Georgetown University Adolescent Health Program

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