Transcript SAMHSA Powerpoint Template

Adolescent Treatment Effectiveness
Offender Re-entry Grantee Meeting
Project Directors & Evaluators
May 3,2011
Robert M. Vincent, MS.Ed, NCAC II, CDP
Adolescent Lead
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration,
Rockville, MD
Goals
 To take stock of how far we have come as a
field, particularly in the last few years
 To identify Evidence-Based Treatments that
are the most effective for populations with cooccurring mental health and trauma related
problems that are manualized, replicable, and
have training/certification
Early Adolescent Treatment Work
1910
Worth Street Narcotic Clinic in NY – 743 youth
1920
Federal Narcotic Farms in Lexington, KY & Fort Worth, TX 22–440/yr
1930
Riverside Hospital in NYC – 250 youth
1940
Teen Addiction Hospital Wards in several cities
1950
Drug Abuse Reporting Program (DARP)- 5,405 youth (587 followed)
1960
Treatment Outcome Prospective Study (TOPS) – 1042 youth (256
followed)
1970
Services Research Outcome Study (SROS) – 156 youth
1980
National Treatment Improvement Evaluation Study (NTIES) – 236
youth
Drug Abuse Treatment Outcome Study of Adolescents (DATOS-A) –
3,382 youth (1,785 followed)
1990
1996
Source: Dennis, M.L., Dawud-Noursi, S., Muck, R., & McDermeit, M. (2003)
What these early studies taught us
• Treatment of adolescents with adult models and/or
mixed with adults does not work and is actually
associated with drop out and increased use
• Need to modify models to be more developmentally
appropriate for youth
• Need for assess and treat a wider range of problems
including victimization, co-occurring mental health
and education needs
• Need to modify materials to be more concrete and
use examples relevant to youth
Major limits through 1997
• Lack of standardized and evidence-based assessment
and treatment limited the reliability of what was
done
• Participation, treatment completion, and follow-up
rates were often low, limiting the validity of what
could be learned
• The lack of any manualized, evidence-based
adolescent approaches limited the ability to
disseminate and replicate what did work
• Difficult for clinicians, evaluators, and/or researchers
to work together or even enter the field
CSAT’s 10+ Year Investment in Improving
Adolescent Treatment Effectiveness
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
1997–2001, Cannabis Youth Treatment (CYT) – 600 youth
1998–2001, Adolescent Treatment Models (ATM) – 1334 youth
1998–2004, CSAT/NIAAA experiments – several hundred youth
2000–2002, Persistent Effects of Treatment Study of Adolescents (PETS-A) –
1200 youth
2001–2003, CSAT/RWJF Reclaiming Futures, 445 youth
2002–2007, Strengthening Communities for Youth (SCY) – 2,249 youth
2002–2012, Targeted Capacity Expansion (TCE) – 1,417 youth
2003–2006, Adolescent Residential Treatment (ART) – 1,458 youth
2003–2007, Effective Adolescent Treatment (EAT) – 5,854 youth
2004–2009, Co-occurring State Infrastructure Grants (COSIG) – system
2004–2009, Young Offender Re-entry Program (YORP) – 1,597 youth
2005–2008, State Adolescent Coordinator (SAC) – system
2005–2010, Juvenile Treatment Drug Court (JTDC) – 1,678 youth
2006–2010, Adolescent Assertive Family Tx (AAFT) – 2,769 youth
2007–2011, Brief Interventions and Referrals to Treatment (BIRT) and other
Office of Juvenile Justice and Delinquency Prevention and Robert Woods
Johnson Foundation (OJJDP/RWJF)- 315 youth
2010–Currently working to extend work in collaboration with CSAP, ED, DOL,
HRSA, and OJJDP
7
Big Changes
• Over 80% participation, use of evidence-based
assessment, use of evidence-based intervention, and
follow-up
• Have pooled data from 19,229 youth assessed with
the Global Appraisal of Individual Needs (GAIN),
including 88% with one more follow-up, made
available for program evaluation and secondary
analysis, and helped to generate over 200
publications
• Have supported the creation and evaluation of over
20 adolescent treatment manuals
• Several System level grants
Big Changes (continued…)
• Funded large-scale replications of three major evidence-based
practices
– Motivational Enhancement Therapy/ Cognitive Behavior
Therapy (MET/CBT) in the 36 site EAT program and
multiple independent grants
– Adolescent Community Reinforcement Approach (A-CRA)
and Assertive Continuing Care (ACC) in the 74 Site AAFT
program and multiple independent grants
• Also funded multiple state and independent grants to
replicate other evidence-based practices including
–
–
–
–
–
Family Support Network (FSN)
Motivational Interviewing
Multidimensional Family Therapy (MDFT)
Multi-Systemic Therapy (MST)
Seven Challenges (7C)
CSAT Sites with adolescent clients 12–17 and
included in the 2009 Summary Analytic GAIN Data
Set
NH
WA
MT
OR
ND
ID
WY
MN
CA
SD
AZ
AK
HI
PA
CT
NJ
DC
IN
IL
DE AAFT
VA
MO
MD ART
KY
ATM
NC
CYT
TN
EAT
SC
AR
JTDC
MS AL GA
OJJDP
OJJDP-BIRT
LA
SCY
TCE
YORP
FL
OH
OK
TX
RI
IA
KS
NM
MA
NY
MI
UT
CO
ME
WI
NE
NV
VT
PR
VI
10
Female
African American
100%
90%
80%
70%
60%
CSAT data is
diverse with
large numbers
of females
minorities, and
younger
adolescents
16%
39%
18%
Hispanic*
12 to 14 Years Old
50%
26%
Caucasian
Mixed/Other
40%
30%
20%
10%
0%
Demographic Characteristics
33%
18%
15 to 17 Years Old
Single Parent
82%
51%
*Any Hispanic ethnicity separate from race group
Sources: CSAT 2009 SA data set Adolescent Subset (n=19,145).
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Employed
Controlled environment
Prior Substance Abuse Treatment
Prior Mental Health Treatment
Current justice system involvement
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Youth are involved in multiple systems placing competing
demands on them and potentially in conflict with each other
9%
22%
33%
40%
68%
In School
Source: CSAT 2009 SA Data Set Adolescent Subset (n=19,108)
73%
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Total Disorder
Screener Severity by Level of Care
Total Disorder Screener for Adolescents
Outpatient & Student
Asst. Prog. are Similar
(Median
6.0 vs. 6.4)
% within Level of Care
11%
Lo Mod. High ->
Residential (n=1,965)
10%
w
OP/IOP (n=2,499)
9%
SAP (n=10,649)
8%
7%
6%
5%
4%
Residential
3%
Median
2%
(10.5) is
higher
1%
0%
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Well
Targeted
Total Disorder Sceener (TDScr) Score
95% 1+
85% 3+
About 30% of OP & SAP are in the high
Source: SAPISP 2009 Data and Dennis et al 2006
severity range more typical of residential 13
Alcohol
100%
90%
80%
70%
33%
Other drug disorder
27%
34%
Depression
14%
Trauma
24%
ADHD
41%
CD
Suicide
60%
20%
Cannabis
Anxiety
50%
40%
30%
20%
10%
0%
Multiple Clinical Problems are the NORM!
48%
11%
Victimization
Violence/ illegal activity
Source: CSAT 2009 Summary Analytic Data Set (n=20,826)
63%
80%
14
The Number of Clinical Problems
is related to Level of Care
100%
None
90%
80%
One
70%
Two
60%
Three
50%
80%
40%
65%
30%
20%
41%
45%
53%
Five Plus
10%
0%
Outpatient
Intensive
Outpatient
OP Cont.
Care
Four
Long Term Short Term
Resid.
Resid.
Source: CSAT 2009 Summary Analytic Data Set (n=21,332)
Significantly
more likely to
have 5+
problems
(OR=5.8)
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The Number of Major Clinical Problems
is highly related to Victimization
100%
None
90%
80%
One
70%
Two
60%
Three
50%
40%
71%
30%
10%
Five to Twelve
46%
20%
15%
0%
Low (0)
Moderate (1-3)
Source: CSAT 2009 Summary Analytic Data Set (n=21,784)
Four
High (4-15)
Significantly
more likely to
have 5+
problems
(OR=13.9)
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Sexually Active
100%
90%
80%
70%
63%
30%
Multiple Sex Partners
Any Unprotected Sex
26%
19%
High Risk Sex*
20%
Victimized
Any Needle Use
60%
50%
40%
30%
20%
10%
0%
Past 90 day HIV Risk Behaviors are more
Related to Sexual Activity than Needle Use
Also important to
recognize the role of
interpersonal violence
as a HIV risk factor –
particularly for girls
2%
*Based on 1+ times had sex while intoxicated, with an injection drug user, with a man who had sex with
men, with someone who was HIV positive, or traded sex for goods (n=415)
Source: CSAT 2009 SA Data Set Adolescent Subset (n=18,674)
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Screening & Brief Inter.(1-2 days)
In-prison Therap. Com. (28 weeks)
Outpatient (18 weeks)
Intensive Outpatient (12 weeks)
Treatment Drug Court (46 weeks)
Residential (13 weeks)
Methadone Maintenance (87 weeks)
Therapeutic Community (33 weeks)
$407
$1,249
$1,132
$1,384
$2,486
$2,907
$4,277
$14,818
$22,000 / year
to incarcerate
an adult
$30,000/
child-year in
foster care
Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004
$70,000
$60,000
$50,000
$40,000
$30,000
$20,000
$10,000
$0
The Cost of Treatment is Small Relative
to Reductions in other Costs
• $750 per night in Detox
• $1,115 per night in hospital
• $13,000 per week in intensiv
care for premature baby
• $27,000 per robbery
• $67,000 per assault
$70,000/year to
keep a child in
detention
Investing in Treatment has a Positive
Annual Return on Investment (ROI)
• Substance abuse treatment has been shown to have a
ROI within the year of between $1.28 to $7.26 per dollar
invested
– The main difference being how many different kinds
of things economists “valued” in a given study
• Best estimates are that Treatment Drug Courts have an
average ROI of $2.14 to $2.71 per dollar invested
This also means that for every dollar treatment is cut, we
lose more money than was saved.
Source: Bhati et al., (2008); Ettner et al., (2006)
Major Predictors of Bigger Effects Found in
Multiple Meta Analyses (Lipsey, 1997, 2005)
1. A strong intervention protocol based on
prior evidence
2. Quality assurance to ensure protocol
adherence and project implementation
3. Proactive case supervision of individual
4. Triage to focus on the highest severity
subgroup
Impact of the numbers of these Favorable
features on Recidivism in 509 Juvenile Justice
Studies in Lipsey Meta Analysis
Average
Practice
Source: Adapted from Lipsey, 1997, 2005
The more
features,
the lower
the
recidivism
Evidence-Based Treatment (EBT) that
Typically do Better than Usual Practice in
Reducing Juvenile Use & Recidivism
• Adolescent Community Reinforcement Approach
(A-CRA)
• Aggression Replacement Training (ART)
• Assertive Continuing Care (ACC)
• Cognitive Behavior Therapy (CBT)
• Functional Family Therapy (FFT)
• Seven Challenges (7C)
• Thinking for a Change (TFC)
• Interpersonal Social Problem Solving (ISPS)
Small or no differences in mean effect size between these brand names
Source: Adapted from Lipsey et al 2001, 2010; Waldron et al, 2001, Dennis et al, 2004
Evidence-Based Treatment (EBT) that
Typically do Better than Usual Practice in Reducing Juvenile
Use & Recidivism
• Motivational Enhancement Therapy/Cognitive
Behavior Therapy (MET/CBT)
• Motivational Interviewing (MI)
• Multi Systemic Therapy (MST)
• Multidimensional Family Therapy (MDFT)
• Reasoning & Rehabilitation (RR)
• Seven Challenges (7C)
Small or no differences in mean effect size between these brand names
Source: Adapted from Lipsey et al 2001, 2010; Waldron et al, 2001, Dennis et al, 2004
Other Common Findings
 Low structure and ad hoc “treatment as
usual” does not do as well as evidence-based
practice
 Wilderness programs have mixed effects
 Treating adolescents like adults and in boot
camp causes harm on average
 Relapse is still common and there is a need for
ongoing support, monitoring, and, when
necessary, re-intervention
Similarity of Clinical Outcomes:
Cannabis Youth Treatment (CYT)
Trial 2
Trial 1
300
50%
280
40%
260
30%
240
20%
But better than the
average for OP in220
ATM (200 days of
200
abstinence)
10%
MET/ CBT5
(n=102)
MET/
CBT12
FSN
(n=102)
MET/ CBT5
(n=99)
ACRA
(n=100)
MDFT
(n=99)
Total Days Abstinent*
269
256
260
251
265
257
Percent in Recovery**
0.28
0.17
0.22
0.23
0.34
0.19
* n.s.d., effect size f=0.06
** n.s.d., effect size f=0.12
Source: Dennis et al., 2004
* n.s.d., effect size f=0.06
** n.s.d., effect size f=0.16
0%
Percent in Recovery
.
at Month 12
Total days abstinent
over 12 months
.
Not significantly different
by condition.
$20
$16
ACRA did better than
MET/CBT5,
and both did
Trial 2
better than MDFT
MET/CBT5 and
Trial 1
12 did better
than FSN
Cost per person in recovery
at month 12
Cost per day of abstinence
over 12 months
Moderate to large differences
in Cost-Effectiveness by Condition
$20,000
$16,000
$12
$12,000
$8
$8,000
$4
$4,000
$0
MET/
CBT5
MET/
CBT12
CPDA*
$4.91
CPPR**
$3,958
$0
FSN
MET/
CBT5
ACRA
MDFT
$6.15
$15.13
$9.00
$6.62
$10.38
$7,377
$15,116
$6,611
$4,460
$11,775
* p<.05 effect size f=0.48
** p<.05, effect size f=0.72
Source: Dennis et al., 2004
* p<.05 effect size f=0.22
** p<.05, effect size f=0.78
Suggest the need to consider cost-effectiveness of
treatment approaches
Implementation is Essential
(Reduction in Recidivism from .50 Control Group Rate)
The best is to
have a strong
program
implemented
well
Thus one should optimally pick the
strongest intervention that one can
implement well
Source: Adapted from Lipsey, 1997, 2005
The effect of a well
implemented weak program
is as big as a strong
program implemented poorly
% Point Change in Abstinence
Change in Abstinence by level of Quality Assurance:
Adolescent Community Reinforcement Approach
(A-CRA)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Effects associated with
Coaching, Certification
and Monitoring (OR=7.6)
24%
4%
Training Only
Training, Coaching,
Certification, Monitoring
Source: CSAT 2008 SA Dataset subset to 6 Month Follow up (n=1,961)
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Which general approaches address co-occurring mental
health/trauma issues?
A Comparison of Nine Treatment Approaches
• Seven Challenges (Schwebel, 2004) (n=114)
• Chestnut Health Systems (CHS; Godley et al. 2002) Treatment
(n=192)
• Adolescent Community Reinforcement Approach (A-CRA; Godley
et al., 2001) – CYT/AAFT (n=2144) and -Other (n=276)
• Multi-Systemic Therapy
(MST; Henggeler et al., 1998) (n=85)
• Multi-Dimensional Family Therapy
(MDFT; Liddle, 2002) (n=258)
• Motivational Enhancement Therapy-Cognitive Behavior Therapy
(METCBT; Sampl & Kadden, 2001) – CYT/EAT (n=5262) and – Other
(n=878)
• Family Support Network
(FSN; Hamilton et al., 2001) (n=369)
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Co-occurring Disorders
Mental Health
• Emotional Problems Scale
• Days of Victimization
• Days of Traumatic Memories
30
Change (post-pre) Effect Size for Emotional
Problems by Type of Treatment
Figure 8. Change (post-pre) Effect Size for Emotional Problems
by Type of Evidenced Based Treatment
Seven
Challenges
(n=114)
CHS
Treatment
(n=192)
A-CRACYT/AAFT
(n=2144)
MST
(n=85)
MDFT
(n=258)
METCBTCYT/EAT
(n=5262)
METCBTOther
(n=878)
FSN
(n=369)
A-CRAOther
(n=276)
-0.60
-0.29
-0.08
-0.16
-0.13
-0.08
-0.29
-0.34
-0.37
-0.21
-0.15
-0.13
-0.12
-0.04
-0.19
-0.37
-0.39
-0.32
-0.45
-0.43
-0.40
-0.22
-0.19
-0.14
-0.28
-0.18
-0.20
-0.09
-0.08
0.00
-0.54
Change Effect Size d
((mean follow-up - mean intake)/ std dev. intake)
0.20
Four best on mental health
outcomes include 7 challenges,
CHS, A-CRA, & MST
-0.80
Emotional Problem Scale
Days of traumatic memories
Days of victimization
Change (post-pre) Effect Size for Core
Treatment
Outcomes by Type of Treatment
Figure 9. Change (post-pre) Effect Size for Core Treatment Outcomes
CHS
A-CRATreatment CYT/AAFT
(n=192)
(n=2144)
MST
(n=85)
MDFT
(n=258)
-0.37
-0.38
-0.38
-0.36
Seven
Challenges
(n=114)
-0.39
-0.45
-0.43
-0.39
-0.38
-0.41
by Type of Evidenced Based Treatment
METCBTCYT/EAT
(n=5262)
METCBTOther
(n=878)
FSN
(n=369)
A-CRAOther
(n=276)
-0.29
-0.36
-0.48
-0.23
-0.18
-0.31
-0.29
-0.30
-0.37
-0.29
-0.47
-0.51
-0.34
-0.33
-0.26
-0.19
-0.17
-0.26
-0.27
-0.37
-0.38
-0.33
-0.18
-0.28
-0.23
-0.36
-0.45
-0.43
-0.42
-0.17
-0.11
0.04
-0.30
-0.11
0.00
-0.43
-0.37
-0.50
-0.60
-0.65
-0.40
-0.30
-0.20
-0.32
-0.15
0.00
-0.54
-0.62
Change Effect Size d
((mean follow-up - mean intake)/ std dev. intake)
0.20
-0.80
Emotional Problem Scale
Substance Problem Scale
Substance Frequency Scale
HIV Risk Scale
Illegal Activity Scale
Average
Summary
• All programs reduced mental health / trauma problems with
4 doing particularly well: Seven Challenges, CHS, A-CRA, &
MST
• Where we could break in two (A-CRA & MET/CBT), programs
with more training, quality assurance, monitoring and
technical assistance did better than those with less
• A-CRA with a mix of BA/MA did as well as MST which targets
MA level therapists and family therapists that are often in
short supply
• While it is not the most effective, the shortest & least
expensive (MET/CBT5) still has positive effects
33
References
Applegate, B. K., & Santana, S. (2000). Intervening with youthful substance abusers: A preliminary analysis of a juvenile drug court. The Justice System
Journal, 21(3), 281–300.
Bhati et al. (2008) To Treat or Not To Treat: Evidence on the Prospects of Expanding Treatment to Drug-Involved Offenders. Washington, DC: Urban
Institute.
Capriccioso, R. (2004). Foster care: No cure for mental illness. Connect for Kids. Accessed on 6/3/09 from http://www.connectforkids.org/node/571
Chandler, R.K., Fletcher, B.W., Volkow, N.D. (2009). Treating drug abuse and addiction in the criminal justice system: Improving public health and
safety. Journal American Medical Association, 301(2), 183–190
Dennis, M.L., Coleman, V., Scott, C.K & Funk, R. (forthcoming). The Prevalence of Remission from Major Mental Health Disorder in the US: Findings
from the National Co morbidity Study Replication.
Dennis, M. L., Dawud-Noursi, S., Muck, R. D., & McDermeit [Ives], 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.
Dennis, M.L., Foss, M.A., & Scott, C.K (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of
recovery. Evaluation Review, 31(6), 585–612
Dennis, M. L., Scott, C. K. (2007). Managing Addiction as a Chronic Condition. Addiction Science & Clinical Practice , 4(1), 45–55.
Dennis, M. L., Scott, C. K., Funk, R., & Foss, M. A. (2005). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse
Treatment, 28, S51–S62.
Dennis, M. L., Scott, C. K., & Funk, R. (2003). An experimental evaluation of recovery management checkups (RMC) for people with chronic substance
use disorders. Evaluation and Program Planning, 26(3), 339–352.
Dennis, M. L., White, M., & Ives, M. I. (2009). Individual characteristics and needs associated with substance misuse of adolescents and young adults in
addiction treatment. In C. Leukefeld, T. Gullotta, & M. Staton Tindall, Handbook on adolescent substance abuse prevention and treatment:
Evidence-based practice (pp. 45–72). New London, CT: Child and Family Agency Press. Henggeler, S. W. (2007). Juvenile drug courts: Emerging
outcomes and key research issues. Current Opinion in Psychiatry, 20, 242–246.
Ettner, S.L., Huang, D., Evans, E., Ash, D.R., Hardy, M., Jourabchi, M., & Hser, Y.I. (2006). Benefit Cost in the California Treatment Outcome Project:
Does Substance Abuse Treatment Pay for Itself?. Health Services Research, 41(1), 192–213.
French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates of cost bands for program
assessment and reimbursement. Journal of Substance Abuse Treatment, 35, 462–469
Henggeler, S. W., Halliday-Boykins, C. A., Cunningham, P. B., Randall, J., Shapiro, S. B., Chapman, J. E. (2006). Juvenile drug court: enhancing outcomes
by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 74(1), 42–54.
Ives, M. L., Chan, Y-F., Modisette, K. C. and Dennis, M. L., (in press). Characteristics, needs, services, and outcomes of youths in Juvenile Treatment
Drug Courts as compared to adolescent outpatient treatment. Drug Court Review VII(1).
Miller, M. L., Scocas, E. A., & O’Connell, J. P. (1998). Evaluation of the juvenile drug court diversion program. Dover DE: Delaware Statistical Analysis
Center, USA.
References (continued)
National Association of Drug Court Professionals (NADCP), Drug Court Standards Committee. (1997). Defining drug courts: the key components.
Washington, DC: Drug Courts Program Office, Office of Justice Programs, US Department of Justice
Neumark, Y.D., Van Etten, M.L., & Anthony, J.C. (2000). Drug dependence and death: Survival analysis of the Baltimore ECA sample from 1981 to 1995.
Substance Use and Misuse, 35, 313–327.
Office of Applied Studies (2006). Results from the 2005 National Survey on Drug Use and Health: National Findings Rockville, MD: Substance Abuse and
Mental Health Services Administration. http://www.oas.samhsa.gov/NSDUH/2k5NSDUH/2k5results.htm#7.3.1
Office of Applied Studies (OAS, 2006). Substance Abuse and Mental Health Services Administration.(SAMHSA) National Survey on Drug Use and Health,
2006 [Computer file]. ICPSR21240-v4. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2009-08-12.
Office of Juvenile Justice and Delinquency Prevention (OJJDP). (May 2001). Juvenile Drug Court Program. Department of Justice, OJJDP, Washington,
DC. NCJ 184744.
Riley, B.B.,, Scott, C.K, & Dennis, M.L. (2008). The effect of recovery management checkups on transitions from substance use to substance abuse
treatment and from treatment to recovery. Poster presented at the UCLA Center for Advancing Longitudinal Drug Abuse Research Annual
Conference, August 13-15, 2008, Los Angles, CA. http://www.caldar.org.
Rodriguez, N., & Webb, V. J. (2004). Multiple measures of juvenile drug court effectiveness: Results of a quasi-experimental design. Crime &
Delinquency, 50(2), 292–314.
Rush, B., Dennis, M.L., Scott, C.K, Castel, S., & Funk, R.R. (2008). The Interaction of Co-Occurring Mental Disorders and Recovery Management
Checkups on Treatment Participation and Recovery.
Scott, C. K., & Dennis, M. L. (2009). Results from Two Randomized Clinical Trials evaluating the impact of Quarterly Recovery Management Checkups
with Adult Chronic Substance Users. Addiction.
Scott, C. K., Dennis, M. L., & Foss, M. A. (2005). Utilizing recovery management checkups to shorten the cycle of relapse, treatment re-entry, and
recovery. Drug and Alcohol Dependence, 78, 325–338.
Scott, C. K., Dennis, M. L., & Funk, R.R. (2008). Predicting the relative risk of death over 9 years based on treatment completion and duration of
abstinence. Poster 119 at the College of Problems on Drug Dependence (CPDD) Annual Meeting, San Juan, PR, June 16, 2008. Available at
http://www.chestnut.org/li/posters.
Scott, C. K., Foss, M. A., & Dennis, M. L. (2005). Pathways in the relapse, treatment, and recovery cycle over three years. Journal of Substance Abuse
Treatment, 28, S61–S70.
Sloan, J. J., Smykla, J. O., & Rush, J. P. (2004). Do juvenile drug courts educe recidivism? Outcomes of drug court and an adolescent substance abuse
program. American Journal of Criminal Justice, 29(1), 95–116.
Teplin, L. A., Abram, K. M., McClelland, G. M., Dulcan, M.K., & Mericle, A. A. (2002). Psychiatric disorders in youth in juvenile detention. Archives of
General Psychiatry, 59(12), 1133–43.
Volkow ND, Fowler JS, Wang G-J, Hitzemann R, Logan J, Schlyer D, Dewey 5, Wolf AP. (1993). Decreased dopamine D2 receptor availability is
associated with reduced frontal metabolism in cocaine abusers. Synapse 14:169–177.
Volkow, ND, Hitzemann R, Wang C-I, Fowler IS, Wolf AP, Dewey SL. (1992). Long-term frontal brain metabolic changes in cocaine abusers. Synapse
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