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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
1. Comprehensive evaluation (2 hours)2. Two individual and three group sessions (5.5
hours)3. Parent Support Meeting (2.5 hours)4. 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/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.
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
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
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 NetworkGeography 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
510
26
38
26
69
51
72
0
10
20
30
40
50
60
70
80
Asked opinionsolution
Helped w/ subuse
Sensititve toculture
Mixed
Agree
Strongly Agree
3 Month Outcomes
16.7
55
83
10091
100
0
20
40
60
80
100
No Use PastMonth
No orreduced
legal
permantplace to live
Intake
3 Month
6 Month Outcomes
39
69
51
69
55
85
0102030405060708090
No Alc PastMonth
No sub usepast month
No pot usepast month
Intake
6 Month
6 Month Outcomes
9582
98
8090
100
0
20
40
60
80
100
Nodepressionpast month
No Anxietypast month
No Rx pastmonth
Intake
6 Month
EcologicalInterview
Other places
Residence
Risky
Safe
Important
Free listing Typical Week
Locations
Details about locations: How
When, Who,Length of stay
Geographic Information
SubjectiveRating 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
StressDepression
User
Non User
Use Pressure
Negative Activities
Non userNon User
User
H.S Grad
Clinic Connected
Alcohol Outlets High Crime
Poverty UnemploymentChurch 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
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
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
Contact Information
Michael Mason, Ph.D., Principal Investigator(202) 687-1357 email: mjm66@georgetown.edu
Our Web site: http://gumc.georgetown.edu/departments/psychiatry/guadolescenthealth.html
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