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Biomedical subjects

Yifrah Kaminer

Publications and source records attributed to Yifrah Kaminer.

At least 19 recordsLinked to original sources
PubMed2006

Adolescent and therapist perception of barriers to outpatient substance abuse treatment.

Attrition is one of the most vexing problems for the effective delivery of behavioral health services. Most prior studies focus on patient demographics and psychopathology factors predicting dropout. We examined patient and therapist post-treatment reports of barriers to attending treatment. Six hundred adolescents and their therapists completed the Perceived Barriers to Treatment scale (PBT) at discharge from a brief substance abuse intervention. After adjusting for covariates, results suggest that perceived barriers, in particular, practical obstacles, lack of treatment readiness, relevance, and compatibility, are related to sessions attended. Shifting to a more patient-centered approach for understanding treatment retention is discussed.

Adolescent↗
PubMed2006

Absence of iatrogenic or contagion effects in adolescent group therapy: findings from the Cannabis Youth Treatment (CYT) study.

Though widely used and presumed effective in practice, some scholars (Dishion et al., 1999) have raised the concern that group therapy for adolescents with substance use disorder and a range of deviancy has the potential for causing iatrogenic effects (e.g., increased substance use, behavior and legal problems) for those with low deviancy. Using data from 400 youth in the largest adolescent treatment experiment conducted to date (Dennis et al., 2004), this study shows that group composition in terms of conduct disorder symptoms is not associated with worse substance use, psychological, environmental or legal treatment outcomes. The results actually indicated that there was a slight advantage for youth with high conduct disorder to be included in the groups with less symptoms. The results appear consistent with recent meta-analyses of delinquency studies (Lipsey, 2006) which have found no evidence of iatrogenic effects. These results support the common clinical belief that group therapy for youths with substance use disorders is a safe and effective treatment modality.

Adolescent↗
PubMed2006

An interactive voice response (IVR) system for adolescents with alcohol use disorders: a pilot study.

In order to understand predictors of relapse among adolescents treated for alcohol use disorders (AUD), it is important to accurately assess the daily circumstances associated with use. This pilot study investigates the feasibility and acceptability of an interactive voice response (IVR) system in adolescents with AOSUD. Twenty-six adolescents 14 to 19 years old, with a mean age of 16.8, who were enrolled into an adolescent treatment program for AUD consented to make phone calls for 14 successive evenings to an IVR system and answer 14 questions pertaining to daily use of alcohol and other drugs. The subjects were compensated for their participation. A satisfaction questionnaire was administered at the end of the study. Participants completed 72% of scheduled recordings, with an average of 10.1 calls per subject. Most participants reported that they answered the questions honestly and accurately and were very much satisfied with the IVR system. The preliminary data presented here suggests that the use of IVR for the purpose of generating daily reports in youth is feasible and acceptable. The utilization of IVR systems should be explored to improve efficacy and attainment of generalizability to heterogeneous adolescent populations and lifestyles including for other psychiatric disorders.

Adolescent↗
PubMed2006

Suicidal ideation among adolescents with alcohol use disorders during treatment and aftercare.

The objectives of this study are to assess the magnitude and course of suicidal ideation during outpatient treatment and aftercare for adolescents with alcohol use disorders (AUD). One hundred seventy-seven adolescents meeting eligibility criteria, including no past 30-day suicidal behavior, participated in 9 weeks of outpatient cognitive-behavioral group therapy. Treatment completers were randomized into: (1) No-Active, (2) In-Person, or (3) Telephone aftercare conditions for a period of 12 weeks. No specific intervention for suicidal behavior was provided during the study. The Suicide Ideation Questionnaire (SIQ-JR, Reynolds, 1988) was administered at baseline, end of treatment, and end of aftercare. The results are as follows, a higher baseline suicidal ideation was associated with higher retention at the end of treatment and through aftercare. The In-Person Aftercare condition showed a significant decrease in suicidal ideation, relative to the No-Active Aftercare condition. There was a trend for similarly reduced severity of suicidal ideation in the Telephone Aftercare condition. In conclusion, the type of aftercare and resulting decrease in AUD may play a role in the reduction in suicidal ideation. The mechanism of change by which suicidal ideation is reduced in adolescents in treatment for AUD needs to be further explored.

Adolescent↗
PubMed2005

Self-efficacy as a predictor of treatment outcome in adolescent substance use disorders.

Youth substance abuse relapse prevention was examined as a function of patients' situational self-efficacy (SE), their confidence to abstain from substance use in high-risk situations. An increase in SE has been shown to be enhanced by cognitive behavioral therapy (CBT) in adults. Eighty-eight adolescent substance abusers were randomly assigned to either CBT or psycho-education (PET) group therapy. Substance use and SE were assessed at end of treatment, 3- and 9-months after the end of planned treatment. Increased SE predicted subsequent abstinence independently from drug urinalysis and treatment condition only during treatment, while previous substance use predicted subsequent self-efficacy. CBT was not differentially effective than PET in promoting SE. It is recommended that potential mediators and moderators of SE in the treatment of adolescent substance abuse should be further explored.

Adolescent↗
PubMed2005

Challenges and opportunities of group therapy for adolescent substance abuse: a critical review.

Group intervention has been the most commonly employed treatment modality for adolescents with substance use disorders (SUD). Evidence has been accumulating in support for the efficacy of diverse forms of group therapy that have been utilized with adolescents. It has been argued however, that aggregation of youths who display problem behavior into group interventions may, under some conditions, produce iatrogenic effects on all participants. This assertion known also as "deviancy training" and its presumed effect on treatment outcomes has created a barrier to progress regardless of the fact that it has not been tested or empirically supported in heterogeneous groups of adolescents treated for SUD. It is imperative to optimize group intervention while considering how to prevent, reduce and control, potentially iatrogenic effects associated with the aggregation of antisocial youths in heterogeneous groups. The main objective of this review is to address the challenges and opportunities regarding group treatment of adolescent SUD.

Adolescent↗
PubMed2005

Conversion and validation of the Teen-Addiction Severity Index (T-ASI) for Internet and automated-telephone self-report administration.

This study converted the Teen-Addiction Severity Index (T-ASI) into self-report formats using Internet (Net) and interactive voice response (IVR) automated-telephone technologies. Reliability and convergent validity were assessed among 95 inpatient adolescent participants. Current functioning scores obtained by clinician interview correlated well with self-report Net (mean r=.74, SD=.14) and IVR (mean r=.72, SD=.16). Lifetime history items obtained by clinicians were consistent with self-report Net (mean r=.60, SD=.32; mean kappa=.67, SD=.24) and IVR formats (mean r=.60, SD=.30; mean kappa=.64, SD=.26). Participants rated "ease of use" as being high for both Net and IVR formats. These findings suggest that automated T-ASI administration is a valid and potentially less expensive alternative to clinician-administered T-ASI interviews.

Adolescent↗
PubMed2004

The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials.

This article presents the main outcome findings from two inter-related randomized trials conducted at four sites to evaluate the effectiveness and cost-effectiveness of five short-term outpatient interventions for adolescents with cannabis use disorders. Trial 1 compared five sessions of Motivational Enhancement Therapy plus Cognitive Behavioral Therapy (MET/CBT) with a 12-session regimen of MET and CBT (MET/CBT12) and another that included family education and therapy components (Family Support Network [FSN]). Trial II compared the five-session MET/CBT with the Adolescent Community Reinforcement Approach (ACRA) and Multidimensional Family Therapy (MDFT). The 600 cannabis users were predominately white males, aged 15-16. All five CYT interventions demonstrated significant pre-post treatment during the 12 months after random assignment to a treatment intervention in the two main outcomes: days of abstinence and the percent of adolescents in recovery (no use or abuse/dependence problems and living in the community). Overall, the clinical outcomes were very similar across sites and conditions; however, after controlling for initial severity, the most cost-effective interventions were MET/CBT5 and MET/CBT12 in Trial 1 and ACRA and MET/CBT5 in Trial 2. It is possible that the similar results occurred because outcomes were driven more by general factors beyond the treatment approaches tested in this study; or because of shared, general helping factors across therapies that help these teens attend to and decrease their connection to cannabis and alcohol.

Adolescent↗
PubMed2004

On the learning curve: the emerging evidence supporting cognitive-behavioral therapies for adolescent substance abuse.

AIMS: Cognitive-behavioral therapy (CBT) approaches to intervention for adolescent substance use disorders has been limited and formal controlled clinical efficacy trials have been rare. Moreover, the early literature on the efficacy of CBT for adolescent substance abuse has been characterized by significant methodological limitations. Recent innovations in the treatment of adolescent substance abuse and the recent completion of several randomized clinical trials has brightened the picture with respect to establishing the empirical support for CBT. The aim of this review is to integrate the findings from controlled trials of CBT for adolescent substance abuse. METHOD: Studies representing randomized clinical trials were reviewed using criteria provided by Lonigan et al. and Nathan & Gorman as a guide. FINDINGS AND CONCLUSIONS: Despite some prominent differences in design and methodology, the studies reviewed provide consistent empirical evidence that group and individual CBT are associated with significant and clinically meaningful reductions in adolescent substance use. The evidence for the efficacy of group therapy is particularly important, countering the assertion that aggregating problem youths into group treatment settings is associated with iatrogenic effects. The findings from the randomized trials reviewed represent significant developments in treatment outcome research and lay the foundation for validating CBT for adolescent substance use disorders. Future research directions include improving short- and long-term outcomes, enhancing treatment motivation and engagement, and identifying mechanisms and processes associated with positive change, especially for youths with comorbid conditions.

Adolescent↗
PubMed2004

Correlation between ancillary community services with adolescent substance use disorders treatment outcome.

OBJECTIVE: This study explores whether participation in ancillary out-of-program services predicts outcomes of adolescents treated for substance use disorders. METHOD: Eighty-eight consenting adolescents, 13-18 years of age recruited at an outpatient program filled the Teen Treatment Services Review (T-TSR) during eight weekly sessions, and at 3-and 9-Month post-treatment. Outcome variables included urinalysis and three subscales of the Teen-Addiction Severity Index (T-ASI) during Treatment (DT) and at follow-ups. The predictor variable was the number of reported Out-of-Program service contact Days (OD). RESULTS: While DT OD did not correlate with DT urinalysis, high DT OD days showed a trend toward predicting negative 3-month (3-M) urinalysis. By contrast, high 3-M OD days-predicted positive 3-M urinalyses as well as high use on all three T-ASI subscales. Out-of-Program services between 3-and 9-M post-treatment were not correlated with 9-M objective or subjective outcomes. CONCLUSION: The more therapeutic services received during treatment, the better the short-term outcome. The more therapeutic services received post-treatment, however, the poorer the shortterm outcome. Use of outside services presented a response rather than a cause of substance use.

Adolescent↗
PubMed2002

Adolescent substance abuse treatment: evidence-based practice in outpatient services.

Adolescent substance use disorder (SUD) is a serious public health concern. The majority of youth with SUD receive outpatient treatment. There is a pressing need to improve treatment outcome due to high rates of both premature treatment termination and relapse during and after treatment completion. Reviews of the latest innovations in the treatment of adolescent substance abuse and the recent completion of several randomized clinical trials examining singular and integrative treatment modalities have established empiric support for the efficacy of adolescent treatment. Despite some prominent differences in treatment modalities, design, and methodology, recent studies have reported remarkably similar short-term outcomes. Taken together, the findings represent significant developments in treatment outcome research, and lay the foundation for continued future research addressing important challenges. Potential directions include improving short- and long-term outcomes, enhancing motivation for treatment, improving engagement strategies, identifying challenges associated with psychiatric comorbidity, addressing patient-treatment matching, and developing aftercare programs.

Adolescent↗
PubMed2002

The Cannabis Youth Treatment (CYT) experiment: rationale, study design and analysis plans.

AIMS: This paper provides a description of the rationale, study design, treatments and assessment procedures used in the Cannabis Youth Treatment (CYT) experiment. DESIGN: CYT was designed to (a) test the relative effectiveness, cost and benefit-cost of five promising treatment interventions under field conditions and (b) provide evidence based manual-guided models of these interventions to the treatment field. SETTING: The study involved two community-based treatment programs and two major medical centers. PARTICIPANTS: Participants were 600 adolescents recruited from the regular intake who were between the ages of 12 and 18, had used marijuana in the past 90 days, and met one or more criteria of dependence or abuse. INTERVENTIONS: Participants were randomly assigned to one of five interventions: Motivational Enhancement Therapy (MET), Cognitive Behavioral Therapy (CBT), Family Support Network (FSN), Adolescent Community Reinforcement Approach (ACRA), or Multidimensional Family Therapy (MDFT). MEASUREMENTS: Self-report data were collected at intake, 3, 6, 9 and 12 months post discharge using the Global Appraisal of Individual Needs (GAIN), as well as several supplemental self-reports, collateral reports, urine testing, and service logs. FINDINGS: This paper reports on the study's implementation including the psychometric properties of the measures (alphas over 0.8), validity of self-report (kappa over 0.6), high rates of treatment completion (81% completed two or more months), and high rates of follow-up (over 94% per wave). CONCLUSIONS: The feasibility of implementing the CYT manual-guided treatment and quality assurance model in community-based adolescent treatment programs is discussed.

Adolescent↗
PubMed2002

Subtypes for classifying adolescents with marijuana use disorders: construct validity and clinical implications.

AIMS: To evaluate the construct and predictive validity of six different subtyping classifications selected on the basis of their empirical support in the literature on adolescent substance abuse. METHODS: Typological data were collected from a heterogeneous sample of 600 adolescents presenting for marijuana treatment. The classification schemes were gender, onset age, family history, externalizing disorders, internalizing disorders and temperament. Subgroups were compared in terms of substance use frequency, substance abuse problems, social support for substance use, family conflict, school problems and negative peer associations. RESULTS: Each of the categorical classification schemes differentiated subtypes significantly on some or all of the construct validation measures after controlling for demographic factors, thereby indicating that each has valuable explanatory power from a theoretical perspective. Externalizing disorders, onset age, difficult temperament and internalizing disorders continued to add unique variance to discrimination after the effects of the other subtypes had been removed. At 12-month follow-up there were no differences between subtypes on substance use frequency, but adolescents with higher levels of externalizing disorders and internalizing disorders continued to experience more substance use problems. CONCLUSION: Categorical subtypes may have particular relevance to the development of treatment interventions as well as prevention measures.

Adolescent↗