Psychiatry and Behavioral Sciences
Psychiatry and Behavioral Sciences
1. Hall, J. A., Henggeler, S. W., Ferreira, D. K., & East, P. L. (1992). Sibling relations and substance use in high-risk female adolescents. Family Dynamics of Addiction Quarterly, 2, 44-51.
7. Hall, J. A., Henggeler, S. W., Felice, M. E., Reynoso, T., Williams, N. M. & Sheets, R. (1993). Adolescent substance use during pregnancy. Journal of Pediatric Psychology, 18, 265-271.
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34. Pickrel, S. G., Hall, J. A., & Cunningham, P. B. (1997). Interventions for adolescent who abuse substances. In S. W. Henggeler & A. B. Santos (Eds.), Innovative approaches for "difficult-to-treat" populations, ( pp. 99-116). Washington, D.C.: American Psychiatric Press.
40. Henggeler, S. W., Pickrel, S. G., Brondino, M. J., & Crouch, J. L. (1996). Eliminating (almost) treatment dropout of substance abusing or dependent delinquents through home-based multisystemic therapy. American Journal of Psychiatry, 153, 427-428.
50. Pickrel, S. G., & Henggeler, S. W. (1996). Multisystemic therapy for adolescent substance abuse and dependence. Child and Adolescent Psychiatric Clinics of North America, 5, 201-211.
54. Schoenwald, S.K., Ward, D.M., Henggeler, S.W., Pickrel, S.G., Patel, H. (1996). Multisystemic therapy treatment of substance abusing or dependent adolescent offenders: Costs of reducing incarceration, inpatient and residential placement. Journal of Child and Family Studies, 5, 431-444.
71. Brown, T. L., Henggeler, S. W., Schoenwald, S. K., Brondino, M.J., & Pickrel, G. (1999). Multisystemic treatment of substance abusing and dependent juvenile delinquents: Effects on school attendance at posttreatment and 6-month follow-up. Children's Services: Social Policy, Research, and Practice, 2, 81-93.
72. Brown, T. L., Henggeler, S. W., Brondino, M.J., & Pickrel, S.G. (1999). Trauma exposure, protective factors, and the mental health functioning of substance abusing and dependent juvenile offenders. Journal of Emotional and Behavioral Disorders, 7(2), 94-102.
85. Henggeler, S.W., Pickrel, S.G., & Brondino, M.J. (1999). Multisystemic treatment of substance abusing and dependent delinquents: Outcomes, treatment fidelity, and transportability. Mental Health Services Research, 1, 171-184.
86. Randall, J., Henggeler, S.W., Pickrel, S.G., & Brondino, M.J. (1999). Psychiatric comorbidity and the 16-month trajectory of substance abusing and dependent juvenile offenders. Manuscript submitted for publication. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 1118-1124.
101. Henggeler, S. W., Borduin, C. M., Melton, G. B., Mann, B. J., Smith, L., & Hall, J. A., Cone, L., & Fucci, B. R. (1991). Effects of multisystemic therapy on drug use and abuse in serious juvenile offenders: A progress report from two outcome studies. Family Dynamics of Addiction Quarterly, 1, 40-51.
208. Cunningham, P.B., Henggeler, S. W. (2001). Implementation of an empirically based drug and violence prevention and intervention program in public school settings. Journal of Clinical Child Psychology, 30(1), 221-232.
209. Randall, J., Henggeler, S.W., Cunningham, P.B., Rowland, M.D., & Swenson, C.C. (2001). Adapting multisystemic therapy to treat adolescent substance abuse more effectively. Cognitive and Behavioral Practice, 8, 359 - 366.
219. Randall, J., Halliday-Boykins, C.A., Cunningham, P.B., Henggeler, S.W. (2001). Integrating evidence-based substance abuse treatment into juvenile drug courts: Implications for outcomes. National Drug Court Institute Review, Vol. III, 2, 89-115.
223. Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., Pickrel, S. G. (2002). Four-year follow-up of Multisystemic therapy with substance-abusing and substance-dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 41(7), 868-874.
239. Henggeler, S.W. (1998). Commentary on AACAP practice parameters for the assessment and treatment of children and adolescents with substance use disorders. Abstracts of Clinical Care Guidelines: A Joint Commission Newsletter, 10 , 4-5.
246. Randall, J., Cunningham, P.B. (2003). Multisystemic therapy: A treatment for violent substance-abusing and substance-dependent juvenile offenders. Addictive Behaviors, 28, 1731-1739.
250. Clingempeel, W.G., Henggeler, S.W., Pickrel, S.G., Brondino, M.J., Randall, J.(2005). Beyond treatment effects: Predicting emerging adult alcohol and marijuana use among substance-abusing delinquents. American Journal of Orthopsychiatry, 75, 540-552.
261. Schaeffer, C.M., & Borduin, C.M. (2005). Long-term follow-up to a randomized clinical trial of multisystemic therapy with serious and violent juvenile offenders. Journal of Consulting and Clinical Psychology, 73(3),445-453.
270. Henggeler, S.W., Halliday-Boykins, C.A., Cunningham, P.B., Randall, J., Shapiro, S.B., Chapman, J.E. (2006). Juvenile drug court: enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 34(4), 658-670.
281. Sheidow, A. J., & Henggeler, S. W. (in press). Multisystemic therapy with substance using adolescents: A synthesis of the research. In N. Jainchill (Ed.), Understanding and Treating Adolescent Substance Use Disorders. Kingston, NJ: Civic Research Institute.
298. Henggeler, S.W., Chapman, J.E., Rowland, M.D., Halliday-Boykins, C.A., Randall, J., Shackelford, J., Schoenwald, S.K. (2007). If you build it, they will come: Statewide practitioner interest in contingency management for youths. Journal of Substance Abuse Treatment, 32(2), 121-131.
300. Henggeler, S. W. (2007). Juvenile drug courts: Emerging outcomes and key research issues. Current Opinion in Psychiatry, 20, 242-246.
301. Saldana, L., Chapman, J.E., Henggeler, S.W., Rowland, M.D. (2007). The organizational readiness for change scale in adolescent programs: Criterion validity. Journal of Substance Abuse Treatment, 33, 159-169.
315. Sheidow, A.J. & Henggeler, S.W. (2008). Multisystemic therapy for alcohol and other drug abuse in delinquent adolescents. Alcoholism Treatment Quarterly, 26, 125-145.
316. Sheidow, A.J. & Henggeler, S.W. (2008). Multisystemic therapy with substance using adolescents: A synthesis of the research. In A. Stevens, Crossing frontiers international developments in the treatment of drug dependence (pp. 11-33). Brighton: Pavillion Publishing.
320. Rowland, M.D., Chapman, J.E. & Henggeler, S.W. (2008). Sibling outcomes from a randomized trial of evidence-based treatments with substance abusing juvenile offenders. Journal of Child and Adolescent Substance Abuse, 17(3), 11-26.
321. Shaeffer, C.M., Saldana, L., Rowland, M.D., Henggeler, S.W., & Swenson, C.C. (2008). New initiatives in improving youth and family outcomes by importing evidence-based practices. Journal of Child and Adolescent Substance Abuse, 17(3), 27-45.
322. Chapman, J.E., Sheidow, A.J., Henggeler, S.W., Halladay-Boykins, C.A., & Cunningham, P.B. (2008). Developing a measure of therapist adherence to contingency management: An application of the Many-Facet Rasch Model. Journal of Child and Adolescent Substance Abuse, 17(3), 47-68.
329. Henggeler, S.W., Chapman, J.E., Rowland, M.D., Halliday-Boykins, C.A., Randall, J., Shackelford, J., & Schoenwald, S.K. (2008). Statewide adoption and initial implementation of contingency management for substance-abusing adolescents. Journal of Consulting and Clinical Psychology, 76(4), 556-567.
331. Clingempeel, W.G., Britt, S.C., & Henggeler, S.W. (2008). Beyond treatment effects: Comorbid psychopathologies and long-term outcomes among substance-abusing delinquents. American Journal of Orthopsychiatry, 78(1), 29-36.
332. Henggeler, S.W., Sheidow, A.J., Cunningham, P.B., Donohue, B.C., & Ford, J.D. (2008). Promoting the implementation of an evidence-based intervention for adolescent marijuana abuse in community settings: Testing the use of intensive quality assurance. Journal of Clinical Child & Adolescent Psychology, 37(3), 682-689.
333. Sheidow, A.J., Donohue, B.C., Hill, H.H., Henggeler, S.W., & Ford, J.D. (2008). Development of an audio-tape review system for supporting adherence to an evidence-based treatment. Professional Psychology: Research and Practice, 39, 553-560.
338. Swenson, C.C., Schaeffer, C.M., Tuerk, E.H., Henggeler, S.W., Tuten, M., Panzarella, P., Lau, C., Remmele, L., Foley, T., Cannata, E., & Guillorn, A. (2009). Adapting multisystemic therapy for co-occurring child maltreatment and parental substance abuse: The building stronger families project. Emotional & Behavioral Disorders in Youth, 3–8.
339. McCollister, K.E., French, M.T., Sheidow, A.J., Henggeler, S.W., & Halliday-Boykins, C.A. (2009). Estimating the differential costs of criminal activity for juvenile drug court participants: Challenges and recommendations. The Journal of Behavioral Health Services & Research, 36(1), 111–126.
346. Schaeffer, C.M., Chang, R., & Henggeler, S.W. (2009). Responding to use of illicit drugs. In K. Geldard (Ed.), Practical interventions for young people at risk (pp. 134-144). Thousand Oaks, CA: Sage Publications.
351. Foster, S. L., Cunningham, P. B., Warner, S. E., McCoy, D. M., Barr, T. S., & Henggeler, S. W. (2009). Therapist behavior as a predictor of black and white caregiver responsiveness in multisystemic therapy. Journal of Family Psychology, 23, 626-635. doi: 10.1037/a0016228
361. Donohue, B., Tracy, K., & Sheidow, A. J. (2010). Substance use disorders. In J. Thomas & M. Hersen (Eds.), Handbook of clinical psychology competencies: Volume III: Intervention and treatment for children and adolescents (pp. 1461-1480). New York: Springer-Verlag.
384. Halliday-Boykins, C. A., Schaeffer, C. M., Henggeler, S. W., Chapman, J. E., Cunningham, P. B., Randall, J., Shapiro, S.B. (2010). Predicting nonreponse to juvenile drug court interventions. Journal of Substance Abuse Treatment, 39, 318-328.
385. Schaeffer, C. M., Henggeler, S. W., Chapman, J. E., Halliday-Boykins, C. A., Cunningham, P.B., Randall, J., & Shapiro, S. B. (2010). Mechanisms of effectiveness in juvenile drug court: Altering risk processes associated with delinquency and substance abuse. Drug Court Review, 7, 57-94.
386. Henggeler, S. W., & Marlowe, D. B. (2010). Introduction to special issue on juvenile drug treatment courts. Drug Court Review, 7, 1-9.
391. Ashcraft, R. G. P., Foster, S. L., Lowery, A. E., Henggeler, S. W., Chapman, J. E., Rowland, M. D. (2011). Measuring practitioner attitudes toward evidence-based treatments: A validation study. Journal of Child & Adolescent substance Abuse, 20, 166-183.
397. Holth, P., Torsheim, T., Sheidow, A. J., Ogden, T., Henggeler, S. W. (2011). Intensive quality assurance of therapist adherence to behavioral interventions for adolescent substance use problems. Journal of Child and Adolescent Substance Abuse, 20, 289-313.
399. Trupin, E. J., Kerns, S. E. U., Walker, S. C., DeRobertis, M. T., & Stewart, D. G. (2011). Family integrated transitions: A promising program for juvenile offender with co-occurring disorders. Journal of Child & Adolescent Substance Abuse, 20, 421-436.
401. Schoenwald, S. K., Chapman, J. E., Henry, D. B., & Sheidow, A. J. (2012). Taking effective treatments to scale: Organizational effects on outcomes of multisystemic therapy for youths with co-occurring substance use. Journal of Child and Adolescent substance Abuse, 21(1), 1-31.
403. Tuerk, E. H., McCart, M. R., & Henggeler, S. W. (2012). Collaboration in family therapy. Journal of Clinical Psychology: In Session, 68(2), 168-178.
407. Henggeler, S. W., McCart, M. R., Cunningham, P. B., & Chapman, J. E. (2012). Enhancing the effectiveness of juvenile drug courts by integrating evidence-based practices. Journal of Consulting and Clinical Psychology, 80, 264-275.
411. Sheidow, A. J., McCart, M. R., Zajac, K., Davis, M. (2012). Prevalence and impact of substance use among emerging adults with serious mental health conditions. Psychiatric Rehabilitation Journal, 35, (3), 235-43.
422. McCart, M. R., Henggeler, S. W., Chapman, J. E., & Cunningham, P. B. (2012). System-level effects of integrating a promising treatment into juvenile drug courts. Journal of Substance Abuse Treatment, 43, 231-243.
429 McCart, M. R., Zajac, K., Kofler, M. J., Smith, D. W., Saunders, B. E., & Kilpatrick, D. G. (2012). Longitudinal examination of PTSD symptoms and problematic alcohol use as risk factors for adolescent victimization. Journal of Clinical Child and Adolescent Psychology, 41, 822-836.
430 Danielson, C. K., McCart, M. R., Walsh, K., de Arellano, M. A., White, D., & Resnick, H. S. (2012). Reducing substance use risk and mental health problems among sexually assaulted adolescents: A pilot randomized controlled trial. Journal of Family Psychology, 26(4), 628-635, PMCID: PMC3419329
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437 McCart, M. R., Zajac, K., Danielson, C. K., Strachan, M., Ruggiero, K. J., Smith, D. W., Saunders, B. E., & Kilpatrick, D. G. (2011). Interpersonal victimization, posttraumatic stress disorder, and change in adolescent substance use prevalence over a ten-year period. Journal of Clinical Child and Adolescent Psychology, 40, 136-143, PMCID: PMC3106225
440 Danielson, C. K., McCart, M. R., de Arellano, M. A., Macdonald, A., Silcott, L., & Resnick, H. (2010). Risk reduction for substance use and trauma-related psychopathology in adolescent sexual assault victims: Findings from an open trial. Child Maltreatment, 15(3), 261-268, PMCID: PMC3105119
446 McCart, M. R., & Henggeler, S. W. (2008). Evidence-based interventions for adolescent substance use. In P. Korsmeyer & H. R. Kranzler (Eds.), Encyclopedia of drugs, alcohol, and addictive behavior, 3rd edition (pp. 209-213). Farmington Hills, Michigan: Gale Cengage.
453 Ryan, S. R., Brennan, P. A., Cunningham, P. B., Foster, S. L., Brock, R. L. & Whitmore, E. (2013). Biosocial processes predicting multisystemic therapy treatment response. Biological Psychology, 92, 373-379.
454 Sheidow, A. J., & Houston, J. L. (2013). Multisystemic therapy for adolescent substance use. In P. M. Miller (Ed.), Interventions for addiction: Comprehensive addictive behaviors and disorders (pp. 77-86). San Diego, CA: Elsevier Academic Press.
468 Robinson, B.A., Winiarski, D.A., Brennan, P.A., Foster, S.L., Cunningham, P.B., & Whitmore, E. A. (2014, November 3). Social Context, parental monitoring, and Multisystemic Therapy outcomes. Psychotherapy. http://dx.doi.org/10.1037/a0037948
This study examined the linkage between sibling relations and substance use in 37 high-risk female adolescents. Standardized measures assessed sibling relations, global family relations, parent-child relations, and substance use. Consistent with extant research, adolescent substance use was associated with family affection and parental control. Several aspects of sibling relations were linked with substance use, and in some cases, sibling relations measures (especially sibling conflict) accounted for significantly more variance in substance use than did family relations measures. Findings suggest that sibling relations may constitute a linkage with adolescent substance use that is independent of family relations. Therefore, investigators should consider integrating sibling relations into their multivariate models of adolescent substance use.
Substance use during pregnancy may be a key mediator of the association between adolescent childbearing and poor newborn outcome. Substance use during pregnancy was evaluated for 50 teens who were consecutive patients at an inner-city university clinic. Although teens reported typical lifetime rates of substance use, self-reports and two urine assays indicated minimal substance use throughout pregnancy. Findings suggest that the adolescents exercised judicious decision making in light of the known health risks of substance use during pregnancy.
This chapter provides an overview of the multisystemic approach to treating serious antisocial behavior in adolescents and builds a case for using multisystemic therapy (MST) (Henggeler and Borduin 1990) in the treatment of substance-abusing adolescents. As such, sections in the chapter focus on similarities between delinquency and substance use in their identified correlates, recalcitrance to treatment, and service delivery issues; results from controlled outcome studies supporting the effectiveness of MST and future directions in the validation and diffusion of MST; and an overview of clinical interventions used in MST.
The overriding purpose of this chapter is to recommend directions in the development of more effective drug-abuse prevention and treatment programs for youth. To accomplish this purpose, several pertinent research literatures are examined and their respective findings are integrated. These literatures pertain to (a) the correlates of drug use and abuse in adolescents, (b) findings from the prevention and treatment literatures, (c) lessons learned from the ongoing national reform of mental health services for children, adolescents, and their families, and (d) lessons learned from the treatment of drug abuse and dependence in adults.
Assuming that prevention and treatment programs should focus on the empirically-determined correlates/predictors of drug use and abuse, such correlates are examined, with special emphasis on findings from well-designed causal modeling studies. The correlational literature presents a clear and consistent picture: Drug use and abuse in youth are multidetermined, with contributing factors pertaining to youth cognitive structures, family relations, peer associations, school performance, and neighborhood context.
(from the chapter) In this chapter we delineate the prevalence and consequences of adolescent substance abuse, examine the scope and content of current treatment options, and present research on treatment and prevention of adolescent substance abuse. These topics serve as a springboard for exploring the need for innovative approaches in this area and for the exposition of existing promising new approaches to this difficult problem.
Objective: This study examined the effects of an innovative treatment model that was designed to reduce treatment dropout among substance abusing or delinquent juvenile offenders. Method: One hundred eighteen delinquents who met diagnostic criteria for substance abuse of dependence were randomly assigned to receive either home-based multisystemic therapy (N=58) or treatment that was provided by the usual community services (N=60). Results: In the multisystemic therapy condition, 98% (N=57) of the families completed a full course of treatment, which lasted an average of 130 days. In contrast, 78% (N=47) of the families assigned to treatment through the usual community services received no mental health or substance abuse treatment in the 5 months after referral. Conclusions: The serious and long-standing problem of high dropout rates in the substance abuse field can be greatly attenuated by services that increase accessibility and place greater responsibility for engagement on service providers.
Empiric models demonstrate that adolescent substance abuse is multiply determined Multisystemic therapy (MST) is a social ecologic model of treatment that addresses the multisystemic factors involved in the generation of substance abuse and dependence in adolescents. This article contains the principles of generating Multisystemic interventions, with illustrative case examples. MST for substance abusing or dependent adolescent populations is supported by the empiric descriptive and causal modeling literature for substance-abusing youth and by preliminary outcome data regarding the short-term effects of MST on self-reported adolescent substance use, criminal offending, and parent-figure alcohol use among substance-abusing or-dependent youth and their families.
The development of more effective and less costly family- and community based services to serve as alternatives to out-of-home placements of children is an important priority in the reform of mental health services for children and adolescents. Within the context of a randomized trial with 118 substance abusing or dependent juvenile offenders, we examined the incremental costs of multisystemic therapy (MST) and related these costs to observed reductions in days of incarceration, hospitalization, and residential treatment at approximately 1-year postreferral. Results showed that the incremental costs of MST were nearly offset by the savings incurred as a result of reductions in days of out-of-home placement during the year. The need to validate effective treatments for youth with serious clinical problems and to link the cost of treatments.
The effectiveness of multisystemic therapy (MST) in promoting school participation among substance abusing dependent juvenile offenders with high rates of psychiatric comorbidity was examined. Youth were randomly assigned to receive MST versus usual community-based services. Results indicated that MST (but not usual services) significantly increased school attendance at posttreatment, and that these treatment gains were maintained at the 6-month follow-up assessment. Explanations for the findings and directions for future research are discussed.
This study examined the linkages of trauma exposure and protective factors with important aspects of mental health and behavioral functioning in a sample of youth presenting serious clinical difficulties. In general, results suggest that the effects of trauma vary considerably with the nature of the trauma. Specifically, findings indicated that, after controlling for important third variable explanations, violence exposure was linked with adolescent criminal offending, whereas sexual abuse was linked with psychiatric comorbidity. Additionally, several of the demographic and protective factors showed significant associations with measures of criminal activity and mental health. Implications of these findings are discussed and directions for future research are suggested.
The effectiveness and transportability of multisystemic therapy (MST) were examined in a study that included 118 juvenile offenders meeting DSM-III-R criteria for substance abuse or dependence and their families. Participants were randomly assigned to receive MST versus usual community services. Outcome measures assessed drug use, criminal activity, and days in out-of-home placement at posttreatment (T2) and at a 6-month posttreatment follow-up (T3); also treatment adherence was examined from multiple perspectives (i.e., caregiver, youth, and therapist). MST reduced alcohol, marijuana, and other drug use at T2 and total days in out-of-home placement by 50% at T3. Reductions in criminal activity, however, were not as large as have been obtained previously for MST. Examinations of treatment adherence measures suggests that the modest results of MST were due, at least in part, to difficulty in transporting this complex treatment model from the direct control of its developers. Increased emphasis on quality assurance mechanisms to enhance treatment fidelity may help overcome barriers to transportability.
Objectives: To examine the concurrent correlates of internalizing and externalizing disorders among substance-abusing and substance-dependent juvenile offenders and to determine the association between psychiatric comorbidity and psychosocial functioning of the youths 16 months later. Method: Participants were 118 juvenile offenders meeting DSM-lll-R criteria for substance abuse or dependence and their families. A multisource measurement battery was used to assess drug use, criminal activity, family relations, peer relations, school functioning, and out-of-home placements. Results: Comorbidity for externalizing disorders was associated with high rates of antisocial behavior and predicted worse 16-month outcomes than substance abuse alone or substance abuse with comorbid internalizing disorders. For criminal activity and drug use, the presence of internalizing disorders buffered the deleterious effect of externalizing disorders on substance-abusing and substance-dependent juvenile offenders. Conclusions: Even in substance-abusing delinquents, a population already extreme in antisocial behavior, the presence of externalizing disorders indicates high risk for deterioration.
Although treatment approaches for adolescent substance abuse have proliferated, treatment efficacy has been rarely evaluated. This study presents a progress report, focusing on reductions in substance use and abuse, from two independent evaluations of the efficacy of multisystemic therapy (MST) in treating the antisocial behavior of serious juvenile offender, were assigned randomly either to MST or individual counseling conditions. Analyses of arrests data, which were collected for an average of 4 years posttreatment, indicated that youths who participated in MST had significantly lower rate of substance-related arrests than did youths who participated in individual counseling. In the Family and Neighborhood Solutions project, conducted in South Carolina, serious juvenile offenders were assigned randomly either to MST or usual juvenile justice services. Based on self-report measures of substance use collected pretreatment and posttreatment, youths in the MST condition reported a significant reduction in soft drug use relative to youths who received usual services. Together, these finding support the value of conducting a rigorous and more comprehensive evaluation of the efficacy of MST in treating substance-abusing delinquents and their families.
Describes the implementation of a collaborative preventive intervention project (Healthy Schools) designed to reduce levels of bullying and related antisocial behaviors in children attending two urban middle schools serving primarily African American students. These schools have high rates of juvenile violence, as reflected by suspensions and expulsions for behavioral problems. Using a quasi-experimental design, empirically based drug and violence prevention programs, Bullying Prevention and Project ALERT, are being implemented at each middle school. In addition, an intensive evidence-based intervention, multisystemic therapy, is being used to target students at high risk of expulsion and court referral. Hence, the proposed project integrates both universal approaches to prevention and a model that focuses on indicated cases. Targeted outcomes, by which the effectiveness of this comprehensive school-based program will be measured, are reduced youth violence, reduced drug use, and improved psychosocial functioning of participating youth.
The article illustrates an adaptation of multisystemic therapy (MST) coupled with community reinforcement plus vouchers approach (CRA) to treat adolescent substance abuse and dependency. Key features of CRA enable the MST therapist and adolescent caregiver to more specifically detect and address adolescent substance use. These features include: frequent random urine screens to detect drug use, functional analyses to identify triggers for drug use, self management plans to address identified triggers, and development of drug avoidance skills. To highlight the integration of MST and CRA in treating substance abusing or dependent adolescents, a case example is provided. Prior to the case example, an overview of clinical and program features of MST and substance-related outcomes is presented.
This article describes the importance of integrating evidence-based substance abuse treatments into juvenile drug courts. Guidelines from the National Institute on Drug Abuse (NIDA) are offered as a template to enable drug courts to select substance abuse treatments based on available evidence of effectiveness. Multisystemic therapy (MST) is presented as an example of an evidence-based model of treatment that meets NIDA guidelines and has been integrated into several juvenile drug courts. Substance abuse outcomes from published MST trials are summarized, and a current study that examines the relative effectiveness of drug court with MST versus drug court with traditional substance abuse treatment is described.
Objective: Although several treatments for adolescent substance abuse have been identified as promising by reviewers and federal agencies, treatment effects extending beyond 12 months have not been demonstrated in randomized clinical trials. The primary purpose of this report was to examine the 4-year outcomes of an evidence-based treatment of substance-abusing juvenile offenders. Method: Eighty of 118 substance-abusing juvenile offenders participated in a follow-up 4 years after taking part in a randomized clinical trial comparing (MST) with usual community services. A multimethod (self-report, biological, and archival measures) assessment battery was used to measure the criminal behavior, illicit drug use, and psychiatric symptoms of the participating young adults. Results: Analyses demonstrated significant long-term treatment effects for aggressive criminal activity (0.15 versus 0.57 convictions per year) but not for property crimes. Findings for illicit drug use were mixed, with biological measures indicating significantly higher rates of marijuana abstinence for MST participants (55% versus 28% of young adults). Long-term treatment effects were not observed for psychiatric symptoms. Conclusions: Findings provide some support for the long-term effectiveness of an evidenced-based family-oriented treatment of substance -abusing juvenile offenders. The clinical, research, and policy implications of these findings are noted. Key Words: substance abuse, treatment, delinquency, multisystemic therapy.
The American Academy of Child and Adolescent Psychiatry (AACAP) has developed a practice guideline on the assessment and treatment of children and adolescents with substance use disorders (SUDs). The practice parameters, defined as strategies for patient management developed to assist clinicians in psychiatric decision making, are based on evaluation of the scientific literature and relevant clinical consensus and describe generally accepted approaches to assess and treat specific disorders or to perform specific SUDs in children and adolescents, many of the recommendations are drawn from the adult literature and current clinical practice.
Adolescent violence and substance abuse result in substantial personal and societal cost. Many treatments fail to produce favorable outcome in terms of both violence and substance abuse with adolescents because they fail to comprehensively address etiological and maintaining factors. This article describes multisystemic therapy (MST), a family- and community-based treatment that has produced favorable outcomes with violent substance-abusing or –dependent adolescents in both realms. The clinical basis for the success of MST and studies supporting its effectiveness with violent and substance-abusing adolescents are presented.
Secondary analyses of a randomized clinical trial (RCT) examined the effects of four putative risk factors and two protective factors in predicting drug use among 80 emerging adults treated 5 years earlier for delinquency and alcohol and/or marijuana use disorders. Frequency of marijuana use and the number of comorbid psychiatric disorders in adolescence predicted cannabis use in emerging adulthood. Increasing academic competence at high levels of social competence predicted less marijuana use. At emerging adulthood, greater use of alcohol and marijuana were associated with both criminality and psychopathology.
In this study, the authors examined the long-term criminal activity of 176 youths who had participated in either multisystemic therapy (MST) or individual therapy (IT) in a randomized clinical trial (C.M. Borduin et al. 1995). Arrest and incarceration data were obtained on average 13.7 (range = 10.2-15.9) years later when participants were on average 28.8 years old. Results show that MST participants had significantly lower recidivism rates at follow-up than did their counterparts who participated in IT (50% vs. 81%, respectively). Moreover, MST participants had 54% fewer arrests and 57% fewer days of confinement in adult detention facilities. This investigation represents the longest follow-up to date of a MST clinical trial and suggests that MST is relatively effective in reducing criminal activity among serious and violent juvenile offenders.
Evaluated the effectiveness of juvenile drug court for 161 juvenile offenders meeting diagnostic criteria for substance abuse or dependence, and determined whether the integration of evidence-based practices enhanced the outcomes of juvenile drug court. Youths averaged 15.2 years of age, 83% were male, 67% were African-American, and 31% were white. Over a 1-year assessment period, a four condition randomized design evaluated the outcomes for family court with usual community services (FC), drug court with usual community services (DC), drug court with multisystemic therapy (DC/MST), and drug court with MST enhanced with contingency management (DC/MST/CM) for adolescent substance use, criminal behavior, symptomatology, and days in out-of-home placement. In general, findings supported the view that drug court was more effective than family court services in decreasing rates of adolescent substance use and criminal behavior. Possibly due to the greatly increased surveillance of youths in drug court, however, these relative reductions in antisocial behavior did not translate to corresponding decreases in rearrest or incarceration. In addition, findings supported the view that the use of evidence-based treatments within the drug court context improved youth substance related outcomes. The clinical and policy implications of these findings are discussed.
Multisystemic therapy (MST) is a well-validated, evidenced-based treatment for serious clinical problems presented by adolescents and their families. Using a family and community-based treatment approach, MST targets youth with serious clinical problems who are at risk for out-of-home placement. Based on an extensive body of controlled clinical research, MST has been identified as an effective treatment of youth antisocial behavior, including substance abuse (National Institute on Drug Abuse, 1999; President's New Freedom Commission on Mental Health, 2003; U.S. Public Health Service, 2001). This chapter begins by outlining the empirical bases of MST for treating adolescent substance use and is followed by a brief overview of the MST treatment model. The remainder of the chapter summarizes the empirical findings from clinical trials using MST to treat substance use disorders in adolescents, and describes current efforts that aim to enhance substance use outcomes with families of adolescent and adult substance abusers.
Addressing the science–service gap, we examined in this study the amenability of a large heterogeneous sample of community-based therapists in the state mental health and substance abuse treatment sectors to learn about an evidence-based practice (EBP) for adolescent substance abuse (i.e., contingency management [CM]) when such learning was supported administratively and logistically. Leadership in most (44 of 50) public sector agencies supported practitioner recruitment, and 432 of 543 eligible practitioners subsequently attended a 1-day workshop in CM. Workshop attendance was predicted by organizational factors but not by practitioner demographic characteristics, professional background, attitudes toward EBPs, or service sector. Moreover, the primary reason for workshop attendance was to improve services for adolescent clients; the primary barriers to attendance, for those who did not attend, were practical in nature and not due to theoretical incompatibility. The findings demonstrate a considerable amount of interest practitioners showed in both the substance abuse and mental health sectors in learning about an EBP.
This review examines the emerging outcomes of juvenile drug courts and, within the context of the much more extensive adult drug court literature, suggests priorities for juvenile drug court research. Particular attention is devoted to the potential for evidence-based treatments of adolescent substance abuse to enhance the effectiveness of juvenile drug courts.
This study examined the convergent validity and concurrent validity of the Organizational Readiness for Change (ORC; Lehman WEK, Greener JM, Simpson DD, 2002. Assessing organizational readiness for change. Journal of Substance Abuse Treatment. 22 197-210) scale among practitioners who treat adolescents. Within the context of a larger study, we administered the ORC scale and measures of practitioner attitudes toward evidence-based practices as well as treatment manuals to a heterogeneous sample of 543 community-based therapists in the state mental health and substance abuse treatment sectors. Using a contextual random-effects regression model, the association between ORC scale domains and measures of practitioner characteristics and attitudes were examined at both therapist and agency levels. The results support the convergent validity and concurrent validity of several domains. Namely, the domains focusing on motivational readiness and training needs were associated with higher appeal and openness to innovations. Those on program resources and climate were less related, however. Our discussion focuses on the utility of the ORC scale in helping evaluate the needs of programs considering the adoption of evidence-based practices.
Multisystemic therapy (MST) has been identified as an effective treatment of youth antisocial behavior, including substance abuse. This article provides an overview of the clinical application of MST, focusing on its implementation with alcohol and other drug using adolescents, and summarizes findings from clinical trials using MST to treat substance use disorders in adolescents.
Multisystemic therapy (MST) is a well-validated, evidence-based treatment for serious clinical problems presented by adolescents and their families. Using a family and community-based treatment approach, MST targets youth with serious clinical problems who are at risk of out-of-home placement (for example detention, incarceration, or residential treatment facility). Based on an effective treatment of youth antisocial behaviour, including substance abuse (National Institute on Drug Abuse, 1999; National Institutes of Health, 2006; President's New Freedom Commission on Mental Health, 2003; US Public Health Service, 2001). This chapter begins by outlining the empirical bases of MST for treating adolescent substance use and is followed by a brief overview of the MST treatment model. The remainder of the chapter summarises the empirical findings from clinical trials using MST to treat substance use disorders in adolescents, and describes current efforts that aim to enhance substance use outcomes with families of adolescent and adult substance abusers.
This article describes three community-based research projects that are designed to enhance the effectiveness of real-world adolescent substance abuse treatment and prevention, and presents preliminary study results from each. The first project is examining statewide public sector practitioner interest in and implementation of contingency management in treating adolescent substance abuse. The second project is integrating the Community Reinforcement Approach for adults into Multisystemic Therapy (MST) programs for use with substance-abusing caregivers. The third project is integrating Reinforcement-Based Therapy for adults with MST for child abuse and neglect in the treatment of families with co-occurring child maltreatment and caregiver substance abuse. Each project highlights the complexity of using the evidence base in the treatment of substance abuse, and the potential to improve outcomes for challenging clinical populations in real world practice settings.
A unique application of the Many-Facet Rasch Model (MFRM) is introduced as the preferred method for evaluating the psychometric properties of a measure of therapist adherence to Contingency Management (CM) treatment of adolescent substance use. The utility of psychometric methods based in Classical Test Theory was limited by complexities of the data, including: (1) ratings provided by multiple informants (i.e., youth, caregivers, and therapists), (2) data from separate research studies, (3) repeated measurements, (4) multiple versions of the questionnaire, and (5) missing data. Two dimensions of CM adherence were supported: adherence to Cognitive Behavioral components and adherence to monitoring components. The rating scale performed differently for items in these subscales, and of 11 items evaluated, eight were found to perform well. The MFRM is presented as a highly flexible approach that can be used to overcome the limitations of traditional methods in the development of adherence measures for evidence-based practices.
Four hundred thirty-two public sector therapists attended a workshop in contingency management (CM) and were interviewed monthly for the following 6 months to assesss their adoption and initial implementation of CM to treat substance-abusing adolescent clients. Results showed that 58 % (n= 225) adopted CM. Rates of adoption varied with therapist service sector (mental health vs. substance abuse), educational background, professional experience, and attitudes toward treatment manuals and evidence-based practices. Competing clinical priorities and client resistance were often reported as barriers to adopting CM, whereas unfavorable attitudes toward and difficulty in implementing CM were rarely cited as barriers. The fidelity of initial CM implementation among adopters was predicted by organizational characteristics. Overall, the findings support the amenability of public sector practitioners to adopt evidence-based practices and suggest that the predictors of adoption and initial implementation are complex and multifaceted.
Secondary analyses of a randomized clinical trial controlled for treatment condition effects and examined the impact of comorbid psychopathologies on the mental health, physical health, and criminal behavior of 80 substance abusing delinquents approximately 5 years later in emerging adulthood. Overall, emerging adults with comorbid disorder during adolescence scored higher on psychopathology, criminal behavior, and health problems. Participants with both internalizing and externalizing disorders exhibited more negative outcomes than those with a comorbid externalizing disorder. For the entire sample, more internalizing diagnoses forecasted higher internalizing and aggression scores, more criminality, and poorer physical health. More externalizing disorders predicted higher internalizing, delinquency, and criminality scores, but was unrelated to physical health. More internalizing diagnoses for females but not males preficted greater criminality, and especially more aggressive crimes in emerging adulthood.
The development and evaluation of effective strategies for transporting evidence-based practices to community-based clinicians has become a research and policy priority. Using multisystemic therapy programs as a platform, an experimental design examined the capacity of an Intensive Quality Assurance (IQA) system to promote therapist implementation of contingency management (CM) for adolescent marijuana abuse. Participants included 30 therapists assigned to Workshop Only (WSO) versus IQA training conditions, and 70 marijuana-abusing youths and their caregivers who were treated by these clinicians. Analyses showed that IQA was more effective than WSO at increasing practitioner implementation of CM cognitive-behavioral techniques in the short-term based on youth and caregiver reports, and these increases were sustained based on youth reports. On the other hand, IQA did not increase therapist use of CM monitoring techniques relative to WSO, likely because of an unanticipated ceiling effect. Both sets of findings contribute to the emerging literature on the transport of evidence-based practice to real-world clinical settings.
In bridging the science-to-service gap, effective yet practical strategies are needed for supportig practitioner implementation of evidence-based treatments. The development and preliminary evaluation of an adherence monitoring system to support clinician fidelity to an evidence-based treatment for substance-abusing adolescents was tested for community-based practitioners. Session tapes were monitored for adherence to a family-based approach to contingency management for 27 practitioners during baseline, postworkshop, and follow-up periods. Approximately half of the practitioners were randomized to receive intensive quality assurance following a family-based contingency management workshop as part of a larger study. Findings supported the clinical feasibility of the developed system as well as the face and content validity, reliability, and concurrent validity. Future directions are discussed in light of these results, including instructions for the use of the developed system to efficiently train clinicians to adequate fidelity.
Juvenile drug court (JDC) programs have expanded rapidly over the past 20 years and are an increasingly popular option for rehabilitating juvenile offenders with substance use problems. Given the hgih cost of crime to society, an important economic question is whether and to what extent JDC programs reduce criminal activity among juvenile offenders. To address this question, the present study added an economic cost analysis to an ongoing randomized trial of JDC conducted in Charleston, South Carolina. Four treatment conditions were included in the parent study: Family court with usual community-based treatment (FC, the comparison group), Drug Court with usual community-based treatment (DC), DC with Multisystemic Therapy (DC/MST), and DC/MST enhanced with Contingency Management (DC/MST/CM). The economic study estimated the cost of criminal activity for nine specific crimes at baseline (pretreatment) and 4 and 12 months thereafter. A number of methodological challenges were encountered, suggesting that it may be more difficult to economically quantify frequency and type of criminal activity for adolescents than for adults. The present paper addresses methodological approaches and challenges, and proposes guidelines for future economic evaluations of adolescents substance abuse and crime prevention programs.
This chapter provides an overview of factors that are important to consider when working with young people who use illicit substances. It also describes key features of interventions that have empirical support for their effectiveness.