How to Assess Whether Outpatient Treatment Is Successful Research Paper

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gathered using a number of key word searches and combinations of terms, such as "adolescent," "substance abuse," "treatment," "drug," "outcome," "drug abuse, "juvenile drug abusers," juvenile drug use," "juvenile drug treatment," "adolescent drug treatment," and "adolescent drug use." These key word searches were conducted in online databases such as PsychInfo, PubMed, NCBI, JSTOR, National Institute of Mental Health, National Criminal Justice Reference Service, and Google Scholar. These searches resulted in a number of studies that appeared useful for this analysis. The five chosen were chosen because of common key words and their relevance to this study's focus on if adolescent males with substance disorder are given inpatient treatment instead of outpatient treatment whether they will have a greater chance of maintaining their sobriety.

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Article

Branson, Clemmey, and Mukherjee (2013). This study is a sample size 48 adolescents with roughly half Latino and half African-American, male and female. Treatment was outpatient only so is helpful only in so far as it is able to give some background on outpatient therapies and their success rates. The focus of the study is on reducing attrition by incorporating text message reminders of therapy sessions to patients. The study found that text messages reduced attrition rates. Also, only 4% of the sample did not receive text messages throughout the duration of the trial due to phone complications.

The comparability of the groups in the study is that it consists mainly of minorities, who are all receiving outpatient treatment, so the focus is tight. They are different after treatment in that there is a higher rate of success (completion) due to text message reminders. Pretest attrition rates are in the 40%ile, while post-test attrition rates are much better with completion being in the 60%ile range. The demographic of the study is largely homogenous in that it consists of minority population (African-American and Latino). There was negligible attrition in the trial sample. Hawthorne's effect was not taken into consideration as there was no mention of it in the study.

The reliability and validity of the measures used in the study are substantial: there is no significant temporal validity other than the one study of the sample, in which a 7-month span passed for the trial study to be complete. Thus, the temporal framework is 7 months. The criterion and construct are valid, with the outcome signifying that text messaging does reduce attrition and the construct validity does show that appropriate inferences can be made about the usefulness of text message reminders in getting youths to complete outpatient treatment.

The external validity of this study may be more than meets the eye as it could indicate that one key to increasing outpatient treatment success rate is to use the tools of the young generation, cell phones, to remind them of their need to attend treatment. Text message is a simple way to send that message, which conveys a sense of care that the recipient can sense even in such a simple way. This may relate to the problem of the adolescent male substance abuser in that it provides a "way into" the user's life and gives the support needed to offer a "way out" of the substance abuse.

Article 2:

Esposito-Smythers, Spirito, Kahler, Hunt and Monti (2011). This study examines CBT protocol as treatment for adolescents with substance abuse disorder and suicidality. The sample is randomized. The study is a clinical trial. Treatments were integrated outpatient CBT. Results showed that outpatient treatment was successful in reducing suicide attempts, inpatient stays, emergency visits, as well as arrests. Adolescents had reduced suicidal ideation as well as reduction in alcohol and marijuana use.

Groups are comparable in age and ethnicity, with the overwhelming majority (80%ile) Caucasian. There is no baseline heterogeneity, as sample is mainly homogenous and treatment is similar and sample users have same dependencies. Pre-treatment, patients show higher suicidality; post-treatment this risk is reduced. The demographic of the group does not appear to be a concern of the researchers and there is no indication of attrition or of consideration given to the Hawthorne effect.

The temporal validity of the study may be of some use considering the time frame used and the essence of the study's impact, which focuses on CBT outpatient treatment, an applicable therapy for adolescents. The appropriateness of inferences regarding construct validity appear accurate and the criterion validity is consistent as variables match outcomes and CBT appears to be a model with applicability to the subject.

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The study has external validity in that it can be used as a basis for further research, which the researchers advocate in their concluding remarks, as they point out that they cannot say with certainty that integrated CBT is the main reason for successful outcomes or whether other outpatient treatments would be as effective. For this study, it showed to be so, but more research must be conducted in order to bear this out.

Article 3:

Friedman, Terras, and Ali (1998). This study is an outpatient sample of 70% male participants, collected randomly from cities in four states (Ohio, Texas, Pennsylvania, Oregon) and the inpatient sample is half male-hale female percentile. Pre-test, participants were assessed using ADAD and post-test as well. Study was conducted in order to test prognosticators and variable predictors. Results showed that less than half of variables were effective in predicting outcomes in either outpatient or inpatient cases of adolescent substance users seeking treatment. The variables were based on 157 historical cases of adolescent inpatient substance users and 296 historical cases of adolescent outpatients seeking treatment.

The groups were heterogenous and there were signs of baseline heterogeneity in that several variables produced different results across the board, such as age, gender, attribution, therapy. The demographics were not considered as significant given the random sample size. And the study showed no sign of attrition awareness of consideration for the Hawthorne effect.

The outcome criterion validity was a reduction in substance use. Of the variables, 12 were helpful in predicting inpatient outcome, 15 in predicting outpatient outcome. Two variables were equally bad in predicting outcome in both inpatient and outpatient outcome -- school and failure to view substance use as detrimental. Prognosticators were also not the same for adolescents as historically seen for adults, which indicates that the study may have some external validity as a basis point for future research. The example given in the study is that increased substance use in follow-up sessions was a predictor in adults of increased substance use at admission -- but in adolescents this showed to be the case only for outpatients.

The study has external validity in that it creates a framework for predictive variables that may be of use in the field. For example, assumptions that schooling (education) and positive/negative associations with substance abuse would be indicators of outcomes showed to be misleading and there was no correlation between the two. This is a strength of the study. One weakness of the study's external validity is its weakness in methodology in that treatment phases were not homogenous and samples and focus of the study was too wide to produce any substantial findings. More research must be conducted in order to corroborate findings, but the study serves as a useful starting point in understanding predictors.

Article 4:

Waldron, Slesnick, and Brody (2001). This study is a randomized sample involved in a clinical trial used to assess different forms of therapy -- CBT, family therapy, combined individual and family, and group intervention. The sample size was 114 adolescents who were substance users. This study focuses primarily on outpatient therapy so does not give any reference to inpatient treatment although it does recognize that "treatment outcomes may differ for youths in inpatient" settings.

The sample was heterogenous with Anglo Americans and Hispanic-Americans, although the majority were Anglos and the study may be not have much external validity in terms of applying un-acculturated Hispanics, African-Americans, Native Americans or other minorities. The groups are comparable in terms of substance use (marijuana) but more research is needed in terms of identifying effective treatment modalities, as numerous modalities were used in this study. Hawthorne's effect was not taken into consideration as there was no mention of it in the study.

Thus, the reliability of this study is hampered by its inclusion of several modalities and its validity is kept in a narrow window in terms of substance and sample. Likewise, the treatment sessions per each case were not equal, which is a limitation in terms of construct validity and temporal validity. Inferences made, however, appear to be appropriate and with the proper associations, so there is some construct validity to this study.

The problem with this study's external validity is that it only examines outpatient treatment, with a majority of the sample being Anglo and English speaking Hispanic-Americans. It may allow a research to make generalizations about this demographic adolescent male substance user. The strength of this study's external.....

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