Treatment for Adolescent Alcohol Use Disorders : Part 2

by National Institute of Health

(Page 6 of 6)

Adolescent Treatment Interventions

Complex interventions have been developed and tested in adolescents referred for treatment of alcohol and other drug disorders. Many of these patients are likely to have more than one substance use disorder and to have other psychiatric disorders as well (depression, anxiety, or conduct disorder). Brief interventions are, as a rule, delivered to adolescents in general medical settings (e.g., primary care clinics, emergency rooms) or in school-based settings. The range in severity of substance use problems encountered in the nonaddiction specialty settings is greater than in treatment centers, thereby providing the opportunity to intervene before serious social consequences and alcohol use disorders develop.

Complex Interventions. Some of the most promising interventions for adolescents with alcohol use disorders have incorporated multiple components and systems. These include 1. family therapies with both familial and community components (multidimensional family therapy) and multisystemic therapy and 2. cognitive-behavioral therapies (CBT). Several studies have demonstrated significant improvement among teens with alcohol use disorders who were receiving family-based intervention, group or individual cognitive-behavioral therapy, and therapeutic community interventions. All forms of these treatments have substantive differences in intervention design and delivery as well as efficacy evaluation compared with adult alcoholism treatment research. In particular, consideration of youth motivation appears critical in engagement and retention of youth in single- component and complex interventions as well as their continued success following treatment. Although limited at this time, evidence is emerging that pharmacologic treatment of co-occurring psychiatric disorders benefits adolescents with alcohol use disorders. Research on adolescents funded by NIAAA and the National Institute on Drug Abuse has shown that longer adolescent treatments generally show better outcomes. Yet longer treatments can be expensive, and the current health financing system stresses the need for shorter, more cost-effective treatment. This poses a major challenge to alcohol and other drug treatment research today - to identify active ingredients and mechanisms of action of specific components in complex treatments and to determine if such treatments can maintain their effectiveness in reduced forms.

Several models have been proposed to explain adolescent relapse following treatment (cognitive-behavioral, self-medication) and to predict clinical course after treatment. Environmental factors of exposure to substances and use patterns of peers in the immediate social network most consistently emerge as proximal risk factors for adolescent alcohol relapse. Personal characteristics including coping skills, self-esteem, and outcome expectancies have been associated with clinical course, as have personality/temperament features linked to disinhibition and negative reactivity. Because a substantial portion of youth relapses are planned rather than unexpected, motivation for sustained abstinence appears to play a critical role in the initial decisions of youth to return to alcohol or other drug involvement after treatment. Although current evidence suggests that developmental factors such as stage of neurocognitive development, psychiatric disorders, and emotional self-regulation play a role in the decisionmaking process regarding relapse, research is needed to explicate the role of each on variability in clinical course.

Brief Interventions. A primary function of brief interventions is to motivate people to initiate specific health-related behavior changes. The target of the intervention may be the harmful health behavior itself or consequences of that behavior (alcohol-related problems). One of the best known of these time-limited strategies (one to five sessions) is motivational enhancement. This intervention is based on a nonauthoritarian empathic approach that encourages people to take personal responsibility for change, provides objective personalized assessment results on the relative magnitude of the problem behavior, provides explicit advice on the direction to change, and delineates a menu of change options. Brief interventions are flexible in that they can be used to motivate a person to engage in treatment or they can be used as a stand-alone early intervention.

Early evidence on the effectiveness of brief interventions in reducing or eliminating alcohol-related problems in adolescents indicates that they may be effective in reducing both drinking and its consequences (drunk driving). Recent school-based brief intervention studies suggest that reductions in alcohol use and consequences are mediated by purposeful self-change efforts on the part of teens and that expectations of reduction/cessation outcomes may be critical to this change process. One 4-year followup of college freshmen found, however, that reduction in consequences had a lasting effect, whereas reductions in quantity and frequency of alcohol use had washed out by then.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.