Georgetown University Adolescent Health Program

Georgetown University Adolescent Health Program Michael Mason, Ph.D. Assistant Professor of Psychiatry & Principal Investigator

Project Description

Our program is a brief, manualized, evidence-based substance use treatment program for DC area teens.

Treatment: Motivational Enhancement Therapy/Cognitive Behavioral Therapy-5 (MET/CBT-5) Sampl & Kadden, SAMHSA, CSAT. WWW.SAMHSA.GOV

Treatment Structure

Comprehensive evaluation (2 hours)

Two individual and three group sessions (5.5 hours)

Parent Support Meeting (2.5 hours)

Three follow-up meetings over 12 months after treatment (1.5 hours)

MET/CBT-5 Treatment Premise

Teens change when the motivation comes from themselves, rather than being imposed by the parent, adult, or therapist .

Client-centered, directive method for enhancing intrinsic motivation to change by exploring & resolving ambivalence.

Motivational Enhancement Basics

Based on a trans-theoretical model:

1) stages of change theory

2) client-centered approaches

3) clinical research

A strengths-based approach

Differs from traditional, denial-based approaches

Foundations of MET

Therapist style is a powerful determinant of client motivation & change

Show respect for the client

Reflective listening is emphasized rather than confrontation

Ambivalence about change is normal

Cognitive Behavioral Therapy

Therapist and client collaborate to understand the client’s behavior in the context of

situational factors

thoughts

feelings

expected outcomes

Client learns and applies new coping skills to replace maladaptive behaviors and improve outcomes.

CBT: Social- Learning Approach

Focuses on the training of interpersonal and self-management skills

Primary Goal = Mastery of skills needed to maintain long-term abstinence from substance abuse

Identify high risk situations, both external circumstances and internal thoughts & feelings

Develop skills to cope with high risk situations

Practice, with feedback

Teen Treatment Focus

Enhancing intrinsic motivation to change through exploring and resolving ambivalence .

Providing feedback to encourage personal responsibility for change.

Developing personal goals.

Practicing healthful responses to real-life situations .

Evidence-Based Treatment

A randomized national study of 600 adolescents in outpatient substance abuse treatment , the MET/CB T -5 treatment program faired well.

As reported by Dennis, M. (2003). Cannabis youth treatment (trials: 12 and 30 month main finding. Presentation for SAMHSA Center for Substance Abuse Treatment Grantee Meeting, Baltimore, MD November 2003.

Results:

Very positive overall effects as the briefest form of treatment in the study

Compared with treatments that were more than twice as long, MET/CBT-5 had higher rates of abstinence ce and recovery

A 50% decrease in problems at 3 months and 25% reduction at 6 months after intake

Some data to suggest that the positive results last ed for more than 2 years

Benefits Teens May Receive

Enhanced levels of motivation

D evelopment of personal goals

Increased p roblem solving skills

Better coping skills

Effective refusal skills

Development of plans for drug-free activities

Increased supportive social network ties

Improved self- confidence for dealing with high-risk situations

Social Ecological Approach to Urban Adolescent Substance Abuse

Explores the significant connections between teen’s mental health, co-participants of their lives and the everyday settings in which their health behaviors are expressed.

Mental Health Social Network Geography of Risk & Protection Urban Teens

Sample Description

16 years old

87% male

44% African American; 42% White; 11% Hispanic; 2% Asian

Referrals: Health system, Courts, Schools

80% Substance Dependence NOS

76% have had no Tx history

62% Marijuana primary drug; 33% alcohol primary substance

40% no MH Dx; Conduct dx, depression, ADHD; 20% have 2 dxs; 20% have 3 dxs

Longitudinal Naturalistic Design With Quantitative & Qualitative Data

Outcome measures:

GAIN: substance use, health, risk behaviors, mental health, environment, legal, vocational/educational

In-depth Social Network Assessment

Personalized Environmental/Geographical assessment

Parent-teen communication assessment

Case Studies:

Phenomenology of treatment

Self-narrative development

Family topological assessment

Biological Measure: Urine analysis

Treatment Satisfaction

3 Month Outcomes

6 Month Outcomes

Ecological Interview Other places Residence Risky Safe Important Free listing Typical Week Locations Details about locations: How When, Who, Length of stay Geographic Information Subjective Rating of Locations

Natasha + + - + - - 1 2 3 4 5 Natasha’s Social Network

Natasha - + 2 Known each other 5 years; Primary domain = Neighborhood & Church; Weekly contact; 1:1 52:0 positive to negative monthly activities Never feels pressured to use; is encouraged not to use daily; perceives her to be very influential on her life 1=19, AA, Hangs out at Natasha’s most Important & Safe locations

Substance Use Stress Depression User Non User Use Pressure Negative Activities Non user Non User User H.S Grad Clinic Connected Alcohol Outlets High Crime Poverty Unemployment Church Connected Drug Use Personal Risk Social Network Risk Environmental Risk Natasha’s Ecological Risk Profile Satisfaction/Desire to Change Library

References & Resources

Miller, W.R. and Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change . New York: Guilford Press

Monti, P., Barnett, N., O’Leary, T. &Colby, S. (2001). Motivational enhancements for alcohol-involved adolescents. In P.M. Monti S. Colby, & T. O’Leary (Eds.) Adolescents, alcohol, and substance abuse: Reaching teens through brief interventions (pp. 145-182). New York: Guilford Press