cannabis youth treatment (cyt) trials: 12 and 30 month main findings michael dennis, ph.d. chestnut...

Cannabis Youth Treatment (CYT) Trials:

12 and 30 Month Main Findings

Michael Dennis, Ph.D. Chestnut Health SystemsBloomington, IL

Presentation for the Adolescent Treatment Initiative, Concord, NH, April 20, 2005. Sponsored by New Futures. The content of this presentations are based on treatment & research funded by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA) under contract 270-2003-00006 and several individual grants. The opinions are those of the author and do not reflect official positions of the consortium or government. Available on line at www.chestnut.org/LI/Posters or by contacting Joan Unsicker at 720 West Chestnut, Bloomington, IL 61701, phone: (309) 827-6026, fax: (309) 829-4661, e-Mail: [email protected]

Acknowledgement

This presentation is based on the work, input and contributions from several other people including: Nancy Angelovich, Tom Babor, Laura (Bunch) Brantley, Joseph A. Burleson, George Dent, Guy Diamond, James Fraser, Michael French, Rod Funk, Mark Godley, Susan H. Godley, Nancy Hamilton, James Herrell, David Hodgkins, Ronald Kadden, Yifrah Kaminer, Tracy L. Karvinen, Pamela Kelberg, Jodi (Johnson) Leckrone, Howard Liddle, Barbara McDougal, Kerry Anne McGeary, Robert Meyers, Suzie Panichelli-Mindel, Lora Passetti, Nancy Petry, M. Christopher Roebuck, Susan Sampl, Meleny Scudder, Christy Scott, Melissa Siekmann, Jane Smith, Zeena Tawfik, Frank Tims, Janet Titus, Jane Ungemack, Joan Unsicker, Chuck Webb, James West, Bill White, Michelle White, Caroline Hunter Williams, the other CYT staff, and the families who participated in this study. This presentation was supported by funds and data from the Center for Substance Abuse Treatment (CSAT’s) Persistent Effects of Treatment Study (PETS, Contract No. 270-97-7011) and the Cannabis Youth Treatment (CYT) Cooperative Agreement (Grant Nos. TI11317, TI11320, TI11321, TI11323, and TI11324). The opinions are those of the author and steering committee and do not reflect official positions of the government .

CYT Cannabis Youth Treatment Randomized Field Trial

Sponsored by: Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services

Coordinating Center:Chestnut Health Systems, Bloomington, IL, and Chicago, ILUniversity of Miami, Miami, FLUniversity of Conn. Health Center, Farmington, CT

Sites:Univ. of Conn. Health Center, Farmington, CTOperation PAR, St. Petersburg, FLChestnut Health Systems, Madison County, ILChildren’s Hosp. of Philadelphia, Phil. ,PA

Marijuana

Use is starting at younger ages Is at an historically high level among adolescents Potency increased 3-fold from 1980 to 1997 Is three times more likely to lead to dependence

among adolescents than adults Is associated with many health, mental and

behavioral problems Is the leading substance mentioned in adolescent

emergency room admissions and autopsies

Treatment

Marijuana related admissions to adolescent substance abuse treatment increased by 115% from 1992 to 1998

Over 80% of adolescents entering treatment in 1998 had a marijuana problem

Over 80% are entering outpatient treatment Over 75% receive less than 90 days of treatment

(median of 6 weeks) Evaluations of existing adolescent outpatient treatment

suggest that last than 90 days of outpatient treatment is rarely effective for reducing marijuana use.

Purpose of CYT

To learn more about the characteristics and needs of adolescent marijuana users presenting for outpatient treatment.

To adapt evidence-based, manual-guided therapies for use in 1.5 to 3 month adolescent outpatient treatment programs in medical centers or community based settings.

To field test the relative effectiveness, cost, cost-effectiveness, and benefit cost of five interventions targeted at marijuana use and associated problems in adolescents.

To provide validated models of these interventions to the treatment field in order to address the pressing demands for expanded and more effective services.

Design

Target Population: Adolescents with marijuana disorders who are appropriate for 1 to 3 months of outpatient treatment.

Inclusion Criteria: 12 to 18 year olds with symptoms of cannabis abuse or dependence, past 90 day use, and meeting ASAM criteria for outpatient treatment

Data Sources: self report, collateral reports, on-site and laboratory urine testing, therapist alliance and discharge reports, staff service logs, and cost analysis.

Random Assignment: to one of three treatments within site in two research arms and quarterly follow-up interview for 12 months

Long Term Follow-up: under a supplement from PETSA follow-up was extended to 30 months (42 for a subsample)

Randomly Assigns to:

MET/CBT5Motivational Enhancement Therapy/

Cognitive Behavioral Therapy (5 weeks)



FSN

Family Support Network

Plus MET/CBT12 (12 weeks)

ACRAAdolescent Community

Reinforcement Approach(12 weeks)

MDFTMultidimensional Family Therapy

Trial 2Trial 1Incremental Arm Alternative Arm

Two Trials or Study Arms

Randomly Assigns to:



(12 weeks)

Source: Dennis et al, 2002

Contrast of the Treatment Structures

Individual Adolescent Sessions

CBT Group Sessions

Individual Parent Sessions

Family Sessions/Home Visits

Parent Education Sessions

Total Formal Sessions

Type of ServiceMET/CBT5

MET/CBT12 FSN ACRA MDFT

2

3

5

2

10

12

2

10

4

6

22

10

2

2

14

6

3

6

15

Case management/Other Contacts

As needed

As needed

As needed

Total Expected Contacts 5 12 22+ 14+ 15+

Total Expected Hours 5 12 22+ 14+ 15+

Total Expected Weeks 6-7 12-13 12-13 12-13 12-13

Source: Diamond et al, 2002

5

10

5

11

14

23

0

5

10

15

20

25

MET/CBT5

MET/CBT12

MET/CBT12 +

FSN

MET/CBT5

ACRA MDFT

Hou

rs

Day

s

CaseManagement

FamilyCounseling

Collateral only

Multi-Familygroup

Multi-ParticipantGroup

Participant only

Incremental Arm Alternative Arm

Actual Treatment Received by Condition

Source: Dennis et al, under review

MET/CBT12 adds 7 more sessions of

group

FSN adds multi family group,

family home visits and more case management

ACRA and MDFT both rely on

individual, family and case management instead of group

With ACRA using more individual therapy

And MDFT using more

family therapy

Interventions Also Differ in Content

Source: CYT data

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Direct (3-6,9-10,19,99)

Family (1,7-8,15)

External (2,11-14,16-17)

Total (all)

MET/CBT5

MET/CBT12

FSNMMET/CBT5

ACRAMDFT

Variation in Family services

Variation in wrap around

services

Similarity in direct services

$1,559$1,413

$1,984

$3,322

$1,197$1,126

$-

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

MET/C

BT5 (6.8

wee

ks)

MET/C

BT12 (1

3.4 w

eeks

)

FSN (14.2

wee

ks w

/family

)

MET/C

BT5 (6.5

wee

ks)

ACRA (12.8

wee

ks)

MDFT(1

3.2 w

eeks

w/fa

mily)

$1,776

$3,495

NTIES E

st (6

.7 wee

ks)

NTIES E

st.(1

3.1 w

eeks

)

Ave

rage

Cos

t P

er C

lien

t-E

pis

ode

of C

are

|--------------------------------------------Economic Cost-------------------------------------------|-------- Director Estimate-----|

Average Episode Cost ($US) of Treatment

Source: French et al., 2002

Less than average

for 6 weeks

Less than average

for 12 weeks

Implementation of Evaluation

Over 85% of eligible families agreed to participate Quarterly follow-up of 94 to 98% of the adolescents from 3- to

12-months (88% all five interviews) Long term follow-up completed on 90% at 30-months and 91%

(of 116 subsample) at 42-months Collateral interviews were obtained at intake, 3- and 6-months

on over 92-100% of the adolescents interviewed Urine test data were obtained at intake, 3, 6, 30 and 42 months

90-100% of the adolescents who were not incarcerated or interviewed by phone (85% or more of all adolescents).

Self report marijuana use largely in agreement with urine test at 30 months (13.8% false negative, kappa=.63)

5 Treatment manuals drafted, field tested, revised, send out for field review, and finalized

Descriptive, outcome and economic analyses completed

Source: Dennis et al, 2002, under review

Adolescent Cannabis Users in CYT were as or More Severe Than Those in TEDS*

85%

46%

26%

78%

26%

47%

26%

71%

0%

20%

40%

60%

80%

100%

First usedunder age

15

Dependence Weekly ormore use at

intake

PriorTreatment

% o

f A

dm

issi

on

s

.

CYT Outpatient(n=600) TEDS Outpatient (n=16,480)* Adolescents with marijuana problems admitted to outpatient treatment

Source: Tims et al, 2002

Demographic Characteristics

62%

15%

55%50%

30%

83%

17%

0%

20%

40%

60%

80%

100%

Female Male AfricanAmerican

Caucasian Under 15 15 to 16 Singleparentfamily


Institutional Involvement

25%

87%

47%

62%

0%

20%

40%

60%

80%

100%

In school Employed Current CJInvolvement

Coming fromControlled

Environment


Patterns of Substance Use

9%17%

71%73%

0%

20%

40%

60%

80%

100%

Weekly Tobacco Use

WeeklyCannabis Use

Weekly AlcoholUse

Significant Timein ControlledEnvironment


Multiple Problems are the NORM

86%

37%

12%

25%

61%

60%

66%

83%

83%

0% 20% 40% 60% 80% 100%

Any Marijuana Use Disorder

Any Alcohol Use Disorder

Other Substance Use Disorders

Any Internal Disorder

Any External Disorder

Lifetime History of Victimization

Acts of Physical Violence

Any (other) Illegal Activity

Three to Twelve Problems

Self-Reported in Past Year

Source: Dennis et al, under review

Co-occurring Problems are Higher for those Self-Reporting Past Year Dependence

71%

57%

25%

42%

30%37%

22%

5%

13%

22%

0%

20%

40%

60%

80%

100%

Health ProblemDistress*

Acute MentalDistress*

AcuteTraumaticDistress*

AttentionDeficit

HyperactivityDisorder*

ConductDisorder*

Past Year Dependence (n=278) Other (n=322)

Source: Tims et al., 2002 * p<.05

CYT Increased Days Abstinent and Percent in Recovery (no use or problems while in community)

Source: Dennis et al., 2004

0

10

20

30

40

50

60

70

80

90

Intake 3 6 9 12

Day

s A

bsti

nent

Per

Qua

rter

.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

% i

n R

ecov

ery

at t

he E

nd o

f th

e Q

uart

er .

Days Abstinent

Percent in Recovery

Similarity of Clinical Outcomes by Conditions


200

220

240

260

280

300

Tota

l day

abs

tine

nt .

over

12

mon

ths

0%

10%

20%

30%

40%

50%

Per

cent

in R

ecov

ery

. at

Mon

th 1

2

Total Days Abstinent* 269 256 260 251 265 257

Percent in Recovery** 0.28 0.17 0.22 0.23 0.34 0.19

MET/ CBT5 (n=102)

MET/ CBT12

FSNM (n=102)

MET/ CBT5 (n=99)

ACRA (n=100)

MDFT (n=99)

Trial 1 Trial 2

Moderate to large differences in Cost-Effectiveness by Condition


$0

$4

$8

$12

$16

$20

Cos

t per

day

of

abst

inen

ce o

ver

12 m

onth

s

$0

$4,000

$8,000

$12,000

$16,000

$20,000

Cos

t per

per

son

in r

ecov

ery

at m

onth

12

CPDA* $4.91 $6.15 $15.13 $9.00 $6.62 $10.38

CPPR** $3,958 $7,377 $15,116 $6,611 $4,460 $11,775

MET/ CBT5MET/

CBT12FSN MET/ CBT5 ACRA MDFT

* p<.05 effect size f=0.48** p<.05, effect size f=0.72

Trial 1 Trial 2

* p<.05 effect size f=0.22 ** p<.05, effect size f=0.78

MET/CBT5 and 12 did better

than FSN

ACRA did better than MET/CBT5, and both did better than MDFT

Evaluating the Effects of Treatment

Short Term Outcome Stability Difference between average of

early (3-6) and latter (9-12) follow-up interviews

Treatment OutcomeDifference between intake and average

of all short term follow-ups (3-12)

Long Term Stability Difference between average of short term

follow-ups (3-12) and long term follow-up (30)

Source: Dennis et al, under review, forthcoming

Month

Z-S

core

-0.60

-0.50

-0.40

-0.30

-0.20

-0.10

0.00

0 3 6 9 12

15

18

21

24

27

30

Freq. of Use

Sub. Prob.

Change in Substance Frequency Scale in CYT Trial 1: Incremental Arm

Months from Intake

0.00

0.05

0.10

0.15

0.20

0.25

0 3 6 9 12 15 18 21 24 27 30

MET/CBT5

MET/CBT12

FSN

Source: Dennis et al, forthcoming

Treatment Outcome: -Use reduced (-34%)

- No Sig. Dif. by condition

Short Term Stability:- Outcomes stable (-1%) - No Sig. Dif. by condition

Long Term Stability:- Use increases (+64%)


Change in Number of Substance Problems in CYT Trial 1: Incremental Arm

Months from Intake

0

1

2

3

4

5

0 3 6 9 12 15 18 21 24 27 30

MET/CBT5

MET/CBT12

FSN


Long Term Stability:-Problems increase (+17%)

-Sig. Dif. by condition (+37% vs +10% vs +7%)

Treatment Outcome: -Problems reduced (-46%)

- Sig. Dif. by condition(-50% vs. –33% vs. –51%)

Short Term Stability:-Further reductions (-25%)- No difference by condition

Change in Substance Frequency Scale inCYT Trial 2: Alternative Arm

Months from Intake

0.00

0.05

0.10

0.15

0.20

0.25

0 3 6 9 12 15 18 21 24 27 30

MET/CBT5

ACRA

MDFT


Treatment Outcome: - Use reduced (-35%)


Short Term Stability:-Further reductions (-6%)

- Sig. Dif. by condition(+4% vs. –10% vs. –11%)

Long Term Stability:- Outcomes stable

(+20%)-No Sig. Dif. by condition

Change in Number of Substance Problems inCYT Trial 2: Alternative Arm

Months from Intake

0

1

2

3

4

5

0 3 6 9 12 15 18 21 24 27 30

MET/CBT5

ACRA

MDFT


Long Term Stability:- Outcomes stable (+7%)-No Sig. Dif. by condition

Treatment Outcome: - Problems reduced (-43%)- No difference by condition

Short Term Stability:- Outcomes stable (-8%)


Percent in Past Month Recovery (no use or problems while living in the community)

14%17%

6%

14%11%

18%

0%

10%

20%

30%

40%

50%

0 3 6 9 12 30MET/ CBT5

0 3 6 9 12 30MET/ CBT12

0 3 6 9 12 30FSN

0 3 6 9 12 30MET/ CBT5

0 3 6 9 12 30ACRA

0 3 6 9 12 30MDFT


Cumulative Recovery Pattern at 30 months:(The Majority Vacillate in and out of Recovery)


37% Sustained Problems

5% Sustained Recovery

19% Intermittent, currently in

recovery

39% Intermittent, currently not in

recovery

Adolescent’s different in their Relapse trajectories

Source: Godley, et al, 2004

Initially (months 6-12) suppressed by

controlled environment, but similar at

30 months

Environmental Factors are also the Major Predictors of Relapse

RecoveryEnvironment

Risk

SocialRisk

FamilyConfict

FamilyCohesion

SocialSupport

SubstanceUse

Substance-Related

Problems

Baseline

Baseline

Baseline Baseline

.32.18

-.13

.21

-.08

.32

.19

.22

.32

.22

.17

.11

.43

.77

.82

.74 .58

-.54

-.09

.19

Source: Godley et al (2005)

Model Fit CFI=.97 to .99 RMSEA=.04 to .06

The effects of adolescent treatment are mediated by the extent to which they lead to actual changes in the recovery environment or peer group

AOD use in the home, homelessness, family problems, fighting,

victimization, self help group participation, structure activities

Peer AOD use, fighting, illegal activity, treatment,

recovery, vocational activity

Cost Per Person in Recovery at 12 and 30 Months After Intake by CYT Condition

Source: Dennis et al., under review; forthcoming

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

CPPR at 30 months** $6,437 $10,405 $24,725 $27,109 $8,257 $14,222

CPPR at 12 months* $3,958 $7,377 $15,116 $6,611 $4,460 $11,775

MET/ CBT5 MET/ CBT12 FSNM MET/ CBT5 ACRA MDFT

Trial 1 (n=299) Trial 2 (n=297)

Cos

t P

er P

erso

n in

Rec

over

y (C

PP

R)

* P<.0001, Cohen’s f= 1.42 and 1.77 at 12 months** P<.0001, Cohen’s f= 0.76 and 0.94 at 30 months

Stability of MET/CBT-5

findings mixed at 30 months

Integrated family therapy (MDFT) was more cost effective than

adding it on top of treatment (FSN) at 30 months

MET/CBT-5, -12 and ACRA more cost effective at

12 months

Reduction in Average Cost to Society in CYT Trial 1: Incremental Arm

$-

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

Intake 3 6 9 12 15 18 21 24 27 30

Months from Intake

MET/CBT5

MET/CBT12

FSNM

Source: French et al, 2004; forthcoming

Includes the cost of CYT Treatment

Further Reductions

(-47%) occurred out to

30 months

Reductions (-23%) in Average

Cost to Society offset Treatment Costs within 12

months

Reduction in Average Cost to Society in CYT Trial 2: Alternative Arm

$-

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

Intake 3 6 9 12 15 18 21 24 27 30

Months from Intake

MET/CBT5

ACRA

MDFT


Includes the cost of CYT Treatment

Average Cost to Society goes up then down and

does not offset Tx Costs within 12 months (+7%)

Further Reductions

occurred out to 30 months

(-40%)

Average Cost to Society Varied More by Site than Condition

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

0 3 6 9 12 15 18 21 24 27 30

Months from Intake

UCHC, Farmington, CT (-24%, -44%)

PAR, St. Petersburg, FL (-22%, -49%)

CHS, Madison Co., IL (-8%, -51%)

CHOP, Philadelphia, PA (+18%, -34%)


Site differences larger than tx differences

Reprise of Clinical Outcomes Co-occurring problems were the norm and varied with substance use

severity. In Trial 1, FSN and MET/CBT5 were relatively more effective than

MET/CBT12 in reducing substance abuse/dependence problems (treatment effect); With FSN doing better at holding its gains out to 30 months

In Trial 2, ACRA and MDFT were more effective than MET/CBT5 in reducing substance abuse/dependence problems (treatment effect) and short term stability on substance use; With ACRA and MDFT doing better at holding their gains out to 30 months.

These were not easily explained simply by dosage or level of family therapy and there was no evidence of iatrogenic effects of group therapy.

While more effective than many earlier outpatient treatments, 2/3rds of the CYT adolescents were still having problems 12 months latter, 4/5ths were still having problems 30 months latter.

Reprise of Economic Outcomes

There were considerable differences in the cost of providing each of the interventions.

MET/CBT-5, -12 and ACRA were the most cost effective at 12 months, though the stability of the MET/CBT findings were mixed at 30 months.

Reductions in Average Quarterly Cost to Society offset the cost of treatment within 12 months in trial 1 and with 30 months in trial 2.

At 12 months the MET/CBT5 intervention clearly had the highest rate of return.

By 30 months MET/CBT12, ACRA and MDFT were doing better and FSN was doing as well as MET/CBT in terms of costs to society.

Results of clinical outcomes, cost-effectiveness, and benefit cost were different – suggesting the importance of multiple perspectives

Effective Adolescent Treatment (EAT) Replication of MET/CBT 5

Large scale replication of the CYT MET/CBT intervention in early intervention, school, detention and outpatient settings

Data from 22 of 36 grants: Bradley, Brown, Clayton,Curry, Davis, Dillon, Dodge, Kressler, Kincaid, Levine, Levy, Locario, Mason, Moore, Rajaee-Moore, Paull, Payton, Rezende, Taylor, Tims, Turner, Vincent

857 Intake cases and 521 3 Month Follow-up from 22 sites (71% of those due, 82% of those out of window)

Outcome data matched to people with both intake and follow-up Early, but already larger that CYT (n=202 from 4 sites)

General Treatment Process Measures

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Initiated (within 14

days)

Engaged(4+ session, 6+ weeks)

Retained(90+ daysin index

admission)

Continuing Care(post 90 days)

High Satisfaction(TxSI>13.5)

CYT EAT

Better than CYT on initiation

Similar on engagement and

satisfaction

Higher rates of Retention and

Continuing Care

Source: CYT Final Data Set and EAT 8/04 data set

Consistent MET/CBT5 Content Across Sites

UCHC (n=48) PAR (n=54) CHS (n=42) CHOP (n=58)

Total MET/CBT5 (n=202)*Source: CYT data

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Direct (3-6,9-10,19,99)

Family (1,7-8,15)

External (2,11-14,16-17)

Total (all)

Virtually Identical Implementation in CYT

Treatment Content Matches CYT (S7g)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Direct (3-6,9-10,19,99)

Family (1,7-8,15)

External (2,11-14,16-17)

Total (all)

CYT (n=199) EAT (n=201)Source: CYT Final Data Set and EAT 8/04 data set

Top 10 Reasons Adolescents Gave to Quit

1. 73% to show you can quit

10. 52% AOD cause health problems for others

9. 53% don't want to embarrass your family

8. 55% concerned about health problems

7. 56% to improve my memory

6. 57% to feel in control of your life

5. 57% to keep close people from being upset

4. 59% to think more clearly

3. 60% to save money you would have spend on AOD

2. 63% to prove you are not addicted

These reasons provide hooks for MET and counseling in generalSource: EAT 8/04 data set

Not everyone has the same reasons

7 of 10 the same in CYT (included above) 10 of 10 for 15 to 17, male, white adolescents 8 of 10 for other ages

– Under 15 more likely to say known others with health problems (55%) or to have more energy (55%)

– 18 to 20 more likely to say known others with health problems (61%) or legal problems (58%)

7 of 10 for females, who were more likely than males to say– because AOD is less "cool" (55% vs. 23%)– so that hair and clothes won't smell (54% vs. 40%)– To receive special gift if you quit (51% vs. 10%)– to avoid leave social functions to use (49% vs. 28%)

6 or more of 10 for other races– African Americans more likely to say because AOD use may shorten

your life (65%) and to have more energy (62%) – Asians more likely to say to have more energy (60%), so you can get

more things done (60%), and so your hair and clothes will not smell (60%)

– Hispanics more likely to say to have more energy (60%), because AOD use may shorten your life (57%) and because you will be praised by people close to you (57%)

– Native Americans more likely to say to have more energy (100%), so you can get more things done (100%), because you noticed AOD use was hurting your health (100%), you will like yourself better if you quit (90%), because of legal problems (90%), so your hair and clothes will not smell (90%)

Not everyone has the same reasons (continued)

Hence the need for personalized feedback

Comparison of In-Treatment Outcomes

-1.5

-1

-0.5

0

0.5

1

Intake 3 M Intake 3 M

Z-S

core

fro

m C

YT

ME

T/C

BT

5 ba

seli

ne

CYT (n=202) EAT (n=409)

Substance Frequency Scale

(SFS)

Substance Problem Scale

(SPS)

Lower severity at intake, Similar reductions at 3 months


3%

29%27%

40%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Intake 3 Month Intake 3 MonthCYT (n=202) EAT (n=407)

Less Severe at Intake Both Improve

Comparison of In-Treatment Outcomes(continued)


Impact and Next Steps

Papers published on design, validation, characteristics, matching, clinical contrast, treatment manuals, therapist reactions, cost, 12 month outcomes, cost-effectiveness, benefit cost

Papers with main clinical and cost-effectiveness findings at 30 month findings being submitted this year.

Interventions being replicated as part of over four dozen studies currently or about to go into the field

30 to 40,000 copies of each of the 5 manuals distributed to policy makers, providers, individual clinicians and training programs

Source: Dennis et al, 2002, in press

Implications

The CYT interventions provide replicable models of brief (1.5 to 3 month) treatments that can be used to help the field maintain quality while expanding capacity.

While a good start, the CYT interventions were still not an adequate dose of treatment for the majority of adolescents.

The majority of adolescents continued to vacillate in and out of recovery after discharge from CYT.

More work needs to be done on providing a continuum of care, longer term engagement and on going recovery management.

Contact Information

Michael L. Dennis, Ph.D., CYT Coordinating Center PILighthouse Institute, Chestnut Health Systems720 West Chestnut, Bloomington, IL 61701Phone: (309) 820-3805, Fax: (309) 829-4661E-Mail: [email protected]

Manuals and Additional Information are Available at: CYT: www.chestnut.org/li/cyt/findings or

www.chestnut.org/li/bookstore or www.chestnut.org/li/apss/csat/protocols

NCADI: www.health.org/govpubs

CYT References

Babor, T. F., Webb, C. P. M., Burleson, J. A., & Kaminer, Y. (2002). Subtypes for classifying adolescents with marijuana use disorders Construct validity and clinical implications. Addiction, 97(Suppl. 1), S58-S69.

Buchan, B. J., Dennis, M. L., Tims, F. M., & Diamond, G. S. (2002). Cannabis use Consistency and validity of self report, on-site urine testing, and laboratory testing. Addiction, 97(Suppl. 1), S98-S108.

Dennis, M.L., (2002). Treatment Research on Adolescents Drug and Alcohol Abuse: Despite Progress, Many Challenges Remain. Connections, May, 1-2,7, and Data from the OAS 1999 National Household Survey on Drug Abuse

Dennis, M. L., Babor, T., Roebuck, M. C., & Donaldson, J. (2002). Changing the focus The case for recognizing and treating marijuana use disorders. Addiction, 97 (Suppl. 1), S4-S15.

Dennis, M.L., Dawud-Noursi, S., Muck, R., & McDermeit, M. (2003). The need for developing and evaluating adolescent treatment models. In S.J. Stevens & A.R. Morral (Eds.), Adolescent substance abuse treatment in the United States: Exemplary Models from a National Evaluation Study (pp. 3-34). Binghamton, NY: Haworth Press and 1998 NHSDA.

Dennis, M. L., Funk, R., Godley, S. H., Godley, M. D., & Waldron, H. (2004). Cross validation of the alcohol and cannabis use measures in the Global Appraisal of Individual Needs (GAIN) and Timeline Followback (TLFB; Form 90) among adolescents in substance abuse treatment. Addiction, 99(Suppl. 2), 125-133.

Dennis, M. L., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J., Liddle, H., Titus, J. C., Kaminer, Y., Webb, C., Hamilton, N., & Funk, R. (2004). The Cannabis Youth Treatment (CYT) Study: Main Findings from Two Randomized Trials. Journal of Substance Abuse Treatment, in press

Dennis, M. L., Godley, S. and Titus, J. (1999). Co-occurring psychiatric problems among adolescents: Variations by treatment, level of care and gender. TIE Communiqué (pp. 5-8 and 16). Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.

Dennis, M. L. and McGeary, K. A. (1999). Adolescent alcohol and marijuana treatment: Kids need it now. TIE Communiqué (pp. 10-12). Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.

Dennis, M. L., Titus, J. C., Diamond, G., Donaldson, J., Godley, S. H., Tims, F., Webb, C., Kaminer, Y., Babor, T., Roebeck, M. C., Godley, M. D., Hamilton, N., Liddle, H., Scott, C., & CYT Steering Committee. (2002). The Cannabis Youth Treatment (CYT) experiment Rationale, study design, and analysis plans. Addiction, 97, 16-34..

Dennis, M. L., Titus, J. C., White, M., Unsicker, J., & Hodgkins, D. (2003). Global Appraisal of Individual Needs (GAIN) Administration guide for the GAIN and related measures. (Version 5 ed.). Bloomington, IL Chestnut Health Systems. Retrieve from http//www.chestnut.org/li/gain

Dennis, M.L., & White, M.K. (2003). The effectiveness of adolescent substance abuse treatment: a brief summary of studies through 2001, (prepared for Drug Strategies adolescent treatment handbook). Bloomington, IL: Chestnut Health Systems. [On line] Available at http://www.drugstrategies.org

Dennis, M. L. and White, M. K. (2004). Predicting residential placement, relapse, and recidivism among adolescents with the GAIN. Poster presentation for SAMHSA's Center for Substance Abuse Treatment (CSAT) Adolescent Treatment Grantee Meeting; Feb 24; Baltimore, MD. 2004 Feb.

Diamond, G., Leckrone, J., & Dennis, M. L. (In press). The Cannabis Youth Treatment study Clinical and empirical developments. In R. Roffman, & R. Stephens, (Eds.) Cannabis dependence Its nature, consequences, and treatment . Cambridge, UK Cambridge University Press.

CYT References - continued

Diamond, G., Panichelli-Mindel, S. M., Shera, D., Dennis, M. L., Tims, F., & Ungemack, J. (in press). Psychiatric syndromes in adolescents seeking outpatient treatment for marijuana with abuse and dependency in outpatient treatment. Journal of Child and Adolescent Substance Abuse.

French, M.T., Roebuck, M.C., Dennis, M.L., Diamond, G., Godley, S.H., Tims, F., Webb, C., & Herrell, J.M. (2002). The economic cost of outpatient marijuana treatment for adolescents: Findings from a multisite experiment. Addiction, 97, S84-S97.

French, M. T., Roebuck, M. C., Dennis, M. L., Diamond, G., Godley, S. H., Liddle, H. A., and Tims, F. M. (2003). Outpatient marijuana treatment for adolescents Economic evaluation of a multisite field experiment. Evaluation Review,27(4)421-459.

Funk, R. R., McDermeit, M., Godley, S. H., & Adams, L. (2003). Maltreatment issues by level of adolescent substance abuse treatment The extent of the problem at intake and relationship to early outcomes. Journal of Child Maltreatment, 8, 36-45.

Godley, S. H., Dennis, M. L., Godley, M. D., & Funk, R. R. (2004). Thirty-month relapse trajectory cluster groups among adolescents discharged from outpatient treatment. Addiction, 99(Suppl. 2), 129-139.

Godley, S. H., Jones, N., Funk, R., Ives, M., and Passetti, L. L. (2004). Comparing Outcomes of Best-Practice and Research-Based Outpatient Treatment Protocols for Adolescents. Journal of Psychoactive Drugs, 36, 35-48.

Godley, M. D., Kahn, J. H., Dennis, M. L., Godley, S. H., & Funk, R. R. (2005). The stability and impact of environmental factors on substance use and problems after adolescent outpatient treatment for cannabis use or dependence. Psychology of Addictive Behaviors, 19(1), 62-70.

Shelef, K., Diamond, G.M., Diamond, G.S., & Liddle, H.H (under review). Adolescent and Parent Alliance and Treatment Outcome in Multidimensional Family Therapy

Tetzlaff, B. T., Kahn, J. H., Godley, S. H., Godley, M. D., Diamond, G., & Funk, R. R. (in press). Working alliance, treatment satisfaction, and relapse among adolescents participating in outpatient treatment for substance use. Psychology of Addictive Behaviors.

Tims, F. M., Dennis, M. L., Hamilton, N., Buchan, B. J., Diamond, G. S., Funk, R., & Brantley, L. B. (2002). Characteristics and problems of 600 adolescent cannabis abusers in outpatient treatment . Addiction, 97, 46-57.

Titus, J. C., & Dennis, M. L. (in press). Cannabis Youth Treatment (CYT) Overview and summary of preliminary findings. H. A. Liddle, & C. L. Rowe, (Eds.) Treating adolescent substance abuse State of the science. Cambridge, UK Cambridge University Press.

Titus, J. C., Dennis, M. L., Lennox, R., & Scott, C. K. (under review). Development and validation of brief versions of the GAIN's internal mental distress and behavior complexity scales.

Wintersteen, M. B., Mensinger, J. L., & Diamond, G. S. (in press). Do gender and racial differences between patient and therapist affect therapeutic alliance and treatment retention in adolescents? Clinical Psychology Science and Practice.

White, M. K., Funk, R., White, W., & Dennis, M. (2003). Predicting violent behavior in adolescent cannabis users The GAIN-CVI. Offender Substance Abuse Report, 3(5), 67-69.

White, M. K., White, W. L., & Dennis, M. L. (2004). Emerging models of effective adolescent substance abuse treatment. Counselor, 5(2), 24-28.

cannabis youth treatment (cyt) trials: 12 and 30 month main findings michael dennis, ph.d. chestnut...

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