Title: The Current Renaissance of Adolescent Treatment
1The Current Renaissance of Adolescent Treatment
- Michael Dennis, Ph.D.
- Chestnut Health Systems,
- Bloomington, IL
- Presentation for National Conference onBoys
Girls at RiskThe Emerging Science of Gender
Differences , Madison, WI July 21-22, 2008. This
presentation reports on treatment research
funded by the Center for Substance Abuse
Treatment (CSAT), Substance Abuse and Mental
Health Services Administration (SAMHSA) under
contracts 270-2003-00006 and 270-07-0191, as well
as several individual CSAT, NIAAA, NIDA and
private foundation grants. The opinions are those
of the author and do not reflect official
positions of the consortium or government.
Available on line at www.chestnut.org/LI/Posters
or by contacting Joan Unsicker at 720 West
Chestnut, Bloomington, IL 61701, phone (309)
827-6026, fax (309) 829-4661, e-Mail
junsicker_at_Chestnut.Org
2Goals of this Presentation are to
- Examine the prevalence, course, and consequences
of adolescent substance use, co-occurring
disorders and the unmet need for treatment
overall and by gender - Summarize major trends in the adolescent
treatment system and Wisconsin - Highlight what it takes to move the field towards
evidenced-based practice related to assessment,
treatment, program evaluation and planning - Present the findings from several recent
treatment outcome studies on substance abuse
treatment research, trauma and violence/crime
3Severity of Past Year Substance Use/Disorders
(2002 U.S. Household Population age 12
235,143,246)
Dependence 5
Abuse 4
No Alcohol or
Regular AOD
Drug Use 32
Use 8
Any Infrequent
Drug Use 4
Light Alcohol
Use Only 47
Source 2002 NSDUH
4Problems Vary by Age
NSDUH Age Groups
Increasing rate of non-users
100
Severity Category
90
No Alcohol or Drug Use
80
70
Light Alcohol Use Only
60
Any Infrequent Drug Use
50
40
Regular AOD Use
30
Abuse
20
10
Dependence
0
65
12-13
14-15
16-17
18-20
21-29
30-34
35-49
50-64
Source 2002 NSDUH and Dennis et al forthcoming
5Higher Severity is Associated with Higher Annual
Cost to Society Per Person
4,000
Median (50th percentile)
3,500
3,000
2,500
2,000
1,500
1,000
725
406
500
231
231
0
0
0
No Alcohol or
Light Alcohol
Regular AOD
Any
Dependence
Abuse
Infrequent
Drug Use
Use Only
Drug Use
Use
Source 2002 NSDUH
6Past Year Alcohol or Drug Abuse or Dependence
Source OAS, 2006
10.8 Wisc vs. 9.3 National
7Past Year Alcohol Abuse or Dependence
Source OAS, 2006
10.6 Wisc vs. 7.7 National
8Pattern of Teen Substance Use in WI by Gender\a
0
10
20
30
40
50
60
70
80
90
100
.
Female
18
23
10
30
19
Lifetime
Male
24
9
27
20
20
Female
15
19
45
19
2
Past Month\b
Male
3
14
21
42
20
More than Marijuana
Marijuana use
Alcohol Intoxication
Alcohol or Tobacco Use
No Use
\a Each severity level includes any substance to
the right
\b More than marijuana is only Cocaine for Past
month
Most drug users also drink to intoxication
Source Wisconsin 2005 YRBS
9Behavior Problems by Substance Severity in WI\a
Behavior problems increase with substance use
severity
More than Marijuana
Marijuana use
Alcohol Intoxication
Alcohol or Tobacco Use
No Use
\a Each lifetime severity level includes any
substance to the right
Source Wisconsin 2005 YRBS
plt.05
10Victimization by Substance Severity in WI\a
Victimization also goes up with substance use
severity
More than Marijuana
Marijuana use
Alcohol Intoxication
Alcohol or Tobacco Use
No Use
\a Each lifetime severity level includes any
substance to the right
Source Wisconsin 2005 YRBS
plt.05
11Mental Health by Substance Severity in WI\a
As does mental health
More than Marijuana
Marijuana use
Alcohol Intoxication
Alcohol or Tobacco Use
No Use
\a Each lifetime severity level includes any
substance to the right
Source Wisconsin 2005 YRBS
plt.05
12Other Problems by Substance Severity in WI\a
..and other problems
More than Marijuana
Marijuana use
Alcohol Intoxication
Alcohol or Tobacco Use
No Use
\a Each lifetime severity level includes any
substance to the right
Source Wisconsin 2005 YRBS
plt.05
13Count of Problems by Substance Severity in WI\a
More than Marijuana
Marijuana use
Alcohol Intoxication
Alcohol or Tobacco Use
No Use
\a Each severity level includes any substance to
the right
Source Wisconsin 2005 YRBS
plt.05
14Brain Activity on PET Scan After Using Cocaine
Rapid rise in brain activity after taking cocaine
Actually ends up lower than they started
Photo courtesy of Nora Volkow, Ph.D. Mapping
cocaine binding sites in human and baboon brain
in vivo. Fowler JS, Volkow ND, Wolf AP, Dewey SL,
Schlyer DJ, Macgregor RIR, Hitzemann R, Logan J,
Bendreim B, Gatley ST. et al. Synapse
19894(4)371-377.
15Brain Activity on PET Scan After Using Cocaine
With repeated use, there is a cumulative effect
of reduced brain activity which requires
increasingly more stimulation (i.e., tolerance)
Normal
Cocaine Abuser (10 days)
Even after 100 days of abstinence activity is
still low
Cocaine Abuser (100 days)
Photo courtesy of Nora Volkow, Ph.D. Volkow ND,
Hitzemann R, Wang C-I, Fowler IS, Wolf AP, Dewey
SL. Long-term frontal brain metabolic changes in
cocaine abusers. Synapse 11184-190, 1992 Volkow
ND, Fowler JS, Wang G-J, Hitzemann R, Logan J,
Schlyer D, Dewey 5, Wolf AP. Decreased dopamine
D2 receptor availability is associated with
reduced frontal metabolism in cocaine abusers.
Synapse 14169-177, 1993.
16Image courtesy of Dr. GA Ricaurte, Johns Hopkins
University School of Medicine
17Adolescent Brain Development Occurs from the
Inside to Out and from Back to Front
Photo courtesy of the NIDA Web site. From A Slide
Teaching Packet The Brain and the Actions of
Cocaine, Opiates, and Marijuana.
18Substance Use Careers Last for Decades
1.0
Median of 27 years from first use to 1 years
abstinence
.9
Cumulative Survival
.8
.7
Years from first use to 1 years abstinence
.6
.5
.4
.3
.2
.1
0.0
30
25
20
15
10
5
0
Source Dennis et al., 2005
19Substance Use Careers are Longer the Younger the
Age of First Use
Age of 1st Use Groups
1.0
.9
.8
Cumulative Survival
.7
Years from first use to 1 years abstinence
.6
.5
under 15
.4
15-20
.3
.2
21
.1
0.0
plt.05 (different from 21)
30
25
20
15
10
5
0
Source Dennis et al., 2005
20Substance Use Careers are Shorter the Sooner
People Get to Treatment
Year to 1st Tx Groups
1.0
.9
.8
Cumulative Survival
.7
Years from first use to 1 years abstinence
20
.6
.5
.4
.3
10-19
.2
.1
0.0
0-9
plt.05 (different from 20)
30
25
20
15
10
5
0
Source Dennis et al., 2005
21Treatment Careers Last for Years
1.0
.9
Cumulative Survival
.8
Median of 3 to 4 episodes of treatment over 9
years
.7
Years from first Tx to 1 years abstinence
.6
.5
.4
.3
.2
.1
0.0
25
20
15
10
5
0
Source Dennis et al., 2005
22Key Implications
- Adolescence is the peak period of risk for and
actual on-set of substance use disorders - Adolescent substance use can have short and long
terms costs to society - There are real and often lasting consequence of
adolescent substance use on brain functioning and
brain development - Earlier Intervention during adolescence and young
adult hood can reduce the duration of addiction
careers
23Trends in Adolescent (Age 12-17) Treatment
Admissions in the U.S.
15 drop off from 160,750 in 2002 to 136,660 in
2006
69 increase from 95,017 in 1992 to 160,750 in
2002
Source Office of Applied Studies 1992- 2005
Treatment Episode Data Set (TEDS)
http//www.samhsa.gov/oas/dasis.htm
24Change in WI Public Treatment Admissions Age at
Admission from 1995 to 2005
Has led to growing admissions in young and older
adults
30,000
30,000
25,559
26
23,845
18-25
22,818
25,000
25,000
12-17
20,506
20,354
20,154
Total
17,596
17,322
16,840
20,000
20,000
16,472
15,558
14,606
13,491
15,000
15,000
11,004
10,000
10,000
5,000
5,000
Little Change in Adolescent Admissions
-
-
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
25Variation by State in the Percentage of
Adolescent Residential Treatment 1995 to 2005
New Hampshire
Washington
Vermont
Maine
North
Montana
Minnesota
Dakota
Oregon
Massachusetts
South
Wisconsin
Idaho
Dakota
New York
Rhode Island
Michigan
Wyoming
Pennsylvania
Iowa
Connecticut
Nebraska
Ohio
Nevada
New Jersey
Indiana
Illinois
Utah
W. Virginia
Delaware
Colorado
California
Kansas
Virginia
Missouri
Kentucky
Maryland
North Carolina
Tennessee
District Of Columbia
Oklahoma
New Mexico
Arkansas
South Carolina
Arizona
Residential
Georgia
Mississippi
1.6 to 5.9
Alabama
6.0 to 10.5
Texas
Louisiana
10.6 to 18.7
Alaska
Florida
18.8 to 29.9
30.0 to 52.3
Hawaii
Wisconsin significantly lower than the 16 11
year average for U.S.
Puerto Rico
10/07
26Median Length of Stay is only 50 days
Median Length of Stay
Total
50 days
(61,153 discharges)
Less than 25 stay the 90 days or longer time
recommended by NIDA Researchers
LTR
49 days
(5,476 discharges)
STR
21 days
(5,152 discharges)
Level of Care
Detox
3 days
(3,185 discharges)
IOP
46 days
(10,292 discharges)
Outpatient
59 days
(37,048 discharges)
0
30
60
90
Source Data received through August 4, 2004 from
23 States (CA, CO, GA, HI, IA, IL, KS, MA, MD,
ME, MI, MN, MO, MT, NE, NJ, OH, OK, RI, SC, TX,
UT, WY) as reported in Office of Applied Studies
(OAS 2005). Treatment Episode Data Set (TEDS)
2002. Discharges from Substance Abuse Treatment
Services, DASIS Series S-25, DHHS Publication
No. (SMA) 04-3967, Rockville, MD Substance Abuse
and Mental Health Services Administration.
Retrieved from http//wwwdasis.samhsa.gov/teds02/2
002_teds_rpt_d.pdf .
2753 Have Unfavorable Discharges
Despite being widely recommended, only 10 step
down after intensive treatment
Source Data received through August 4, 2004 from
23 States (CA, CO, GA, HI, IA, IL, KS, MA, MD,
ME, MI, MN, MO, MT, NE, NJ, OH, OK, RI, SC, TX,
UT, WY) as reported in Office of Applied Studies
(OAS 2005). Treatment Episode Data Set (TEDS)
2002. Discharges from Substance Abuse Treatment
Services, DASIS Series S-25, DHHS Publication
No. (SMA) 04-3967, Rockville, MD Substance Abuse
and Mental Health Services Administration.
Retrieved from http//wwwdasis.samhsa.gov/teds02/2
002_teds_rpt_d.pdf .
28Key Problems
- Lack of standardized assessment for substance use
disorders, mental health disorders,
crime/violence, HIV risk and child maltreatment - No or inconsistent use of placement criteria -
knowing nothing about the person other than what
door they walked through we can correctly predict
75 (kappa.51) of the adolescent level of care
placements (including ASAM systems) - Virtually no link to actual data on the expected
outcomes by level of care to inform decision
making related to placement - The lack of the full continuum of care to refer
people due to availability or finance
29Summary of Problems in the Treatment System
- The public systems is changing size, referral
source, and focus - Less than 50 stay 50 days (7 weeks)
- Less the 25 stay the 3 months recommended by
NIDA researchers - Less than half have positive discharges
- After intensive treatment, less than 10 step
down to outpatient care - Major problems are not reliably assessed (if at
all) - Difficult to link assessment data to placement or
treatment planning decisions
30So what does it mean to move the field towards
Evidence Based Practice (EBP)?
- Introducing explicit intervention protocols that
are - Targeted at specific problems/subgroups and
outcomes - Having explicit quality assurance procedures to
cause adherence at the individual level and
implementation at the program level - Having the ability to evaluate performance and
outcomes - For the same program over time,
- Relative to other interventions
- Introducing reliable and valid assessment that
can be used - At the individual level to immediately guide
clinical judgments about diagnosis/severity,
placement, treatment planning, and the response
to treatment - At the program level to drive program evaluation,
needs assessment, performance monitoring and long
term program planning
31Major Predictors of Bigger Effects
- Chose a strong intervention protocol based on
prior evidence - Used quality assurance to ensure protocol
adherence and project implementation - Used proactive case supervision of individual
- Used triage to focus on the highest severity
subgroup
32Impact of the numbers of Favorable features on
Recidivism (509 JJ studies)
Average Practice
Source Adapted from Lipsey, 1997, 2005
33Cognitive Behavioral Therapy (CBT) Interventions
that Typically do Better than Usual Practice in
Reducing Recidivism (29 vs. 40)
- Aggression Replacement Training
- Reasoning Rehabilitation
- Moral Reconation Therapy
- Thinking for a Change
- Interpersonal Social Problem Solving
- MET/CBT combinations and Other manualized CBT
- Multisystemic Therapy (MST)
- Functional Family Therapy (FFT)
- Multidimensional Family Therapy (MDFT)
- Adolescent Community Reinforcement Approach
(ACRA) - Assertive Continuing Care
NOTE There is generally little or no
differences in mean effect size between these
brand names
Source Adapted from Lipsey et al 2001, Waldron
et al, 2001, Dennis et al, 2004
34Need for Short Protocols Targeted at Specific
Issues
- Detoxification services and medication,
particularly related to opioid and
methamphetamine use - Tobacco cessation
- Adolescent psychiatric services related to
depression, anxiety, ADHD, and conduct disorder - Trauma, suicide ideation, parasuicidal behavior
- Need for child maltreatment interventions (not
just reporting protocols) - HIV Intervention to reduce high risk pattern of
sexual behavior - Anger Management
- Problems with family, school, work, and probation
- Recovery coaches, recovery schools, recovery
housing and other adolescent oriented self help
groups / services
35Recovery by Level of Care
100
Outpatient (79, -1)
90
Residential(143, 17)
80
Post Corr/Res (220, 18)
70
CC better
60
Percent in Past Month Recovery
50
OP Resid Similar
40
30
20
10
0
Pre-Intake
Mon 1-3
Mon 4-6
Mon 7-9
Mon 10-12
Recovery defined as no past month use, abuse,
or dependence symptoms while living in the
community. Percentages in parentheses are the
treatment outcome (intake to 12 month change) and
the stability of the outcomes (3months to 12
month change) Source CSAT Adolescent Treatment
Outcome Data Set (n-9,276)
36Need for Tracks, Phases and Continuing Care
- Almost a third of the adolescents are returning
to treatment, 23 for the second or more time - We need to understand what did and did not work
the last time and have alternative approaches - We need tracks or phases that recognize that they
may need something different or be frustrated by
repeating the same material again and again - We need to have better step down and continuing
care protocols
37Implementation is Essential (Reduction in
Recidivism from .50 Control Group Rate)
Thus one should optimally pick the strongest
intervention that one can implement well
Source Adapted from Lipsey, 1997, 2005
38On-site proactive urine testing can be used to
reduce false negatives by more than half
Reduction in false negative reports at no
additional cost
Effects grow when protocol is repeated
39Implications of Implementation Science
- Can identify complex and simple protocols that
improve outcomes - Interventions have to be reliably delivered in
order to achieve reliable outcomes - Simple targeted protocols can make a big
difference - Need for reliable assessment of need,
implementation, and outcomes
40GAIN Clinical Collaborators Adolescent and Adult
Treatment Program
New Hampshire
Washington
Vermont
Maine
North
Montana
Dakota
Minnesota
Oregon
Massachusetts
South
Wisconsin
Idaho
Dakota
New York
Michigan
Wyoming
Rhode Island
Pennsylvania
Iowa
Connecticut
Nebraska
Ohio
Nevada
New Jersey
Indiana
Illinois
Utah
W. Virginia
Delaware
Colorado
California
Kansas
Virginia
Missouri
Kentucky
Maryland
North Carolina
Tennessee
District Of Columbia
Oklahoma
New Mexico
Arkansas
South Carolina
Arizona
Number of GAIN Sites
Georgia
Mississippi
0
Alabama
1 to 10
Texas
11 to 25
Louisiana
26 to 130
Alaska
GAIN State System
Florida
GAIN-SS State or
County System
Hawaii
Virgin Islands
Puerto Rico
10/07
41CSAT GAIN Data (n15,254)
CSAT data dominated by Male, Caucasians, age 15
to 17
CSAT data dominated by Outpatient
CSAT residential more likely to be over 30 days
Any Hispanic ethnicity separate from race group.
Sources CSAT AT 2007 dataset subset to
adolescent studies (includes 2 18 or older).
42Substance Use Problems
Source CSAT 2007 AT Outcome Data Set (n12,601)
43Past Year Substance Severity by Level of Care
Note OPOutpatient, IOPIntensive Outpatient
LTR Long Term Residential (90 days) MTR
Moderate Term Residential (30-90 days) STRShort
Term Residential (0-30 days) Source CSAT 2007
AT Outcome Data Set (n12,824)
44Past Year Substance Severity by Gender
Source CSAT 2007 AT Outcome Data Set (n15,254)
45Past 90 day HIV Risk Behaviors
Source CSAT AT 2007 dataset subset to
adolescent studies (N15,254)
46Sexual Partners by Level of Care
Source CSAT 2007 AT Outcome Data Set (n12,824)
47Sexual Partners by Gender
Source CSAT 2007 AT Outcome Data Set (n15,254)
48Co-Occurring Psychiatric Problems
Source CSAT AT 2007 dataset subset to
adolescent studies (N15,254)
49Co-Occurring Psychiatric Diagnoses by Level of
Care
Source CSAT 2007 AT Outcome Data Set (n12,824)
50Severity of Victimization by Level of Care
Source CSAT 2007 AT Outcome Data Set (n12,824)
51Co-Occurring Psychiatric Diagnoses by Gender
Source CSAT 2007 AT Outcome Data Set (n15,254)
52Severity of Victimization by Gender
Source CSAT 2007 AT Outcome Data Set (n15,254)
53Past Year Violence Crime
Dealing, manufacturing, prostitution, gambling
(does not include simple possession or use)
Source CSAT AT 2007 dataset subset to adolescent
studies (N15,254)
54Type of Crime by Level of Care
Source CSAT 2007 AT Outcome Data Set (n12,824)
55Type of Crime by Gender
Source CSAT 2007 AT Outcome Data Set (n15,254)
56Multiple Problems are the Norm
Few present with just one problem (the focus of
traditional research)
Most acknowledge 1 problems
In fact, 45present acknowledging 5 major
problems
(Alcohol, cannabis, or other drug disorder,
depression, anxiety, trauma, suicide, ADHD, CD,
victimization, violence/ illegal activity)
Source CSAT AT 2007 dataset subset to
adolescent studies (N15,254)
57Number of Problems by Level of Care
Source CSAT 2007 AT Outcome Data Set (n12,824)
58Number of Problems by Level of Care
Source CSAT 2007 AT Outcome Data Set (n15,254)
59No. of Problems by Severity of Victimization
Those with high lifetime levels of victimization
have 117 times higher odds of having 5 major
problems
Severity of Victimization
(Alcohol, cannabis, or other drug disorder,
depression, anxiety, trauma, suicide, ADHD, CD,
victimization, violence/ illegal activity)
Source CSAT AT 2007 dataset subset to
adolescent studies (N15,254)
60CSAT Adolescent Treatment GAIN Data from 203
level of care x site combinations
Source Dennis, Funk Hanes-Stevens, 2008
61Ratings of Problem Severity (x-axis) by
Treatment Utilization (y-axis) by Population Size
(circle size)
1.00
F. Hi- Hi (CC)
H. Hi-Hi (Intx Sx PH/MH Tx) 12
0.80
12
0.60
G. Hi-Mod (Env Sx/ PH Tx) 9
C
E
Average Current Treatment Utilization
.
Hi- Mod
0.40
Mod-Mod
B
14
14
Low- Mod
0.20
20
A
D
0.00
Low-Low
Hi-Low
8
12
-0.20
-0.20
0.00
0.20
0.40
0.60
0.80
1.00
Average Current Problem Severity
62Variance Explained in 10 NOMS Outcomes
\1 Past month \2 Past 90 days All
statistically Significant
63Best Level of Care Cluster A Low - Low
(n1,025)
64Best Level of Care Cluster C Mod-Mod (n1209)
65Best Level of Care Cluster F Hi-Hi (CC) (n968)
66Best Level of Care Cluster G Hi-Mod (Env/PH)
(n749)
67NOMS Outcome Treatment Received by Gender
Source CSAT 2007 AT Outcome Data Set (n11,294)
68NOMS Outcome 50 Reduction or None
Source CSAT 2007 AT Outcome Data Set (n11,294)
69NOMS Outcome at 12 months post-intake
Source CSAT 2007 AT Outcome Data Set (n11,013)
70Change in Days Abstinent (while in community) by
Level of Care and Gender
Source CSAT 2007 AT Outcome Data Set (n11,013)
71MALES Change in Adjusted Days Abstinent by type
of Outpatient Approach
90
80
70
FSN (d0.48)
Other (d0.44)
60
METCBT5 (d0.33)
Total (d0.33)
50
Days of abstinence
Other CBT (d0.32)
40
Seven Challenges (d0.27)
METCBT12 (d0.2)
30
EMPACT (d0.18)
20
CHS OP (d0.15)
10
0
Intake
Last Followup
Source CSAT 2007 AT Outcome Data Set (n11,013)
72FEMALES Change in Adjusted Days Abstinent by
type of Outpatient Approach
90
80
70
Other (d0.51)
CHS OP (d0.48)
60
METCBT12 (d0.48)
Seven Challenges (d0.44)
50
Days of abstinence
Total (d0.42)
40
FSN (d0.41)
Other CBT (d0.41)
30
METCBT5 (d0.4)
20
METCBT7 (d0.38)
MDFT (d0.36)
10
ACRA/ACC (d0.35)
0
Intake
Last Follow-up
Source CSAT 2007 AT Outcome Data Set (n11,013)
7336 Site Replication on MET/CBT5
WA
NH
ME
VT
MT
ND
OR
MN
MA
NY
WI
ID
SD
MI
WY
RI
CT
PA
IA
NE
NJ
IL
OH
IN
NV
UT
DE
WV
CO
VA
CA
KS
MD
KY
MO
DC
NC
TN
OK
AZ
AR
NM
SC
GA
AL
MS
CYT 4 Sites
TX
LA
FL
AK
HI
Source Dennis, Ives, Muck, 2008
74Replication and Site Effects
- Treatment can vary by implementation within
site/clinic - We want to compare the range of implementation in
practice with the clinical trials - In order to compare sites, we will at both the
central tendency (median) and distribution using
a Tukey Box Plot like the one shown here.
3.00
2.50
2.00
1.50
1.00
0.50
0.00
-0.50
-1.00
-1.50
-2.00
Criteria
75Range of Effect Sizes (d) for Change in Days of
Abstinence (intake to 12 months) by Site
1.40
1.40
6 programs completely above CYT
1.20
1.20
1.00
1.00
0.80
0.80
Cohens d
0.60
0.60
0.40
0.40
0.20
0.20
75 above CYT median
0.00
0.00
4 CYT Sites (f0.39) (median within site d0.29)
36 EAT Sites (f0.21) (median within site d0.49)
Source Dennis, Ives, Muck, 2008
76Findings from the Assertive Continuing Care
(ACC) Experiment
- 183 adolescents admitted to residential substance
abuse treatment - Treated for 30-90 days inpatient, then discharged
to outpatient treatment - Random assignment to usual continuing care (UCC)
or assertive continuing care (ACC) - Over 90 follow-up 3, 6, 9 months post
discharge
Source Godley et al 2002, 2007
77Time to Enter Continuing Care and Relapse after
Residential Treatment (Age 12-17)
100
90
80
70
Relapse
60
Percent of Clients
50
40
30
20
10
0
0
10
20
30
40
50
60
70
80
90
Days after Residential (capped at 90)
Source Godley et al., 2004 for relapse and 2000
Statewide Illinois DARTS data for CC admissions
78ACC Enhancements
- Continue to participate in UCC
- Home Visits
- Sessions for adolescent, parents, and together
- Sessions based on ACRA manual (Godley, Meyers et
al., 2001) - Case Management based on ACC manual (Godley et
al, 2001) to assist with other issues (e.g., job
finding, medication evaluation)
79Assertive Continuing Care (ACC)Hypotheses
Assertive Continuing Care
80ACC Improved Adherence
100
20
30
10
40
50
60
70
80
90
0
Weekly
Tx
Weekly 12 step meetings
Relapse prevention
Communication skills training
Problem solving component
Regular urine tests
Meet with parents 1-2x month
Weekly telephone contact
Contact w/probation/school
Referrals to other services
Follow up on referrals
Discuss probation/school compliance
Adherence Meets 7/12 criteria
Source Godley et al 2002, 2007
81GCCA Improved Early (0-3 mon.) Abstinence
100
90
80
70
60
50
38
36
40
30
24
20
10
0
Any AOD (OR2.16)
Alcohol (OR1.94)
Marijuana (OR1.98)
Low (0-6/12) GCCA
Source Godley et al 2002, 2007
82Early (0-3 mon.) Abstinence Improved Sustained
(4-9 mon.) Abstinence
100
90
80
70
60
50
40
30
22
22
19
20
10
0
Any AOD (OR11.16)
Alcohol (OR5.47)
Marijuana (OR11.15)
Early(0-3 mon.) Relapse
Source Godley et al 2002, 2007
83Post script on ACC
- The ACC intervention improved adolescent
adherence to the continuing care expectations of
both residential and outpatient staff doing so
improved the rates of short term abstinence and,
consequently, long term abstinence. - Despite these GAINs, many adolescents in ACC (and
more in UCC) did not adhere to continuing care
plans. - The ACC1 main findings are published and findings
from two subsequent experiments are currently
under review - CSAT is currently replicating ACRA/ACC in 32
sites - The ACC manual is being distributed via the
website and the CD you have been provided.
84Recommendations for Further Developments
- Evidenced based interventions can come from both
research and practice - Evidence based interventions can improve
implementation of treatment and treatment
outcomes - Practice based evidence can be used to improve
outcomes - Evidenced based interventions and their outcomes
can be replicated in practice - Continuing care and is a key determinant of long
term outcomes