This chapter focuses on the empirical, data-driven research pertaining to the public health issue of whether or not gambling expansion significantly alters the prevalence rate of disordered gambling and how this research can inform... more
This chapter focuses on the empirical, data-driven research pertaining to the public health issue of whether or not gambling expansion significantly alters the prevalence rate of disordered gambling and how this research can inform responsible gambling policies and practices. It is a legitimate public health concern that the expansion of gambling opportunities will contribute not just to increases in the prevalence rate of those who gamble and in gambling involvement (e.g., number of days gambling) but also to an increase in the rate of disordered gambling. This latter point is the central issue of this chapter. The authors rely on recent and peer-reviewed publications, although at times “gray” publications (i.e., government reports not in the peer-reviewed literature) are included.
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Twelve-step treatment and mutual help organizations, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), are common elements in the treatment and recovery of adolescents with a substance use disorder. Adapting the 12 steps for... more
Twelve-step treatment and mutual help organizations, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), are common elements in the treatment and recovery of adolescents with a substance use disorder. Adapting the 12 steps for youth is recommended; these adaptations can retain the core step concepts and yet provide a more amenable version for teenagers. There is a growing descriptive research base supporting the efficacy of 12-step programs. Whereas there are no random assignment studies of 12-step treatment when delivered in a residential setting, 12-step facilitation as an outpatient program has shown promise when studied with controlled conditions. AA/NA self-help groups are free community resources that are widely available in most parts of the country and have no restriction on length of participation. The longer and more intensive the participation, the more likely the person will remain in recovery. Participation by adolescents in self-help groups is more likely when the age composition of a meeting includes many young people.
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This chapter addresses treatment and treatment planning for youth with a substance use disorder. Youth who are using substances may benefit from some type of intervention or treatment response; some may require multiple interventions and... more
This chapter addresses treatment and treatment planning for youth with a substance use disorder. Youth who are using substances may benefit from some type of intervention or treatment response; some may require multiple interventions and treatments. It is advisable to assign a youth the appropriate level of care that is the least intensive and step up to a more intensive treatment if needed. Assessing placement or referral along the continuum of care for an adolescent suspected of drug involvement is complex. The American Society of Addiction Medicine (ASAM) provides a description of several levels of response along a continuum of care. The Comprehensive Adolescent Structured Interview (CASI) is one example of a tool to assess the extent of several problems that can help with determining level of care.
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Cognitive-behavioral therapy (CBT) strategies take the view that clinical problems, such as substance use disorder and other behavioral problems, are learned behaviors. These learned behaviors are hypothesized to be the result of... more
Cognitive-behavioral therapy (CBT) strategies take the view that clinical problems, such as substance use disorder and other behavioral problems, are learned behaviors. These learned behaviors are hypothesized to be the result of environmental factors. CBT techniques address underlying cognitions and behaviors that are unduly influenced by these environmental factors. CBT approaches are organized around three learning principles that are typically combined into a multicomponent program: classical conditioning (the role of environmental stimuli that contribute to behaviors), operant conditioning (how rewards and punishment influence behaviors), and social learning theory (the power that influential role models have on a person’s behaviors). Dialectical behavior therapy (DBT), originally developed by Marsha Linehan to treat her female patients diagnosed with borderline personality disorder, focuses on client skills for identifying and transforming negative thinking patterns and learning ways to effectively cope with stress and to regulate emotions. DBT encompasses components of CBT.
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The counseling and treatment approach that promotes motivation to change is motivational enhancement therapy (MET) and related strategies. This counseling strategy helps a client to address their reluctance about participating in... more
The counseling and treatment approach that promotes motivation to change is motivational enhancement therapy (MET) and related strategies. This counseling strategy helps a client to address their reluctance about participating in counseling and making a commitment to change. The theoretical underpinnings of MET is the transtheoretical Stage of Change (SOC) model. This model posits that the behavioral health change process involves progress through six stages of change: precontemplation, contemplation, preparation, action, relapse, and maintenance. A common clinical approach as part of MET is motivational interviewing: The therapist uses feedback to help elicit “change talk” from the youth and eventually have them make a commitment to change. MET is typically delivered in conjunction with other treatment approaches to treat adolescents with a substance use disorder and co-occurring disorders.
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This chapter discusses the traditional disorders that comprise the cluster of externalizing disorders:—attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD)—and their prevalence... more
This chapter discusses the traditional disorders that comprise the cluster of externalizing disorders:—attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD)—and their prevalence among adolescents. Schizophrenia and personality disorders are also considered as affiliated externalizing disorders. Discussed are the clinical characteristics and epidemiology of each disorder, along with case studies illustrating the disorder in an adolescent. Generally, the risk of developing a substance use disorder among youth with an externalizing disorder is greater than the risk if the youth has an internalizing disorder (e.g., depression). Many treatment options are available to treat externalizing disorders, including medication, psychotherapy, and education.
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Adolescents go through significant brain development during their teenage years. This process likely contributes to increased risk taking and lapses in sound decision making but also supports learning and being open to new experiences. A... more
Adolescents go through significant brain development during their teenage years. This process likely contributes to increased risk taking and lapses in sound decision making but also supports learning and being open to new experiences. A growing research base points to the view that drug use is a harmful activity for youth and that early-onset and frequent use of drugs may disrupt brain development. The “brain under construction” of a teenager is vulnerable to the effects of stress, and in combination with biological risk, adolescence is a period of onset of many mental illnesses. Several cognitive deficits have been linked to early use of alcohol or cannabis; the earlier age of onset of regular use, the worse the neurocognitive outcomes. Also, the risk for addiction for all licit and illicit drugs is greatly increased when a person starts to use a drug during their teen years.
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Addiction occurs when repeated use of drugs changes how a person’s brain functions over time. The transition from voluntary to compulsive drug use reflects changes in the brain’s natural inhibition and reward centers that keep a person... more
Addiction occurs when repeated use of drugs changes how a person’s brain functions over time. The transition from voluntary to compulsive drug use reflects changes in the brain’s natural inhibition and reward centers that keep a person from exerting control over the impulse to use drugs even when there are negative consequences—the defining characteristic of addiction. Many adolescent risk factors, including genetic vulnerability, prenatal exposure to alcohol or other drugs, lack of parental supervision or monitoring, a history of physical and/or sexual abuse, and an association with drug-using peers are risk factors that contribute to a greater likelihood of being diagnosed with a substance use disorder. On average, adolescents tend to show a reduction in use following treatment, but post-treatment course is variable. Aftercare helps to maintain treatment gains, and more than one episode of treatment may be needed for some adolescents with more severe substance involvement.
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This chapter reviews the signs and symptoms of cannabis use disorder (CUD). Core clinical characteristics of addiction as reflected by the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) apply... more
This chapter reviews the signs and symptoms of cannabis use disorder (CUD). Core clinical characteristics of addiction as reflected by the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) apply to cannabis, although certain substance use disorder symptoms are less salient to cannabis relative to other substances. The chapter addresses cannabis use prevalence, onset and progression of cannabis use, and heterogeneity in the course of cannabis use. The core features of addiction and the DSM CUD diagnosis are described with reference to the prevalence of CUD based on the fourth edition of the DSM, differences between the fourth and fifth editions for the criteria for diagnosis, and DSM-based cannabis symptoms. The course of CUD and remission and recovery from CUD are also addressed. The chapter closes with a discussion of research and treatment gaps.
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Objectives: The purpose of this study was to: (1) describe the alcohol and other drug use patterns among adolescents discharged from a unique long-term semiresidential treatment program in Canada; (2) compare graduates and nongraduates on... more
Objectives: The purpose of this study was to: (1) describe the alcohol and other drug use patterns among adolescents discharged from a unique long-term semiresidential treatment program in Canada; (2) compare graduates and nongraduates on alcohol and other drug use, and 12-step program attendance; and (3) evaluate the relationship between psychosocial outcomes and continuous abstinence during the 2 years following discharge from the program (ie, obtaining education, becoming employed, maintaining a steady relationship with a significant other, and less involvement in deviant behaviors). Materials and Methods: Fifty individuals (41 treatment graduates and 9 treatment nongraduates) were interviewed by telephone after discharge. The time interval between discharge from treatment and study interview ranged from 2 to 9 years, with a median of 5 years. Additional data for 48 participants were obtained from administrative records at the treatment program. Results: Among the overall sample, 50.0% were abstinent for the first 2 years postdischarge, and maintaining abstinence for 2 years was more prevalent among program graduates than nongraduates (58.5% vs. 11.1%). Nearly all relapses involved alcohol or cannabis. With the exception of being in a serious relationship, continuous abstinence was unrelated to other psychosocial variables. Conclusions: This specialized, long-term residential program yielded high continuous abstinence rates for program graduates, but intensive support during and following treatment discharge for these young adults is warranted to improve educational attainment and employment prospects, and decrease deviant behaviors following discharge. Additional research is needed to more fully understand the long-term outcomes of adolescents attending community-based drug treatment programs.
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ABSTRACT To date, little is known about psychosocial and behavioral effects of marijuana (MJ) use among youths in substance abuse disorder (SUD) treatment. We recruited 80 youths (Mage = 20.4 ± 3.5 years old) to participate in an... more
ABSTRACT To date, little is known about psychosocial and behavioral effects of marijuana (MJ) use among youths in substance abuse disorder (SUD) treatment. We recruited 80 youths (Mage = 20.4 ± 3.5 years old) to participate in an aftercare pilot program from SUD treatment programs in Southern California. This article explores differences in psychosocial and behavioral treatment outcomes between youths in SUD treatment for MJ compared to youths in treatment for another primary substance other than MJ (i.e., stimulants, opioids, alcohol). Youths in SUD treatment for MJ reported being less likely to quit, continued MJ use at treatment completion, less substance use severity, less psychosocial distress, and fewer criminal behaviors compared to youths who received treatment for substances other than MJ. There were differences in HIV-risk outcomes in the past year; however, both groups reported risky sexual behavior in the past month at treatment discharge.
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ABSTRACT There is an absence of empirical work on the measurement of adolescent drug abuse among non-White ethnic youths. The field would benefit from psychometrically sound measures for ethnic groups. The psychometric properties of a... more
ABSTRACT There is an absence of empirical work on the measurement of adolescent drug abuse among non-White ethnic youths. The field would benefit from psychometrically sound measures for ethnic groups. The psychometric properties of a multi-scale assessment tool for adolescent drug abuse, the Personal Experience Inventory (PEI), have been examined largely in White samples. The current study reports reliability and validity data for the PEI across four samples of boys (White, African American, Native American, and Hispanic). The results provide general psychometric support for the non-White groups. The use and limitations of the PEI in different ethnic/racial groups are discussed.
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24 Clinical Assessment of Adolescent Drug Abuse With the Personal Experience Inventory (PEI) Ken C. Winters and Randy Stinchfield University of ... recent years such that the average length of stay for residential patients is... more
24 Clinical Assessment of Adolescent Drug Abuse With the Personal Experience Inventory (PEI) Ken C. Winters and Randy Stinchfield University of ... recent years such that the average length of stay for residential patients is approximately 30 days (Latimer, Newcomb, Winters, & ...
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Adolescents differ from adults physiologically, cognitively, and emotionally. This is a unique developmental period, characterized by a time of dramatic change in the life of every person in every corner of the world. The relatively... more
Adolescents differ from adults physiologically, cognitively, and emotionally. This is a unique developmental period, characterized by a time of dramatic change in the life of every person in every corner of the world. The relatively uniform growth of childhood is suddenly shifted to an increase in the speed of growth and is characterized by rapid physical and psychological changes. It is important for emerging professionals who wish to work with this population to be familiar with the developmental issues and current trends in adolescent substance use and mental health disorders. Despite improvements in prevention and treatment services, adolescent substance abuse and co-existing disorders continue to be a major public health problem. Adolescent Co-Occurring Substance Use and Mental Health Disorders is a textbook on adolescent substance abuse and co-existing mental and behavioral disorders aimed at students seeking a degree or certificate as an addiction counselor. The book’s 13 cha...
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24 Clinical Assessment of Adolescent Drug Abuse With the Personal Experience Inventory (PEI) Ken C. Winters and Randy Stinchfield University of ... recent years such that the average length of stay for residential patients is... more
24 Clinical Assessment of Adolescent Drug Abuse With the Personal Experience Inventory (PEI) Ken C. Winters and Randy Stinchfield University of ... recent years such that the average length of stay for residential patients is approximately 30 days (Latimer, Newcomb, Winters, & ...
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Background The goal of this paper is to advance the understanding of mechanisms of action involved in behavioral-driven aftercare interventions for substance use disorders (SUDs) among youth populations. This paper reports data from a... more
Background The goal of this paper is to advance the understanding of mechanisms of action involved in behavioral-driven aftercare interventions for substance use disorders (SUDs) among youth populations. This paper reports data from a study that measured the impact of an aftercare intervention on primary substance use relapse among youth who completed treatment in Los Angeles County for SUDs. The aftercare intervention, Project ESQYIR- Educating and Supporting inQuisitive Youth In Recovery, utilized text messaging to monitor relapse and recovery processes, provide feedback, reminders, support, and education among youth from SUD specialty settings during the initial 3-month period following treatment completion. Method Mediational modeling informed by Baron and Kenny was used to examine the extent to which select recovery processes including participation in extracurricular activities and self-help, were impacted by the texting intervention, and if such processes helped sustain recov...
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Objective: The study sought to describe a Canadian sample of university students’ medicinal use of cannabis, including prevalence of cannabis use disorder (CUD) and replacement of traditional treatments with cannabis. Method: A random... more
Objective: The study sought to describe a Canadian sample of university students’ medicinal use of cannabis, including prevalence of cannabis use disorder (CUD) and replacement of traditional treatments with cannabis. Method: A random sample of 4000 university students was asked to complete a cross-sectional web-based survey. The survey was completed by 2212 (average age 23.2 years, SD = 5.2 years), representing a 55.3% response rate. To be eligible, students had to be enrolled in a class on campus and were 18 years or older. Result: Half (52%) of respondents used cannabis at least once in their lifetime, with ∼11% reporting medicinal cannabis use. Recreational motives to use cannabis were common among medicinal users (85%), several (38%) replaced traditional medication with cannabis, and more than a third received authorization by a health care provider. Of the medicinal users, 13.6% met the criteria for CUD. Common ailments for medicinal cannabis use were anxiety, sleep problems, ...