The BEST plus approach to assisting families recover from youth substance problems

The Best plus program is a whole-of-family therapy option for families to address not only youth substance abuse issues, but also challenging and antisocial adolescent behaviours. It uses an evidence-based strategy that can be implemented widely in the community, and is proving to be a popular and relevant framework for professionals to engage and assist families in reducing adolescent problem behaviours. Evaluations indicate that the program is an effective forum for parents and siblings of adolescent drug abusers to redevelop positive family environments that encourage responsible behaviour and recovery from drug abuse.

Does family intervention for adolescent substance use impact parental wellbeing?

Adolescent substance abuse is a prevalent problem and family interventions are increasingly used to prevent this problem and to assist family coping. The effectiveness of a prevention-focussed family intervention was evaluated within a randomised school trial for its secondary impacts on improving parental mental health and family functioning.

Exploring family and community involvement to protect Thai youths from alcohol and illegal drug abuse

Youth substance abuse is widely recognized as a major public health issue in Thailand. This study explores family and community risk and protective factors relevant to alcohol and illegal drug misuse in 1,778 Thai teenagers. Strong family attachment and a family history of antisocial behaviors were strongly associated with nearly all forms of substance abuse, with adjusted odds ratios ranging from 5.05 to 8.45. Community disorganization was strongly associated with self-reported substance use, although involvement in prosocial activities acted as a protective factor. The findings suggest that interventions that promote family cohesion and encourage community involvement may have considerable benefits in reducing substance abuse in Thai adolescents.

The relationship between child sexual abuse and academic achievement in a sample of adolescent psychiatric inpatients

Objectives:
To examine the relationship between sexual abuse and academic achievement in an adolescent inpatient psychiatric population. Individual factors expected to influence this relationship were measured to explore the way they each interacted with sexual abuse and its relationship to academic achievement.

Method:
Eighty-one adolescent psychiatric inpatients participated in the study (aged 12–18 years: M = 16.0). Participants were administered tests of academic achievement (dependent variable) and intelligence, and completed a number of self-report measures of their experience of different types of maltreatment, their perception of the parenting they received, socio-economic status, substance abuse, and psychopathology.

Results:
Hierarchical regression analysis revealed that intelligence was the main predictor of academic achievement (uniquely explaining 26% of the variance). A number of interaction effects were also significant indicating that intelligence, substance abuse, internalizing behavior problems, externalizing behavior problems all influenced the relationship between sexual abuse and academic achievement.

Narcotics Anonymous participation and changes in substance use and social support

In Victoria (a southern Australian state) in 1995, Narcotics Anonymous had a small but growing membership providing an opportunity to study the early experience of new self-help members. Ninety-one new members were interviewed and 62 (68%) were reinterviewed after 12 months. Three measures of self-help participation were examined: service role involvement, step work, and stable meeting attendance. Lower prior involvement in treatment services and greater participation in self-help predicted subsequent self-help participation. Higher levels of secondary school education predicted service role involvement and longer periods in stable meeting attendance. Higher self-help participation through the 12 months prior to follow-up was associated with lower levels of hazardous alcohol use and higher emotional support at reinterview. Multivariate regression analysis suggested stable self-help meeting attendance and step work continued to predict reductions in hazardous alcohol use and improvements in social support, after controlling for a range of alternative predictors.

Does family intervention for adolescent substance use impact parental mental health? A systematic review

Adolescent substance abuse is a prevalent problem and both individual and group family interventions are increasingly being used to assist families to cope. A literature review was conducted to identify whether individual and group family interventions for adolescent substance abuse enhance the mental health of parents and other family members. The review also sought to identify direct and indirect effects of family intervention processes on depressive symptoms and general distress. Based on quality criteria a total of nine studies were included. Of these, six quantitatively examined family intervention outcomes on family member mental health, with all six reporting positive effects. Four of the nine studies measured levels of depressive symptoms and three of these four studies reported significant direct effects of family intervention on parental depression. The positive effects were also found in the three qualitative studies included in the review. Indirect therapeutic mechanisms that contributed to mental health improvements included: reduction of stress symptoms, improved coping, improved family functioning, more effective parenting behaviours, attitude changes, perceived changes in relative’s substance use, and improved social support. The available literature suggests that a number of determinants of family mental health may potentially be impacted through family intervention for adolescent substance abuse. However, definitive conclusions cannot be made at this point as the literature is mostly descriptive and there have been few longitudinal studies or randomised controlled trials.

Mental illness and substance use : an Australian perspective

This paper presents a review of the literature of service trends and practice recommendations for management of those with the dual diagnosis of mental illness and substance abuse. The method for the review was to search bibliographical data bases and hand held literature published in English between 1990 and 2007. Using the search terms dual diagnosis, and co-morbidity and mental illness, 93 abstracts were selected and reviewed. The authors concluded that a collaborative approach to care with better integration of drug and alcohol services within mental health would benefit clients with a dual diagnosis. Improved education to enhance the assessment and diagnosis of this client group is also considered essential for clinicians in both mental health and alcohol and drugs services.

Can emotion-focused coping help explain the link between posttraumatic stress disorder severity and triggers for substance use in young adults

High rates of posttraumatic stress disorder (PTSD) have been reported among people seeking treatment for substance use disorders (SUDs), although few studies have examined the relationship between PTSD and substance use in young drug users. This study compared levels of substance use, coping styles, and high-risk triggers for substance use among 66 young adults with SUD, with or without comorbid PTSD. Young people with current SUD–PTSD (n = 36) reported significantly higher levels of substance use in negative situations, as well as emotion-focused coping, compared to the current SUD-only group (n = 30). Severity of PTSD was a significant predictor of negative situational drug use, and emotion-focused coping was found to mediate this relationship. The findings underscore the need for youth substance abuse treatment programs to include coping skills training and management of affect regulation for those individuals with comorbid SUD–PTSD.

Factors influencing the relationship between sexual abuse and academic achievement

This study examined factors expected to influence the relationship between sexual abuse and academic achievement in an adolescent inpatient psychiatric population. It was found that sexual abuse combined with either low intelligence, substance abuse, internalising behaviour problems or externalising behaviour problems predicted poor academic achievement. The supporting portfolio aims to discuss the proposed relationship between attachment and adolescent depression, highlighting the clinical relevance of this body of research with four cases of adolescent depression.

Delayed allegations of sexual abuse, complainant credibility and juror verdict

This study investigated laypersons' perceptions of memory evidence in a mock childhood sexual abuse trial. Results indicated that delay, memory type (continuous vs. recovered) and the nature of the alleged sexual assault (penetrative vs. fondling) influenced both how witnesses were perceived and the outcome of the trial.

Self-reported substance use and intervention experience of prisoners with intellectual disability

Background It has been increasingly recognised that many offenders with intellectual disability (ID) have substance use issues, yet surprisingly little is known about the treatment needs of this population.Method In order to explore pre-sentence patterns of substance use, the role of substance use in offending behaviour, and experience with substance treatment programs, interviews were conducted with 33 sentenced prisoners.Results The findings of this study identified hazardous and harmful rates of alcohol use and high rates of substance use among prisoners with ID. Most participants reported being intoxicated at the time of their offence. Participants experience of substance intervention programs varied. Although many reported a positive experience, others reported significant participation barriers.Conclusions This study supports the increasingly recognised link between substance use and offending behaviour among prisoners with ID and highlights the importance of tailored and coordinated treatment initiatives, both within corrections facilities and the community.

What do we know about preventing drug-related harm through social developmental intervention with children and young people

This chapter examines the evidence for the effectiveness of interventions aiming to reduce drug-related harm by improving conditions for healthy develeopment in the earliest years through adolescence. Of the interventions beginning prior to birth, there is efficacy evidence that family home visitation is a feasible strategy for implementation with disadvataged families and can reduce risk factors for early developmental deficits and thereby improve childhood development outcomes. There is efficacy evidence for strategies such as parent education and school preparation through the pre-school age period. Some of the strongest evidence for efficacy in reducing developmental pathways to drug-related harm comes from interventions delivered through the early school years to improve educational environments. Of the interventions targeting the high school age period, school drug education has been the most commonly evaluated. The evidence suggests that short term reduction in both drug use and progression to frequent drug use may be achievable through this strategy, but the prospects for longer-term and population-level behaviour change is still unclear. In overview, a range of prevention strategies have been developed and evaluated. Most of the exisiting evidence is restricted to efficacy studies and there are future challenges to progress evaluation through to studies of effectiveness. In general, prevention programmes appear more successful where they maintain intervention activities over a number of years and incorporate more than one strategy. Much of the existing research has been based in North America and evaluates discrete programmes. Future research should test effects in other countries, in different social contexts and seek to better understand the interrelated effects of combining interventions within the community. Developmental prevention programmes target different age periods and social settings, hence communities have the challenge of coordinating a mixture of programmes that address the local conditions that adversely influence child and youth development. There are opportunities in this work to coordinate prevention activities using funding from different jurisdictions (e.g., crime prevention, health promotion, mental health, education, substance abuse prevention).