Observational Study

. 2020 Nov:118:108075.

doi: 10.1016/j.jsat.2020.108075. Epub 2020 Jul 6.

Expanding outcomes when considering the relative effectiveness of two evidence-based outpatient treatment programs for adolescents

Beth Ann Griffin¹, Lynsay Ayer², Joseph Pane³, Brian Vegetabile⁴, Lane Burgette⁵, Daniel McCaffrey⁶, Donna L Coffman⁷, Matthew Cefalu⁸, Rod Funk⁹, Mark D Godley¹⁰

Affiliations

¹ RAND Corporation, 1200 South Hayes Street, Arlington, VA, USA. Electronic address: bethg@rand.org.
² RAND Corporation, 1200 South Hayes Street, Arlington, VA, USA. Electronic address: layer@rand.org.
³ RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA. Electronic address: josephp@rand.org.
⁴ RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA. Electronic address: bvegetab@rand.org.
⁵ RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA. Electronic address: burgette@rand.org.
⁶ ETS, 660 Rosedale Road, Princeton, NJ 08541, USA. Electronic address: dmccaffrey@ets.org.
⁷ Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th floor, Philadelphia, PA 19122, USA. Electronic address: dcoffman@temple.edu.
⁸ RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA. Electronic address: mcefalu@rand.org.
⁹ Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761, USA. Electronic address: rfunk@chestnut.org.
¹⁰ Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761, USA. Electronic address: mgodley@chestnut.org.

PMID: 32972649
PMCID: PMC7519172
DOI: 10.1016/j.jsat.2020.108075

Observational Study

Expanding outcomes when considering the relative effectiveness of two evidence-based outpatient treatment programs for adolescents

Beth Ann Griffin et al. J Subst Abuse Treat. 2020 Nov.

. 2020 Nov:118:108075.

doi: 10.1016/j.jsat.2020.108075. Epub 2020 Jul 6.

Authors

Beth Ann Griffin¹, Lynsay Ayer², Joseph Pane³, Brian Vegetabile⁴, Lane Burgette⁵, Daniel McCaffrey⁶, Donna L Coffman⁷, Matthew Cefalu⁸, Rod Funk⁹, Mark D Godley¹⁰

Affiliations

¹ RAND Corporation, 1200 South Hayes Street, Arlington, VA, USA. Electronic address: bethg@rand.org.
² RAND Corporation, 1200 South Hayes Street, Arlington, VA, USA. Electronic address: layer@rand.org.
³ RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA. Electronic address: josephp@rand.org.
⁴ RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA. Electronic address: bvegetab@rand.org.
⁵ RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA. Electronic address: burgette@rand.org.
⁶ ETS, 660 Rosedale Road, Princeton, NJ 08541, USA. Electronic address: dmccaffrey@ets.org.
⁷ Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th floor, Philadelphia, PA 19122, USA. Electronic address: dcoffman@temple.edu.
⁸ RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA. Electronic address: mcefalu@rand.org.
⁹ Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761, USA. Electronic address: rfunk@chestnut.org.
¹⁰ Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761, USA. Electronic address: mgodley@chestnut.org.

PMID: 32972649
PMCID: PMC7519172
DOI: 10.1016/j.jsat.2020.108075

Erratum in

Corrigendum to "Expanding outcomes when considering the relative effectiveness of two evidence-based outpatient treatment programs for adolescents" [J. Subst. Abuse Treat. 118 (2020) 108075].
Griffin BA, Ayer L, Pane J, Vegetabile B, Burgette L, McCaffrey D, Coffman DL, Cefalu M, Funk R, Godley MD. Griffin BA, et al. J Subst Abuse Treat. 2020 Nov;118:108126. doi: 10.1016/j.jsat.2020.108126. Epub 2020 Sep 3. J Subst Abuse Treat. 2020. PMID: 32985983 Free PMC article. No abstract available.

Abstract

The current study seeks to advance understanding about how to address substance use and co-occurring mental health problems in adolescents. Specifically, we compared the effectiveness of two evidence-based treatment programs (Motivational Enhancement Treatment/Cognitive Behavior Therapy, 5 Sessions [MET/CBT5] and Adolescent Community Reinforcement Approach [A-CRA]) for both substance use and mental health outcomes (i.e., crossover effects). We used statistical methods designed to approximate randomized controlled trials when comparing nonequivalent groups using observational study data. Our methods also included an assessment of the potential impact of omitted variables. We found that after applying balancing weighting to ensure similarity of the baseline samples (given the nonrandomized study design), both groups significantly improved on the two substance use outcomes (days abstinent and percent of youth in recovery) and on the two mental health outcomes (post-traumatic stress disorder (PTSD) symptoms and general emotional problems). Youth in A-CRA were significantly more likely to be in recovery at the 3-month follow-up compared to youth in MET/CBT5, but the size of this effect was very small. Youth receiving MET/CBT5 appeared to show significantly more improvement in the two mental health measures compared to youth in A-CRA, though these effect sizes were also very small. The findings indicate that adolescents with co-occurring substance use and mental health problems improve on both substance use and mental health outcomes with both treatments even though they are not specifically targeting mental health problems.

Keywords: Adolescent; Causal inference; Mental health; Omitted variable; Substance use treatment.

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Figures

**Figure D1:. Sensitivity analyses for the traumatic stress scale**
**Variable Definitions (baseline measures):** Substance abuse treatment index (**sati**); Adjusted days abstinent (**ada**); Substance use dependence past year (**sud_sy**); Emotional problem scale (**eps7p**); Parent activity index (**pai**); Recovery environment index (**reri**); In detoxification program during past 90 days (**detox90**); Behavior complexity scale (**bcs**); Living environment index (**lri7**); Traumatic stress scale (**tss**); Substance frequency scale (**sfs8p**); Internal mental distress scale (**imds**); General conflict tactic scale (**gcts**); Mental health treatment (**mhtrt**); Current withdrawal scale past week (**cws**); Used needle or not (**nps**); Depressive symptom scale (**dss9**); Social environmental risk index (**sri7**); Cognitive impairment screen (**cis**); Continued substance use despite prior treatment (**csudptx**); Homicidal suicidal thought scale (**hsts2**); Categorization of internal and/or external problems (**codis4**); Worsening physical health due to substance use (**wphsu**); In recovery (**recov**) – *Note: imds (rho = .41) and tss (rho = .39) had correlations shifted to 0.35 for visual purposes*

**Figure D2:. Sensitivity analyses for days abstinent**
**Variable Definitions (baseline measures):** Substance abuse treatment index (**sati**); Adjusted days abstinent (**ada**); Substance use dependence past year (**sud_sy**); Emotional problem scale (**eps7p**); Parent activity index (**pai**); Recovery environment index (**reri**); In detoxification program during past 90 days (**detox90**); Behavior complexity scale (**bcs**); Living environment index (**lri7**); Traumatic stress scale (**tss**); Substance frequency scale (**sfs8p**); Internal mental distress scale (**imds**); General conflict tactic scale (**gcts**); Mental health treatment (**mhtrt**); Current withdrawal scale past week (**cws**); Used needle or not (**nps**); Depressive symptom scale (**dss9**); Social environmental risk index (**sri7**); Cognitive impairment screen (**cis**); Continued substance use despite prior treatment (**csudptx**); Homicidal suicidal thought scale (**hsts2**); Categorization of internal and/or external problems (**codis4**); Worsening physical health due to substance use (**wphsu**); In recovery (**recov**) – *Note: ada (rho = .45) had correlation shifted to 0.4 for visual purposes*

**Figure D3:. Sensitivity analyses for youth in recovery**
**Variable Definitions (baseline measures):** Substance abuse treatment index (**sati**); Adjusted days abstinent (**ada**); Substance use dependence past year (**sud_sy**); Emotional problem scale (**eps7p**); Parent activity index (**pai**); Recovery environment index (**reri**); In detoxification program during past 90 days (**detox90**); Behavior complexity scale (**bcs**); Living environment index (**lri7**); Traumatic stress scale (**tss**); Substance frequency scale (**sfs8p**); Internal mental distress scale (**imds**); General conflict tactic scale (**gcts**); Mental health treatment (**mhtrt**); Current withdrawal scale past week (**cws**); Used needle or not (**nps**); Depressive symptom scale (**dss9**); Social environmental risk index (**sri7**); Cognitive impairment screen (**cis**); Continued substance use despite prior treatment (**csudptx**); Homicidal suicidal thought scale (**hsts2**); Categorization of internal and/or external problems (**codis4**); Worsening physical health due to substance use (**wphsu**); In recovery (**recov**)

**Figure 2:. Sensitivity analyses for the emotional problem scale**
**Variable Definitions (baseline measures):** Substance abuse treatment index (**sati**); Adjusted days abstinent (**ada**); Substance use dependence past year (**sud_sy**); Emotional problem scale (**eps7p**); Parent activity index (**pai**); Recovery environment index (**reri**); In detoxification program during past 90 days (**detox90**); Behavior complexity scale (**bcs**); Living environment index (**lri7**); Traumatic stress scale (**tss**); Substance frequency scale (**sfs8p**); Internal mental distress scale (**imds**); General conflict tactic scale (**gcts**); Mental health treatment (**mhtrt**); Current withdrawal scale past week (**cws**); Used needle or not (**nps**); Depressive symptom scale (**dss9**); Social environmental risk index (**sri7**); Cognitive impairment screen (**cis**); Continued substance use despite prior treatment (**csudptx**); Homicidal suicidal thought scale (**hsts2**); Categorization of internal and/or external problems (**codis4**); Worsening physical health due to substance use (**wphsu**); In recovery (**recov**) – *Note: dss9 (rho = .43), imds (rho = .49), bcs (rho = .41), tss (rho = .41), and eps (rho = .52) had correlations shifted to 0.4 for visual purposes*

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Cited by

Nonparametric Estimation of Population Average Dose-Response Curves using Entropy Balancing Weights for Continuous Exposures.
Vegetabile BG, Ann Griffin B, Coffman DL, Cefalu M, Robbins MW, McCaffrey DF. Vegetabile BG, et al. Health Serv Outcomes Res Methodol. 2021 Mar;21(1):69-110. doi: 10.1007/s10742-020-00236-2. Epub 2021 Feb 13. Health Serv Outcomes Res Methodol. 2021. PMID: 34483714 Free PMC article.
A tutorial comparing different covariate balancing methods with an application evaluating the causal effects of substance use treatment programs for adolescents.
Markoulidakis A, Taiyari K, Holmans P, Pallmann P, Busse M, Godley MD, Griffin BA. Markoulidakis A, et al. Health Serv Outcomes Res Methodol. 2023;23(2):115-148. doi: 10.1007/s10742-022-00280-0. Epub 2022 May 27. Health Serv Outcomes Res Methodol. 2023. PMID: 37207016 Free PMC article.
Comparative effectiveness of individual versus family-based substance use treatment on adolescent self-injurious thoughts and behaviors.
Ayer L, Pane JD, Godley MD, McCaffrey DF, Burgette L, Cefalu M, Vegetabile B, Griffin BA. Ayer L, et al. J Subst Abuse Treat. 2022 Aug;139:108782. doi: 10.1016/j.jsat.2022.108782. Epub 2022 Apr 16. J Subst Abuse Treat. 2022. PMID: 35461747 Free PMC article.
Best practices in statistical computing.
Sanchez R, Griffin BA, Pane J, McCaffrey DF. Sanchez R, et al. Stat Med. 2021 Nov 30;40(27):6057-6068. doi: 10.1002/sim.9169. Epub 2021 Sep 6. Stat Med. 2021. PMID: 34486156 Free PMC article.
Volunteer Recovery Support for Adolescents: Using propensity score based methods to understand dosage effects within a randomized controlled trial.
Godley MD, Passetti LL, Hunter BD, Griffin BA. Godley MD, et al. J Subst Abuse Treat. 2022 Jan;132:108637. doi: 10.1016/j.jsat.2021.108637. Epub 2021 Oct 8. J Subst Abuse Treat. 2022. PMID: 34654584 Free PMC article. Clinical Trial.

References

1. Agrawal A, Grant JD, Waldron M, Duncan AE, Scherrer JF, Lynskey MT, Madden PA, Bucholz KK, & Heath AC (2006). Risk for initiation of substance use as a function of age of onset of cigarette, alcohol and cannabis use: findings in a Midwestern female twin cohort. Preventive Medicine, 43(2), 125–128. - PubMed
1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. American Psychiatric Association.
1. Azrin N, Sisson R, Meyers R, & Godley M (1982). Outpatient alcoholism treatment by community reinforcement and disulfiram therapy. Journal of Behavior Therapy Experimental Psychiatry, 13, 105–112. - PubMed
1. Belur V, Dennis ML, Ives ML, Vincent R, & Muck R (2014). Feasibility and impact of implementing motivational enhancement therapy–cognitive behavioral therapy as a substance use treatment intervention in school-based settings. Advances in School Mental Health Promotion, 7(2), 88–104. - PMC - PubMed
1. Bisson JI, Ehlers A, Matthews R, Pilling S, Richards D, & Turner S (2007). Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis. The British Journal of Psychiatry, 190(2), 97–104. - PubMed

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Expanding outcomes when considering the relative effectiveness of two evidence-based outpatient treatment programs for adolescents

Affiliations

Expanding outcomes when considering the relative effectiveness of two evidence-based outpatient treatment programs for adolescents

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