Dropping out of substance abuse treatment: A clinically oriented review

This article presents evidence for the effectiveness of a strategy for engaging adolescent drug users and their families in therapy. The intervention method is based on strategic, structural, and systems concepts. To overcome resistance, the identified pattern of interactions that interferes with entry into treatment is restructured. Subjects were 108 Hispanic families in which an adolescent was suspected of. or was observed, using drugs. Subjects were randomly assigned to a strategic structuralsystems engagement (experimental) condition or to an engagement-as -usual (control) condition. Subjects in the experimental condition were engaged at a rate of 93% compared with subjects in the control condition, who were engaged at a rate of 42%. Seventy-seven percent of subjects in the experimental condition completed treatment compared wiih 25"! of subjects in the control

Engaging adolescent drug abusers and their families in treatment: a strategic structural systems approach.

This study reports data on the efficacy of Strategic Structural Systems Engagement (SSSE), which is designed to bring hard-to-reach families into treatment. The study also explores variables that may contribute to differential effectiveness. Participants were 193 Hispanic families, who were randomly assigned to either experimental or control conditions. Several important findings emerged. First, the overall results replicated earlier findings showing the superiority of SSSE : 81% of SSSE families, compared to 60% of control families, were successfully engaged, χ 2 (1, N = 193) = 7.5, p <.001. Second, SSSE interventions were more successful with non-Cuban Hispanics (97% successfully engaged) than with Cuban Hispanics (64% successfully engaged), χ 2 (1, N = 51) = 7.53, p =.006. Third, an analysis of intervention failures suggests a mechanism by which culture and ethnicity influence clinical processes (resistance to engagement) and may result in differential effectiveness.

Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness.

On the basis of the literature, the following risk factors for drug abuse by adolescents were identified: biological predisposition to drug abuse; personality traits that reflect a lack of social bonding; a history of low quality and consistency of family management, family communication, family relationships and parental role-modelling, a history of being abused or neglected; low socioeconomic status; emotional or psychiatric problems; significant stressors and/or inadequate coping skills and social supports; inadequate social skills; history of associating with drug-using peers, rejection by prosocial peers due to poor social skills; a history of low commitment to education, failure at school; a history of anti-social behaviour and delinquency and early initiation to drug use. Models for conceptualizing the aetiology of drug abuse are discussed, namely Jessor's problem behaviour syndrome and Rhodes & Jason's Social Stress Model. It is clear that the path to drug abuse is complex, so simple solutions to ...

Causes and correlates of adolescent drug abuse and implications for treatment

Background Although numerous studies recognize the importance of social network support in engaging substance abusers into treatment, there is only limited knowledge of the impact of network involvement and support during treatment. The primary objective of this research was to enhance retention in Therapeutic Community treatment utilizing a social network intervention.



Aims  The specific goals of this study were (1) to determine whether different pre-treatment factors predicted treatment retention in a Therapeutic Community; and (2) to determine whether participation of significant others in a social network intervention predicted treatment retention.



Design, setting and participants  Consecutive admissions to four long-term residential Therapeutic Communities were assessed at intake (n = 207); the study comprised a mainly male (84.9%) sample of polydrug (41.1%) and opiate (20.8%) abusers, of whom 64.4% had ever injected drugs. Assessment involved the European version of the Addiction Severity Index (EuropASI), the Circumstances, Motivation, Readiness scales (CMR), the Dutch version of the family environment scale (GKS/FES) and an in-depth interview on social network structure and perceived social support. Network members of different cohorts were assigned to a social network intervention, which consisted of three elements (a video, participation at an induction day and participation in a discussion session).



Findings  Hierarchical regression analyses showed that client-perceived social support (F1,198 = 10.9, P = 0.001) and treatment motivation and readiness (F1,198 = 8.8; P = 0.003) explained a significant proportion of the variance in treatment retention (model fit: F7,197 = 4.4; P = 0.000). By including the variable ‘significant others’ participation in network intervention’ (network involvement) in the model, the fit clearly improved (F1,197 = 6.2; P = 0.013). At the same time, the impact of perceived social support decreased (F1,197 = 2.9; P = 0.091).



Conclusions  Participation in the social network intervention was associated with improved treatment retention controlling for other client characteristics. This suggests that the intervention may be of benefit in the treatment of addicted individuals.

Arthur A. Weidman

Papers

Engaging the families of substance abusing adolescents in family therapy

Family therapy and reductions in treatment dropout in a residential therapeutic community for chemically dependent adolescents