Yifrah Kaminer1, Christine McCauley Ohannessian2, Rebecca H Burke3. 1. Alcohol Research Center, and Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, United States. Electronic address: kaminer@uchc.edu. 2. Alcohol Research Center, and Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, United States; Children's Center for Community Research, Connecticut Children's Medical Center, Hartford, CT, United States. 3. Alcohol Research Center, and Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, United States.
Abstract
OBJECTIVE: Treatment response as measured by both retention and abstinence attainment rates for adolescents with cannabis use disorders (CUD) has been unsatisfactory. This study tested the hypothesis that adaptive treatment (AT) will improve outcomes for poor responders (PR) to evidence-based practice interventions. METHOD: A total of 161 adolescents, 13-18years of age, diagnosed with DSM-IV CUD, enrolled in this outpatient, randomized, AT study. Following a 7-session weekly motivational enhancement and cognitive behavioral therapy intervention (MET/CBT-7) only poor responders (defined as failing to achieve abstinence at week seven for any reason) were randomized into a 10-week AT phase of either an individualized enhanced CBT or an Adolescent Community Reinforcement Approach (ACRA) intervention. Good responders (GR) enrolled only in follow-up assessments starting at the completion of the AT phase (week 17). RESULTS:Eighty adolescents (50%) met the criterion for poor response to treatment. Thirty seven percent of poor responders completed the AT phase and 27% of them achieved abstinence. There was no significant difference in retention and abstinence rates between the AT conditions. Although the majority of GR relapsed by week 17, they significantly differed from PR both for drug use (71% vs. 91%, respectively; p<0.05) and reporting to scheduled assessment on that week (78% vs. 54%, respectively; p<0.01). CONCLUSION: Continuity of care to achieve abstinence among poor responders remains a therapeutic necessity and a research challenge. Examining innovative AT designed interventions including potential integrative approaches should be further studied in order to improve treatment outcomes.
RCT Entities:
OBJECTIVE: Treatment response as measured by both retention and abstinence attainment rates for adolescents with cannabis use disorders (CUD) has been unsatisfactory. This study tested the hypothesis that adaptive treatment (AT) will improve outcomes for poor responders (PR) to evidence-based practice interventions. METHOD: A total of 161 adolescents, 13-18years of age, diagnosed with DSM-IV CUD, enrolled in this outpatient, randomized, AT study. Following a 7-session weekly motivational enhancement and cognitive behavioral therapy intervention (MET/CBT-7) only poor responders (defined as failing to achieve abstinence at week seven for any reason) were randomized into a 10-week AT phase of either an individualized enhanced CBT or an Adolescent Community Reinforcement Approach (ACRA) intervention. Good responders (GR) enrolled only in follow-up assessments starting at the completion of the AT phase (week 17). RESULTS: Eighty adolescents (50%) met the criterion for poor response to treatment. Thirty seven percent of poor responders completed the AT phase and 27% of them achieved abstinence. There was no significant difference in retention and abstinence rates between the AT conditions. Although the majority of GR relapsed by week 17, they significantly differed from PR both for drug use (71% vs. 91%, respectively; p<0.05) and reporting to scheduled assessment on that week (78% vs. 54%, respectively; p<0.01). CONCLUSION: Continuity of care to achieve abstinence among poor responders remains a therapeutic necessity and a research challenge. Examining innovative AT designed interventions including potential integrative approaches should be further studied in order to improve treatment outcomes.
Authors: Dustin C Lee; Nicolas J Schlienz; Erica N Peters; Robert H Dworkin; Dennis C Turk; Eric C Strain; Ryan Vandrey Journal: Drug Alcohol Depend Date: 2018-11-15 Impact factor: 4.492
Authors: Matthew C Fadus; Lindsay M Squeglia; Emilio A Valadez; Rachel L Tomko; Brittany E Bryant; Kevin M Gray Journal: Curr Psychiatry Rep Date: 2019-09-14 Impact factor: 5.285
Authors: John F Curry; Yifrah Kaminer; David B Goldston; Grace Chan; Karen C Wells; Rebecca H Burke; Adrienne Banny Inscoe; Allison E Meyer; Shayna M Cheek Journal: J Am Acad Child Adolesc Psychiatry Date: 2021-08-06 Impact factor: 8.829