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contextual factors

ABSMC Research Institute. 2. Levels of Care In Treatment of Adolescents. . Daily - Approximately 100,000 youth participate in public Substance Abuse treatment programs throughout the U.S.. ABSMC Research Institute. 3. Source: Dennis, ML, Dawud-Noursi, S, Much, R, and McDermeit, M. The Need for Developing and Evaluating Adolescent Treatment Models. In Stevens, SJ and Morral, AR (eds.) Adolescent Substance Abuse Treatment in the United States: Exemplary Models from a National Evaluation Study. Bi13

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contextual factors

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    2. ABSMC Research Institute 2 Youth who enter substance abuse treatment nationally can be characterized as entering treatment most frequently through a referral from juvenile justice. The study cohort for these analyses are drawn from those who entered long term residential and short term residential treatment – levels of care that account for only 15% of the placements in AOD treatment nationally. Youth who enter substance abuse treatment nationally can be characterized as entering treatment most frequently through a referral from juvenile justice. The study cohort for these analyses are drawn from those who entered long term residential and short term residential treatment – levels of care that account for only 15% of the placements in AOD treatment nationally.

    3. ABSMC Research Institute 3 Among African American youth, more than 60% enter substance abuse treatment through Juvenile Justice. Among other groups, approximately 25 – 40% enter through Juvenile Justice.Among African American youth, more than 60% enter substance abuse treatment through Juvenile Justice. Among other groups, approximately 25 – 40% enter through Juvenile Justice.

    4. ABSMC Research Institute 4 Contextual Factors Delinquency cases and arrests involving girls have increased dramatically. In California drug abuse cases have increased almost 200% for females between 1988 and 1997. Juvenile drug offenders reportedly have significantly higher recidivism rates than non–drug offenders. (CASA, 2002) Many studies of adolescent criminal behavior have relied on measures such as number of arrests, days on probation, or days in detention. French et al (2003) argues that although criminal justice contacts are concrete and time bound, youth self-report suggests adolescents are committing many more crimes than their apprehensions would suggest (Webb et al, 2002). In a number of studies, reports by participants with histories of substance abuse suggest that as little as 1% of self-reported offenses have resulted in actual arrest. (Kinlock et al, 2004) The Global Appraisal of Individual Needs (GAIN) collects detailed information on criminal activity, whether arrest resulted or not. (French et al 2003)

    5. ABSMC Research Institute 5 Factors (cont.) Research has demonstrated changes in patterns of findings over multiple follow-up periods. These patterns suggest that conclusions about treatment outcomes may differ depending on when follow-up data are collected. Benefits of some aspects of treatment may emerge only over time, while immediate benefits of others may dissipate (Waldron et al, 2001).

    6. ABSMC Research Institute 6 Analytic Questions Are there patterns of illegal activity that are related to patterns of drug use (baseline, tx effect, relapse effect)? Are there patterns that differentiate males and females?

    7. ABSMC Research Institute 7 TO PATRICIA: I changed the “highlighting” of the two sites that were includedTO PATRICIA: I changed the “highlighting” of the two sites that were included

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    12. ABSMC Research Institute 12 Point in Time: Shift in Status on AOD Use and Detention – Whites/Non-Whites WHITES No AOD use/Not in detention @ baseline 0%; @ 12 mos 25% Weekly use of AOD @ baseline 87%; @ 12 mos 49% (weekly ETOH and MJ accounts for 47% of cohorts’ status at baseline and 34% at 12 months) In detention during previous 90 days @ baseline 40%; @ 12 mos 11% Non-Whites No AOD use/ Not in detention @baseline 1%; @ 12 mos 30% Weekly use of AOD @ baseline 80%; @ 12 mos 35% (weekly ETOH and MJ accounts for 51% of cohorts’ status at baseline and 25% at 12 months) In detention during previous 90 days @ baseline 65%; @ 12 mos 19%

    13. ABSMC Research Institute 13 Point in Time: Shift on AOD Use and Detention – Males/Females Males No AOD use/ Not in detention @ baseline 1%; @ 12 mos 27% Weekly use of AOD @ baseline 83%; @ 12 mos 42% (weekly ETOH and MJ accounts for 53% of cohort’s status at baseline and 34% at 12 mos) In detention during previous 90 days @ baseline 58%; @ 12 mos 19% Females No AOD use/ Not in detention @ baseline 0%; @ 12 mos 27% Weekly use of AOD @ baseline 85%; @ 12 mos 42% (wkly ETOH/ MH - 40% of cohort’s status at baseline and 23% at 12 mos; wkly Other Drugs account for 45% of cohort’s status @ intake and 19% at 12 mos) In detention during previous 90 days @ baseline 40%; @ 12 mos 10%

    14. ABSMC Research Institute 14 PETS-A Sites

    15. ABSMC Research Institute 15 Variables In Clusters/Modeling General Conflict Tactic Index (GCTI) Intake only (past year)Increasingly violent strategies used in a disagreement by the respondent. Includes subscales for verbal and physical conflict. Substance Problem Index (SPIY) Intake only (past year)Problems related to substance use that a client endorses, including DSM-IV symptoms of substance use disorders (abuse, dependence) and substance induced disorders (health, psychological). Property Crime Index (PCI) Intake (past year) – Follow up (past 90 days)Illegal activities related to property crimes (vandalism, bad checks, theft, breaking and entering etc) endorsed by the respondent. Typically these are nonviolent crimes and committed to support substance habit. Interpersonal Crime Index (ICI) Intake (past year) - FU (past 90 days)Illegal activities related to personal crime (assault, rape, murder, etc.) endorsed by the respondent. Typically these are violent crimes and committed under the influence of substances. Drug Crime Index (DCI) Intake (past year) – FU (past 90 days)Illegal activities related to substance use (DUI, distribution, prostitution, gang membership, gambling, etc.) endorsed by the respondent. General Crime Index (GCI) Intake (past year) - 12 FU (past 90 days)Aggregate of Property Crime Index, Interpersonal Crime Index, and Drug Crime Index

    16. ABSMC Research Institute 16 Hierarchical Modeling Analytic Strategy Dependent Variable: Number of days using Alcohol or Other Drugs (AOD) in the past 90 days. Analyses were based on data collected at 2162 assessments of 441 persons at 2 residential treatment sites. Assessments were completed at intake, 3, 6, 9, and 12 months after baseline. Hierarchical non-linear models were employed to describe sex and cluster main effects, and sex by cluster interactions in prediction AOD use across time. (HLM2L software was used to conduct the present analyses.)

    17. ABSMC Research Institute 17 2-Level Hierarchical Model Level 1: “Repeated Measures” Level Variation across time is described using a log-link function via person-specific estimates of the following parameters: “Intercept” (i.e., Starting AOD Use) Treatment Effect (change from 0 to 3 months) Relapse Effect (change from 3 to 12 months) Controlled Environment (proportion of days using NCE/CE) Level 2: “Person” Level Individual differences were modeled as a function of “Level 2” predictors. Predictors considered were (1) Cluster membership (Conflict History, Substance Abuse Problem History, and Crime Indices) and (2) Sex - Male/Female.

    18. ABSMC Research Institute 18 Male/Female AOD Use Trajectories No significant main effects for sex or cluster on baseline AOD use were detected. Treatment Effects (0-3 mos.): Males showed a 39% reduction in AOD use, Females showed a 60% reduction. Tx Effect approaches significance at .065 level. No significant erosion of treatment effects between 3 months and 12 months, on average.No significant main effects for sex or cluster on baseline AOD use were detected. Treatment Effects (0-3 mos.): Males showed a 39% reduction in AOD use, Females showed a 60% reduction. Tx Effect approaches significance at .065 level. No significant erosion of treatment effects between 3 months and 12 months, on average.

    19. ABSMC Research Institute 19 AOD Use Trajectories by Cluster (adjusted to days in controlled environment)

    20. ABSMC Research Institute 20 AOD Use in Cluster 1Cluster 1: High Conflict History, Mod Substance Abuse Problem History, and High Crime Index AOD use increased by almost 2.7 times: Note: Baseline to 3 months is Treatment Effect, and 3 to 12 is Relapse EffectsAOD use increased by almost 2.7 times: Note: Baseline to 3 months is Treatment Effect, and 3 to 12 is Relapse Effects

    21. ABSMC Research Institute 21 Male/Female AOD Use in Cluster 3CLUSTER 1: Low Conflict History, Low Substance Abuse Problem History, and Low Crime Treatment Effects (0-3 mos.): AOD use among males decreased 30%, females decreased 78% Relapse Effects (3-12 mos.): AOD use among males decreased by 60%, whereas females showed a 150% increase.Treatment Effects (0-3 mos.): AOD use among males decreased 30%, females decreased 78% Relapse Effects (3-12 mos.): AOD use among males decreased by 60%, whereas females showed a 150% increase.

    22. ABSMC Research Institute 22 Male/Female AOD Use in Cluster 7Cluster 7: Some Conflict History, Moderate Substance Abuse Problem History, and Low to Mod Crime Relapse Effects (3-12 mos.): The trend for females is different than that for males. The trend for females shows a higher relapse effect than males, more pronounced in this cluster than in all other clusters. Relapse Effects (3-12 mos.): The trend for females is different than that for males. The trend for females shows a higher relapse effect than males, more pronounced in this cluster than in all other clusters.

    23. ABSMC Research Institute 23 Male/Female AOD Use in Clusters 6 & 7 6: Some Conflict, Mod SA Problem, and Mod-High Crime (High DCI) 7: Some Conflict, Mod SA Problem, and Low-Mod Crime (Low DCI) Cluster 6 & 7 have similar Conflict and SAP histories, but Cluster 6 is higher on Criminal Activity and high on the Drug Crime Index. For the males in Cluster 6, from baseline to 3 mos. Change is signif. at the .01 level; and for females 0-3 most, and 3-12 mos. change is significant at the .01 level. Male/ female trends are similar in Cluster 6 & 7, yet Cluster 6 is higher overall in AOD use. Cluster 6 & 7 have similar Conflict and SAP histories, but Cluster 6 is higher on Criminal Activity and high on the Drug Crime Index. For the males in Cluster 6, from baseline to 3 mos. Change is signif. at the .01 level; and for females 0-3 most, and 3-12 mos. change is significant at the .01 level. Male/ female trends are similar in Cluster 6 & 7, yet Cluster 6 is higher overall in AOD use.

    24. ABSMC Research Institute 24 Point in Time Comparison Variables Substance Problem Index (SPIM) Intake (past mo.) – 30 Month Follow Up (past mo.)Problems related to substance use that a client endorses, including DSM-IV symptoms of substance use disorders (abuse, dependence) and substance induced disorders (health, psychological). General Crime Index (DCI) Intake (past year) – 30 Month Follow Up (past 90 days)Aggregate of Property Crime Index, Interpersonal Crime Index, and Drug Crime Index

    25. ABSMC Research Institute 25 Point in Time Comparisons Comparison of Substance Problem Index (SPI) and General Crime Index (GCI) at baseline and 30 months. Change in group membership over time (between baseline and 30 month follow-up): Maintenance of Status w/ No Problem Counts Improved Status Unimproved Status

    26. ABSMC Research Institute 26 General Crime Index (GCI) and Substance Problem Index (SPI)Change from Baseline to 30 Mos.

    27. ABSMC Research Institute 27 General Crime Index (GCI)Comparison of Baseline and 30 Mos.

    28. ABSMC Research Institute 28 Substance Problem Index (SPI)Comparison of Baseline and 30 Mos.

    29. ABSMC Research Institute 29 Considerations Change Over Time The “active ingredient” in these analyses is entry into drug treatment. However, perhaps 1 in 10 adolescents who need AOD treatment actually receive services, 50% are in treatment for 6 weeks or less, while 80% are in treatment for 90 days or less. The ATM research followed treatment completers and those who left treatment early. The “dosage” of treatment is highly variable. Other factors may contribute to change over time, including maturation, recovery environment, legal oversight. For example, involvement with the legal system may include probation. While on probation, random or periodic drug testing & monitoring are probable. Graduated sanctions or greater consequences may result from repeated drug test violations or attaining age of 18.

    30. ABSMC Research Institute 30 Conclusions There appear to be some subgroups at higher risk for poorer outcomes. The magnitude of improvement in AOD use at 3 months (Tx Effect) is not, in all cases, predictive of maintenance or continued improvement. Some subgroups experience gradual erosion, indicative of relapse. This AOD pattern is evident among females, clusters (3,6, & 7). It is also evident among those (mostly males) in cluster 1, the group with high conflict histories, and a high crime index, and cluster 6 the subgroup with a high drug crime index.

    31. ABSMC Research Institute 31 Conclusion Within the same clusters, males and females may converge on AOD outcomes at the 12 month follow-up, but exhibit different patterns in their trajectories. Combining males and females in analyses would obscure these differences.

    32. ABSMC Research Institute 32 Future Directions Additional analyses by duration of treatment exposure, involvement with probation, etc. Examination of trends using hierarchic modeling out to 30 months, post-admit to treatment. Considering additional hypotheses to account for differences in male/female trajectories. Conduct additional analyses of those cases that are unimproved over time.

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