Are the ‘Best’ Drug Treatment Programs Effective?
Quality of Highly Regarded Adolescent Substance Abuse Treatment Programs
Rosalind Brannigan, M.P.H.; Bruce Schakman, Ph.D.; Mathea Falco, J.D.; and Roberta Millman, M.D.
Archives of Pediatrics and Adolescent Medicine, Vol.158, September 2004, pages 904-909
Available from Brannigan at Drug Strategies, 1755 Massachusetts Ave. NW, Washington, DC, 20036, or dspolicy@aol.com.
Which substance abuse programs are effective for adolescents? This new study shows that the reputations of programs may have little to do with their effectiveness.
An advisory panel of 22 experts, put together by the researchers, defined nine key elements of effective treatment programs, based on research studies. Those elements are:
• Comprehensive assessments that cover emotional and medical problems, learning disabilities, family functioning and other aspects of an adolescent’s life.
• Comprehensive and integrated services.
• Parental involvement in a youth’s treatment.
• Program design appropriate for adolescents.
• A climate of trust between therapists and youth.
• Staff well-trained to work with adolescents.
• Program addresses the distinct needs of boys and girls and of different racial and ethnic groups.
• Relapse prevention training, aftercare plans, referrals to community resources and follow-up.
• Rigorous evaluation of treatment outcomes.
The researchers asked the directors of all state alcohol and drug abuse agencies to identify five adolescent treatment programs in their jurisdictions that they considered exemplary. Twenty-two national organizations and federal agencies were also contacted. Altogether, the agencies and organizations named 144 programs.
The researchers then interviewed administrators of those programs to determine how well the programs met the nine criteria. Programs could get up to five points for each element, for a total possible score of 45. Nineteen programs scored 30 or higher, and 64 scored 22 or lower. The highest score of any program was 39; the average (mean) was 24.
The programs are not named in the study, because it would not be possible to obtain such a high degree of voluntary participation in a study if programs were risking their reputations by allowing their staff to be interviewed. That might seem like a shortcoming, but it really isn’t, because the importance of the study is in determining whether, in general, programs that have the best local or national reputations deserve those reputations when they are objectively analyzed. Regardless of the specific programs involved, this study indicates that the reputations of programs has little relationship to their quality.
The programs rated in the top quarter tended to have been in existence for 20 years or longer and were more likely to offer multidimensional family therapy and the therapeutic community approach. They were not more likely to be accredited. There were no significant differences in age of the program or use of multidimensional family therapy when programs in the bottom quarter were compared with other programs.
Overall, most programs scored at least four out of five on the qualified staff criterion (average: 3.5), but not on the other eight elements. None scored at least four on all of the elements. The lowest scores were on evaluating treatment outcomes and taking into account gender and cultural differences. On the important element of engaging and retaining teens with a climate of trust, the programs averaged a score of 2.5.
The study indicates that national and local reputations are not necessarily very meaningful, as many highly regarded programs did not score well. On the other hand, perhaps these are the best programs available, a sobering indictment of the state of the art in adolescent drug treatment.
Exercise and Depression
The Relation Between Physical Activity and Mental Health Among Hispanic and Non-Hispanic White Adolescents
Jennifer Brosnahan, M.P.H.; Lyn Steffen, Ph.D., M.P.H.; Leslie Lytle, Ph.D.; and colleagues
Archives of Pediatrics and Adolescent Medicine, Vol. 158, August 2004, pages 818-823
Available free from Steffen at 1300 South Second St., Suite 300, Minneapolis, MN 55454 or steffen@epi.umn.edu.
According to the U.S. Centers for Disease Control and Prevention, 19 percent of high school students have seriously considered attempting suicide, 15 percent have made a suicide plan, and 9 percent have attempted suicide. Suicide is the third leading cause of death for 15- to 19-year-olds.
This study points to a safe, effective and low-cost way to decrease depression in youth: physical activity.
The study of 1,870 high school students between 14 and 18 compared Hispanic and non-Hispanic white boys and girls in a heavily Hispanic county in Texas.
Not surprisingly, boys were more likely to engage in regular physical activity than girls, whether it was strength and toning workouts, vigorous activity that resulted in sweating and hard breathing (such as running, fast dancing, soccer or basketball) or moderate physical activity (at least 30 minutes of fast walking, slow bicycling, skating, pushing a lawn mower or other activity that did not result in sweating or hard breathing).
Girls were more likely to feel sad or hopeless (38 percent) than boys (23 percent), more likely to consider suicide (23 percent vs. 12 percent) and more likely to plan suicide (17 percent vs. 10 percent). There were no sex differences in suicide attempts, and the few racial differences were small.
How did physical activity affect mood and suicide? Youth who participated in three to five days per week of physical education classes were less likely to feel sad than those who participated two days per week or less, after statistically controlling for sex, ethnicity, age, school, body mass index, smoking, drinking and grades in school. Those who reported at least six sessions of physical activity per week (whether classes, sports, fast walking or something else) were significantly less likely to consider suicide than those who were less active.
Youths were significantly less likely to plan suicide if they engaged in more vigorous physical activity, strength and toning activity, or more total physical activity.
The pattern was clear: Youths who were more physically active tended to be less sad and less likely to consider or plan to commit suicide.
Thirty students in the study had attempted suicide. There was no association between physical activity and suicide attempts.
It is known that vigorous physical activity causes physiological changes that can affect mood in the short term. The results of this study show that those changes, and even more moderate activity, can help kids by improving their moods on a longer term basis and reducing suicidal thoughts and plans. Although physical activity is not a magic cure to prevent suicide attempts, these findings are impressive and have important implications for youth workers.
The findings indicate the mental health benefits of even moderate activity, not just team sports and activities that make kids sweat. Instead of spending billions of dollars on anti-depressants, which recent revelations show don’t work and can hurt teens, it would make sense to spend more to expand physical education classes, recreation programs and recreational opportunities in youth development programs.
Immigrant and Ethnic Minority Youth
Preparing Diverse Adolescents for the Transition to Adulthood
Andrew J. Fuligni, Ph.D., and Christina Hardway, Ph.D.
The Future of Children, Vol. 14, Fall 2004
Available free at www.futureofchildren.org/pubs-info2825/pubs-info.htm?doc_id=24016.
A comprehensive report titled “Children of Immigrant Families” is published as part of The Future of Children series of quarterly journals, funded by the David and Lucile Packard Foundation. The report provides a lot of interesting and useful information for youth workers, although it is written for academic researchers and is more technical and detailed than many readers would like.
The report includes chapters on children from birth to 8 years old, the middle childhood years, and growing up American in Latino, Southeast Asian and economically disadvantaged immigrant families.
Following are highlights of the chapter on preparing adolescents for the transition to adulthood, which is based on dozens of major research studies:
The research shows that Latino and African-American youth are less likely than others to complete high school or college; Latino and African-American youth who do not attend college have more trouble finding jobs than white youth with similar levels of education; minority youth are more likely than whites to be in poor physical health and to engage in high-risk behaviors; and immigrant youth (who are foreign-born or whose parents are foreign-born) are healthier than other American youth. The authors conclude that adolescents from Latino and African-American backgrounds appear to be less prepared to become healthy, productive and successful adults than other youth.
Education: A major concern is the dramatically lower educational attainment of immigrant adolescents from Latin American families. This has implications for their later employment, income, housing, marriage and health. Latino and African-American youth are the least likely of all immigrant groups to complete high school. But whereas the educational attainment gap between African-American and white youth narrowed in the 1970s and 1980s and has remained the same for the past 10 to 15 years, the high school completion rate for Latinos is about as low today as it was in the 1970s.
It’s important to note that the authors found that more than half of foreign-born Latino youth in the United States who do not receive a high school degree never attended American schools. They tend to have poor English skills and often came to this country primarily to find jobs. However, second- and third-generation Latino youth in the United States are also less likely to complete high school than are youth in other groups.
In contrast, Asian students complete high school at rates equal to those of whites, with little difference between those from immigrant and American-born families. Asian-Americans are more likely to enroll in college and complete it than are whites or other minority groups.
Employment: Youth who don’t attend college tend to have trouble finding jobs, but the problems are worse for African-American and Latino youth: Their unemployment rates hover around 50 percent. African-Americans age 18 and over who have jobs but did not go to college earn less than white youth with similar levels of education. Latino high school graduates earn less than white high school graduates.
Health: Minority adolescents are more likely to be in poor physical health and to engage in high-risk behaviors than white youth. In contrast, youth from immigrant families are physically and mentally healthier than American-born youth, and more likely to avoid high-risk behaviors. For example, asthma and obesity are more common among adolescents from American-born Latino and African-American families than among white families, but less common among immigrant adolescents.
Compared with white adolescents, youth from ethnic minority and immigrant families are less likely to have regular access to health care.
Risk Behaviors: Latino and African-American teenagers are more likely than other youth in the United States to have sexual intercourse and to bear children. However, youth from immigrant families are less likely to have had sexual intercourse. And foreign-born Latina adolescents are less likely to become pregnant than American-born Latina adolescents.
Foreign-born adolescents and African-American adolescents from American-born families are less likely than other minorities or white youth to use illicit drugs.
Schools: Latino and African-American youth are more likely to attend schools with less experienced teachers and with difficult social environments, (such as overcrowding and violence). They are less likely to participate in the advanced coursework in math and science – classes that would help them get into college. Asian-American students, in contrast, are more likely than whites or other minority students to participate in such advanced coursework. Some of these ethnic variations result from limited offerings in the schools, but similar group differences also exist within the same schools.
Latino and African-American high school students participate in fewer school activities, both academic and nonacademic, than Asian-American or white students.
