Adolescents, Alcohol, and Substance Abuse: Reaching Teens through Brief Interventions / Edition 1

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Overview

This volume reviews a range of empirically supported approaches to prevention and treatment of adolescent substance use problems. The focus is on motivationally based brief interventions that can be delivered in a variety of contexts, that address key developmental considerations, and that draw on cutting-edge knowledge on addictive behavior change. From expert contributors, coverage encompasses alcohol skills training; integrative behavioral and family therapy; motivational interviewing; interventions for dually diagnosed youth; Internet-based education, prevention, and treatment; and applications to HIV prevention. The volume is extensively referenced and includes numerous clinical illustrations and vignettes.
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Editorial Reviews

From the Publisher

"This text does an excellent job of situating substance use assessment and treatment in a developmental framework. Each chapter is richly referenced and features easy-to-read tables that highlight developmentally appropriate tools and strategies. I have found this to be a good text for use in training graduate-level students in adolescent mental health and substance abuse counseling. It is also a useful resource for practicing clinicians who may be new to working with adolescent clients and their families."--Nancy A. Piotrowski, PhD, Harold Abel School of Psychology, Capella University

"Researchers and practitioners looking for better ways to study, prevent, and treat youth alcohol and substance abuse will find this volume invaluable. It presents cutting-edge research on brief interventions for health care, behavioral health, school, and community settings. It also provides fresh perspectives on how emerging transdisciplinary research paradigms and communication technologies can be used to improve the appeal, reach, and impact of treatments designed for adolescents." --C. Tracy Orleans, PhD, Senior Scientist, Robert Wood Johnson Foundation

"We finally have a book that recognizes the important differences between adolescent and adult substance abuse. Filling an important need, this is perhaps the best available work on understanding and intervening in the hazardous use of alcohol and other drugs by adolescents. The book is based on solid science and loaded with clinical insight. It is a 'must' read for clinicians and researchers in the field and an excellent background text for all who treat adolescents." --David C. Lewis, MD, Professor of Medicine and Community Health, Donald G. Millar Professor of Alcohol and Addiction Studies, Brown University

" This book covers its subject like no other in the field. With clarity, breadth, and depth, it illuminates the development of problems among teens, the social forces that surround them, and the reality of difficult clinical encounters. Many of the chapters in this volume amount to landmark reviews of their topics. The authors have provided a sourcebook that will be invaluable not just for students, but also for clinicians and researchers. To accomplish this with such sympathy toward the predicament of so many teens is a real achievement." --Stephen Rollnick, PhD., Department of General Practice, University of Wales College of Medicine, United Kingdom

American Journal of Psychiatry

"An excellent book in all respects. It is very readable (though not a quick read) and shows careful, even meticulous editing. All mental health professionals who work with adolescents and their families will find it of great value."--American Journal of Psychiatry
Addiction

"Given the solid grounding of the book's underlying principles, it offers great promise for engaging diverse groups of young people--as a researcher I found it a valuable resource. The detailed 'how to' of conducting the interventions described will also appeal to clinicians in a variety of contexts."--Addiction
Doody's Review Service
Reviewer: Rajitha Avva, BS, MD (Rush University Medical Center)
Description: This book provides a look at different approaches to dealing with alcohol and substance abuse problems and how substance abuse and dependence differ between adolescents and adults.
Purpose: The purpose is to review interventions that can be used in different settings, that address developmental issues, and that focus on the known processes of addictive behavior in adolescents. It focuses on motivationally-based brief interventions. This book meets the authors' objectives and it is necessary for those working with adolescents who have substance abuse problems.
Audience: The book is written for mental health practitioners and social service providers who work with adolescents with alcohol and substance abuse problems. It is also useful for researchers and students in psychology and public health. The authors are credible authorities in the subject matter of the book.
Features: The book covers current research on substance abuse in adolescents and young adults. It discusses methods for prevention, skills training, and harm reduction in the high risk population. It addresses specific brief interventions with alcohol skills training and behavioral and family therapy. In addition to reviewing data on the efficacy of these methods, case studies are provided for examples of the usefulness of these methods.
Assessment: Overall, this book is useful for psychiatrists and therapists treating adolescents with substance abuse issues. It targets developmental aspects of adolescents in high school and young adults in college that would call for different treatments than those used with an adult population. This is an excellent book that provides specific treatment techniques for the adolescent population. The book also provides up-to-date reviews of research and provides many references.

4 Stars! from Doody
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Product Details

  • ISBN-13: 9781593850906
  • Publisher: Guilford Publications, Inc.
  • Publication date: 7/1/2004
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 350
  • Sales rank: 1,066,742
  • Product dimensions: 5.90 (w) x 8.90 (h) x 1.00 (d)

Meet the Author


Peter M. Monti, PhD, is Professor of Medical Science and Director of the Center for Alcohol and Addiction Studies and the Clinical Psychology Training Consortium at Brown University. His research is supported by a Senior Research Scientist Award from the Department of Veterans Affairs and he holds research grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Drug Abuse (NIDA), and the Department of Veterans Affairs. Widely published, Dr. Monti is coauthor of Treating Alcohol Dependence: A Coping Skills Training Guide.

Suzanne M. Colby, PhD, is Assistant Professor of Psychiatry and Human Behavior at Brown University. Currently, she is Principal Investigator on a National Cancer Institute research grant designed to study teen smoking and quitting, and Co-Principal Investigator on two major research grants from NIAAA and NIDA that study motivational interventions with adolescents. Dr. Colby's recent publications have focused on nicotine dependence among youth, adolescent substance use prevalence and diagnosis, and innovative brief interventions.

Tracy A. O'Leary, PhD, is Assistant Professor of Psychiatry and Human Behavior at Brown University. She is currently studying college student drinking and is Project Director on a research grant from NIDA to test the efficacy of a brief, individual motivational interview for reducing rates and prevalence of adolescent smoking. Dr. O'Leary's recent publications have focused on anxiety and cocaine abuse, and predictors of motivation to change drinking in adolescents.

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Read an Excerpt

Adolescents, Alcohol, and Substance Abuse

Reaching Teens through Brief Interventions

The Guilford Press

Copyright © 2004 The Guilford Press
All right reserved.

ISBN: 1-59385-090-5


Chapter One

Motivational Enhancement for Alcohol-Involved Adolescents

PETER M. MONTI, NANCY P. BARNETT, TRACY A. O'LEARY, and SUZANNE M. COLBY

Adolescent substance use and abuse is a significant public health concern due to its prevalence and associated negative consequences (see Winters, Chapter 3; Brown & Lourie, Chapter 8; Myers, Brown, Tate, Abrantes, & Tomlinson, Chapter 9, this volume). According to the 1998 Monitoring the Future survey (Johnston, O'Malley, & Bachman, 1999), nearly one fourth of 8th graders (23%) and over one half of 12th graders (52%) reported some alcohol consumption in the last month. Estimates of the prevalence of alcohol use disorders among teenagers range from 3%-4%, according to a sample of 14- to 16-year-olds (Cohen et al., 1993), to almost one third of a cohort of high school seniors (32%; Reinhertz, Giaconia, Lefkowitz, Pakiz, & Frost, 1993).

Adolescent drinking has been associated with injuries, motor vehicle crashes, assaults, and suicide attempts (Gould et al., 1998; Hicks, Morris, Bass, Holcomb, & Neblett, 1990; Maio, Portnoy, Blow, & Hill, 1994). Indeed, alcohol-related injuries and crashes are the leading causes of death for young adults (Institute of Medicine, 1990). Whereas adult levels ofalcohol consumption have remained relatively steady over the past 25 years in the United States, teenagers are initiating drinking and using drugs at younger ages than ever before.

Because adolescents typically do not identify themselves as problem drinkers, an optimal approach is to develop proactive screening, assessment, and treatment procedures that target settings in which adolescents with substance-related problems are likely to present. Urgent care settings, primary care clinics, and the courts are potentially good intervention sites. Our group has recently focused on detecting alcohol use in teens in an emergency room (Barnett et al., 1998; Colby et al., 1999), on comparing characteristics of alcohol-positive versus alcohol-negative adolescents in this setting (Monti, 1997), and on developing a brief alcohol screen for adolescent problem drinking (Chung et al., 2000).

Although better identification of adolescent alcohol use problems is necessary, it is obviously not sufficient. In contrast to the adult alcohol-treatment literature (see, e.g., Hester & Miller, 1995; Monti, Abrams, Kadden, & Cooney, 1989), relatively little empirical effort has been directed toward developing effective treatment for adolescents. School-based primary prevention programs have met with some success (see, e.g., Botvin, Schinke, Epstein, Diaz, & Botvin, 1995), but they tend not to address cessation and reduction issues for adolescents who are already drinking; they cannot target school dropouts; and they rarely address motivational issues related to use and abuse. (See Miller, Turner, & Marlatt, Chapter 2, this volume, for an overview of the need to address motivational issues in substance use intervention.)

One approach that has been developed by Alan Marlatt and colleagues (see Miller et al., Chapter 2, this volume) addresses the first two of these issues by employing motivational enhancement with heavy-drinking college students. Although the results are very encouraging, to date the approach has been limited to use with college students. It does not address a large segment of the teenage population who are younger and/or may not be attending school. Furthermore, given the increased alcohol and drug-related risks associated with school dropout (Cook & Moore, 1993; Winters, Chapter 3, this volume), it seems important to develop a program in a nonschool environment that could include a wider segment of the population.

Medical settings provide an opportunity to reach adolescents who need intervention but who are not served by other services (Glynn, Anderson, & Schwartz, 1991). Indeed, the efficacy of brief interventions for adult problem drinkers in clinics or medical settings has been well established (Babor & Grant, 1992; Fleming, Barry, Manwell, Johnson, & London, 1997; Miller & Rollnick, 1991; see also Wilk, Jensen, & Havighurst, 1997, for a review). Recently, the World Health Organization (1996) reported results of a multinational trial of brief interventions in primary care settings that showed a significant decrease in daily alcohol consumption following a 5- to 15-minute intervention with a health care provider.

Yet another compelling reason to conduct a brief alcohol intervention in a medical setting is to capitalize on what might be construed a "teachable moment" or a "window of opportunity," especially if the setting is an emergency room (ER). Indeed, adolescents treated in an ER for an alcohol-related event are likely to be especially receptive to an alcohol intervention due to the salience of the event and their negative emotional reaction to it. Furthermore, if they are frightened and upset when they arrive, it is likely that the confusion and often long wait in a busy ER will increase their discomfort. Practitioners can capitalize on such factors to elicit ambivalence from teens about their alcohol use and promote interest in reducing dangerous drinking.

In this chapter we present a motivational intervention (MI) approach that is particularly well suited for use in an ER in that it combines a nonjudgmental and empathic therapeutic style (Miller & Rollnick, 1991) with personal feedback regarding drinking patterns and effects. This approach has proven effective in reducing problem drinking among adults (Miller, 1995). Indeed, Brown and Miller (1993) found enduring changes in the alcohol use of adult heavy drinkers following a single MI session. The brevity of an MI makes it particularly suitable for use in an ER or other opportunistic settings.

This chapter outlines clinical research that has been conducted with adolescents who range from 13 through 19 years of age. All teens were treated individually with the same treatment approach, except that the parents of 13- to 17-year-old-patients were approached for informed consent and possible involvement in the treatment. Although our work has involved adolescents who volunteer to participate in our studies, we feel that our approach may have wide applicability to treatment programs, to programs for adjudicated youths, and to a variety of prevention efforts. Replication research with these populations is warranted.

In the following section, we present detailed step-by-step coverage of our MI approach, illustrated with relevant clinical examples. Next, we present several topics that require special attention, including counselor training, other populations of interest and treatment modality issues, and dealing with other substances of abuse. Finally, we briefly present empirical results for our approach, conclusions, and some future directions for this line of research.

MOTIVATIONAL INTERVENTION SESSION

The MI protocol we have developed for our research program focuses on alcohol consumption and risky behavior, with an emphasis on heavy drinking and driving after drinking. As is consistent with an MI approach, the intervention should be modified, as appropriate, to be meaningful for each teen and his or her level of interest in changing. The session description that follows is typically conducted in 30-45 minutes. Because we are intervening with teens who have been treated in an ER for alcohol-related reasons (e.g., motor vehicle crash, assault, intoxication), we wait for their alcohol levels to decrease and administer a mini-mental status exam to ensure that they are able to understand and provide informed consent to participate in the intervention.

Introduction and Engagement

The introduction can be made prior to the assessment (which may promote more honest responding) or prior to the MI. The purpose of the introduction is to provide the teen with an idea of the content, style, and limitations of the time that will be spent with the counselor. We introduce the session as an opportunity for teens to talk about their thoughts and feelings about the event that brought them to the ER, to get some information about their pattern of drinking and the effects of alcohol, and to spend some time, if they are interested, talking about ways to avoid similar things happening in the future. In our ER setting counselors emphasize that they will not tell the teen what to do; rather it is up to the teen to make decisions and choices about drinking and about things he or she does when drinking. (Of course, this statement about the counselor's orientation should be made only if it is consistent with the program that the teen is attending.) The circumstances that precipitated the ER visit are then reviewed, including how much the teen had been drinking, whom he or she was with, and any injuries sustained or consequences suffered. The use of open-ended questions in this part of the interview enhances rapport and helps the counselor rapidly develop an understanding of the teen's recent drinking patterns and associations. An open-ended question is a question that cannot be answered with one word or very brief responses. For example, asking "How was alcohol a part of what happened?" is open-ended, whereas "What did you drink?" is not.

For sessions that are preventive in nature (i.e., not following an indentifiable concern about a teen, such as a recent alcohol violation or similar event), the purpose of the session can be articulated as an opportunity to talk about experiences with alcohol and to address any concerns or questions the teen might have. Whether or not there is a precipitating event, the counselor should state his or her interest in getting the teen's perspective overtly at the outset and demonstrate that interest throughout the session.

The introduction provides an opportunity to establish rapport and minimize defensiveness. The counselor should present an empathic, concerned, nonauthoritarian, and nonjudgmental style (see, e.g., Miller, 1995). It is important for teens to believe that the counselor respects their ideas, is interested in hearing about their experiences, and will not scold them or make disapproving statements about their behavior. This introduction is straightforward and can be used regardless of the nature of the referral (i.e., voluntary or involuntary). See Table 5.1 for elements to include in the introduction.

The following introductory statements illustrate the manner in which we describe the MI session to teens. We discuss the structure, content, and aim of the session, with repeated emphasis on the teen's personal responsibility and choice regarding changing alcohol use. Notice the collaborative tenor of the introduction, in that the counselor is establishing that the two will work together to generate strategies to avoid similar situations in the future.

"What I'd like to do now is explore with you your alcohol use. We're concerned about risky drinking and other risky behaviors that tend to go along with drinking, like driving. I can't tell you what to do; only you can decide what you'll do. Rather, I'd like to find out what you think about drinking after this experience and maybe see if together we can come up with some ways to avoid these kinds of situations in the future. You're the one who will decide what happens with your drinking. If you choose, you can make changes in your drinking, but that's really up to you. How does that sound? Can we try this out?"

Many teens express concerns about divulging information about their alcohol use. The following illustrates how we broach the sensitive topic of confidentiality with teens in the ER. Brittany, a 17-year-old white female who arrived by ambulance at the ER after being involved in a motor vehicle accident in which she was the driver, shares her concerns with the counselor.

Counselor: First, before we begin, I'd like to talk to you about the project and what we'll be doing. I'll be asking you a number of questions about your alcohol use and other substance use, ask you about the events that led up to the car accident tonight, provide you with some information from the questionnaires you completed earlier if you're interested, and talk about some ways you may be able to avoid this kind of thing happening again. How does that sound? Brittany: Well, I don't know.... I don't know how much I want to talk about what happened. I don't want this going on my permanent record. I really don't want anyone to know what happened, and besides, I was in a car accident. I probably shouldn't say anything at all. Counselor: I can understand how you might feel that way. Let me tell you about confidentiality and its limits. Everything you tell us is kept strictly confidential-that means that I will not share the information you give me nor anything you say during our discussion with anyone, including your parents or the staff here at the ER. The only times when I'm required by law to report information to the authorities are as follows: when a person says that they are going to hurt themselves or hurt others or when there's suspicion of child abuse or neglect or elder abuse or neglect. Aside from those instances, everything you tell me is confidential. We don't even put your name or any other potentially identifying material on any project material, except our follow-up forms, which are kept in a separate place in a locked file. What other concerns do you have about participating? Brittany: Um, I don't want the police to know what I say. Counselor: We also protect your confidentiality outside of the ER setting. So if the police, your school, or anyone else called and wanted information, we couldn't release anything to them. We also don't acknowledge that you even participated in the project. The only way they would know if you participated in this project would be if you decided to tell them. Brittany: Oh, I see. Well, I guess that sounds okay. What if I decide that I don't want to do this anymore? Will you tell anyone then? Counselor: No. If you decided not to continue in the project, we wouldn't tell anyone about any of the information you gave us. We keep all of the information teenagers give us in a locked filing cabinet, and the only people who have access to it are those directly involved in the research project. Your name is not on any of the questionnaires you answer. Brittany: Okay, I feel a little better about it. You can go ahead with your questions. Counselor: Great. Let's get started.

Participant Assessment

In our program, assessment instruments serve a dual purpose.

Continues...


Excerpted from Adolescents, Alcohol, and Substance Abuse Copyright © 2004 by The Guilford Press. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents


Introduction, Peter M. Monti, Suzanne M. Colby, and Tracy A. O'Leary
I. Background and Context: Theory, Developmental, and Measurement Considerations
1. Developmental Matters: Taking the Long View on Substance Abuse Etiology and Intervention during Adolescence, John Schulenberg, Jennifer L. Maggs, Kenneth J. Steinman, and Robert A. Zucker
2. The Harm Reduction Approach to the Secondary Prevention of Alcohol Problems in Adolescents and Young Adults: Considerations across a Developmental Spectrum, Elizabeth T. Miller, Aaron P. Turner, and G. Alan Marlatt
3. Assessing Adolescent Substance Use Problems and Other Areas of Functioning: State of the Art, Ken C. Winters
4. Personality and Learning Factors Combine to Create Risk for Adolescent Problem Drinking: A Model and Suggestions for Intervention, Gregory T. Smith and Kristen G. Anderson
II. Empirical Illustrations Linked to Part I/Clinical Applications and Brief Interventions
5. Motivational Enhancement for Alcohol-Involved Adolescents, Peter M. Monti, Nancy P. Barnett, Tracy A. O'Leary, and Suzanne M. Colby
6. Alcohol Skills Training for College Students, Elizabeth T. Miller, Jason R. Kilmer, Eleanor L. Kim, Kenneth R. Weingardt, and G. Alan Marlatt
7. Integrative Behavioral and Family Therapy for Adolescent Substance Abuse, Holly Barrett Waldron, Janet L. Brody, and Natasha Slesnick
8. Motivational Interviewing and the Prevention of HIV among Adolescents, Larry K. Brown and Kevin J. Lourie
9. Toward Brief Interventions for Adolescents with Substance Abuse and Comorbid Psychiatric Problems, Mark G. Myers, Sandra A. Brown, Susan Tate, Ana Abrantes, and Kristin Tomlinson
10. New Frontiers: Using the Internet to Engage Teens in Substance Abuse Prevention and Treatment, Harvey Skinner, Oonagh Maley, Louise Smith, Shawn Chirrey, and Meg Morrison
III. Future Directions
11. Transdisciplinary Research to Improve Brief Interventions for Addictive Behaviors, David B. Abrams and Richard R. Clayton
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