News from the worlds of research and clinical practice
Volume 3, No. 3: CSAT's Cannabis Youth Treatment (CYT) Study
February 19, 2001
Brought to you by FAX, email, and on the web by the Mid-Atlantic Addiction Technology Transfer Center
Funded by Center for Substance Abuse Treatment, SAMHSA
Welcome to Addiction Exchange, a forum for the exchange of clinical practice and research information among clinicians, scientists, educators, and administrators in the field of addiction. In this issue, we discuss CSAT's Cannabis Youth Treatment (CYT) study. Conducted in some of the nation's leading community- based treatment systems and medical centers, this was one of the largest randomized field experiments conducted to date. Preliminary findings suggest that all five approaches to outpatient treatment have done better than evaluations of existing practice and are affordable. Below is some more background on the study, its findings, and how to find out more or get the treatment manuals.
From 1992 to 1998 the number of adolescents presenting for substance abuse treatment in the public system has increased by 53%, including a 115% jump in marijuana related admissions; marijuana is now the leading substance (exceeding even alcohol) mentioned in adolescent substance abuse treatment admissions, emergency room admissions and autopsies (Dennis, Noursi, & Muck, in press). While over 80% of these adolescents are treated in outpatient settings, evaluations of existing practice have produced mixed results and been plagued by a myriad of methodological problems.
Following recommendations from the Institute of Medicine (Lamb et al., 1998) and other experts, the field has focused on developing treatment protocol manuals to improve practice. In particular, the Center for Substance Abuse Treatment (CSAT) funded CYT study to identify five of the most promising approaches to adolescent outpatient treatment, develop manuals for their implementation in community based settings, and evaluate them in the largest (n=600) multi-site randomized field experiment ever conducted with this population (see
http://www.samhsa.gov/centers/csat/content/Recoverymonth/000907rptcover.htm).
The sites used for the study were Chestnut Health Systems in Bloomington and Madison County, IL, the University of Connecticut Health Center in Farmington, CT, Operation PAR in St. Petersburg, FL, and the Child Guidance Center in Philadelphia (now called Children's Hospital of Philadelphia). The five treatments ranged in model, duration, modality (e.g, individual, group), degree of family involvement and cost.
According to Dr. Michael Dennis, Principal Investigator for the study and chair of the CYT Steering Committee, the study's findings showed that overall, all five of the study's approaches are more effective than current practice, with some significant differences appearing to emerge in their effectiveness. "The thing that intrigued me the most was that they all worked so much better than existing practice," Dennis said. He attributed their effectiveness to the study's "critical ingredients," which were that they all had treatment manuals and focused a great deal on quality assurance. This was done by changing the duties of the clinical supervisors from mostly paperwork to actual involvement in the clinical protocols. Each supervisor initially sat in on or taped each counselor's sessions off and on for an average of six to eight months, until they felt the counselor had mastered the study's clinical techniques. The staff loved it, said Dennis, because they felt they were getting a lot more out of clinical supervision. "This isn't training," said Dennis, "this is change."
The study's treatment outcomes improved dramatically between intake and three months post-treatment, and there were significant increases in the percentage of adolescents reporting no past-month use (4% to 34%) and those reporting no past-month abuse or dependence symptoms (19% to 61%). The rate of any use decreased by 31% between the three months before and after treatment - better than in all prior studies of adolescent outpatient treatment in community settings.
There were significant differences found by type of treatment, problem severity, and their interaction. However, most of these differences were minor compared to the overall improvement in practice and the fact that their average cost per week ($105 to $244) was similar to that reported by outpatient adolescent program directors. "Which treatments are used in practice," said Dennis, "is more likely to vary based on organizational staffing and resources."
CYT finished its field work in February, 2001. Preliminary analysis reveals that the assessment and five treatment protocols all worked much better than existing practice. The CYT assessment and treatment are being released to the field this spring via CSAT (www.samhsa.gov/csat ) and NCADI (1-800-SAY-NOTO). NOTE: The Mid-ATTC is offering a related online course, Issues in Substance Abuse Treatment for Adolescents, which begins February 26. For more information, visit our web site at www.mid-attc.org and go to Training & Education -> Online Courses.
Go to http://www.mid-attc.org/wwwboard/wwwboard.shtml to discuss this topic on the Addiction Exchange Forum.
We hope you find Addiction Exchange useful in your work. Please let us know about your information needs by emailing the editor of Addiction Exchange at mid-attc@mindspring.com, or discuss your training needs by contacting us by email or telephone at (804)-828-9910. Visit the Mid-ATTC website at http://www.mid-attc.org.
Please copy and distribute to your colleagues and students!!!!
