Abstract: Comparison of the two therapies found that a year after treatment, teen participants in the MDFT group had fewer drug-related problems and showed more improvement on general measures of behavior and mental health than those teens treated with cognitive-behavioral therapy (CBT). The therapies were compared in two randomized trials sponsored by the National Institute on Drug Abuse. The first study included 224 juvenile males, predominantly African-American, average age of 15 years, and from low-income, single-parent homes, who received either MDFT or CBT. Among the participants, 75 percent were diagnosed as cannabis dependent, 20 percent were alcohol dependent, and 13 percent were dependent on other substances. The study found that while both treatments were effective at discharge, in the months following treatment, youth who received MDFT had lower scores on the Personal Experience Inventory, which measures impairment due to personal, social, educational, and legal problems tied to drug abuse, than those youth who received CBT. The second study tested the effectiveness of MDFT versus CBT in a younger group of adolescent substance abusers, average age of 13.5 years. The results of this study were similar to those of the first study, in that both MDFT and CBT were effective at discharge, but those youth who received MDFT experienced longer lasting gains than the CBT youth. The MDFT youth had significantly lower levels of drug use, had improved their academic performance, had fewer arrests and placements on probation, suffered fewer psychiatric symptoms, and reduced self-reported delinquency and their association with delinquent peers. Issues for future research are discussed.

Abstract: Aim: to examine the efficacy of two adolescent drug abuse treatments: individual cognitive behavioral therapy (CBT) and multidimensional family therapy (MDFT). Design: A 2 (treatment condition) x 4 (time) repeated-measures intent-to-treat randomized design. Data were gathered at baseline, termination, 6 and 12 months post-termination. Analyses used latent growth curve modeling. Setting: Community-based drug abuse clinic in the northeastern United States. Participants: A total of 224 youth, primarily male (81%), African American (72%), from low-income single-parent homes (58%) with an average age of 15 years were recruited into the study. All youth were drug users, with 75% meeting DSM-IV criteria for cannabis dependence and 13% meeting criteria for abuse. Measurements: Five outcomes were measured: (i) substance use problem severity; (ii) 30-day frequency of cannabis use; (iii) 30-day frequency of alcohol use; (iv) 30-day frequency of other drug use; and (v) 30-day abstinence. Findings: Both treatments produced significant decreases in cannabis consumption and slightly significant reductions in alcohol use, but there were no treatment differences in reducing frequency of cannabis and alcohol use. Significant treatment effects were found favoring MDFT on substance use problem severity, other drug use and minimal use (zero or one occasion of use) of all substances, and these effects continued to 12 months following treatment termination. Conclusion: Both interventions are promising treatments. Consistent with previous controlled trials, MDFT is distinguished by the sustainability of treatment effects.

Abstract: Objective To determine whether use of cannabis in adolescence increases the risk for psychotic outcomes by affecting the incidence and persistence of subclinical expression of psychosis in the general population (that is, expression of psychosis below the level required for a clinical diagnosis). Design Analysis of data from a prospective population based cohort study in Germany (early developmental stages of psychopathology study). Setting Population based cohort study in Germany. Participants 1923 individuals from the general population, aged 14-24 at baseline. Main outcome measure Incidence and persistence of subthreshold psychotic symptoms after use of cannabis in adolescence. Cannabis use and psychotic symptoms were assessed at three time points (baseline, T2 (3.5 years), T3 (8.4 years)) over a 10 year follow-up period with the Munich version of the composite international diagnostic interview (M-CIDI). Results In individuals who had no reported lifetime psychotic symptoms and no reported lifetime cannabis use at baseline, incident cannabis use over the period from baseline to T2 increased the risk of later incident psychotic symptoms over the period from T2 to T3 (adjusted odds ratio 1.9, 95% confidence interval 1.1 to 3.1; P=0.021). Furthermore, continued use of cannabis increased the risk of persistent psychotic symptoms over the period from T2 to T3 (2.2, 1.2 to 4.2; P=0.016). The incidence rate of psychotic symptoms over the period from baseline to T2 was 31% (152) in exposed individuals versus 20% (284) in non-exposed individuals; over the period from T2 to T3 these rates were 14% (108) and 8% (49), respectively. Conclusion Cannabis use is a risk factor for the development of incident psychotic symptoms. Continued cannabis use might increase the risk for psychotic disorder by impacting on the persistence of symptoms.

Abstract: Using a sample of 614 youths, this study examined differences and similarities between adolescents at risk (age range 11-20 years), and their integration in school or vocational training. We found that mood states (depression, anxiety), secure self (self-esteem and self-efficacy), relationship with parents, delinquency and substance use (alcohol, tobacco and cannabis) were variables which largely influenced social integration (school, work) for youths with poor sociodemographic backgrounds. An important variable we introduced here was sociodemographic background, which investigated the social situation of a youth. We distinguished two different groups (good vs. poor sociodemographic background). There were important differences between both groups. Youths with a poor sociodemographic background scored higher in suicidality and health complaints. The most striking differences were in substance use and delinquency. The structural equation model showed that poor mood was related to substance use at the start. Important paths were found in mood states over time, as for substance use, but interactions between both variables were small. We ran different models (poor vs. good social background, Swiss vs. migrant youths), and concluded that secure self and good family relations protected against poor mood and substance use and both variables indirectly influenced integration 2-3 years later.

Abstract: Purpose: To investigate how prior-to-injury and usual alcohol consumption relate to time of injury. Patients and methods: The associations between injury time of day and day of week and prior-to-injury (labeled as “acute”) alcohol intake and hazardous usual alcohol consumption (considered from the point of view of both heavy episodic drinking [HED] and risky volumes of consumption) are assessed using interview data from a randomized sample of 486 injured patients treated in a Swiss emergency department (ED; Lausanne University Hospital). Results: Acute consumption was associated with both injury time of day and day of week, HED with day of week only, and risky volume with none. Conclusions: Acute consumption and HED, but not risky volume of consumption, show specific time distributions for injuries. These findings highlight the potential importance of considering the time dimension of an injury when providing emergency care and have additional implications for interventions aimed at influencing the alcohol consumption of injured patients presenting to the ED.