Reason for Substance Use Predicts Treatment Outcome in Adolescents

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.

Reference:
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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  • Steven Dawson

    Steven Dawson

    January 22nd, 2013 at 10:45 AM

    Great article. I think now more than ever the “why” is so important to understand. I have seen the same results in my work with young people. The PR group has a very different drug use experience and therefore needs a different approach. Motivational interviewing has shown some very positive results for young people with substance use issues.

  • darius

    darius

    January 22nd, 2013 at 12:06 PM

    I can see how this works..for those that are looking for ways to cope with negative states the substance is a solace, a support.. so if they find a new support without the addiction they will respond and may give up the substance altogether.. but for the PR group it is something that provides an elevated level of feeling good, something that is certainly not easy to give up..!

  • Karen

    Karen

    January 22nd, 2013 at 11:11 PM

    I don’t think this is something of a one-size-fits-all..What negative states pushes a person into something more negative?Such people are only looking to escape their problems.They are no better than those that abuse substances for a good feeling.a thorough analysis for each person may prove to be a better solution.

  • Dane

    Dane

    January 23rd, 2013 at 4:00 AM

    When I first read this I thought that there had to be a mistake, but as I thought about it more I can see how it happens. The ones looking for positive outcomes they are just off searching for the enwest way to get high. It’s not that there’s anything worng, they are just searching for excitement while those looking for a way to overcome the negative are probably a lot more open to finding ways that does not involve abuse to help deal with theirs.

  • CESAR

    CESAR

    January 24th, 2013 at 12:01 AM

    Oh the reason for use may be the key sure! Because after all it is the roots from which a plant gets its nutrients.Likewise if the reason is identified we can better be able to control and fix the addiction.but really,how many deaddiction techniques actually try and find out the reasons for substance use in the first place?not many I’d reckon.that approach needs to change.

  • Tonya

    Tonya

    January 24th, 2013 at 11:44 AM

    Right on Cesar! Not only treatment techniques but if even schools can have their students complete surveys they could potentially reduce addiction cases among students and put an end to this epidemic that has threatened our youth for so long.

  • Sarah

    Sarah

    May 8th, 2014 at 6:47 AM

    As the author of the original article, thank you for your positive comments. In working with individuals with addiction, it is important to consider multiple factors that may lead to disordered use. For a long time, reason for use was thought to be part of motivation for use. We are now seeing these two elements may represent different constructs that need to be assessed separately in order to get a better picture of the individual’s addiction profile. Thank you for pulling these findings out of the journal and presenting them in this public forum.

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