The majority of substance use disorder (SUD) treatment approaches aimed at adolescents are outpatient treatment programs, primarily delivered in group settings. They usually focus on skill building, and for adolescents who are unmotivated to adopt the new skills, these types of interventions can be ineffective. Sarah J. Dow of the Department of Psychiatry at Massachusetts General Hospital at the Harvard Center for Addiction Medicine theorized that the reasons motivating young people to use substances could be the key for preventing that use. Therefore, Dow led a study that looked at the motivating forces for substance use in a sample of 109 adolescents. The participants were asked why they used alcohol or drugs and were assessed for mental health issues and abstinence as they went through treatment. They were evaluated on follow-up at three, six, and 12 months post-treatment.
The participants reported using substances for broadly one of two reasons: to enhance positive states (PR) or to deal with negative states (NR). The NR participants had more mental health problems and higher rates of substance use than the PR groups, but also responded much better to treatment than the PR participants. In fact, those in the PR group did not respond at all to the treatment. The gains made by the NR participants were not only significant, but were sustained at the three-month and six-month follow-up assessments.
Dow believes several conclusions can be drawn from these results. First, the NR group may have benefited more from treatment because the skill building addressed impulsive behaviors and taught adaptive coping strategies. Second, the PR group may be at risk for developing negative substance motivation with prolonged use. Dow believes that traditional SUD programs should still be used on NR participants, but PR individuals may benefit more from programs designed to increase motivation and raise awareness about the risks associated with alcohol and drug use. Finally, these findings shed a new light on group therapy for adolescents. If this study is a valid representation of the general population, then the combined treatment of PR and NR clients could pose a risk for both subgroups. NR individuals may adopt the positive substance attitudes of PR clients, and PR clients may exacerbate their use by taking on the coping strategies of NR clients. “Adolescents’ primary reason for substance use may provide unique clinical information that could inform treatment planning and patient-treatment matching,” Dow said. She hopes her results will help advance that approach.
Dow, S. J., and Kelly, J. F. (2012). Listening to youth: Adolescents’ reasons for substance use as a unique predictor of treatment response and outcome. Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0031065
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