Victimization, Trauma, and Suicidality Among Adolescents Presenting for Substance Abuse Treatment - PowerPoint PPT Presentation

1 / 26
About This Presentation
Title:

Victimization, Trauma, and Suicidality Among Adolescents Presenting for Substance Abuse Treatment

Description:

– PowerPoint PPT presentation

Number of Views:137
Avg rating:3.0/5.0
Slides: 27
Provided by: RonD3
Category:

less

Transcript and Presenter's Notes

Title: Victimization, Trauma, and Suicidality Among Adolescents Presenting for Substance Abuse Treatment


1
Victimization, Trauma, and Suicidality Among
Adolescents Presenting for Substance Abuse
Treatment
  • Michael Dennis, Ph.D.
  • Chestnut Health Systems,
  • Bloomington, IL
  • Part of the continuing education workshop,
    Advancing the Field of Adolescent Substance
    Abuse Treatment, Hamden, CT, April 22, 2005.
    Sponsored by the Department of Children and
    Families Substance Abuse Division. The content of
    this presentations are based on treatment
    research funded by the Center for Substance Abuse
    Treatment (CSAT), Substance Abuse and Mental
    Health Services Administration (SAMHSA) under
    contract 270-2003-00006 using data provided by
    the following grantees (TI11320, TI11324,
    TI11317, TI11321, TI11323, TI11874, TI11424,
    TI11894, TI11871, TI11433, TI11423, TI11432,
    TI11422, TI11892, TI11888, TI013313, TI013309,
    TI013344, TI013354, TI013356, TI013305, TI013340,
    TI130022, TI03345, TI012208, TI013323, TI14376,
    TI14261, TI14189,TI14252, TI14315, TI14283,
    TI14267, TI14188, TI14103, TI14272, TI14090,
    TI14271, TI14355, TI14196, TI14214, TI14254,
    TI14311, TI15678, TI15670, TI15486, TI15511,
    TI15433, TI15479, TI15682, TI15483, TI15674,
    TI15467, TI15686, TI15481, TI15461, TI15475,
    TI15413, TI15562, TI15514, TI15672, TI15478,
    TI15447, TI15545, TI15671)). several individual
    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

2
Goals of this Presentation
  • Demonstrate the feasibility and desirability of
    measuring victimization at intake with the GAINs
    General Victimization Scale (GVS)
  • Show that victimization is common and varies in
    severity
  • Examine the how the severity of victimization
    (measured with GVS) is correlated with with level
    of care, demographic characteristics, substance
    use severity, relapse potential, HIV risk, mental
    health, and crime/violence
  • Examine the implications of traumatic
    victimization for treatment outcome and matching

3
Introduction
  • Victimization (including physical, sexual, and
    emotional abuse) are the norm for adolescents
    presenting to substance abuse treatment.
  • Yet staff often express concerns that they do not
    have the tools for screening that screening
    might disrupt rapport (leading to early drop out
    or mandated reporting) and that they lack the
    resources to do anything about victimization.
  • This is at odds with expert recommendations
    (CSAT, 1993, 1999, 2000 Dennis Stevens, 2003
    Dennis, 2004) that have consistently encouraged
    early systematic screening and intervention among
    adolescents entering substance abuse treatment.

4
Prevalence Rates of Victimization
  • It is estimated that 826,000 to 3,000,000 (3-12)
    adolescents (age 12 to 17) have been victimized
    (DHHS, 2001 Sedlack Broadhurst, 1996).
  • Among adolescents presenting for substance abuse
    treatment, the rates ranged from 40 to 80 -
    varying by gender, timing, definition, and level
    of care (Dennis Stevens, 2003) .
  • 39 of male 59 of females acknowledged a
    lifetime history of physical or sexual
    victimization when interviewed a few questions in
    DATOS-A a month after intake (Grella Joshi,
    2003).
  • 48 of the males and 80 of the females
    acknowledged a lifetime history of physical,
    sexual, or emotional victimization when
    interviewed with the GAIN at intake (Titus,
    Dennis, White, Scott Funk, 2003).

5
Multiple Types of Victimization Measured by the
GAINs General Victimization Scale (GVS)
Sexual Physical,
Sexual, Physical,
Emotional
Emotional, 16
16
none
None
Sexual
43
43
Sexual 6
6
Physical
Physical
Emotional
Emotional, 6
6
Physical Only
Emotional
Emotional
Physical Only
23
6
6
23
Source Titus et al, 2003
6
Additional Traumagenic Factors Measured by GVS
0
10
20
30
40
50
60
70
80
90
100
Abused before 18
Repeated abuse
Multiple abusers
Abused by trusted person
Afraid for life
Abuse resulted in sex
No one believed the abuse
Boys
Girls
Worried about weapon attack
Worried about physical abuse
Worried about sexual abuse
Worried about emotional abuse
Source Titus et al, 2003
All significant
at plt.05
7
CSAT Adolescent Treatment (AT) Programs
Reordered by Level of Care and Severity
  • EAT Effective Adolescent Treatment (2003-2007
    n975) replicating the CYT MET/CBT intervention
    in early intervention, school and outpatient
    settings(22 of 36 grants Bradley, Brown,
    Clayton,Curry, Davis, Dillon, Dodge, Kressler,
    Kincaid, Levine, Levy, Locario, Mason, Moore,
    Rajaee-Moore, Paull, Payton, Rezende, Taylor,
    Tims, Turner, Vincent)
  • CYT Cannabis Youth Treatment (1997-2001 n600)
    Experiments with adolescent outpatient/intensive
    outpatient (5 grants Babor, Dennis, Diamond,
    Godley, Tims)
  • TCE Targeted Capacity Expansion (2002-2007
    n189) evaluation of intensive outpatient
    programs and some residential treatment (2 of 12
    grants Tims, Lloyd)
  • SCY Strengthening Communities-Youth (2002-2007
    n1120) evaluations of early intervention,
    outpatient, intensive outpatient and some
    residential (11 of 12 grants Beach, Bolland,
    Dahl, Gerstel, Godley, Hall, Hutchinson, Keehn,
    Murphy, Noonan, Panzarella)
  • ATM Adolescent Treatment Model (1998-2002
    n1468) evaluations of outpatient, short and long
    term residential (10 grants Batttjes, Fishman,
    Godley, Liddle, Morral, Perry, Sabin, Shane,
    Stevens-2)
  • ART Adolescent Residential Treatment (2003-2006
    n1179) evaluations of residential treatment
    enhancements and continuing care (17 grants
    Beach, Fishman, Flores, Gay, Gnazzo, Hatch,
    Hurtig, Lane, Law, Manov, May, Miley, Nordquist,
    Snipes, Urquahart, Whitmore, Zammarelli)

8
CSAT AT Program Common Data Set
  • The working CSAT adolescent treatment data set
    including data on 5,468 adolescents from 67 local
    evaluations (current through quarterly data
    submission cycle ending in December 2004)
  • All data collected with the Global Appraisal of
    Individual Needs (GAIN) using centrally trained
    and certified staff
  • Outcome data through 12 months available on over
    90 of CYT and ATM clients and over 80 of others
    due in on-going programs
  • Programs include several standardized protocols
    based on both research and practice (ACC, ACRA,
    ATM, FFT, FSN, Matrix, MET/CBT, MDFT, MST)
  • Local evaluations include several experiments and
    quasi experiments
  • Several workgroups working on common themes
    across programs (African American, Co-morbidity,
    Family, Native American/Indian, Spanish
    translation/workforce)
  • Data being shared with several secondary analysis
    grantees and panel presentations for this week

9
GVS Goes up With Level of Care
100
10
20
30
40
50
60
70
80
90
0
Early Intervention
Outpatient
Other
Intensive Outpatient
Medium Term Residential
Resid. Continuing Care
Long Term Residential
Short Term Residential
Low
Mod.
High
Source CSAT AT Common GAIN Data set
10
GVS Goes up With Several Characteristics
100
10
20
30
40
50
60
70
80
90
0
Total
Female
In Controlled
Environment
Mixed Race
Homeless/ Runaway
21-25 Year Olds
Low
Mod.
High
Source CSAT AT Common GAIN Data set
11
GVS predicts higher substance use severity in
multiple measures
100
Low
Mod.
High
90
80
70
60
50
40
30
20
10
0
(3.6)
of Use (3.3)
(4.1)
Prior
(3.9)
of AOD (1.7)
(2.2)
AOD
1st Use
under 10
Severe
5 Years
Dependence
Treatment
Withdrawal
Weekly Use
Source CSAT AT Common GAIN Data set
(Odds Ratios odds for High over odds for Low)
12
GVS predicts greater readiness to change, but
higher relapse risks
100
Low
Mod.
High
90
80
70
60
50
40
30
20
10
0
(3.1)
in home (1.9)
in Home (2.6)
among
among
Believes
treatment
peers (2.3)
peers (1.4)
peers (1.8)
peers (1.8)
needed (2.0)
work/school
work/school
among social
among social
AOD problem
Acknowledges
Regular Drug Use
Regular Alcohol Use
Readiness
Source CSAT AT Common GAIN Data set
(Odds Ratios odds for High over odds for Low)
13
GVS predicts higher HIV/STI risk in the 90 days
before intake
100
Low
Mod.
High
90
Relative to Mod.
80
70
60
50
40
30
20
10
0
Sex (2.7)
Needle Use
(4.8)
(2.5)
Activity (0.8)
Partners (2.0)
(2.1)
Sexual
Unprotected
Multiple Sex
Worries about
Victimization
victimization
Source CSAT AT Common GAIN Data set
(Odds Ratios odds for High over odds for Low)
14
GVS has its strongest relationship with internal
disorders
100
Low
Mod.
High
90
80
70
60
50
40
30
20
10
0
(5.2)
(6.5)
Disorder (6.1)
Disorder (5.2)
Disorder (9.6)
Anxiety Disorder
Mutilation (3.5)
Any Self
Depressive
Any Internal
Any homicidal/
Trauma Related
suicidal thoughts
Source CSAT AT Common GAIN Data set
(Odds Ratios odds for High over odds for Low)
15
GVS is also related to external/impulse control
disorders
100
Low
Mod.
High
90
80
70
60
50
40
30
20
10
0
ADHD (3.7)
(4.7)
(4.7)
Disorder
Conduct
Disorder
And Internal (6.7)
External
Any External
Source CSAT AT Common GAIN Data set
(Odds Ratios odds for High over odds for Low)
16
GVS is also related to Crime and Violence
100
Low
Mod.
High
90
80
70
60
50
40
30
20
10
0
Crime (4.6)
Crimes (3.0)
(4.4)
Crimes (3.1)
Physical
Property
or illegal
Violence
year (2.8)
Any Illegal
activity (3.6)
Interpersonal
Activity-past
Any violence
Drug Related
Source CSAT AT Common GAIN Data set
(Odds Ratios odds for High over odds for Low)
17
GVS is consequently related to the total number
of major problems
100
90
80
70
60
50
40
30
20
10
0
1 Problem
4 Problems
5 or more
2 Problems
3 Problems
Problems (117.2)
Low
Mod.
High
(Alcohol, cannabis, or other drug disorder,
depression, anxiety, trauma, suicide, ADHD, CD,
victimization, violence/ illegal activity)
Source CSAT AT Common GAIN Data set
(Odds Ratios odds for High over odds for Low)
18
Victimization and Gender Interact with Substance
Use Outcomes
Male
Female
60
50
40
Days of 90
30
20
10
0
Pre-Treatment
Post-Discharge
Pre-Treatment
Post-Discharge
Low
Clinical
Acute
Source Titus, Dennis, et al., 2003
19
Victimization Also Interacts with Level of Care
CHS Outpatient
CHS Residential
40
35
30
25
Marijuana Use (Days of 90)
20
15
10
5
0
Intake
6 Months
Intake
6 Months
OP -High
OP - Low/Mod
Resid-High
Resid - Low/Mod.
Source Funk, et al., 2003
20
How do CHS OPs high GVS outcomes compare with
other OP programs on average?
1.00
CYT Total (n217 d0.51)
0.80
0.60
ATM Total (n284 d0.41)
0.40
CHSOP (n57 d0.18)
0.20
Z-Score on Substance Frequency Scale (SFS)
0.00
-0.20
-0.40
-0.60
-0.80
-1.00
Intake
Mon 1-3
Mon 4-6
Mon 7-9
Mon 10-12
Source CYT and ATM Outpatient Data Set
21
Which 5 OP Programs Did the Best with High GVS
adolescents?
1.00
0.80
0.60
0.40
0.20
Z-Score on Substance Frequency Scale (SFS)
0.00
-0.20
-0.40
-0.60
-0.80
-1.00
Intake
Mon 1-3
Mon 4-6
Mon 7-9
Mon 10-12
Source CYT and ATM Outpatient Data Set
22
Which 5 OP Programs Did the Best with High GVS
adolescents?
1.00
0.80
0.60
0.40
0.20
CHSOP (n57 d0.18)
Z-Score on Substance Frequency Scale (SFS)
0.00
-0.20
-0.40
-0.60
-0.80
-1.00
Intake
Mon 1-3
Mon 4-6
Mon 7-9
Mon 10-12
Source CYT and ATM Outpatient Data Set
23
Other approaches specifically targeting trauma
  • Cognitive Behavioral Intervention for Trauma in
    Schools (CBITS) Manual (Lisa H. Jaycox Ph.D.,
    2004) www.sopriswest.com or jaycox_at_rand.org
  • Seeking Safety A Treatment Manual for PTSD and
    Substance Abuse (Najavits, 2002)
    www.seekingsafety.org or from Guilford Press
    (800-365-7006)
  • Trauma Adaptive Recovery Group Education
    Therapy Model for Adolescents (TARGET-A Ford et
    al., 2000, Ford, Mahoney Russo, 2004) from
    www.ptsdfreedom.org or ford_at_psychiatry.uchc.edu
  • Dialectical Behavior Therapy for Adolescents
    (DBT-A Rathus, Miller, Linehan, in press) from
  • School-Based Trauma/Grief Group Psychotherapy
    Program (SPARCS Layne, Saltzman, Pynoos, et
    al., 2000) from Ruth_at_bascom.com

24
Concluding Comments
  • Victimization is the norm among adolescents
    presenting for substance abuse treatment
  • Victimization can and should be comprehensively
    assessed at intake
  • The severity of traumatic victimization is highly
    correlated with a wide range of substance use,
    HIV risk behaviors, mental health, and
    crime/violence problems.
  • Higher levels of victimization interact with
    treatment effectiveness
  • Substance abuse treatment programs vary in their
    effectiveness at dealing with trauma
  • More interventions are need to specifically
    target victimization and trauma
  • It is Time to Stop Ignoring the Elephant in our
    Counseling Room

25
Resources and References
  • Copy of these slides and handouts are at
    http//www.chestnut.org/LI/Posters/ , see also
    www.mayatech
  • Information on the GAIN is at www.chestnut.org/li/
    gain
  • Information on the adolescent treatment manuals
    discussed are at www.chestnut.org/li/apss/csat/pro
    tocols
  • References cited
  • Dennis, M.L. (2004). Traumatic victimization
    among adolescents in substance abuse treatment
    Time to stop ignoring the elephant in our
    counseling rooms. Counselor, April, 36-40.
  • Dennis, M. L., Stevens, S. J., (Eds.). (2003).
    Maltreatment issues and outcomes of adolescents
    enrolled in substance abuse treatment special
    issue. Journal of Child Maltreatment, 8(1) 3-6.
    See http//www.sagepub.com/journalIssue.aspx?pid
    15jiid6072
  • Dennis, M. L., Titus, J. C., White, M., Unsicker,
    J., Hodgkins, D. (2003). Global Appraisal of
    Individual Needs (GAIN) Administration guide for
    the GAIN and related measures. (Version 5 ed.).
    Bloomington, IL Chestnut Health Systems. Retrieve
    from http//www.chestnut.org/li/gain
  • Funk, R. R., McDermeit, M., Godley, S. H.,
    Adams, L. (2003). Maltreatment issues by level of
    adolescent substance abuse treatment The extent
    of the problem at intake and relationship to
    early outcomes. Journal of Child Maltreatment, 8,
    36-45.
  • Grella, C. E., Joshi, V. (2003). Treatment
    processes and outcomes among adolescents with a
    history of abuse who are in drug treatment.
    Journal of Child Maltreatment, 8(1) 7-18.
  • Jaycox, L.H., Stein, B., Kataoka, S., Wong, M.,
    Fink, A., Escudera, P. Zaragoza, C. (2002).
    Violence exposure, PTSD, and depressive symptoms
    among recent immigrant school children. Journal
    of the American Academy of Child and Adolescent
    Psychiatry, 41(9) 1104-1110.

26
References Continued
  • Kataoka, S., Stein, B. D., Jaycox, L. H., Wong,
    M., Escuerdo, P., Tu, W., Zaragosa, C., Fink,
    A. (2003). A school-based mental health program
    for traumatized Latino immigrant children.
    Journal of the American Academy of Child and
    Adolescent Psychiatry, 42(3), 311-318.
  • Najavits, L. (2002). Seeking Safety A Treatment
    Manual for PTSD and Substance Abuse. New York,
    NY Guilford Press. Aavailalbe from
    www.seekingsafety.org or 800-365-7006.
  • Schwebel, R. (2004) The Seven Challenges Manual.
    Available from www.sevenchallenges.com or
    rschwebel_at_sevenchallenges.com
  • Stein, B.D., Jaycox, L.H., Kataoka, S.H., Wong,
    M., Tu, W., Eliot, M.N., Fink, A. (2003). A
    mental health intervention for school children
    exposed to violence A randomized controlled
    trial. Journal of the American Medical
    Association, 290(5), 603-611.
  • Titus, J.C., Dennis, M.L., White, W.L., Scott,
    C.K., Funk, R.R. (2003). Gender Differences in
    Victimization Severity and Outcomes Among
    Adolescents Treated for Substance Abuse. Journal
    of Child Maltreatment, 8(1), 19-35.
  • U.S. Department of Health and Human Services.
    (2001). Child Maltreatment 1999. Washington, DC
    U.S. Government Printing Office.
Write a Comment
User Comments (0)
About PowerShow.com