Adolescents and Treatment of Alcohol Use Disorders.ppt

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1、Adolescents and Treatment of Alcohol Use Disorders,NIAAA Social Work Education Module 10A(revised 3/04),Outline,Prevalence Criteria issues Risk factors Assessment Treatment & prevention concerns,51.7% have tried alcohol 43.1% have had an alcoholic drink in past year 25.1% have been drunk 15.2% repor

2、t 1 or more binge drinking episodes 40.5% have tried cigarettes 3.3% smoke pack or more of cigarettes/day 26.8% have tried at least one illicit drug 1.4% report using marijuana daily for at least one month at some point in their life,3,4,70.6% have tried alcohol 63.7% have had an alcoholic drink in

3、past year 48.9% have been drunk 25.6% report 1 or more binge drinking episodes 1.9% report daily drinking for at least one month at some point in their lives 46.2% have tried at least one illicit drug 57.6% have tried cigarettes 7.6% smoke pack or more of cigarettes/day,Prevalence (10th graders) Mon

4、itoring the Future 2000,5,6,Lifetime prevalence 8.30% Point prevalence 2.34% Annual incidence rate 4.00%,Prevalence (continued),13.8% of ninth graders 22.7% of twelfth graders,Criteria,2002 Microsoft Corporation.,Limitations of DSM-IV Alcohol Use Disorders (AUDs) Criteria with AdolescentsLittle is k

5、nown about the validity of criteria Several symptoms are atypical of adolescent problem drinkers Some symptoms have low specificitySource: Martin & Winters, 1998,Criteria (continued),2002 Microsoft Corporation.,Criteria (continued),2002 Microsoft Corporation.,Nonuser Experimenter Recreational User R

6、egular User AbuserDependent User,Criteria (continued),Increasing Clinician Concern,Risk Factors,A risk factor is defined as: Occurring before the criterion behavior (temporally precedes it) Statistically associated with increased probability of the criterion behavior occurring Risk factors are not n

7、ecessarily: “Causes” or determinants of the behavior/problem Specific or unique to the behavior/problem Always associated with the behavior/problem,Risk Factor Typology,Source: Hawkins et al., 1992; Petraitis et al., 1995,Risk Factors: Individual,Physiological factors Genetic predisposition Alcohol

8、sensitivity Neurochemistry Prenatal environment Cognitive impairment, learning difficulties, school failure Temperament/personality Negative mood states Irritability Tantrums Social withdrawal,Aggressiveness Emotional distress Extraversion and sociability Tendencies toward risk taking and thrill see

9、king,Risk Factors: Individual (continued),External locus of control Low self-esteem Poor coping skills Deficient social interaction skills Alcohol-specific self-efficacy,Early & persistent problem behaviors Low commitment to school, society, and/or religion Oriented toward short-term goals and hedon

10、istic gratification,Disengaged,Risk Factors: Individual (continued),Little interest in success/achievement Positive attitudes toward deviant behavior Alienation and rebelliousness Attitudes favorable to alcohol use,Early onset of alcohol use Beliefs about alcohol use as normative Alcohol expectancie

11、s Co-morbid psychiatric problems Absence of resiliency factors,Early Onset,Risk Factors: Social/Interpersonal,Family alcohol & drug behaviors/attitudes Poor/inconsistent family management Limited parental monitoring Family conflict/home strain Peer rejection in elementary grades,Low bonding to famil

12、y Association with alcohol-involved peers Negative evaluations from parents Parent divorce or separation Absence of risk reduction/resiliency promotion,Conflict,Risk Factors: Contextual/Cultural,Access,Risk Factors (continued),Assessment,Adolescent assessment for alcohol use disorders should include

13、: Developmental factors Biological factors Psychological factors Social factors Multiple information sources,Assessment (continued),Critical domains/content of assessment:Actual alcohol/substance use behavior Type, severity, and temporal sequencing of psychiatric morbidity that may be present Cognit

14、ive processes, neuropsychological functioning Family organization and interaction patterns Social skills,Assessment (continued),Critical domains/content of assessment:School and/or vocational adjustment Recreation and leisure activities Temperament/personality characteristics Peer affiliations Legal

15、 status Physical health,Assessment Instruments,Advantages of a valid, standardized, clinically relevant assessment: Efficiently and accurately determines treatment needs Builds client motivation Supports clinical decision-making as an ongoing process Reduces clinician bias and inconsistencies Afford

16、s common language among professionals,Assessment Instruments (continued),Adolescent Validated Examples:Personal Experiences Inventory (Winters et al., 1999) Drug Use Screening Inventory (Tarter & Hegedus, 1991) Customary Drinking and Drug Use Record (Brown et al., 1998) Teen Addiction Severity Index

17、 (Kaminer et al., 1993),2002 Microsoft Corporation.,Assessment (continued),Developmental appropriateness of content, language, and format is essential!,2002 Microsoft Corporation.,Assessment Feedback,Avoid trying to “prove” things to the adolescent and family Describe each result and its meaning Avo

18、id a “scare tactics” tone Solicit and reflect reactions to assessment information Remain open to feedback Be prepared for strong emotional reactionsSource: Miller & Rollnick, 1991,2002 Microsoft Corporation.,Assessment Feedback (continued),Summary content:Risks and problems that emerged in the asses

19、sment findings Reactions to feedback, emphasis on readiness to change Invitation to correct the summary Assurance of successful treatment availability,2002 Microsoft Corporation.,Treatment with Adolescents,Limited data exist to address treatment effectiveness with adolescents:“Surprisingly, few clin

20、ical studies have investigated the effectiveness of treatment programs for adolescents” Source: Schinke, Botvin, p. 49),Treatment (continued),“There is evidence that treatment is superior to no treatment, but insufficient evidence to compare the effectiveness of treatment types. The exception to thi

21、s is that outpatient family therapy appears superior to other forms of outpatient therapy.”Source: Williams, Chang, & Addiction Centre Adolescent Research Group, 2000,Treatment (continued),“.multiple psychosocial intervention approaches have been developed during the past two decades. Unfortunately,

22、 little is currently known about which of these many approaches is most effective for which individuals.” Source: Wagner, Brown, Monti, Myers, & Waldron, 1999,Intervention can succeed with adolescents Outcomes with adolescents are similar to those with adults Improvement varies across domains,Treatm

23、ent (continued),2002 Microsoft Corporation.,“some treatment is better than none; no particular treatment method has emerged as superior to any other.” Source: Catalano, Hawkins, Wells et al., 1990-1991,Treatment (continued),Treatment as Adolescents,Many existing treatment approaches mirror adult-cen

24、tered strategies Adolescent alcohol and substance use problems may be markedly different from those experienced by adults in terms of: Behavioral manifestations Underlying motivations Associated factors,2002 Microsoft Corporation.,Treatment as Adolescents (continued),Compared to adult substance abus

25、ers, adolescent substance abusers: Have a briefer history of substance use Are more likely to demonstrate episodic consumption. Chronic, daily use is less likely Are less likely to have consequences of protracted use Use a greater number and types of substances Are undergoing rapid developmental cha

26、nges that may mimic or exacerbate substance effects,Compared to adult substance abusers, adolescent substance abusers: Are more likely to have co-occurring problems (e.g., depression, family disruption, academic problems, problem behavior/deviance, low level conventionality, peer drug use) “Outgrow”

27、 patterns of use/abuse without intervention more often May be less amenable to confrontation-of-denial approaches (due to developmental independence and autonomy issues),Treatment as Adolescents (continued),Treatment as Adolescents (continued),Heterogeneity of population: Individual differences Amen

28、ability to treatment Matching factors,2002 Microsoft Corporation.,Treatment Approaches,Evidence-based, developmentally sensitive: Family system approaches Brief motivational interventions Guided personal change programs Cognitive-behavioral skills building Assertive aftercare programs Community-base

29、d treatment models Pharmacological agents,Treatment Approaches (continued),Cautions about treatment (group, AA) Need for interventions suited to range of settings, contexts where adolescents are encountered,2002 Microsoft Corporation.,Diversity Concerns,Inadequate research attention directed to issu

30、es of ethnicity, culture, discrimination, mistrust, and acculturation in adolescent treatment effectiveness studies Need for culturally specific programs? Effects of cultural sensitivity, appropriateness, competence?,2002 Microsoft Corporation.,Motivation to Change,Pretreatment motivation predicts t

31、reatment success among adolescents Choices, self-selection bolster commitment Problem Recognition Questionnaire measures readiness to change, problem recognition,PRQ,Prevention & Early Intervention,Goal = Reduce number of new cases and enhance positive functioning by: Reducing vulnerability and risk

32、 factors Promoting protective and resilience factors Most effective when: Contexts support the intervention messages Interventions are developmentally appropriate Multiple “boosters” are delivered over a long time frame Multiple contexts/domains are engaged Begin young,Summary Issues,Controlled use

33、of substances? What is success? Coexisting problems Family estrangement Matching “Outgrowing” problems Diagnostic criteria,2002 Microsoft Corporation.,Summary (continued),Majority try alcohol/drugs by 12th grade Some develop diagnosable problems Vulnerability, risk, resilience, protective factors ar

34、e known Intervention is usually better than no intervention,What we know,Summary (continued),Which factors are most important and how do they interact with one another? Which interventions are best for which adolescents? How does the interaction between individual and treatment factors affect outcom

35、es? What diagnostic criteria and instruments are most appropriate for adolescents?,What we dont know,Appendices,Comparisons with Russia,Project HOPE (May, 1997) Northern Moscow,Prevalence (continued),Prevalence (continued),Project HOPE, 19975th graders32% have tried alcohol 21% have had an alcoholic

36、 drink in the past year 11% have had an alcoholic drink in the past month 6.6% have tried inhalants 2% have tried marijuana 22% have tried cigarettes,Prevalence (continued),Project HOPE, 19977th graders69% have tried alcohol 49% have had an alcoholic drink in the past year 25% have had an alcoholic

37、drink in the past month 8% have tried inhalants 3% have tried marijuana 49% have tried cigarettes,Project HOPE, 19979th graders91% have tried alcohol 81% have had an alcoholic drink in the past year 50% have had an alcoholic drink in the past month 54% have been drunk 12.8% have tried inhalants 17% have tried marijuana 71% have tried cigarettes,Prevalence (continued),