Novins K20 Award: Co-Morbidity and Treatment Paths for Indian Adolescents
DATES OF FUNDING:
1995 - 2001
Douglas K. Novins, M.D.
CENTER STAFF INVOLVED:
Douglas K. Novins, M.D.; Spero M. Manson, PhD.; Alexandra Fickenscher, MPH
SPECIFIC AIMS/RESEARCH GOALS:
This study examined the patient population and treatment patterns of one of nine American Indian/Alaska Native adolescent residential substance abuse treatment programs established under the 1986 Drug Omnibus Act. It has 2 Specific Aims:
- to determine the effects of comorbid psychiatric disorders as well as individual, social network, and service system characteristics on treatments received and treatment pathways for American Indian adolescents who receive residential substance abuse treatment; and
- to determine the types of treatment received, treatment pathways, and the characteristics listed above (diagnostic, individual, social network, and organizational) on treatment outcome for this population.
The design entails a longitudinal approach with five phases of data collection.
- Admission Assessment: Clients who entered the residential substance abuse treatment program (RSATP) completed a thorough assessment battery covering the following areas: psychiatric and substance use diagnoses, psychiatric symptomatology, a variety of psychosocial measures, treatment history, and attitudes towards treatment.
- Treatment Received: The treatment each patient received while at the RSATP (e.g., individual counseling, 12-Step groups, family therapy, sweat lodge, mental health treatment) was extracted from treatment records as well as indicators of performance within the treatment program (e.g., points earned, incident reports).
- Discharge: At discharge, all patients who stayed at the RSATP one month or longer completed a reduced set of measures from the baseline assessment battery focusing on symptomatology and psychosocial measures as well as satisfaction with treatment.
- Aftercare Follow-up: Three months after discharge, the patient repeated the reduced discharge assessment.
93 American Indian adolescents, 58 male and 35 female, who were consecutively admitted to a tribally-operated residential substance abuse treatment program in the South Central United States.
- Diagnostic Interview Schedule for Children, Version IV, Youth Version (DISC-IV Y; http://www.c-disc.com)
1. Shaffer, D., Fisher, P., Lucas, C., Dulcan, M., & Schwab-Stone, M. (2000). NIMH Diagnostic Interview Schedule for Children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry 39, 28-38. Y.
- Composite International Diagnostic Interview - Substance Abuse Module (CIDI-SAM; http://aianp.uchsc.edu/ncaianmhr/research/pdf_files/cidi.pdf) pp. 260-332 (http://www.niaaa.nih.gov/publications/Assesing%20Alcohol/InstrumentPDFs/20_CIDI.pdf)
Robins, L.N.; Wing, J.; Wittchen, H.U.; Helzer, J.E.; Babor, T.F.; Burke, J.; Farmer, A.; Jablensky, A.; Pickens, R.; Regier, D.A.; Sartorius, N.; and Towle, L.H. The Composite International Diagnostic Interview: An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45:1069-1077, 1989.
- VOICES of Indian Teens Survey (VOICES; http://aianp.uchsc.edu/ncaianmhr/research/pdf_files/vcsurvey.pdf)
Mitchell, C. M., O'Nell, T. D., Beals, J., Dick, R. W., Keane, E., & Manson, S. M. (1995). Dimensionality of alcohol use among American Indian adolescents: Latent structure, construct validity, and implications for developmental research. Journal of Research on Adolescence, 6, 151-180
Novins, D. K., & Mitchell, C. M. (1998). Factors associated with marijuana use among American Indian adolescents. Addiction, 93, 1694-1702.
- Youth Self Report (YSR; http://www.aseba.org)
Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Burlington, VT: University of Vermont, Department of Psychiatry.
- Treatment Readiness Scales. (http://www.datos.org)
Broome, K.M., Joe, G.W., & Simpson, D.D. (2001). Engagement models for adolescents in DATOS-A. Journal of Adolescent Research, 16(6), 608-623. [Abstract]
Joe, G. W., Simpson, D. D., & Broome, K. M. (1999). Retention and patient engagement models for different treatment modalities in DATOS. Drug and Alcohol Dependence, 57, 113-125. [Abstract]
Simpson, D. D. (2001). Modeling treatment process and outcomes. Addiction, 96, 207-211. [Abstract]
Simpson, D. D., Joe, G. W., Rowan-Szal, G. R., & Greener, J. (1997). Drug abuse treatment process components that improve retention. Journal of Substance Abuse Treatment, 14(6), 565-572. [Abstract]
Client Satisfaction Questionnaire (CSQ-8; http://www.qolid.org/public/CSQ.html)
Attkisson, C. C. (1987). Client satisfaction questionnaire (CSQ-8). In K. Corcoran & J. Fischer (Eds.), Measures for clinical practice: A sourcebook (pp. 120-122). New York: The Free Press.
Larsen, D. L., Attkisson, C. C., et al. (1979). Assessment of patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2, 197-207.
- Structured Episode Contacts
Pescosolido BA. Gardner CB. Lubell KM. How people get into mental health services: stories of choice, coercion and "muddling through" from "first-timers". Social Science & Medicine. 46(2):275-86, 1998 Jan.
- Service Utilization
Novins DK, Duclos CW, Martin C, Jewett CS, Manson SM. Utilization of Alcohol, Drug, and Mental Health Treatment Services Among American Indian Adolescent Detainees. Journal of the American Academy of Child & Adolescent Psychiatry. 38(9): 1102-1108, 1999 Sept.
- Social Networks
Pescosolido BA. Wright ER. Alegria M. Vera M. Social networks and patterns of use among the poor with mental health problems in Puerto Rico. Medical Care. 36(7):1057-72, 1998 Jul.
The Project's methodology is described in further detail in the paper: Novins DK, Fickenscher A (2004) Comorbidity and Treatment Paths for Indian Adolescents: Project Methods. This paper and may be accessed at [methods.pdf]
Novins DK (1994) Comorbidity and Treatment Paths for Indian Adolescents: A Preliminary Report. Presented at the 1994 Annual Meeting, Academy of Child and Adolescent Psychiatry, October.
Novins DK (1995) Pilot Study of a Substance Abuse Treatment Program for Indian Teens. Presented at the 1995 Annual Meeting, American Academy of Child and Adolescent Psychiatry, October.
Novins DK (2001) Comorbidity and American Indian Adolescents: Co-Occurring Substance Use and Non-Substance Use Psychiatric Disorders - Challenges for Research, Prevention, and Treatment. Presented at the NIMH meeting Research Approaches To Early Treatment and Prevention of Mental Disorders for Minority Children and Adolescents, July.
Novins DK (2002) Developing a Services Research Agenda with Rural American Indian and Alaska Native Communities. Presented at the NIMH meeting Research on the Impact of Socio Cultural Factors on Access and Use of Mental Health Services in Rural Populations, March.
Novins DK, Fickenscher A, Manson SM (2002) Psychiatric and Psychosocial Characteristics of American Indian Adolescents Entering Substance Abuse Treatment: What Evidence Do We Need? Presented at the NIMH meeting Evidence in Mental Health Services Research - What Types, How Much, and Then What? April.
Novins DK, Fickenscher A, Manson SM (2002) American Indian Adolescents In Substance Abuse Treatment: Psychiatric Diagnostic Status. Presented at the Annual Meeting, American Academy of Child and Adolescent Psychiatry, October.
Fickenscher A, Novins DK (2002) Gender Differences in Conduct Disorder Among American Indian Adolescents in Residential Substance Abuse Treatment Program. Presented at the Annual Meeting, American Public Health Association, November.
Novins DK, Fickenscher A, Beals J (2005) Motivation and Substance Abuse Treatment for American Indian Adolescents. Presented at the Annual Meeting of the Society for the Study of Psychiatry and Culture, Estes Park, October.
Novins DK, Fickenscher A, Beals J (2005) A Pilot Study of Motivation and Treatment Completion Among American Indian Adolescents in Substance Abuse Treatment. Presented at the Annual Meeting of the American Academy of Child and Adolescent Psychiatry, Toronto, October.
Novins DK, Beals J, Manson SM, Shore JH (1996). The substance abuse treatment of American Indian adolescents: Comorbid symptomatology, gender differences, and treatment patterns. Journal of the American Academy of Child and Adolescent Psychiatry, 35:1593-1601.
Fickenscher A, Novins DK (2003). Gender differences in conduct disorder among American Indian adolescents. Journal of Psychoactive Drugs, 35:79-84.
Fickenscher A, Novins DK, Manson SM (in press). Illicit Peyote Use Among American Indian Adolescents In a Residential Substance Abuse Treatment Program. Substance Use and Misuse.
Fickenscher A, Novins DK, Beals J (in press). Symptom Endorsement of Alcohol and other Substance Abuse and Dependence Criteria Among American Indian Adolescents in Substance Abuse. Journal of Addictive Diseases.
Fickenscher A, Novins DK (in press). Motivation and Treatment Completion Among American Indian Adolescents Entering Residential Substance Abuse Treatment. Journal of Addictive Behaviors.
Novins DK, Fickenscher A, Manson SM (under review). American Indian Adolescents in Substance Abuse Treatment: Psychiatric Diagnostic Status. Under review, Journal of Substance Abuse Treatment.
Deters P, Novins DK, Fickenscher A (under review). Trauma and Post Traumatic Stress Disorder Among American Indian Adolescents in Residential Substance Abuse Treatment. Under Review, American Journal of Orthopsychiatry.
Novins DK, Spicer P, Fickenscher A (in preparation). Pathways to Residential Substance Abuse Treatment Among American Indian Adolescents: Qualitative and Quantitative Findings.