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Substance Abuse
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A Group Therapy Program for Opioid-Dependent
Adolescents and Their Parents
Marianne Pugatch MSW
abdf
, John R. Knight MD
bcd
, Patricia McGuiness MSW
e
, Lon Sherritt
MPH
bcd
& Sharon Levy MD, MPH
acd
a
Adolescent Substance Abuse Program, Boston Children's Hospital, Boston, Massachusetts,
USA
b
Center for Substance Abuse Research, Boston Children's Hospital, Boston, Massachusetts,
USA
c
Division of Developmental Medicine, Boston Children's Hospital, Boston Massachusetts, USA
d
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
e
Tenacity, Inc., Boston, Massachusetts, USA
f
Heller School for Social Policy and Management, Brandeis University, Waltham,
Massachusetts, USA
Accepted author version posted online: 30 Aug 2014.Published online: 11 Dec 2014.
To cite this article: Marianne Pugatch MSW, John R. Knight MD, Patricia McGuiness MSW, Lon Sherritt MPH & Sharon Levy MD,
MPH (2014) A Group Therapy Program for Opioid-Dependent Adolescents and Their Parents, Substance Abuse, 35:4, 435-441,
DOI: 10.1080/08897077.2014.958208
To link to this article: http://dx.doi.org/10.1080/08897077.2014.958208
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2. A Group Therapy Program for Opioid-Dependent
Adolescents and Their Parents
Marianne Pugatch, MSW,1,2,4,6
John R. Knight, MD,2,3,4
Patricia McGuiness, MSW,5
Lon Sherritt, MPH,2,3,4
and Sharon Levy, MD, MPH1,3,4
ABSTRACT. Background: Opioid dependence is a significant problem for adolescents in the
United States. Psychosocial treatment for adolescents with opioid use disorders may be
effective, although it has not been well studied. Methods: This paper describes a 13-week
psychoeducational group therapy program with parallel tracks for adolescents with opioid
use disorders and their parents attending an outpatient substance use program in a children’s
hospital. In addition to group therapy, participating adolescents received medical care,
including medication-assisted treatment for opioid dependence, drug testing, medical follow-
up, psychopharmacology, individual counseling, and parent guidance. Data were collected as
part of a quality improvement project for the program. Forty-two adolescents and 72 parents
attended the group program between 2006 and 2009. Frequencies were computed and a
weighted kappa was used to assess agreement between adolescent and parent reports of use
and driving risk. Results: Of the 42 adolescents participating in the 13-week group program,
36 (86%) completed 3 or more group sessions, and 24 (57%) completed 10 or more sessions.
Twenty-two (52%) adolescent participants reported abstinence from all substances on each
of their weekly evaluations. Adolescent-parent agreement for substance use was good to very
good: weighted kappa (95% confidence interval) .76 (.60, .87), but poor for driving risk,
weighted kappa .11 (¡.20, .40). Conclusions: Completion rates and self-report of outcomes
from this group program indicate promise and warrant further testing.
Keywords: Adolescents, opioid-related disorders, substance use treatment, group therapy,
parents
INTRODUCTION
Misuse of opioids—a pharmacologic class of medications com-
prising both naturally occurring opiates such as morphine,
codeine, and opium and opioid pain medications such as oxyco-
done—is a major public health problem for adolescents in the
United States. Among 12th graders, trends in annual prevalence of
“nonmedical” use of narcotics other than heroin peaked at 9.4% in
2002 before dropping slightly to the current rate of 7.1%.1
In
2013, 11% of 12th graders reported lifetime prevalence of non-
medical use of narcotics other than heroin.1
Opioids have a very high addiction potential and many teens
who use opioids “nonmedically” develop opioid addiction.2,3
The
Massachusetts Department of Public Health reported 151 opioid-
related deaths from 2006 to 2008 and 2161 nonfatal poisonings
from 2007 to 2009 among youth between 15 and 25.4
These statis-
tics underestimate the true harm related to opioid addiction, which
includes homelessness, incarceration, treatment costs, and spread
of blood-borne pathogens, including human immunodeficiency
virus (HIV) and hepatitis virus.
About three quarters of all adolescents receiving treatment for
opioid use disorders reported first use before age 25.5
Yet in 2011,
adolescents made up only 22.1% of the admissions to publicly
funded treatment facilities in the United States.5
Access to quality
treatment for opioid-dependent adolescents is essential to address
this problem.
Although few trials have investigated the effectiveness of treat-
ment for opioid-dependent adolescents, combining medications
1
Adolescent Substance Abuse Program, Boston Children’s Hospital,
Boston, Massachusetts, USA
2
Center for Substance Abuse Research, Boston Children’s Hospital,
Boston, Massachusetts, USA
3
Division of Developmental Medicine, Boston Children’s Hospital,
Boston Massachusetts, USA
4
Department of Pediatrics, Harvard Medical School, Boston, Massa-
chusetts, USA
5
Tenacity, Inc., Boston, Massachusetts, USA
6
Heller School for Social Policy and Management, Brandeis Univer-
sity, Waltham, Massachusetts, USA
Correspondence should be addressed to Marianne Pugatch, MSW,
Adolescent Substance Abuse Program, Boston Children’s Hospital, 300
Longwood Avenue, Boston, MA 02115, USA. E-mail: Marianne.
Pugatch@Childrens.Harvard.Edu
SUBSTANCE ABUSE, 35: 435–441, 2014
Copyright Ó Taylor & Francis Group, LLC
ISSN: 0889-7077 print / 1547-0164 online
DOI: 10.1080/08897077.2014.958208
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3. with psychosocial counseling appears promising.6
In one trial,
buprenorphine together with counseling reduced opioid use in the
first 20 days of treatment more than clonidine.7
A second trial
found that 12 weeks of medication-assisted treatment combined
with counseling was superior to shorter medication protocols.8
Based on their findings, authors concluded that clinicians “should
not be in a hurry to take patients off the medication just because
they are young and have not been addicted for a long time.”8
Although the evidence for psychosocial therapies specifically
for adults with opioid dependence is mixed,9
several psychosocial
treatments for adolescents with substance use disorders (SUDs) in
general are promising. There is growing evidence for the effec-
tiveness of motivational interviewing,10–14
contingency manage-
ment,7,15–17
cognitive-behavioral therapy,18,19
and family
therapy20–22
for adolescents with SUDs. There have been few
reported scientific studies of group therapy,23
yet groups have
been the mainstay for addiction treatment because they are an effi-
cient use of staff, and because associating with peers is a develop-
mental preference for adolescents. In spite of concern for
contagion in adolescent groups,24
iatrogenic effects were not
found in groups in the Cannabis Youth Treatment Study.25
“Group
therapy” may include any number of treatment modalities, includ-
ing peer support, psychoeducation, psychotherapy, self-help, and
task-centered groups. One review of treatment indicated that
group behavioral therapy (including cognitive-behavioral and
motivational interviewing therapies, both separately and in combi-
nation) was valuable in treating “mild” to “serious” adolescent
SUDs.26
Additionally, a controlled study of group therapy for ado-
lescents with SUDs found “behavioral” modality, consisting of
stimulus control procedures to extinguish drug use in response to
external stimuli, urge control, and social contracting, was superior
to “discussion”-based groups.27
The objective of this paper is to
describe the results of an analysis of program data undertaken for
the purposes of quality improvement of a manualized 13-week
research-informed, psychoeducational group therapy program for
opioid-dependent adolescents and their parents, receiving treat-
ment in an outpatient substance abuse program, herein referred to
as adolescent and parent groups. The Boston Children’s Hospital
Committee on Clinical Investigation (i.e., institutional review
board) reviewed the project and determined that the evaluation
constituted programmatic quality improvement. No funding
agency supported this work.
METHODS
This paper reports on data from weekly and final self-report evalu-
ations administered to all participants in adolescent and parent
groups. In addition to group therapy, participating adolescents
received medical care, including drug testing, medical follow-up,
pharmacotherapy, individual counseling, and parent guidance.
Forty-one of the 42 adolescents also received medication-assisted
treatment for opioid dependence. The Adolescent Substance Abuse
Program has been described in detail elsewhere.28
The evaluation
forms had a study identification number that was linked to adoles-
cent or parent name and were administered by group assistants at
the end of each group session. Information from the forms was
not shared with adolescents, parents, or clinical team members.
The weekly evaluation for adolescents and parents had 5 questions
with forced response items and 2 questions with open-ended
responses that asked about knowledge, satisfaction, and high-risk
behavior. The evaluation for adolescents included 3 questions
about frequency of alcohol, marijuana, opioid, or other drug use,
needle use, and driving risk. The parent evaluation asked for their
perception of their child’s frequency of alcohol, marijuana, and
other drug use and child’s high-risk behaviors.
Adolescent participants who completed 10 or more group ses-
sions, and parents who participated consistently, were offered the
opportunity to complete a final evaluation about knowledge of
content covered in group (12 items) and change in their or their
child’s status of psychosocial domains of functioning (10 items),
including home, school, and internal state, as shown in Tables 4
and 5. Each item used a forced-choice Likert-type scale, with
response items varying from “not at all” to “a great deal,” and also
included space for open-ended written response. Group assistants
administered the final evaluation tool to adolescents at the comple-
tion of their 13-week cycle.
Group Participants
Adolescents aged 16–22 years who presented for management of
opioid dependence were initially evaluated in a children’s hospi-
tal–based outpatient substance abuse program and were offered
the opportunity to participate in a structured buprenorphine pro-
gram as described in a previous report.29
All parents and guardians
(e.g., stepparents, older siblings, grandparents) who were involved
in care were invited to participate in parent groups. This resulted
in 0–4 “parent participants” associated with each adolescent par-
ticipant. In some cases, parents participated even though their
child did not, due to need for higher level of care or preference for
individual therapy. A master’s level licensed independent clinical
social worker met with each patient individually to screen both
adolescent and parent for “group readiness” through establishing
group norms around attendance, safety, confidentiality, and absti-
nence, as well as to support the adolescent in creating an individ-
ual strengths-based goal (Table 1). Adolescents with active mood
or anxiety disorders, cognitive delays, autism spectrum disorders,
or conduct disorders were admitted to group; a small number of
adolescents with active psychotic disorders were excluded and
offered individual therapy.
Group Curriculum and Structure
The adolescent group curriculum consisted of thirteen 90-minute
modules that utilized a variety of therapeutic modalities, including
cognitive-behavioral therapy30–32
(e.g., completing “thought logs”
as relapse prevention activities), contingency management33
(e.g.,
drawing prizes), motivational interviewing34
(e.g., completing a
“pros and cons” or decisional balance exercise), and self-help
strategies35
(e.g., listening to a young adult speaker from Alco-
holics Anonymous share his/her story). Six modules of the adoles-
cent curriculum focused on the adolescent’s awareness of
addiction and 6 sessions focused on recovery. The 13th session
concentrated on the process of group termination. Each module
had a specific learning objective directed at abstinence or harm
reduction (e.g., lessening needle use, decreasing the occurrence of
driving while impaired or riding with an impaired driver [DRWI]).
Parents were invited to participate in a curriculum that
addressed addiction as a family disease and also addressed family
strengths. The parent and adolescent group curricula were
436 SUBSTANCE ABUSE
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4. matched—parents either received the same materials (such as an
identical presentation on “Drug Education”) or complementary
materials (such as a skills-based training in communicating through
active listening, whereas adolescents received training on negotiat-
ing with authority figures; Table 2). Adolescents and parents were
encouraged to discuss what they learned after the group session to
support open communication about addiction and recovery.
Each session was led by one facilitator (a master’s level
licensed independent clinical social worker) and one co-facilitator,
(a second-year master’s-level social work intern, or a bachelor’s-
level trained volunteer, or staff member), all of whom received
weekly supervision. Each adolescent session began with a “check-
in” to discuss drug use, stressful situations, and progress towards
their individual goal. The group then typically proceeded with two
30-minute group activities based on 1 of 12 topics. At the end of
each session, participants drew a small prize worth $1 to $20 from
a prize jar;36
those who did not use drugs or alcohol since the pre-
vious session also drew a second prize from the same jar.
The facilitator and co-facilitator led the parent group that took
place at the same time as the adolescent group but in a different room.
The parent group similarly began with a “check-in” to share about
their child’s substance use and progress towards an individualized par-
ent or family goal. In each group session, the parent group leader
reviewed the content of the adolescent curriculum with parents.
Adolescents and parents had the opportunity to make up
missed sessions in an individual counseling appointment in which
identical material was covered. We defined adolescent patients
who attended a pre–group program “screening” session as well as
3 or more group sessions as “engaged,”37
and those that attended
10 or more group sessions as “completers.” SUD treatment out-
comes have been associated with treatment engagement,37,38
retention,39
completion,39,40
and dropout rates.39,41
At the end of
TABLE 1
Group Guidelines: Expectations and Norms
Attendance norms I understand that this group lasts 13 weeks, and that each session lasts for 1 hour and 30 minutes. I agree to participate fully in all 13
groups. If I want to withdraw from the group, then I agree to discuss this decision with my group leader prior to taking this
action. If I do decide to leave, I will communicate honestly with other group members about my reasons for leaving the group
either in person or through a letter.
I agree to attend all sessions and to be on time. If it is necessary that I cancel a session, or I am running late, I agree to call the clinic
to leave a message to let them know as soon as I know.
If I miss a group, I will make up the session. I will call the clinic coordinator to schedule the make-up session.
Abstinence I understand that group treatment is intended for adolescents who are committed to abstaining from all drugs and alcohol. I
understand that I must remain abstinent for this program to be most effective.
I understand that it is essential for me to attend the session drug and alcohol free. I understand that I will not be able to participate in
any session to which I come after using drugs or alcohol. If a group therapist thinks that I might be high, s/he may ask me to go
for a drug test.
I understand that if I use drugs or alcohol, that I will meet with the pediatrician and the group therapist and that we will decide
together about whether it is best for me to continue in the group at this time.
If I do use drugs or alcohol, I will communicate honestly with the group leaders and other group members about my use. I
understand that my parent(s) will find out if I use. In order to establish a positive trusting group environment, if I have a positive
drug test, even if I disagree with the test results, I agree to share this with the other group members.
Confidentiality I agree not to talk about other group members or the discussion that happened in sessions outside of the group.
Safety I will be respectful of other people in the group: I will not physically touch others and I will not use threatening, demeaning, or
sexualized language in the group.
I will not have contact with any group members outside of the group unless I receive approval from the therapist.
TABLE 2
Parallel and Complementary Adolescent-Parent Curriculum
Group session Adolescent Parent
1 Telling Our Story: Part I. Drug History and Telling Our Story Getting to Know Each Other
2 Coping Skills: Adaptive and Nonadaptive Adolescent Development
3 Drug Education Drug Education
4 Stages of Use Positive Parenting Practices
5 High Risk Situations Supporting Your Child in Recovery
6 Coping With Cravings Support for Children and Parents
7 Telling Your Story: Part II. Strengths Getting to know New Members
8 Valuing Our Emotions Voice of Addict in Recovery
9 Negotiating With Authority Figures Communicating With Your Child
10 Taking Care of Yourself: Part I Valuing Your Child’s Non-addicted Self
11 Taking Care of Yourself: Part II Stress Management
12 Relapse Prevention Parents in Recovery
13 Empowerment and Advocacy Completion Ceremony
PUGATCH ET AL. 437
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5. the group program, adolescents were referred to continuing care
services or encouraged to repeat the program if clinically
indicated.
Evaluation Methods
Data collection
Group assistants entered the de-identified data from the evalua-
tions into an SPSS Version 19 (IBM, Armonk, NY) data set for
analysis. Two authors (P.M. and M.P.) spot-checked data for accu-
racy, reviewed all missing data, and crosschecked against the orig-
inal surveys.
Data analysis
Simple frequencies were calculated for all demographic factors
and self- and parent-reported number of weeks of drug and alcohol
use, use of needles, and driving while impaired or riding with an
impaired driver (DRWI). On the final evaluation, scores were cal-
culated as simple frequencies and collapsed into dichotomous var-
iables to determine the proportion of participants who reported
any improvement in knowledge on the various domains of func-
tioning. A weighted kappa with 95% confidence interval (CI)42
was calculated for agreement between parents and adolescents in
the number of weekly reports that were positive for substance use
and DRWI behaviors. A Fisher’s exact statistic was calculated to
examine significance between adolescent group attendance rates
and adolescents diagnosed with a co-occurring mood disorder as
well as group attendance rates between male and female parents.
RESULTS
Study Sample
This report includes data of 42 adolescents who completed at least
1 group therapy session between 2006 and 2009. Adolescent par-
ticipants were primarily white, non-Hispanic, from 2-parent fami-
lies, and evenly mixed between males and females (Table 3).
Overall, 42 adolescents attended a total of 369 group sessions
(median D 10, interquartile range [IQR]: 5–12). Thirty-six (86%)
adolescents attended 3 or more sessions, 24 (57%) completed 10
or more, and 7 (17%) completed 13 or more group sessions. Seven
adolescents (17%) made up 1 or more missed group sessions.
Completing 10 or more group or makeup sessions was not associ-
ated with gender, race, or socioeconomic status (SES). The 24
(57%) adolescents who were diagnosed with a mood disorder
(depression, dysthymia, mood disorder not otherwise specified
[NOS], or bipolar disorder) were significantly less likely to com-
plete 10 or more sessions than peers (83% vs. 38%; Fisher’s exact
test, P < .001).
Parents completed a total of 449 sessions (median D 5.5 ses-
sions, IQR: 2–10). There were no significant differences in atten-
dance rates between fathers and mothers.
Weekly Self-Reports of Drug and Alcohol Use
and Other High-Risk Behaviors
Overall, 42 adolescents completed 339 self-report evaluations.
Twenty-two (52%) adolescents reported abstinence from all sub-
stances on each of their weekly evaluations. Fifty-eight (17%)
weekly encounters included adolescent self-reported use of any
drug. Thirty-eight adolescents (91%) reported no needle use and
35 (83%) reported no DRWI throughout the duration of the group
program. Of the 336 weekly group encounters by adolescents,
there were 58 (17%) self-reports of past-week substance use and
16 (5%) reports of past-week DRWI. There was good to very
good agreement between adolescents and parents in number of
weeks with “no drug use,” with a reported weighted kappa (95%
CI) of .76 (.60, .87). Agreement regarding driving risk between
adolescents and parents was poor, with a reported weighted kappa
of .11 (¡.20, .40). There was no significant difference in agree-
ment between male and female parents.
Final Self-Reports of Knowledge and Functioning
Out of the 24 adolescents who completed 10 or more group ses-
sions, 19 (79%) completed a final evaluation; and out of the 72
parents who attended group sessions, 32 (44%) completed a final
evaluation (Table 4). Ninety percent of adolescents and almost
80% of parents reported that adolescents increased their ability to
say no to drugs after participating in the group. Rates of self-
reported increase in knowledge were high (74%–94%) for all items.
At least 90% of adolescents and 97% of parents reported increasing
their knowledge of relapse prevention skills. One hundred percent
of adolescents and parents self-reported that adolescents improved
in a variety of domains of psychosocial functioning (Table 5).
DISCUSSION
We describe a manualized group therapy program for adolescents
with opioid use disorders. That a majority of adolescents com-
pleted 10 or more sessions suggests acceptability of the approach
to the target group. This finding is important because rates of com-
pletion are known to be one of the best predictors of outcomes for
adolescents in treatment for substance use disorders.41
Adoles-
cents in this group therapy with a co-occurring mood disorder
were less likely to complete the curriculum; enhanced individual
TABLE 3
Description of Adolescents and Parents
Adolescents (n D 42)
Age mean (range) 19 § 1.5 (16–22)
Female 41%
White 98%
Co-occurring substance use disorder 81%
Alcohol disorder 69%
Marijuana disorder 86%
Co-occurring mental health disorder (any) 81%
ADHD 29%
Mood disorder 57%
Anxiety disorder 36%
Parents (n D 72)a
Female 61%
2-Parent family 62%
College degree 68%
a
Two parents did not have adolescents in the group.
438 SUBSTANCE ABUSE
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6. therapy or a curriculum that includes a greater focus on treating
co-occurrence of mood disorders may be necessary for this group.
A large majority of participants reported increased knowledge and
psychosocial functioning at the end of the curriculum.
Half of all adolescent participants reported abstinence from all
substances while participating in the group therapy program, and
self-reported rates of driving risk and needle use were very low. We
found very high rates of agreement on weekly reports of substance
use between adolescent and parent participants. This finding is
important because parents typically substantially underestimate the
amount of drug and alcohol use by their children,43
and parent
reports of substance use are generally not considered valid. Our
group curriculum, which trained parents to recognize the signs and
symptoms of drug use, and emphasized improving communication
between parents and adolescents, may have resulted in improve-
ments in both of these domains. These improvements could have a
significant impact on the course of treatment, and this aspect of the
curriculum in particular is worthy of further assessment.
A number of limitations to this report should be noted. This
was an observational study of treatment-seeking adolescents.
Forty-three percent of participants did not complete group pro-
gram, and we do not know the drug use outcomes for participants
once they left the group program. Woody et al.8
reported a
“treatment completion” rate of 70% in a research trial that had
devoted resources to participant retention, although the number of
participants who completed the entire group therapy program was
not reported and may have been lower. Our group completion rate
of 57% is somewhat lower. Our group program was embedded
within a structured clinical program; some adolescents who did
not complete group program continued to receive medications and
individual counseling, whereas others were referred to a higher
level of care for ongoing substance use—both clinically meaning-
ful outcomes. We believe that this paper describing outcomes
from a group therapy program for opioid-dependent adolescents in
a naturalistic setting makes a particularly important contribution.
We did not have baseline reports of substance use for compari-
son, and we are not able to determine whether substance use, nee-
dle use, or DRWI dropped during group participation. There are
limitations to self-report of substances,44
including the tendency
of adolescents to underestimate use to avoid negative consequen-
ces.45
However, self-reports by adults46
and adolescents47
partici-
pating in treatment programs are considered reliable. We
reviewed all drug test results, and although it is difficult to corre-
late specific results to self-reports because they were collected on
different dates and represent different time windows, overall our
clinical judgment is that the results were highly correlated with
self-report. All adolescents also received other forms of treatment
in an outpatient substance abuse program, which, for many of
them, included medications, drug testing, individual counseling,
and physician follow-up. We are not able to determine whether
reported improvements in knowledge and functioning were related
to the group program, other therapy received in the substance
abuse program, other sources, or a combination. Our adolescents
were primarily white, of upper SES, and supported by parents, and
it is unclear whether this curriculum would be well received by
other groups. Although our outcomes measures have face validity,
our self-report tool has not been previously validated. Despite
these limitations, given the dearth of information on successful
psychosocial treatment for opioid-addicted adolescents, we
TABLE 5
Percentage of Participants Self-Reporting Improvements on Markers of Functioning
Adolescents (n D 19) Parents (n D 32)
Since you started the group: No At least a little No At least a little
Has your self-esteem improved? Or your child’s self-esteem? 5 90 3 97
Have your grades in school increased?a
32 58 4 97
Have you built a better support network? 11 84 22 69
Did you increase your sense of competency/self-efficacy?b
11 83 19 69
Did you increase your sense of hope about your life? 5 90 3 97
Did you make progress toward your individual goal?c
— 94 15 76
a
One patient and three parent were not asked this question.
b
One patient was not asked this question.
c
Two patients and 3 parents were not asked this question.
TABLE 4
Percentage of Participants Self-Reporting Increased Knowledge
on the Final Evaluation
Evaluation Adolescents
(n D 19)
Parents
(n D 32)
Increased knowledge of:
Personal drug history 90 94
Drug education 74 88
Learned more about:
Stages of drug usea
82 83
Triggers and high-risk situations 79 88
Neurobiology of cravings 90 88
Strengths 84 81
Dealing with emotions 79 88
Preventing a relapse 90 97
Self-care 90 94
12-Step programsb
68 76
After group I am better able to:
Identify coping skills 90 81
Say no to drugs and alcohol 90 75
Negotiate with parents 90 81
Feel comfortable attending a
12-step program
58 —
a
Two patients and 3 parents were not asked this question.
b
Three parents were not asked this question.
PUGATCH ET AL. 439
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7. believe our program description makes an important contribution
to the field. We conclude that research-informed group therapy for
opioid-dependent adolescents appears promising. Further study on
the therapeutic effect of this modality is warranted.
ACKNOWLEDGMENTS
The authors would like to thank the group workers and clinicians
at the Adolescent Substance Abuse Program particularly between
2006 and 2009. The authors also want to recognize Ariel Botta,
MSW, and Jennifer Rein, MSW for nurturing the inception of the
program. Additionally, authors want to acknowledge Shari Van
Hook, MPH, PA, and S.K. Harris, PhD, for their respective
contributions.
FUNDING
The Office of Child Advocacy at Boston Children’s Hospital
awarded a grant in 2005 to support the establishment of the group
program at the Adolescent Substance Abuse Program (ASAP).
The Social Work Department at Boston Children’s Hospital
awarded four internal grants (94485) between 2006 and 2009 to
support the group therapy program.
AUTHOR CONTRIBUTIONS
M. Pugatch, S. Levy, and J. K. Knight were responsible for research
conception and design. M. Pugatch and P. McGuiness were respon-
sible for data collection. L. Sherritt and P. McGuiness were respon-
sible for data analysis. M. Pugatch, S. Levy, and P. McGuiness
were responsible for writing; all authors contributed to revision.
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