Georgetown University Adolescent Health Program

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Georgetown University Adolescent Health Program

• Michael Mason, Ph.D. Assistant Professor of
  Psychiatry Principal Investigator

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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

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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)

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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.

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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

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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

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Cognitive Behavioral Therapy

• Therapist and client collaborate to understand
  the clients 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.

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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

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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.
•  

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Evidence-Based Treatment

•  A randomized national study of 600 adolescents
  in outpatient substance abuse treatment, the
  MET/CBT-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.

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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
  abstinencece 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
  lasted for more than 2 years

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Benefits Teens May Receive

• Enhanced levels of motivation
• Development of personal goals
• Increased problem 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

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Social Ecological Approach to Urban Adolescent
Substance Abuse

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

Mental Health
Urban Teens
Geography of Risk Protection
Social Network
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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

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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

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Treatment Satisfaction
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3 Month Outcomes
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6 Month Outcomes
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6 Month Outcomes
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Geographic Information
Ecological Interview
Residence
Free listing Typical Week Locations
Other places
Risky
Details about locations How When, Who, Length
of stay
Safe
Important
Subjective Rating of Locations
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Natasha
Natashas Social Network
1

2
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5
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3
4
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Natasha
119, AA, Hangs out at Natashas most Important
Safe locations
2
-
Never feels pressured to use is encouraged not
to use daily perceives her to be very
influential on her life
520 positive to negative monthly activities

Known each other 5 years Primary domain
Neighborhood Church Weekly contact 11
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Natashas Ecological Risk Profile
Substance Use
Depression
Stress
Personal Risk
H.S Grad
User
Negative Activities
User
Social Network Risk
Satisfaction/Desire to Change
Non User
Use Pressure
Non user
Non User
Alcohol Outlets
High Crime
Drug Use
Environmental Risk
Clinic Connected
Poverty
Unemployment
Church Connected
Library
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References Resources

• Miller, W.R. and Rollnick, S. (2002).
  Motivational Interviewing Preparing People for
  Change. New York Guilford Press
• Monti, P., Barnett, N., OLeary, T. Colby, S.
  (2001). Motivational enhancements for
  alcohol-involved adolescents. In P.M. Monti S.
  Colby, T. OLeary (Eds.) Adolescents, alcohol,
  and substance abuse Reaching teens through brief
  interventions (pp. 145-182). New York Guilford
  Press
• Beck, A., Wright, F., Newman, C. Liese, B.
  (1993). Cognitive Therapy of Substance Abuse. New
  York Guilford Press
• Enhancing Motivation for Change in Substance
  Abuse by Miller. Treatment Improvement Protocol
  Series (TIPS) 35.
• Call 1(800) 729-6686 ask for BKD342

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Conclusions

• Preliminary data suggests reduction of substance
  use at 3 6 month follow-up
• Monitor mental health outcomes
• Use case study data for implementation
• Compare with other cohort project outcomes

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Contact Information

• Michael Mason, Ph.D., Principal Investigator
• [phone] email mjm66_at_georgetown.edu
• Our Web site http//gumc.georgetown.edu/departmen
  ts/psychiatry/guadolescenthealth.html