treatment (8 weeks) and at 3 and 6 months post treatment. The participants were all diagnosed with stimulant abuse or dependence utilising DSM IV (n = 450) and were enrolled in ten intensive outpatients substance use treatment programs in the USA. The study found that younger age was associated with improved treatment outcomes and that abstinence was greater in those who had participated in 12-step programs as opposed to treatment as usual (TAU). Conversely, for those who did not remain abstinent during treatment, younger age was associated with greater rates of stimulant use at follow up for those in 12-step as opposed to those in TAU. There were greater rates of participation in activities in young adults in 12-step programs than those in TAU programs. Users of non-stimulant drugs exhibited no differences in age by treatment interactions, but younger users were less likely to be abstinent at follow-up regardless of the treatment they had received. The study recommends ongoing assessment of the consumer’s readiness to change to guide the focus of treatment and that age appropriate treatment may benefit clinical outcome. Data collected was self-reported and was identified as a limitation of the study.

Hatch-Maillette, M., Wells, E. A., Doyle, S. R., Brigham, G. S., Daley, D., DiCenzo, J., & … Perl, H. I. (2016). Predictors of 12-Step Attendance and Participation for Individuals with Stimulant Use Disorders. Journal of Substance Abuse Treatment, 68(1), 74-82.

The authors of this study identified a gap in the research examining the effectiveness of 12-step peer recovery programs for drug use. They conducted a multi-site randomised clinical trial of 12-step facilitation on individuals with cocaine or methamphetamine use disorders (n =471) attending in one of ten settings. Participants were randomly assigned to 12-step with TAU or TAU alone for an eight week intervention. They were then assessed at 4 week and 8 weeks into treatment and again at 3 and 6 months after treatment commencement. Four outcome variables were examined:

  1. To what extent do treatment-seeking stimulant users choose 12-step interventions
  2. Do the factors, which predict 12-step participation in people with alcohol use disorders, apply in stimulant users?
  3. Which baseline “12-step readiness” factors predict program attendance and participation?
  4. Does choice of stimulant predict participation and attendance in 12-step programs?

The study found that attendance, speaking, allocated duties and peer were unrelated to demographics and substance use history or severity. Cocaine users were more likely to attend follow up meetings at 1, 3 and 6 months than methamphetamine users, as were those who perceived the groups as being beneficial to their recovery. Consumers who had attended the program prior to the study were also more likely to attend follow up sessions and participate in self-help activities, whereas those who perceived barriers to 12-step groups prior to the study were less likely to participate in these. Those who participated in self-help activities were more likely to volunteer for group duties. It concluded that continuity, prior attendance and active involvement with the 12-step programs were the main predictors for future program involvement and participation. The study was limited in that it only studied participants in a select set of treatment programs

Ibabe, I., Stein, J. A., Nyamathi, A., & Bentler, P. M. (2014). Predictors of substance abuse treatment participation among homeless adults. Journal of Substance Abuse Treatment, 46(3), 374-381.

This study examines the relationships among a history of trauma, a history of substance abuse, chronic homelessness and emotional distress in predicting participation in drug treatment programs, as enrolment and retention of clients in these programs is difficult, particularly among homeless people. Structural equation modelling was used, which indicated an association between chronic homelessness, trauma history and substance use history. This association significantly predicted recent emotional distress in the 853 participants, who were all homeless adults living in Los Angeles. Those with recent emotional distress were less likely to participate in substance abuse treatment, both formal and self-help. However, those with only a history of substance use were more likely to participate in treatment. It recommends providers focusing on dual-diagnosis interventions in order to encourage engagement and participation amongst this client group. They also cite the success of outreach services in establishing an initial contact with treatment services for this group as a method of reducing barriers to treatment seeking, including distrust. The authors state the over reliance on self-reporting is a limitation in this research.

Jaffe, A., Du, J., Huang, D., & Hser, Y. (2012). Drug-abusing offenders with comorbid mental disorders: Problem severity, treatment participation, and recidivism. Journal of Substance Abuse Treatment, 43(2), 244-250.

The aim of this study was to examine problem severity, treatment participation and recidivism in 1016 drug-abusing offenders who had a co-existing mental disorder. The participants were first assessed utilising the Addiction Severity Index (ASI) and their mental health diagnoses, treatment program participation and arrest records were obtained. The severity of their mental health disorder was then classified as mild or severe based on their specific diagnoses. Ordinal logistic regression was then used to examine predictors of recidivism separately for those with mild or severe mental health disorders. It was indicated that previous arrests, education level and treatment participation are predictors of recidivism generally. However, gender, age, primary drug, ASI score and treatment method are differentially important depending on the severity of the offender’s mental illness. The report recommends intervention strategies focusing on dual-diagnosis among offenders, to take into consideration the severity of their mental illness in order to increase their effectiveness and reduce recidivism. The data obtained is mainly self-reported which is identified as a limitation of the study.

Knight, D. K., Joe, G. W., Crawley, R. D., Becan, J. E., Dansereau, D. F., & Flynn, P. M. (2016). The Effectiveness of the Treatment Readiness and Induction Program (TRIP) for Improving During-Treatment Outcomes. Journal of Substance Abuse Treatment, 62(1), 20-27.

Engagement in treatment is an important factor in its success and this is consistently predicted by motivation. As problem recognition is an important aspect of motivation, it is essential to target efforts to improve this to achieve sustained recovery following treatment. This study aimed to compare the effectiveness of Standard Operating Practice (SOP) against SOP plus 8 sessions of TRIP on cognitive indicators and engagement in treatment for young people in 5 residential substance abuse treatment centres. The original sample consisted of 1228 adolescents (SPO = 749, TRIP = 479), which had reduced to 729 (SPO = 445, TRIP = 274) at the end of the study. Data was collected using the Texas Christian University Adolescent Screening and Assessment Package on admission (Time 1) and 30-45 days into treatment (Time 2), which was usually at the completion of the program. The study found that adolescents who received TRIP demonstrated higher problem recognition, decision-making and treatment engagement than those who received SOP only. This was true even when controlling for background factors such as demography and drug use severity. A limitation of this study was that only youths who completed the treatment were included in the final analysis.

McKay, J. R., Van Horn, D., Rennert, L., Drapkin, M., Ivey, M., & Koppenhaver, J. (2013). Factors in sustained recovery from cocaine dependence. Journal of Substance Abuse Treatment, 45(2), 163-172.

This study aimed to establish factors that predicted abstinence from cocaine use and shifts from use to abstinence over a 24-month period. The participants (n = 268) were recruited from three centres which provided intensive outpatient programs. The data was collected over 24-months and the participants were assessed within 2 weeks of admission and then at 3-monthly periods thereafter using a variety of screening tools. It identified that both abstinence from cocaine and transitioning into abstinence at the next follow-up were associated with older age, less education and lower severity of alcohol and cocaine use at baseline. Additional factors contributing to abstinence and transition to abstinence were higher self-efficacy, readiness to change, better social networks, lower depression and lower severity of co-existing problems. A limitation of the research was that it was correlational, so it is not conclusive if the variables resulted in the changes in cocaine use or if it was the changes in the predictors (e.g. raising self-esteem) that caused the reduction in cocaine use

Timko, C., Below, M., Schultz, N. R., Brief, D., & Cucciare, M. A. (2015). Patient and Program Factors that Bridge the Detoxification-Treatment Gap: A Structured Evidence Review. Journal of Substance Abuse Treatment, 52(1), 31-39.
Completion of detoxification and transitioning to substance use disorder (SUD) treatment and/or mutual self-help groups (MSHG) predict improved consumer outcomes. However, many consumers do not complete detoxification or receive SUD treatment afterwards. The authors conducted a structured evidence review on 26 articles to ascertain consumer, program and other factors associated with the successful completion of detoxification and transitioning to SUD treatment and/or MSHG. They found wide variations in the studies, between 45-95% of consumers completed detoxification and 14-92% transitioned to SUD treatment and/or MSHG. Family support and motivational-based approaches both contributed to completion of detoxification and transition to SUD care and/or MSHG. They suggest targeting these approaches at young people, who are less likely to complete detoxification and that barriers to detoxification and the subsequent transition to SUD care and/or MSHG can be overcome to improve consumer outcomes. The authors of this study relied on one database (PubMed) to collect their data, which is a major limitation of the study.

Zemore, S. E., & Ajzen, I. (2014). Predicting substance abuse treatment completion using a new scale based on the theory of planned behavior. Journal of Substance Abuse Treatment, 46(2), 174-182.

This study evaluated whether a 9-item scale based on the theory of planned behaviour (TPB) predicted the completion of substance abuse treatment. TPB is a general, social cognitive model of behaviour that has been useful in modelling a range of public health behaviours and can be applied to predicting treatment completion for SUDs. The data was collected from clients (n = 200) at a public outpatient program. The participants had all initiated treatment and baseline data was collected using surveys, which included attitudes towards treatment and perceived control and intention. The participants status on discharge was then collected using program records. TPB attitude and control components independently predicted intention and intention was positively related to treatment outcomes. TPB components were frequently related to readiness and were predictive of increased levels of coercion. Results indicate that the use of TPB improves treatment completion. A limitation of the study is the sample size and that the data was obtained from a single treatment program.