Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

25. Adolescent Substance Abuse 573tion with nonusing peers, involvement in leisure time activities, work, andschool.In more recent reviews of the literature (Deas & Thomas, 2001; Williams& Chang, 2000; Winters, 1999), similar variables were reported to be mostconsistently related to successful outcome: treatment completion, low pretreatmentuse, peer and parent social support, and nonuse of substances. These morerecent reviews also found evidence that treatment was superior to no treatment.Although insufficient evidence was found to compare the effectiveness of treatmentmodalities, early reports indicated that outpatient family therapy appearedto be superior to other forms of outpatient treatment. These findingshowever, have not been supported by most recent studies.The Drug Abuse Treatment Study for Adolescents (DATOS-A) is amultisite, prospective treatment outcome study of 1,732 adolescent admissionsto 23 programs in four U.S. cities (Grella, Hser, Joshi, & Rounds-Bryant, 2001;Hser et al., 2001). In the year following treatment, patients reported decreasedheavy drinking, marijuana and other illicit drug use, and decreased criminalinvolvement, as well as improved psychological adjustment and school performance.Although the length of time in treatment was generally short, longertreatment stays were associated with several favorable outcomes. Nearly twothirds(63%) of the sample reported at least one comorbid DSM-IV-TR disorder.At baseline, when compared with noncomorbid youth with SUDs, theseyouth with comorbid disorders were more likely to be alcohol- or other-drugdependentand to have more problems with family, school, and criminalinvolvement. Although comorbid youth reduced their drug use and problembehaviors after treatment, they were more likely to use marijuana and hallucinogens,and to engage in delinquent behavior in the 12 months after treatmentwhen compared with noncomorbid adolescents (Grella et al., 2001).Data indicate that most adolescents return to some level of alcohol orother drug abuse following treatment (Brown, Vik, & Creamer, 1989; Brown etal., 1990). Adolescents in substance abuse treatment begin substance use at anearlier age and progress rapidly to the use of multiple drugs, followed by thedevelopment of SUDs (Brown et al., 1989; Myers & Brown, 1990). Other clinicalfeatures of adolescents entering treatment include high levels of coexistingpsychopathology or early personality difficulties; deviant behavior; school difficulties,including high levels of truancy; and family disruption and substanceabuse (Bukstein et al., 1992; Doyle, Delaney, & Trobin, 1994). Several pretreatmentcharacteristics predict completion of treatment by adolescents, includinggreater severity of alcohol problems; greater use of drugs other thanalcohol, marijuana, and tobacco; a higher level of internalizing problems; andlower self-esteem (Blood & Cornwall, 1994; Doyle et al., 1994, Kaminer,1992a). Premorbid psychopathology (e.g., conduct disorder) is negatively correlatedwith treatment completion and with future abstinence (Kaminer,Burleson, & Goldberger, 2002; Myers, Brown, & Mott, 1995). Although factorssuch as severity of substance use may predict short-term treatment outcomes,