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September 1, 2004
Community-based drug treatment programs can help troubled teens reduce substance abuse and improve their psychological health, according a RAND Corporation study issued today that is one of the most thorough examinations ever of the effectiveness of a commonly available treatment approach.
Researchers found that teen probationers enrolled in a drug treatment program that follows a widely used care model were more likely to curb their drug use and have better psychological health such as fewer symptoms of depression than their peers who received other probation services such as camps, detention or long-term placements that were not focused on treating substance abuse.
“This is the first clear evidence that the kinds of substance abuse treatments commonly available to teens can be effective,” said Andrew Morral, a RAND researcher and lead author of the study. “In the program we studied, improvement began immediately and continued for at least 12 months.”
Researchers from RAND’s Drug Policy Research Center say the findings raise important questions about calls for community-based treatment programs to adopt new substance abuse treatment methods developed in academic researcher centers.
“Everyone wants the treatments provided to teens to be effective, so there is a lot of interest in encouraging community-based treatment providers to adopt one of a handful of approaches that have been rigorously evaluated,” Morral said. “Our finding that a widely available community-based treatment approach can be effective suggests that before we replace the current treatment system with the few experimentally validated treatment approaches, we should first make sure that they are, in fact, more effective than what’s already out there.”
The findings appear in the September issue of the journal Psychology of Addictive Behaviors.
The RAND study examined 175 youths ages 13 to 17 who received treatment at the Phoenix Academy of Los Angeles after being placed on probation by the court system. Phoenix Academy is a residential drug abuse treatment program for adolescents using a “therapeutic community” treatment model that emphasizes personal responsibility and mutual self-help.
The Phoenix Academy in Los Angeles is operated by Phoenix House, one of the largest non-profit substance abuse treatment providers in the nation. The organization operates Phoenix Academies for adolescents in: Los Angeles, Santa Ana and San Diego, CA; Augusta, ME; Springfield, MA; Dublin, NH; Long Island, New York and Westchester, NY; Pascoag, RI; Austin and Dallas, TX.
In the RAND study, the treated group was compared with 274 other adolescent probationers using a sophisticated statistical procedure that ensured that before treatment comparison youths were similar to treated youths in terms of drug use, criminal history and many other factors.
All adolescents were followed for one year, with researchers collecting periodic information about their drug use, psychological health and criminal behavior.
Drug use among both groups dropped sharply during the first three months, when most were in residential settings that inhibited such use. But those who took part in the Phoenix Academy program consistently reported less drug use both during and after the period when most were in the residential portion of the treatment.
Adolescents in the Phoenix Academy program also received mental health benefits from treatment. “It appears that adolescents who took part in the Phoenix Academy developed coping skills that helped them even after they left the residential part of the program,” Morral said. “They continued to experience reductions in symptoms of depression, anxiety and other forms of psychological distress even after they left the structured treatment setting.”
The one area where adolescents treated at Phoenix Academy did worse was in cigarette smoking. By the end of the 12-month study, those enrolled in the treatment program were more likely to be smoking cigarettes, and the proportion of treated youths smoking appeared to be rising.
“It may be that recovery, or recovery communities, place adolescent substance abusers at special risk for developing tobacco dependence,” Morral said. “This suggests that adolescent treatment programs should make special efforts and perhaps develop new tools for ensuring that young people do not develop a life threatening dependence on tobacco when they give up their use of other drugs.”
The number of adolescents enrolled in substance abuse treatment nationally rose nearly 50 percent from 1995 to 1998, reaching 138,000 admissions. Most of the increase is due to increased referrals from the criminal justice system, which now accounts for half of all adolescent substance abuse treatment admissions.
While there is substantial scientific evidence that demonstrates the usefulness of treatment programs designed in academic settings, there is relatively little research about the effectiveness of the community-based programs that provide most of the services nationally, according to researchers.
The most common treatment approaches available to adolescents draw upon self-help principles derived from recovery communities and the experiential knowledge of counselors.
Funding for the study was provided by the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, as part of a nationwide evaluation of community-based treatments for adolescents. Additional funding was provided by the National Institute on Drug Abuse. Other authors of the study are RAND researchers Daniel F. McCaffrey and Greg Ridgeway.
RAND's Drug Policy Research Center conducts research to provide firm empirical evidence that can lead to better policies. The center is a joint project of RAND Health and RAND Infrastructure, Safety and Environment.
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