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

574 V. TREATMENTS FOR ADDICTIONSmost longer term outcomes may depend on social–environmental factors. Thisis consistent with studies of relapse among adolescent populations, which suggestthat relapse in adolescents is more often associated with social pressures touse rather than situations involving negative affect, as is usually found in adultrelapse (Brown, Myers, Mott, & Vik, 1994; Vik, Grisel, & Brown, 1992). Adolescents’attendance at self-support or aftercare groups is associated with higherrates of abstinence and other measure of improved outcome when comparedwith those adolescents who did not attend such groups (Harrison & Hoffmann,1989).Despite a higher level of return to substance use among adolescents aftertreatment, abstinent teens may expect decreased interpersonal conflict, improvedacademic functioning, and increased involvement in social and occupationalactivities (Brown et al., 1994). Patterns of substance abuse among adolescentsappear to become more stable between 6 and 12 months after treatment(Brown et al., 1994). An extensive review of treatment outcome studies conductedin the 1970s and 1980s concluded that treatment can be effective and isbetter than no treatment (Catalano et al., 1990–1991). However, an unequivocalsuperiority of specific treatment modalities or components has not beendemonstrated (Winters, 1999).Psychosocial treatment strategies that have shown promise in reducingSUDs among adolescents include family therapies such as multisystemictherapy (Henggeler, Pickrel, & Brondino, 1996), functional family therapy(Waldron, Slesnick, Brody, Turner, & Peterson, 2001), and multidimensionalfamily therapy (Liddle, Dakov, & Diamond, 2001), as well as behavioraltherapy (Azrin, Donohue, & Besalel, 1994), cognitive-behavioral therapy(Kaminer, Blitz, Burleson, Sussman, & Rounsaville, 1998; Kaminer, Burleson,& Goldberger, 2002), Motivational Interviewing (Monti, 1999), contingencymanagement reinforcement (Corby, Roll, & Ledgerwood, 2000), the Minnesota12-step model (Winters et al., 2000), and integrative models of treatment(Dennis et al., 2004; Kaminer, 2001). A common recommendation for youth isto attend 12-step groups. It is noteworthy, however, that little is known regardingthe effects of this approach on adolescents. Kelly, Myers, and Brown (2000)reported modest beneficial effects of 12-step attendance, which were mediatedby motivation but not by coping or self-efficacy.PHARMACOTHERAPY OF DUAL DIAGNOSESPharmacotherapy or medication treatment potentially targets several areas, includingtreatment of withdrawal, use to counteract or decrease the subjectivereinforcing effects of illicit substance use, and treatment of comorbid psychopathology.Unfortunately, no systematic research evaluates the efficacy and safetyof any psychotropic medication in the treatment of adolescents with SUDs(Kaminer, 1995). Although clinically significant withdrawal symptoms appear to