National Institute on Drug Abuse
Behavioral Therapies Development Program
Workshop on the Development of Treatment Strategies for Pre/Early Adolescent Drug Abuse
September 4-5, 1997
Summary of Workshop Accomplishments
Clinical researchers in the areas of child and adolescent drug abuse treatment met September 4-5, 1997 at the DoubleTree Hotel, Rockville, Maryland. The Workshop was co-chaired by Drs. Rahdert, Czechowicz and Onken of the NIDA Treatment Research Branch, Division of Clinical and Services Research, with a welcome from NIDA Director, Dr. Alan Leshner. The purpose of the Workshop was to discuss, within the context of the NIDA Behavioral Therapies Development Program, future research on the development of discrete therapies that could address the unique needs and perspectives of pre/early adolescent drug abusers with and without co-occurring mental disorders. Toward filling these gaps in knowledge, Workshop participants first discussed what is known about drug abusing pre/early adolescents who appear to need treatment, and clinical characteristics that may or may not differentiate them from older or younger youths. Participants then identified a number of therapeutic models with evidence of effectiveness in treating older (>15 years) drug abusing adolescents or non-drug abusing younger (<9 years) children with other DSM-IV diagnosed psychiatric disorders as variations on these models might provide a starting point from which to consider creating a variety of developmentally appropriate behavioral therapies for this in-between-age group of drug abusing adolescents.
Key points raised during the discussion:
To date, pre/early adolescents, age 9 through 15 years, have received little attention from drug treatment researchers when compared to the number of past and present studies focused on drug abusing older adolescents or drug-affected younger children.
Drug abusing pre/early adolescents appear qualitatively different from younger children and older adolescents. Such qualitative differences appear in the following domains: psychosocial characteristics (pre/early adolescents are more rapidly and radically redefining and transforming their relationships with their parents, relatives, other authorities, and peer group); biological characteristics (pre/early adolescents are more rapidly changing in physiological growth and sexual development); drug abuse profile (pre/early adolescents differ from younger or older peers in the types and numbers of drugs used, frequency, duration, and social consequences in regard to their parents, peers, teachers and the legal authorities); therefore, a significant number of pre/early adolescents have a clinically diagnosable, if not always a diagnosed, DSM-IV Substance Abuse Disorder (SAD); psychiatric comorbidities (when pre/early adolescents have a SAD, they frequently have another diagnosable mental disorder (e.g., conduct disorder; attention deficit/hyperactivity disorder; depression; anxiety).
Cultural factors must be considered when developing therapeutic interventions. This is because drug abusing pre/early adolescents from families with different cultural backgrounds (e.g., African American; Hispanic; Native American) differ in patterns of socialization with their peers, in their gender roles, family relationships, family ethos, and communication patterns with friends and family members.
Developmental stage-appropriate therapeutic interventions are needed. Thus, cognitive-behavioral therapies (e.g., skills training; problem solving techniques), operant-behavioral therapies (e.g., contingency contracting between patient and therapist or patient and parent), peer group therapy, and motivational interviewing combined with brief therapeutic intervention which have been shown to be promising approaches in reducing drug use or abuse among older adolescents or younger children, must take into account those developmental tasks such as separation from parents, individuation and identity formation if the therapy is to be maximally efficacious for youths in the 9-to-15 year age group.
Stigma complicates the development and acceptability of treatment for drug abusing youths in this age group.
For more information on this topic or on the NIDA Behavioral Therapies Development Program Announcement Number PA-94-078, please contact Dr. Rahdert.
Elizabeth Rahdert, Ph.D.
Treatment Research Branch, Room 10A-10
Division of Clinical and Services Research
National Institute on Drug Abuse, NIH
[Behavioral Therapies Development Program Index]
List of participants
Nathan Azrin, Ph.D.
Nova Southeastern University
Fort Lauderdale, FL
Fred Beauvais, Ph.D.
Colorado State University
Fort Collins, CO
Oscar G. Bukstein, M.D., M.P.H.
Western Psychiatric Institute and Clinic
Richard F. Catalano, Ph.D.
University of Washington
Ross W. Greene, Ph.D.
Massachusetts General Hospital
James A. Hall, Ph.D.
University of Iowa
Iowa City, IA
Ledro Justice, M.D.
Children’s National Medical Center
Yifrah Kaminer, M.D.
University of Connecticut School of Medicine
Kate Kavanagh, Ph.D.
Oregon Social Learning Center
John Knight, M.D.
Harvard Medical School
Joan D. Koss, Ph.D.
Arizona State University
Paul Kymissis, M.D.
New York Medical College
Peter M. Monti, Ph.D.
Paula Riggs, M.D.
University of Colorado School of Medicine
Howard Schubiner, M.D.
Wayne State University School of Medicine
Roger D. Weiss, M.D.
Harvard Medical School