DRUG ALCOHOL AND SUBSTANCE ABUSE: RESEARCH :
ADOLESCENTS: HEALTH :
FAMILY THERAPY :
RESEARCH ARTICLES :
The Comparative Effectiveness of Outpatient Treatment for Adolescent Substance Abuse: A Meta-Analysis
Tanner-Smith E.E., Wilson S.J., Lipsey M.W.
Journal of Substance Abuse Treatment: 2013, 44, p. 145–158.
KEY POINTS FROM SUMMARY AND COMMENTARY
Studies included in the analysis were required to involve an identifiable non-residential treatment
for substance use problems for patients aged between 12 and 20.
Generally the substance use outcomes of the various distinct treatment types represented
in the studies did not significantly differ.
The exception was family therapies, which returned the most convincing and consistent evidence
of comparative effectiveness, but even here the evidence was too limited to support definitive conclusions.
SUMMARY Causes and consequences of substance use disorders may differ for adolescents and adults.
One implication is that evidence on the effectiveness of treatment for adolescents should be based on research
conducted with adolescents, not inferred from research with adults. To this end, the featured review amalgamated
findings from research on young people aged 12–20 to assess the relative effectiveness of different non-residential
substance use treatments for young people.
The only relatively comprehensive previous review with a similar remit was limited to trials which randomly allocated
patients to different treatments or no treatment, and analysis of treatment differences was limited to cognitive-behavioural
therapy and two forms of family therapy.
Instead, the featured analysis aimed to analyse all treatment modalities represented in all the available studies capable
of providing useful information about comparative treatment effects. It included not just randomised trials, but also
non-randomised studies (though in the event there were few) which took steps to eliminate or adjust for pre-existing
difference between participants allocated to different treatments or to treatment versus no treatment.
Studies included in the analysis were required to involve an identifiable non-residential treatment for substance use problems
for patients aged between 12 and 20 who met diagnostic criteria for substance abuse or dependence. Restriction to
non-residential was to avoid the differences in participants, treatment modalities, and treatment intensity between these and
residential programmes. Studies had to have been reported in English in 1980 or after. Comparisons of very similar treatments
were not included in the analyses.
An extensive attempt was made to extract data about research methods, outcome measures, and sample and treatment
characteristics which might have affected outcomes and to adjust for these in the analysis. New techniques were used to
amalgamate data on the multiple outcomes reported in many of the studies.
An extensive literature search found 45 published and unpublished studies reported from 1981 to 2008, nearly all of which had
randomly allocated participants to (usually) alternative approaches or (less commonly) to treatment versus no treatment.
Because some studies evaluated several treatments, the 45 studies yielded 73 different comparisons between treatments, or
between treatment versus no treatment. Outcomes related to alcohol were most commonly reported followed by mixed substance
use and cannabis. Nearly half the samples included youngsters with clinical levels of psychiatric comorbidity and most participants
had some arrest or police-contact history. On average their substance use was of moderate severity. Treatment duration averaged
about 10 weeks, during which patients were seen on average about twice a week. The follow-up assessment was on average just
over five months after the pre-treatment assessment, ranging up to four years.
Additional to no treatment at all, the types of treatment compared in the studies were categorised as either:
behavioural therapies such as contingency management based on the principles of rewards, punishment, and
reinforcement; cognitive-behavioural therapies; family therapies; generic counselling in a group, individual or
family format which does not fall in other clearly defined categories; approaches based on motivational interviewing
including motivational enhancement therapy, which develops motivational principles into a self-contained,
manualised treatment programme; combined motivational and cognitive-behavioural strategies; psychoeducation
involving teaching clients about substance use and substance-related issues; pharmacological therapies;
skills training (eg, in relaxation) which does not fall in another clearly defined category; and practice as usual.
Findings based on post-treatment assessments
Findings based on post-treatment assessments
Findings based on before v. after treatment assessments
The authors’ conclusions
Evidence was limited
Researcher’s allegiance to the approach might have affected results
Do family therapies warrant the extra costs?
Reserve for most severe cases?
MATRIX CELL 2013 Drug Matrix cell A4: Interventions; Psychosocial therapies
MATRIX CELL 2013 Drug Matrix cell B4: Practitioners; Psychosocial therapies
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