Psychiatry 2008 - September 2008 - (Page 36)

TABLE 1. Empirically supported psychosocial treatments for substance-abusing adolescents AUTHOR INTERVENTION STUDY DESIGN SAMPLE SIZE OUTCOME Arzin, et al. 1994 Behavioral therapy or supportive therapy Random assignment 26 Behavioral treatment significantly better at achieving abstinence Adolescents assigned to CBT showed significant reductions in severity of substance use CBT subjects had significantly lower rates of positive urinalysis than did PET subjects Significant reduction in adolescent drug use FFT significantly associated with percentage of youths achieving minimal substance use Home-based MST effective in reducing treatment drop-out and recidivism Urine documented abstinence increased from 37% to 74% by study end Completing treatment significantly associated with improvement in drug use Kaminer, et al. 1998 CBT or interactional group treatment Random assignment 32 Kaminer, et al. 2002 CBT or PET Random assignment 88 Liddle, et al. 2001 MDFT Random assignment 182 Waldron, et al. 2001 FFT Random assignment 114 Hennegler, et al. 1996 MST or treatment as usual Random assignment 118 Kamon, et al. 2005 CM Intent to treat 19 Winters, et al. 2000 Minnesota 12-Step Model Consecutive referrals to completer, non-completer, or wait list groups 179 KEY: CBT: cognitive behavioral therapy; PET: psychoeducational therapy; MDFT: multidimensional family therapy; FFT: functional family therapy; MST: multisystemic therapy; CM: contingency management drugs; 3) roll with resistance; and 4) support self-efficacy.23 CASE EXAMPLE, CONTINUED: IMPLEMENTATION OF A DUAL DIAGNOSIS TREATMENT PLAN The goals for Joe’s treatment were explicit, realistic, obtainable, and shared by his clinicians, himself, and his father. It was emphasized to Joe and his father that realistic expectations from treatment included awareness that although the ultimate 36 Psychiatry 2008 [ S E P T E M B E R ] goal is abstinence, treatment is a process and not an event. Recovery often involves periods of improvement, followed by relapse, and changes in symptom severity. Since Joe was not suicidal or dangerous, treatment was able to occur in an outpatient setting. After three years of continuous drug abuse, Joe was at risk of withdrawal once he stopped using cannabis. Withdrawal symptoms from cannabis reported in youth11 include the following three categories: mood (e.g., irritability 47%; increased anger 40%; depressed mood 58%; nervousness/anxiety 33%), behavioral (e.g., craving 71%; restlessness 46%; increased aggression 36%; sleep difficulty 43%; strange dreams 26%), and physical (e.g., headache 32%; shakiness 29%; sweating 19%; stomach pains 18%; nausea in 15%). A treatment duration of 12 weeks was recommended for a first treatment episode of cannabis use disorder.10

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Psychiatry 2008 - September 2008 Editor’s Message Editorial Advisory Board Contents Psych Rx Letters to the Editor Use of Benzodiazepines in the Treatment of Anxiety Functional Neurosurgery in the Treatment of Severe Obsessive Compulsive Disorder and Major Depression: Overview of Disease Circuits and Therapeutic Targeting for the Clinician Treatment of Comorbid Adolescent Cannabis Use and Major Depressive Disorder Risperidone Long-acting Injections: Successful Alternative Deltoid Muscle Injections for Refractory Schizophrenia Alcohol/Substance Misuse and Treatment Nonadherence: Fatal Attraction Transforming the Psychiatric Inpatient Unit from Short-term Pseudo-asylum Care to State-of-the-art Treatment Setting Journal Watch Classified Advertising Information for Authors

Psychiatry 2008 - September 2008

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