Predictors of Engagement in Adolescent Drug Abuse Treatment

doi:10.1097/00004583-200103000-00006

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 40, Issue 3, March 2001, Pages 274-281

https://doi.org/10.1097/00004583-200103000-00006 Get rights and content

ABSTRACT

Objective

To identify key demographic, parent, and adolescent characteristics that influence engagement in outpatient drug abuse treatment.

Method

Youths aged 12 to 17 years (N = 224; 81% male and 72% African American) referred for drug treatment and their parents participated in this study. Marijuana was the primary substance of abuse. Data were gathered prior to treatment on demographic variables as well as on both parent and youth perspectives on youth, parent, and family functioning.

Results

A discriminant function analysis revealed that engagement in treatment was related to, in order of weighting, more positive parental expectations for their adolescent's educational achievement (standardized discriminant function coefficient [SDF] = 0.68), higher parental reports of youth externalizing symptoms (SDF = 0.59), and higher levels of family conflict perceived by the youth (SDF = 0.36). Family income, gender, juvenile justice status, minority group status, family structure, parental age and psychopathology, and treatment characteristics did not distinguish treatment-engaged from unengaged adolescents.

Conclusions

The results suggest that both parent and youth perceptions are pivotal to whether or not adolescents are engaged in psychotherapy. These findings lead the authors to recommend adolescent engagement interventions focusing on both the youth and his or her parents and suggest a content focus for adolescent engagement interventions.

Section snippets

Participants

Study participants were urban families with an adolescent between 12 and 17 years old who had been referred to treatment by the criminal justice, social welfare, or educational system for substance abuse and associated mental health problems. Upon referral, youth and parent participated in a two-session initial evaluation. After this evaluation, and as part of a larger project to evaluate treatment outcome, youths were randomly assigned to either individual or family therapy.

Two hundred

RESULTS

The hypotheses were examined through two types of analyses. First, one-way univariate analyses of variance were conducted on the demographic, adolescent, and family variables hypothesized to be important predictors of adolescent engagement. Next, discriminant function analysis was conducted to examine the relative contribution of each variable to predicting engagement in therapy.

DISCUSSION

As expected, adolescents engaged in treatment were distinguished from the teenagers not engaged primarily in terms of parent and family characteristics. The findings reveal, in particular, the importance of parents’ perceptions and attitudes. First, parents who perceived more externalizing symptoms in their adolescent were more likely to have their child remain in treatment than those who perceived less externalizing. These results suggest that parents’ recognition of a serious problem

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The impact of social network dynamics on engagement in drug use reduction programs among men and women who use drugs
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Continuing recovery support care over a protracted period of at least 12 months appears to be essential if an individual desires an outcome of sustained recovery (Proctor & Herschman, 2014). Despite the well-documented benefits of prolonged engagement in SUD treatment and recovery support, many people with SUD often leave care programs before drug use cessation or control (Dakof, Tejeda, & Liddle, 2001; Deane, Wootton, Hsu, & Kelly, 2012; Lin et al., 2013; McHugh et al., 2013; McKay et al., 2004; Samuel, LaPaglia, Maccarelli, Moore, & Ball, 2011; Smyth, Fagan, & Kernan, 2012). While considerable research has addressed program and individual-based factors associated with retention (drug use severity, proper use of medications, program satisfaction (Arfken, Klein, di Menza, & Schuster, 2001; Hser, Evans, Huang, & Anglin, 2004; Siqueland et al., 2002; Zhang, Gerstein, & Friedmann, 2008), less study has occurred of the social environment where PWUDs spend most of their time.
Cross-sectional studies have shown strong relationships between social network characteristics and substance use disorder (SUD) treatment engagement. The current study examined associations between longitudinal changes in egocentric social networks of male and female people who use drugs (PWUD) and engagement in drug use reduction programs, broadly defined as either formal SUD treatment or self-help groups.
Using data from an HIV prevention and care study in Baltimore, MD, this study categorized PWUD into those who engaged and did not engage in any drug use reduction programs over two follow-ups during a one-year observation window. The study used multivariate logistic generalized estimating equations (GEE) to examine associations between network composition and stability measures and drug use reduction program engagement, stratified by gender.
Of the 176 subjects participating in drug use reduction programs at baseline, 56.3% remained engaged at one year. Among both male and female respondents, higher turnover into non-kin networks was associated with increased odds of engagement in drug use reduction programs (AOR 1.4; 95% CI: 1.1–1.9, AOR 1.3; 95% CI: 1.0–1.8, respectively). For males, retention of intimate partner networks was associated with increased odds of program engagement (AOR 2.9; 95% CI: 1.1–7.6); for females, higher turnover into kin networks was associated with decreased odds of engagement (AOR 0.8; 95% CI: 0.5–1.0).
Evaluation of associations between social network characteristics and drug use reduction program engagement appears to benefit from longitudinal analyses that are stratified by gender. Efforts to improve retention in formal SUD treatment or self-help groups might consider intervening through social networks, perhaps by increasing overall levels of social support.
Personal characteristics of adolescent girls placed in rehabilitation centres related to the quality of the early working alliance
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L’alliance de travail est un prédicteur important des résultats de l’intervention auprès d’adultes et d’adolescents. L’établissement de l’alliance de travail avec les adolescents pose certains défis particuliers, notamment parce que la consultation est fréquemment initiée par un tiers, que leur motivation à changer est souvent faible et que l’intervention est parfois imposée. Identifier les facteurs susceptibles d’influencer la qualité de l’alliance de travail dans ce contexte est donc important. Cette étude vise à examiner les liens entre quatre caractéristiques individuelles et la qualité de l’alliance de travail précoce chez des adolescentes placées en centres éducatifs.
Quarante-six adolescentes (12–17 ans) recrutées dans différents centres montréalais ont répondu à cinq questionnaires autorapportés évaluant la motivation au changement, le sentiment d’efficacité personnelle, l’attitude envers l’autorité, les difficultés comportementales présentées et la qualité perçue de l’alliance de travail.
Les résultats d’une régression multiple suggèrent que la motivation au changement et le sentiment d’efficacité personnelle expliquent 39,5 % (p < 0,01) de la variance de la qualité perçue de l’alliance de travail.
Ces résultats soulignent l’intérêt de ces variables comme cibles thérapeutiques potentielles pour favoriser une alliance de travail positive auprès d’adolescentes en centres éducatifs.
The working alliance is an important predictor of the outcomes of intervention with adults and adolescents. Establishing the working alliance with adolescents involves some specific challenges. Indeed, the consultation among this population is often initiated by a third party, who is usually a parent or an authority figure. The intervention may even be imposed on the youth if his behaviour involves significant risks to himself or others, as is the case in rehabilitation centres. In addition, it is also important to note that their motivation to change is often low at the beginning of the intervention, which makes the development of the working alliance even more complex. Therefore, it seems relevant to identify factors that may influence the quality of the working alliance, especially when it is a coercive intervention such as in rehabilitation centres. This study aims to examine the links between some personal characteristics and the quality of the early working alliance among adolescent girls placed in rehabilitation centres. The four personal characteristics investigated are: motivation to change, self-efficacy, attitude towards authority figures and behavioural difficulties.
Forty-six adolescent girls (12–17 years old) were recruited at the time of their admission to one of the rehabilitation centres located in Montreal. They all completed five self-reported questionnaires: the Working Alliance Inventory Short, the University of Rhode Island Change Assessment Scale, the Self-Efficacy Questionnaire for Children, the Attitudes to Formal Authority Questionnaire, and the Youth Self Report.
The results indicated that motivation for change (β = .55) and sense of self-efficacy (β = .36) are the variables most closely related to the quality of the perceived working alliance at the beginning of the intervention. Motivation to change and self-efficacy explained 39.5% (p < .01) of the variance of the perceived quality of the working alliance. Attitude towards authority and behavioural problems were not significantly associated with the quality of the working alliance. These findings are consistent with those of other studies conducted with adults or young people in other contexts.
Our results suggest that motivation to change and self-efficacy are therapeutic targets to consider in order to promote the establishment of a positive working alliance at the beginning of an intervention with adolescent girls placed in rehabilitation centres.
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We hypothesize that severity would predict cluster membership based on the present results. Multiple variables tested that did not discriminate across clusters were significant predictors of treatment outcome in past studies including age (Friedman et al., 1995; Hendriks et al., 2012), and internalizing and externalizing psychopathology (Dakof et al., 2001; Hendriks et al., 2012). Some of these variables, including age and externalizing, were significant predictors at the univariate level, but not at the multivariate level.
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View all citing articles on Scopus

: Completion of this research was supported by grants P50-DA07697 and P50-DA11328 from the National Institute on Drug Abuse . The authors thank Cindy Rowe for comments on an earlier version of this article.

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ArticlesPredictors of Engagement in Adolescent Drug Abuse Treatment

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

Participants

RESULTS

DISCUSSION

J Behav Ther Exp Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Manual for the Child Behavior Checklist/4–18 and Profile

Manual for the Youth Self Report and 1991 Profile

Clinical, sociodemographic, and systems risk factors for attrition in a children's mental health clinic

Am J Orthopsychiatry

Attrition in child psychotherapy

Adv Clin Child Psychol

Cognitive Therapy of Depression

Pretreatment variables that predict completion of an adolescent substance abuse treatment program

J Nerv Ment Dis

A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy

Arch Gen Psychiatry

SCL-90-R: Administration, Scoring, and Procedures Manual SE-II

Preventing escalation in problem behaviors with high-risk young adolescents: immediate and one-year outcomes

J Consult Clin Psychol

Day-care treatment for multiple drug abusing adolescents: social factors linked with completing treatment

J Psychoactive Drugs

Factors associated with dropping out of child and family treatment

Am J Fam Ther

Factors associated with dropout from psychotherapy with depressed adolescents

Can J Psychiatry

Eliminating (almost) treatment dropout of substance abusing or dependent delinquents through home-based multisystemic therapy

Am J Psychiatry

Clinical-developmental interface: implications of developmental research for adolescent psychotherapy

Psychother Theory Res Pract Train

National Survey Result on Drug Use From the Monitoring the Future Study, 1975–1995: College Students and Young Adults

Premature termination from treatment among children referred for antisocial behavior

J Child Psychol Psychiatry

Family experience of barriers to treatment and premature termination from child therapy

J Consult Clin Psychol

Dropping out of child psychotherapy: distinguishing early and late dropouts over the course of treatment

J Consult Clin Psychol

Risk for attrition in treatment of antisocial children and families

J Clin Child Psychol

Articles
Predictors of Engagement in Adolescent Drug Abuse Treatment