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1.  Continuing Care in High Schools: A Descriptive Study of Recovery High School Programs 
Data from 17 recovery high schools suggest programs are dynamic and vary in enrollment, fiscal stability, governance, staffing, and organizational structure. Schools struggle with enrollment, funding, lack of primary treatment accessibility, academic rigor, and institutional support. Still, for adolescents having received treatment for substance abuse, recovery schools appear to successfully function as continuing care providers reinforcing and sustaining therapeutic benefits gained from treatment. Small size and therapeutic programming allow for a potentially broader continuum of services than currently exists in most of the schools. Recovery schools thus provide a useful design for continuing care warranting further study and policy support.
PMCID: PMC3938279  PMID: 24591808
2.  The Association Between Attention-Deficit Hyperactivity Disorder and Nicotine Use Among Adolescents and Young Adults 
Previous research indicates that youth with ADHD are more susceptible to nicotine use compared to those without ADHD and one explanation for this association is the self-medication theory. The present study examines nicotine use in a prospective sample derived from a community sampling procedure rather than a clinical setting. Nicotine use was measured through young adulthood (mean ages: 18, 20 and 22) and three groups were compared based on childhood status: ADHD-only, ADHD-extemalizers and control groups. Results indicated that at all three data points, individuals with childhood ADHD plus an externalizing disorder reported higher nicotine use on all variables compared to the ADHD group absent of an externalizing disorder and the comparison group of non-ADHD youth. The group differences were significant even after controlling for possible confounding variables (age, gender, and current treatment with psychostimulant medication). Study results are discussed in light of the self-medication hypothesis and of the importance of including nicotine prevention programs for adolescents and young adults with ADHD and externalizing problems.
PMCID: PMC4306279  PMID: 25632218
ADHD; Externalizing disorder; Nicotine; Self-medication hypothesis
3.  [No title available] 
PMCID: PMC4290751  PMID: 25589826
4.  Do Sources of Cigarettes Among Adolescents Vary by Age Over Time? 
Trends in sources of cigarettes among adolescents were assessed using data from a teen cohort (2000-2006). Five sources—bought from store, got from other teen, stole from others, bought from others, and got from an adult—were measured over time by age. The most common source among all ages was other teens. Fewer teens bought cigarettes from stores, with a downward trend for all ages. Among all ages there was an upward trend in stealing with younger teens more likely to steal cigarettes. In addition to targeting cigarette sales, interventions are needed to target other youth cigarette sources.
PMCID: PMC3927921  PMID: 24563604
cigarettes; smoking; source; access; adolescents
5.  A Behaviorally-Anchored Rating System to Monitor Treatment Integrity for Community Clinicians Using the Adolescent Community Reinforcement Approach 
This study evaluated a process for training raters to reliably rate clinicians delivering the Adolescent Community Reinforcement Approach (A-CRA) in a national dissemination project. The unique A-CRA coding system uses specific behavioral anchors throughout its 73 procedure components. Five randomly-selected raters each rated “passing” and “not passing” examples of the 19 A-CRA procedures. Ninety-four percent of the final ICCs were at least ‘good’ (≥.60) and 66.7% were ‘excellent’ (≥.75), and 95% of the ratings exceeded the 60% or better agreement threshold between raters and the gold standard. Raters can be trained to provide reliable A-CRA feedback for large-scale dissemination projects.
PMCID: PMC4000045  PMID: 24778544
Evidence-based treatment; A-CRA; community reinforcement; rater training; coder training; treatment adherence
6.  Alcohol Use and Related Behaviors among Late Adolescent Urban Youth: Peer and Parent Influences 
Peer and parent influences on alcohol use and related risky behaviors were examined in a sample of late adolescent (M = 17.3 years; SD = 1.11 years) urban youth. Participants (N = 400) completed an online measure assessing peer influences of alcohol use and alcohol offers, and parent influences of rules against alcohol use and perceived levels of emotional family support, relative to youths’ alcohol use, binge drinking, alcohol-related consequences, and intentions to drink. Hierarchical regression analyses revealed that increased peer alcohol use and alcohol offers were associated with youths’ increased drinking, binge drinking, alcohol-related consequences, and intentions to drink. Controlling for peer influences, parental rules against alcohol use were associated with decreased drinking, binge drinking, and intentions to drink; increased levels of family support was associated with decreased alcohol-related consequences and intentions to drink. These findings suggest that parental influences, albeit small relative to peer influences, are associated with fewer instances of monthly alcohol use and related risky behaviors among late adolescent urban youth.
PMCID: PMC4167796  PMID: 25246757
youth; alcohol; peers; parents; influences
7.  Reducing Alcohol Risk in Adjudicated Male College Students: Further Validation of a Group Motivational Enhancement Intervention 
This study examined the effectiveness of a single-session group motivational enhancement alcohol intervention on adjudicated male college students. Over two sequential academic years, 230 students sanctioned by the university for alcohol-related infractions attended a 60- to 75-minute group intervention. The intervention consisted of a timeline followback, social norms education, decisional balance for behavioral change, blood alcohol content (BAC) information, expectancy challenge, and generation of behavioral goals. Participants were followed weekly for three months and showed reductions in drinking (29%) and alcohol-related consequences (32%) at three-month follow-up. The intervention was successful in reducing drinking for both first-year students and upperclassmen, with reductions appearing to be a function of the intervention and not the citation itself. Furthermore, a post hoc control condition revealed that those participants randomly assigned to the intervention group condition reduced drinking (19%) and alcohol-related consequences (44%) more than participants in the control condition over one month. These results provide continued evidence of the effectiveness of group motivational enhancement interventions with adjudicated male college students.
PMCID: PMC4267112  PMID: 25525319
adjudicated college students; alcohol consequences; group intervention; motivational interviewing
8.  Sexual Experience and Risky Alcohol Consumption among Incoming First-Year College Females 
This study examines the relationship between sexual experience and various drinking measures in 550 incoming first-year college females. During this transition period, sexually experienced participants reported stronger alcohol expectancies and endorsed higher drinking motives, and drank more frequently and in greater quantities than sexually inexperienced participants. Sexual status was also a significant predictor of alcohol-related nonsexual consequences, over and above amount consumed. Furthermore, controlling for drinking, sexual status moderated the relationship between coping motives and consequences. Among women who endorsed strong coping motives for drinking, sexual experience was linked to greater nonsexual alcohol-related consequences. Implications for prevention and intervention are discussed.
PMCID: PMC4226333  PMID: 25392606
alcohol; alcohol-related consequences; college females; college transitions; drinking motives; sexual experience
9.  MTFC for High Risk Adolescent Girls: A Comparison of Outcomes in England and the United States 
The current study examined 12-month outcomes for girls enrolled in an implementation trial of Multidimensional Treatment Foster Care (MTFC) in England. In addition to examining changes from pre-treatment to post-treatment, we also compared results for girls enrolled in the England implementation trial to girls enrolled in two randomized controlled trials (RCTs) of MTFC in the United States (US). The England MTFC sample included 58 girls in foster care between the ages of 12 and 16 years. The US MTFC intervention samples included 81 girls between the ages of 13 and 17 years who were referred to out-of-home care due to chronic delinquency. Results indicated improvement in offending, violent behavior, risky sexual behavior, self-harm, and school activities for girls enrolled in the England implementation trial. The effect sizes of these results were similar to those obtained in the US RCTs, with the exception of substance use which showed significant decreases for girls enrolled in the US RCTs, but not for girls enrolled in the England implementation trial. These results, in combination with other cross-cultural findings, support the notion that MTFC might be relevant across US and European cultures.
PMCID: PMC3758489  PMID: 24003300
MTFC; implementation; cross-cultural; girls; delinquency
10.  Adolescent Onset of Maternal Substance Abuse: Descriptive Findings from a Feasibility Trial 
Although maternal substance abuse in child welfare populations is a well-documented occurrence, little is known about the onset of these behaviors or the substance abuse histories of these mothers. Descriptive data from a small feasibility trial of mothers referred for substance abuse and child neglect suggest adolescent onset of hard substance use. Age of onset was associated with family history of use. The majority of mothers reported polysubstance abuse starting at an early age and quickly escalating patterns of behavior including IV drug use. Implications for prevention efforts for children of families identified with substance abuse problems are discussed.
PMCID: PMC3726274  PMID: 23908582
child welfare; methamphetamine; early onset
11.  Intervention Effects on Health-Risking Sexual Behavior Among Girls in Foster Care: The Role of Placement Disruption and Tobacco and Marijuana Use 
The present study examined the effects of the Middle School Success intervention (MSS), a program to promote healthy adjustment in foster girls, on their health-risking sexual behavior, using a randomized controlled trial (RCT) design. As hypothesized, girls in the intervention condition (n = 48) showed significantly lower levels of health-risking sexual behavior than did girls in the control condition (n = 52) at 36 months postbaseline. Further path analysis indicated that this intervention effect was fully mediated through its effects on girls’ tobacco and marijuana use. Findings highlight the importance of providing preventive intervention services to foster girls during early adolescence.
PMCID: PMC3772734  PMID: 24043921
foster care; girls; tobacco and marijuana use; health-risking sexual behavior; adolescent; intervention
12.  Trauma, Delinquency, and Substance Use: Co-occurring Problems for Adolescent Girls in the Juvenile Justice System 
Girls in the juvenile justice system are known to have high rates of co-occurring childhood abuse, trauma, and substance abuse. Girls with this constellation of problems are at high risk for serious adverse outcomes, including problems with drug dependence and abuse. The relationship between childhood sexual abuse, childhood physical abuse, other types of childhood trauma, and rates of substance use during adolescence were examined for girls in the juvenile justice system. As expected, childhood sexual abuse was significantly related to girls’ substance use during adolescence. In contrast to prior research, no link was found between physical abuse, lifetime trauma, and substance use. Limitations and future directions are discussed.
PMCID: PMC3771528  PMID: 24039384
Females; delinquency; substance use; treatment
13.  Amygdala Activation and Emotional Processing in Adolescents at Risk for Substance Use Disorders 
Studies are needed that examine neurobiological characteristics in high risk individuals prior to substance use disorder (SUD) development. In this pilot study, 4 adolescent subjects at high risk (having at least 1 parent with a SUD) for SUD were compared with 4 adolescent reference subjects on a corticolimbic reactivity paradigm, where they were presented with affect-laden faces or geometric shapes. FMRI was used to measure cortical activation in response to these stimuli. High risk subjects, compared to low risk, exhibited greater left amygdala activation (t=3.60, df=6, p=0.01), suggesting they may exhibit hyper-responsivity of the amygdala in response to emotional stimuli.
PMCID: PMC3988200  PMID: 24748761
14.  What Adolescents Need to Prevent Relapse after Treatment for Substance Abuse: A Comparison of Youth, Parent, and Staff Perspectives 
Little is known about what factors and supports youths identify as important for their sustained recovery after substance abuse treatment, and if their caregivers and treatment staff identify similar needs. The purpose of this study was to explore what youths, caregivers, and staff perceive as important to remain substance free after completing a residential treatment program.
Semi-structured interviews were conducted with 28 adolescents, 30 parents, and 29 staff at 3 treatment agencies. Data were coded thematically and themes were organized by respondent type.
There was high frequency and concordance across respondents regarding the need for aftercare services, supportive relationships, and activities. Only one item, outpatient treatment, demonstrated significant differences across groups.
External supports and activities are important to recovery of adolescents from substances following treatment completion. Implications and potential areas of inquiry are discussed.
PMCID: PMC3979558  PMID: 24723746
abstinence; adolescent substance abuse; posttreatment services; substance abuse
15.  The Role of Parenting in Alcohol and Tobacco Use Among Latino Adolescents 
Parents can impact adolescent substance use, but it is unclear which substances are most affected. This study compared associations between parenting behaviors and alcohol and tobacco use to see if parenting was equally related to both behaviors. Alcohol and tobacco use data were collected from 252 Latino adolescents living along the San Diego-Tijuana border. Logistic regression was used to test parenting behaviors’ impact. Parenting was protective against alcohol use, but not related to tobacco use. Substance using peers affected both alcohol and tobacco use. Alcohol prevention efforts among Latino adolescents should target parenting behaviors.
PMCID: PMC3579539  PMID: 23439845
adolescents; alcohol; tobacco; Latinos; parental influence
16.  Adolescent Substance Abuse and Mental Health: Problem Co-Occurrence and Access to Services 
The purpose of this study is to identify factors associated with adolescent alcohol or drug (AOD) abuse/dependence, mental health and co-occurring problems; as well as factors associated with access to treatment. This is a secondary analysis of data from the National Survey on Drug Use and Health (NSDUH) 2000. The 12-month prevalence rate of adolescents with only mental health problems was 10.8%, 5.1% had only AOD abuse/dependence only, and 2.7% had co-occurring problems. Approximately 15% of youth reported receiving behavioral health treatment in the past 12 months. Several factors associated with having behavioral health problems and receiving treatment are presented.
PMCID: PMC3923628  PMID: 24532964
adolescent; substance abuse; mental health; epidemiology
17.  Social Anxiety and Onset of Drinking in Early Adolescence 
The present study examines several types of social anxiety that may be associated with the onset of alcohol use in middle school students, and whether the relationship differs by sex and grade. Students in the seventh and eighth grades (N = 2621) completed the Social Anxiety Scale for Adolescents and a measure of lifetime drinking via school-wide surveys. Distinct aspects of social anxiety were associated with higher and lower rates of onset of alcohol use. A high level of fear of negative evaluation was associated with drinking initiation in boys and girls, while girls who reported no social anxiety or distress in new situations were more likely than other groups to have started drinking by early adolescence. Youth with either very low or very high levels of generalized anxiety had higher rates of drinking than youth with scores in between. These findings suggest that the relationship between social anxiety and initiation of alcohol use is complex and varies by type of anxiety symptomatology.
PMCID: PMC3573349  PMID: 23420393
alcohol use; adolescent; social anxiety
18.  Young Adult Outcomes Associated with Teen Pregnancy Among High-Risk Girls in an RCT of Multidimensional Treatment Foster Care 
Teen pregnancy is associated with a host of deleterious outcomes for girls such as drug use and poor parenting. Thus, reducing teen pregnancy rates could improve long-term developmental outcomes for girls, improving adjustment during young adulthood. Based on the positive effects of Multidimensional Treatment Foster Care (MTFC) relative to group care (GC) in a study of adolescent girls—significantly fewer pregnancies reported in the 2-year follow-up for MTFC girls—the present study followed this sample into young adulthood (approximately 7 years postbaseline) to examine the effects of adolescent pregnancy on young adult substance use and pregnancy-related outcomes. All participants were randomly assigned to MTFC (n = 81) or GC (n = 85) as adolescents as part of two RCTs. Results from logistic regression analyses indicated that becoming pregnant during the 2-year follow-up was significantly related to illicit drug use, miscarriage from a new pregnancy, and child welfare involvement at 7 years postbaseline. In addition, baseline marijuana use predicted marijuana use at 7 years postbaseline.
PMCID: PMC3894060  PMID: 24453470
teen pregnancy; young adulthood; juvenile justice; drug use; RCT
19.  Preventing Child Behavior Problems and Substance Use: The Pathways Home Foster Care Reunification Intervention 
This paper evaluated the Pathways Home manualized selective preventive intervention designed to prevent reunification failures once children are returned home to their biological parent(s) after first time stays in foster care (n = 101). The theoretically based intervention focused on support and parent management practices designed to prevent the development of child behavior problems including internalizing and externalizing problems, and substance use. Intent to treat analyses employed probability growth curve approaches for repeated telephone assessments over 16 weeks of intervention. Findings showed that relative to services as usual reunification families, the Pathways Home families demonstrated better parenting strategies that were in turn associated with reductions in problem behaviors over time. Growth in problem behaviors in turn predicted foster care re-entry. Maternal substance use cravings were a risk factor for growth in problem behaviors that were buffered by participation in the Pathways Home intervention.
PMCID: PMC3727288  PMID: 23914130
reunification; foster care; prevention; parenting; substance use
20.  Psychosocial Problems Among Truant Youth: A Multi-Group, Exploratory Structural Equation Modeling Analysis 
Truant youth represent a critical group needing problem-oriented research and involvement in effective services. The limited number of studies on the psychosocial functioning of truant youths have focused on one or a few problem areas, rather than examining co-morbid problem behaviors. The present study addresses the need to examine the interrelationships of multiple domains of psychosocial functioning, including substance involvement, mental health, and delinquency, among truant youth. Exploratory structural equation modeling on baseline data collected on 219 truant youths identified two major factors reflecting psychosocial functioning, and found the factor structure was similar across major sociodemographic subgroups. Further analyses supported the validity of the factor structure. The research and service delivery implications of the findings are discussed.
PMCID: PMC3519441  PMID: 23243383
Truancy; psychosocial problems; mental health; substance use; delinquency
21.  Self-Reported Age of Onset and Telescoping for Cigarettes, Alcohol, and Marijuana Across Eight Years of the National Longitudinal Survey of Youth 
Smoking, drinking, and illicit drug use are leading causes of morbidity and mortality, both during adolescence as well as later in life. Although for some adolescents, substance use may last for only a brief period of experimentation, use of these substances in adolescence may have negative consequences. The determination of how well national and local policy and intervention efforts address teen substance use depends largely on the collection of valid and accurate data. Assessments of substance use rely heavily on retrospective self-report measures. The reliability and validity of self-reported substance use measures, however, may be limited by various sources of measurement error. This study utilizes four waves of data from the National Longitudinal Survey of Youth spanning eight years. Our wave-to-wave analyses examined the accuracy of self-reported age of onset for cigarette, alcohol and marijuana users. Findings indicate that approximately one-fourth of cigarette users, one-fifth of alcohol users and one-third of marijuana users reported their age of onset exactly the same across waves. Of those who reported the age of onset inaccurately, the error tended to be in the direction of reporting their age of onset as older at a latter wave relative to what was reported previously, known as forward telescoping. Results from multiple linear regression analyses showed that the single most consistent variable associated with telescoping was the number of years since the substance was first reported. Time since first report was the single consistent and strongly associated with telescoping in each wave-to-wave comparison for all three substances under study. Implications for policy and research are discussed.
PMCID: PMC3532889  PMID: 23284228
22.  Girls’ Tobacco and Alcohol Use During Early Adolescence: Prediction from Trajectories of Depressive Symptoms Across Two Studies 
Associations between trajectories of depressive symptoms and subsequent tobacco and alcohol use were examined in two samples of girls assessed at age 11.5 (T1), 12.5 (T2), and 13.5 (T3). Two samples were examined to ascertain if there was generalizability of processes across risk levels and cultures. Study 1 comprised a United States-based sample of 100 girls in foster care; Study 2 comprised 264 girls in a United Kingdom community-based sample. Controlling for T1 aggression and T1 substance use, individual variation in intercept and slope of depressive symptoms was associated with tobacco use at T3 in both samples: greater intercept and increases in depressive symptoms increased the risk for T3 tobacco use. A similar pattern of associations was found for alcohol use in Study 1. The replicability of findings for the prediction of tobacco use from trajectories of depressive symptoms suggests potential benefit in identifying girls with elevated depressive symptoms for tobacco use prevention programs prior to the transition to secondary school.
PMCID: PMC3686476  PMID: 23794795
adolescent girls; alcohol use; tobacco use; depression; longitudinal
23.  Stress, Mental Health and Substance Abuse Problems In a Sample of Diversion Program Youth: An Exploratory Latent Class Analysis* 
Reflective of interest in mental health and substance abuse issues among youths involved with the justice system, we performed a latent class analysis on baseline information collected on 100 youths involved in two diversion programs. Results identified two groups of youths: Group 1: a majority of the youths, who had high levels of delinquency, mental health and substance abuse issues, Group 2: youths with low levels of these problems. Comparison of these two groups on a variety of psychosocial measures and parent/guardian reports found differences between them that were consistent with their problem group classification. Follow-up analysis confirmed problem behavior that was consistent with the youths’ latent class placement. Implications of the findings for research and practice will be presented.
PMCID: PMC3368702  PMID: 22685378
diversion youth; risk classification of juvenile offenders; latent class analysis
24.  Money Matters: Cost Effectiveness of Juvenile Drug Court with and without Evidence-Based Treatments 
The 12-month cost effectiveness of juvenile drug court and evidence-based treatments within Court were compared with traditional Family Court for 128 substance abusing/dependent juvenile offenders participating in a four-condition randomized trial. Intervention conditions included Family Court with community services (FC), Drug Court with community services (DC), Drug Court with Multisystemic Therapy (DC/MST), and Drug Court with MST enhanced with a contingency management program (DC/MST/CM). Average cost effectiveness ratios for substance use and criminal behavior outcomes revealed that economic efficiency in achieving outcomes generally improved from FC to DC, with the addition of evidence-based treatments improving efficiency in obtaining substance use outcomes.
PMCID: PMC3290130  PMID: 22389577
juvenile drug court; cost effectiveness; substance abuse; multisystemic therapy; contingency management
25.  Substance Use and Sexual Orientation Among East and Southeast Asian Adolescents in Canada 
The purpose of this study was to examine the relationship between substance use and sexual orientation among Asian adolescents in Canada. We analyzed an East and Southeast Asian subsample of a province-wide, school-based survey (weighted N = 51,349). Compared to heterosexual adolescents of the same gender, gay, lesbian, bisexual, and mostly heterosexual adolescents were more likely to use alcohol, marijuana, or other illicit drugs. Particularly, sexual minority girls were at increased risk for substance use. The findings suggest the need for substance use prevention interventions that are sensitive to gender, sexual orientation, and culture.
PMCID: PMC3318955  PMID: 22485070
adolescents; Asian; sexual orientation; substance use

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