Developing Effective Drug Treatment For Adolescents: Results from the Cannabis Youth Treatment CYT T - PowerPoint PPT Presentation

Loading...

PPT – Developing Effective Drug Treatment For Adolescents: Results from the Cannabis Youth Treatment CYT T PowerPoint presentation | free to view - id: 4b08b-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Developing Effective Drug Treatment For Adolescents: Results from the Cannabis Youth Treatment CYT T

Description:

Developing Effective Drug Treatment. For Adolescents: Results from the ... ( prepared for Drug Strategies adolescent treatment handbook) ... – PowerPoint PPT presentation

Number of Views:112
Avg rating:3.0/5.0
Slides: 35
Provided by: RonD3
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Developing Effective Drug Treatment For Adolescents: Results from the Cannabis Youth Treatment CYT T


1
Developing Effective Drug TreatmentFor
Adolescents Results from the Cannabis Youth
Treatment (CYT) Trials
  • Michael Dennis, Ph.D.
  • Chestnut Health Systems
  • Bloomington, IL
  • Scientific Approaches to Improving Practice
    Panel Presentation at the American Society of
    Addiction Medicine (ASAM) 2004 Annual Conference,
    Washington, DC, April 25, 2004. The opinions are
    those of the author do not reflect official
    positions of the government . Available on-line
    at www.chestnut.org/li/posters.

2
AcknowledgementThis presentation is based on
the work, input and contributions from several
other people including Nancy Angelovich, Tom
Babor, Laura (Bunch) Brantley, Joseph A.
Burleson, George Dent, Guy Diamond, James Fraser,
Michael French, Rod Funk, Mark Godley, Susan H.
Godley, Nancy Hamilton, James Herrell, David
Hodgkins, Ronald Kadden, Yifrah Kaminer, Tracy L.
Karvinen, Pamela Kelberg, Jodi (Johnson)
Leckrone, Howard Liddle, Barbara McDougal, Kerry
Anne McGeary, Robert Meyers, Suzie
Panichelli-Mindel, Lora Passetti, Nancy Petry, M.
Christopher Roebuck, Susan Sampl, Meleny Scudder,
Christy Scott, Melissa Siekmann, Jane Smith,
Zeena Tawfik, Frank Tims, Janet Titus, Jane
Ungemack, Joan Unsicker, Chuck Webb, James West,
Bill White, Michelle White, Caroline Hunter
Williams, the other CYT staff, and the families
who participated in this study. This presentation
was supported by funds and data from the Center
for Substance Abuse Treatment (CSATs) Persistent
Effects of Treatment Study (PETS, Contract No.
270-97-7011) and the Cannabis Youth Treatment
(CYT) Cooperative Agreement (Grant Nos. TI11317,
TI11320, TI11321, TI11323, and TI11324). The
opinions are those of the author and steering
committee and do not reflect official positions
of the government .
3
CYT
Cannabis Youth Treatment Randomized Field Trial
Coordinating Center Chestnut Health Systems,
Bloomington, IL, and Chicago, IL University
of Miami, Miami, FL University of Conn. Health
Center, Farmington, CT
Sites Univ. of Conn. Health Center, Farmington,
CT Operation PAR, St. Petersburg, FL Chestnut
Health Systems, Madison County, IL Childrens
Hosp. of Philadelphia, Phil. ,PA
Sponsored by Center for Substance Abuse
Treatment (CSAT), Substance Abuse and Mental
Health Services Administration (SAMHSA), U.S.
Department of Health and Human Services
4
Objectives
  • Describe the development of manual-guided,
    cost-effective, outpatient treatment
    interventions for adolescent drug abusers.
  • Summarize methodological advances in assessment,
    retention, supervision, and follow-up
  • Summarize evidence on their cost, effectiveness,
    and cost-effectiveness
  • Examine the diffusion of these methodological and
    substantive advances to the field.

5
The Adolescent Marijuana Problem (circa
1997-1998)
  • Use was starting at younger ages
  • Was at an historically high level among
    adolescents
  • Potency increased 3-fold from 1980 to 1997
  • Was three times more likely to lead to dependence
    among adolescents than adults
  • Was associated with many health, mental and
    behavioral problems
  • Was the leading substance mentioned in adolescent
    emergency room admissions and autopsies

6
The State of Adolescent Treatment(circa
1997-1998)
  • Marijuana related admissions to adolescent
    substance abuse treatment increased by 115 from
    1992 to 1998
  • Over 80 of adolescents entering treatment in
    1998 had a marijuana problem
  • Over 80 were entering outpatient treatment
  • Over 75 received less than 90 days of treatment
    (median of 6 weeks)
  • Evaluations of existing adolescent outpatient
    treatment suggest that adult models or less than
    90 days of outpatient treatment is rarely
    effective for reducing marijuana use.
  • No empirically evaluated treatment manuals were
    publicly available to help expand or enhance the
    system

7
Purpose of CYT
  • To learn more about the characteristics and needs
    of adolescent marijuana users presenting for
    outpatient treatment.
  • To adapt evidence-based, manual-guided therapies
    for use in 1.5 to 3 month adolescent outpatient
    treatment programs in medical centers or
    community based settings.
  • To field test the relative effectiveness, cost,
    cost-effectiveness, and benefit cost of five
    interventions targeted at marijuana use and
    associated problems in adolescents.
  • To provide validated models of these
    interventions to the treatment field in order to
    address the pressing demands for expanded and
    more effective services.

8
Design
  • Target Population Adolescents with marijuana
    disorders who are appropriate for 1 to 3 months
    of outpatient treatment.
  • Inclusion Criteria 12 to 18 year olds with
    symptoms of cannabis abuse or dependence, past 90
    day use, and meeting ASAM criteria for outpatient
    treatment
  • Data Sources self report, collateral reports,
    on-site and laboratory urine testing, therapist
    alliance and discharge reports, staff service
    logs, and cost analysis.
  • Random Assignment to one of three treatments
    within site in two research arms and quarterly
    follow-up interview for 12 months
  • Long Term Follow-up under a supplement from
    PETSA follow-up was extended to 30 months (42 for
    a subsample)

9
Two Trials or Study Arms
Trial 2
Trial 1
Incremental Arm
Alternative Arm
Randomly Assigns to
Randomly Assigns to
MET/CBT5
MET/CBT5
Motivational Enhancement Therapy/
Motivational Enhancement Therapy/
Cognitive Behavioral Therapy (5 weeks)
Cognitive Behavioral Therapy (5 weeks)
MET/CBT12
ACRA
Motivational Enhancement Therapy/
Adolescent Community
Reinforcement Approach(12 weeks)
Cognitive Behavioral Therapy (12 weeks)
MDFT
FSN
Family Support Network
Multidimensional Family Therapy
Plus MET/CBT12 (12 weeks)
(12 weeks)
Source Dennis et al, 2002
10
Actual Treatment Received by Condition
ACRA and MDFT both rely on individual, family and
case management instead of group
FSN adds multi family group, family home visits
and more case management
And MDFT using more family therapy
MET/CBT12 adds 7 more sessions of group
With ACRA using more individual therapy
Source Dennis, Godley et al, in press
11
Average Episode Cost (US) of Treatment
--------------------------------------------Econo
mic Cost------------------------------------------
--------- Director Estimate-----
4,000
3,322
3,500
3,000
2,500
Average Cost Per Client-Episode of Care
1,984
2,000
1,559
1,413
1,500
1,197
1,126
1,000
500
-
ACRA (12.8 weeks)
MET/CBT5 (6.8 weeks)
MET/CBT5 (6.5 weeks)
MET/CBT12 (13.4 weeks)
FSN (14.2 weeks w/family)
MDFT(13.2 weeks w/family)
Source French et al., 2002, 2003
12
Implementation of Evaluation
  • Over 85 of eligible families agreed to
    participate
  • Quarterly follow-up of 94 to 98 of the
    adolescents from 3- to 12-months (88 all five
    interviews)
  • Long term follow-up completed on 90 at 30-months
  • Collateral interviews were obtained at intake, 3-
    and 6-months on over 92-100 of the adolescents
    interviewed
  • Urine test data were obtained at intake, 3, 6, 30
    and 42 months 90-100 of the adolescents who were
    not incarcerated or interviewed by phone (85 or
    more of all adolescents).
  • Self report marijuana use largely in agreement
    with urine test at 30 months (13.8 false
    negative, kappa.63)
  • 5 Treatment manuals drafted, field tested,
    revised, send out for field review, and finalized
    (10-30,000 copies of each already printed and
    distributed)
  • Descriptive, outcome and economic analyses
    completed

Source Dennis et al, 2002, in press
13
Adolescent Cannabis Users in CYT were as or More
Severe Than Those in TEDS
Source Tims et al, 2002
14
Demographic Characteristics
Source Tims et al, 2002
15
Institutional Involvement
Source Tims et al, 2002
16
Patterns of Substance Use

100
73
80
71
60
40
17
20
9
0
Weekly Alcohol
Weekly
Weekly
Significant Time
Tobacco Use
Cannabis Use
Use
in Controlled
Environment
Source Tims et al, 2002
17
Multiple Problems are the NORM
Self-Reported in Past Year
Source Dennis et al, under review
18
Co-occurring Problems are Higher for those
Self-Reporting Past Year Dependence
Source Tims et al., 2002

plt.05
19
CYT Increased Days Abstinent and Percent in
Recovery (no use or problems while in community)
Source Dennis et al., in press
20
Similarity of Clinical Outcomes by Conditions
Source Dennis et al., in press.
21
Moderate to large differences in
Cost-Effectiveness by Condition
Source Dennis et al., in press
22
Evaluating the Long Term Effects of Treatment
Month
Z-Score
Source Dennis et al, under review, forthcoming
23
Cumulative Recovery Pattern at 30 months(The
Majority Vacillate in and out of Recovery)
Source Dennis et al, forthcoming
24
Cost Per Person in Recovery at 12 and 30 Months
After Intake by CYT Condition

Trial 1 (n299)
Trial 2 (n297)
Cost Per Person in Recovery (CPPR)
30,000
25,000
20,000
15,000
10,000
5,000
0
MET/ CBT5
MET/ CBT12
FSNM
MET/ CBT5
ACRA
MDFT
3,958
7,377
15,116
6,611
4,460
11,775
CPPR at 12 months
Plt.0001, Cohens f 1.42 and 1.77 at 12
months Plt.0001, Cohens f 0.76 and 0.94 at 30
months
Source Dennis et al., in press forthcoming
25
Average Cost to Society Varied More by Site than
Condition
6,000
5,000
4,000
3,000
2,000
1,000
0
0
3
6
9
12
15
18
21
24
27
30
Months from Intake
Source French et al, 2003 forthcoming
26
How does CYT compare with Regular OP/IOP
Frequency of Substance Use
27
How does CYT compare with Regular OP/IOP
Substance Abuse/Dependence Problems
28
Dissemination and Impact
  • Papers published on design, validation,
    characteristics, matching, clinical contrast,
    treatment manuals, therapist reactions, 6 month
    outcomes, cost, benefit cost
  • Papers with main clinical and cost-effectiveness
    findings at 12 months in press and 30 month
    findings being submitted this year.
  • Interventions being replicated as part of over
    four dozen studies currently or about to go into
    the field
  • 20 to 30,000 copies of each of the 5 manuals
    distributed to policy makers, providers,
    individual clinicians and training programs (via
    NCADI or www.chestnut.org/li/apss )
  • The Global Appraisal of Individual Needs (GAIN)
    assessment has been used in over 70 subsequent
    adolescent treatment studies and combined into
    one large data base that will be used to support
    case mix adjustments, benchmarking and meta
    analysis
  • Supervision, Retention, and Follow-up models also
    being replicated in these adolescent treatment
    studies

29
CYT was part of a Renascence of Adolescent
Treatment Research/Practice
From 1998 to 2002 the number of adolescent
treatment studies doubled and has doubled again
in the past 2 years with over 100 currently in
the field Source Dennis , White (2003) at
www.drugstrategies.org.
30
CSATs Adolescent Treatment Programs
Currently Using the GAIN or CYT Txs
CSAT Grantees
Other Collaborators
Cannabis Youth Treatment (CYT)
RWJF Reclaiming Futures Program
Adolescent Treatment Model (ATM)
RWJF Other RWJF Grantees
Strengthening Communities for Youth (SCY)
Adolescent Residential Treatment (ART)
NIAAA/NIDA Other Grantees
Effective Adolescent Treatment (EAT)
Other CSAT Grantees
31
Conclusions
  • The CYT interventions provide replicable models
    of effective brief (1.5 to 3 month) treatments
    that can be used to help the field maintain
    quality while expanding capacity.
  • While a good start, the CYT interventions were
    still not an adequate dose of treatment for the
    majority of adolescents.
  • The majority of adolescents continued to
    vacillate in and out of recovery after discharge
    from CYT.
  • More work needs to be done on providing a
    continuum of care, longer term engagement and on
    going recovery management.
  • Adolescent treatment can be cost effective and
    cost beneficial to society
  • CYT also helped to spur a new wave of
    methodological improvements related to
    assessment, supervision, retention, and follow-up
    that benefit researchers, evaluators, and program
    planners

32
Contact Information
  • Michael L. Dennis, Ph.D., CYT Coordinating Center
    PI
  • Lighthouse Institute, Chestnut Health Systems
  • 720 West Chestnut, Bloomington, IL 61701
  • Phone (309) 827-6026, Fax (309) 829-4661
  • E-Mail Mdennis_at_Chestnut.Org
  • Manuals and Additional Information are Available
    at
  • CYT www.health.org/govpubs or
    www.chestnut.org/li/bookstore
  • PETSA www.samhsa.gov/centers/csat/csat.html
  • (then select PETS from program resources)
  • APSS www.chestnut.org/li/APSS
  • (copies of CYT and over a dozen other
    adolescent treatment
  • manuals and information on the Society for
    Adolescent
  • Substance Abuse Treatment Effectiveness
    (SASATE)

33
CYT Related References
  • Babor, T. F., Webb, C. P. M., Burleson, J. A.,
    Kaminer, Y. (2002). Subtypes for classifying
    adolescents with marijuana use disorders
    Construct validity and clinical implications.
    Addiction, 97(Suppl. 1), 58-69.
  • Buchan, B. J., Dennis, M. L., Tims, F. M.,
    Diamond, G. S. (2002). Cannabis use Consistency
    and validity of self report, on-site urine
    testing, and laboratory testing. Addiction,
    97(Suppl. 1), 98-108.
  • Dennis, M. L., Babor, T., Roebuck, M. C.,
    Donaldson, J. (2002). Changing the focus The case
    for recognizing and treating marijuana use
    disorders. Addiction, 97 (Suppl. 1), S4-S15.
  • Dennis, M.L., Dawud-Noursi, S., Muck, R.,
    McDermeit, M. (2003). The need for developing
    and evaluating adolescent treatment models. In
    S.J. Stevens A.R. Morral (Eds.), Adolescent
    substance abuse treatment in the United States
    Exemplary Models from a National Evaluation Study
    (pp. 3-34). Binghamton, NY Haworth Press and
    1998 NHSDA.
  • Dennis, M. L., Godley, S. H., Diamond, G., Tims,
    F. M., Babor, T., Donaldson, J., Liddle, H.,
    Titus, J. C., Kaminer, Y., Webb, C., Hamilton,
    N., Funk, R. (in press). The Cannabis Youth
    Treatment (CYT) Study Main Findings from Two
    Randomized Trials. Journal of Substance Abuse
    Treatment.
  • Dennis, M. L., Godley, S. and Titus, J. (1999).
    Co-occurring psychiatric problems among
    adolescents Variations by treatment, level of
    care and gender. TIE Communiqué (pp. 5-8 and 16).
    Rockville, MD Substance Abuse and Mental Health
    Services Administration, Center for Substance
    Abuse Treatment.
  • Dennis, M. L. and McGeary, K. A. (1999).
    Adolescent alcohol and marijuana treatment Kids
    need it now. TIE Communiqué (pp. 10-12).
    Rockville, MD Substance Abuse and Mental Health
    Services Administration, Center for Substance
    Abuse Treatment.
  • Dennis, M. L., Titus, J. C., Diamond, G.,
    Donaldson, J., Godley, S. H., Tims, F., Webb, C.,
    Kaminer, Y., Babor, T., Roebuck, M. C., Godley,
    M. D., Hamilton, N., Liddle, H., Scott, C. K.,
    CYT Steering Committee. (2002). The Cannabis
    Youth Treatment (CYT) experiment Rationale, study
    design, and analysis plans. Addiction, 97 (Suppl.
    1), S16-S34.
  • Dennis, M.L., White, M.K. (2003). The
    effectiveness of adolescent substance abuse
    treatment a brief summary of studies through
    2001, (prepared for Drug Strategies adolescent
    treatment handbook). Bloomington, IL Chestnut
    Health Systems. On line Available at
    http//www.drugstrategies.org
  • Dennis, M.L., White,M.A., Titus, J.C. Godley,
    M.D. (in press). The effectiveness of
    adolescent substance abuse treatment a brief
    summary of studies through 2002. (prepared for
    Drug Strategies adolescent treatment handbook).
    Bloomington, IL Chestnut Health Systems.
  • Diamond, G., Leckrone, J., Dennis, M. L. (In
    press). The Cannabis Youth Treatment study
    Clinical and empirical developments. In R.
    Roffman, R. Stephens, (Eds.) Cannabis
    dependence Its nature, consequences, and
    treatment . Cambridge, UK Cambridge University
    Press.
  • Diamond, G., Panichelli-Mindel, S. M., Shera, D.,
    Dennis, M. L., Tims, F., Ungemack, J. (in
    press). Psychiatric syndromes in adolescents
    seeking outpatient treatment for marijuana with
    abuse and dependency in outpatient treatment.
    Journal of Child and Adolescent Substance Abuse.

34
CYT Related References - continued
  • Godley, M.D., Kahn, J.H., Dennis, M.L., Godley,
    S.H., Funk, R.R. (in press). The stability and
    impact of environmental factors on substance use
    and problems after adolescent outpatient
    treatment. Psychology of Addictive Behavior.
  • Godley, S. H., White, W. L., Diamond, G.,
    Passetti, L., Titus, J. (2001). Therapists'
    reactions to manual-guided therapies for the
    treatment of adolescent marijuana users. Clinical
    Psychology Science and Practice, 8(4), 405-417.
  • Godley, S. H., Meyers, R. J., Smith, J. E.,
    Godley, M. D., Titus, J. M., Karvinen, T., Dent,
    G., Passetti, L., Kelberg, P. (2001). The
    Adolescent Community Reinforcement Approach
    (ACRA) for adolescent cannabis users (Cannabis
    Youth Treatment (CYT) Manual Series, No. Volume
    4). Rockville, MD Center for Substance Abuse
    Treatment, Substance Abuse and Mental Health
    Services Administration.
  • Hamilton, N., Brantley, L., Tims, F., Angelovich,
    N., McDougall, B. (2001). Family Support
    Network (FSN) for adolescent cannabis users
    (Cannabis Youth Treatment (CYT) Manual Series,
    No. Volume 3). Rockville, MD Center for Substance
    Abuse Treatment, Substance Abuse and Mental
    Health Services Administration.
  • Jensen, K. A. (2001). The effects of adolescent
    peer-based intervention Contextual influence of
    peers during cannabis treatment. University of
    South Florida.
  • Liddle, H. A. (2002). Multidimensional Family
    Therapy (MDFT) for adolescent cannabis users
    (Cannabis Youth Treatment (CYT) Manual Series,
    No. Volume 5). Rockville, MD Center for Substance
    Abuse Treatment, Substance Abuse and Mental
    Health Services Administration.
  • Petry, N. M., Tawfik, Z. (2001). A comparison
    of problem gambling and non-problem gambling
    youth seeking treatment for marijuana abuse.
    Journal of the American Academy of Child and
    Adolescent Psychiatry, 40(11), 1324-1331.
  • Roebuck, M. C., French, M. T., Dennis, M. L.
    (2004). Adolescent marijuana use and school
    attendance. Economics of Education Review, 23(2),
    145-153.
  • Sampl, S., Kadden, R. (2001). Motivational
    Enhancement Therapy and Cognitive Behavioral
    Therapy for Adolescent Cannabis Users 5 Sessions
    (Cannabis Youth Treatment (CYT) Manual Series,
    No. Volume 1). Rockville, MD Center for Substance
    Abuse Treatment, Substance Abuse and Mental
    Health Services Administration.
  • Tims, F. M., Dennis, M. L., Hamilton, N., Buchan,
    B. J., Diamond, G. S., Funk, R., Brantley, L.
    B. (2002). Characteristics and problems of 600
    adolescent cannabis abusers in outpatient
    treatment . Addiction, 97, 46-57.
  • Titus, J. C., Dennis, M. L. (in press).
    Cannabis Youth Treatment (CYT) Overview and
    summary of preliminary findings. H. A. Liddle,
    C. L. Rowe (Eds.), Treating adolescent substance
    abuse State of the science . Cambridge, UK
    Cambridge University Press.
  • 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, 19-35.
  • Webb, C., Scudder, M., Kaminer, Y., Kadden, R.,
    Tawfik, Z. (2002). The MET/CBT 5 Supplement 7
    Sessions of Cognitive Behavioral Therapy (CBT 7)
    for adolescent cannabis users (Cannabis Youth
    Treatment (CYT) Manual Series, No. Volume 2).
    Rockville, MD Center for Substance Abuse
    Treatment, Substance Abuse and Mental Health
    Services Administration.
About PowerShow.com