Type of Document Dissertation Author Gangi, Jennifer M. URN etd-04082011-100739 Title The Impact of Self-help Groups Following Substance Abuse Treatment Among Adolescents: Substance Use Outcomes and Mechanisms of Change Degree Doctor of Philosophy Department Family and Child Sciences, Department of Advisory Committee
Advisor Name Title Carol A. Darling Committee Chair Lenore McWey Committee Member Nicholas Mazza University Representative Keywords
- 12-step Groups
- Self-help Groups
- Substance Abuse Treatment
Date of Defense 2011-03-22 Availability unrestricted AbstractResearch on adolescent substance abuse treatment effectiveness has grown in quantity, as evidenced by several review articles (Deas & Thomas, 2001; Muck, Zempolich, Titus, Fishman, Godley, & Schwebel, 2001; Williams & Chang, 2000). The results have shown substance use dissipates during treatment, but relapse to substance use occurs at high rates following treatment discharge (Catalano, Hawkins, Wells, Miller, & Brewer, 1991; Godley, Godley, & Dennis, 2001). Despite the heterogeneity of post-treatment outcomes, the likelihood of post-treatment relapse is often dependent on a number of variables, including whether or not the adolescent participates in continuing care services, such as self-help groups. However, there remains a dearth of empirical studies examining the use and effectiveness of self-help groups among adolescent outpatients. Therefore, this research examined the effects of self-help group meeting attendance among adolescents during the three-month time period immediately following publicly funded outpatient substance abuse treatment.
Factors postulated within social-cognitive theory, social learning theory, group theory and included in cognitive and behavioral relapse prevention models were assessed to determine how they are influenced by self-help group attendance and whether these effects can be used to help explain all or some of these observed relations. The following research hypothesis was examined: at the end of the three-month time period following treatment, there will be no differences between male and female adolescents who attended self-help groups during that three-month time period and those who do not attend regarding substance use frequency, severity of substance-related problems, cognitive and behavioral factors (motivation, coping, self-efficacy), and social-environmental factors (social support, environmental risk). In addition, the following research question was incorporated: while controlling for gender and attending a self-help group, can severity of substance-related problems, motivation, coping, self-efficacy, social support, and environmental risk be integrated to predict substance use frequency?
To examine the hypothesis and research question, a secondary analysis was performed using data from the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (CSAT) Adolescent Treatment (AT) 2008 Outcome Dataset. The final dataset focused on adolescent outpatients and key questions from the original assessment that addressed the hypotheses and research question. Variables of interest were constructed, using items from scales and indices that were part of the assessment. The secondary data were analyzed using PASW Statistics (formerly SPSS) and AMOS 18.0 software.
Analysis of variance (ANOVA) revealed no differences in the mean scores between self-help group attendees and non-attendees at the end of the three-months following treatment on motivation, social support, substance use frequency, and environmental risk. However, differences existed for coping, self-efficacy, and severity of substance-related problems. In addition, gender differences were found when adolescents entered treatment, in that females presented for treatment with higher environmental risk and higher severity of substance-related problems.
Path analysis was performed to test for the relationship of predictor variables in the model to the substance use frequency outcome variable. The findings revealed that higher severity of substance-related problems, higher coping, greater environmental risk, less self-efficacy, and no self-help group attendance during the first three-month period following treatment were the factors related to more substance use among adolescents in that period. In addition, environmental risk followed by severity of substance-related problems had the greatest total effects on substance use frequency following treatment.
There were also some indirect relationships to substance use, as severity of substance-related problems had indirect relationships on substance use through risk, and coping; coping was indirectly related to substance use through self-efficacy; and self-help group attendance was indirectly related to substance use through environmental risk. Overall, this model fit well with the observed data (x2=15.71, df=13, p=.265, GFI=.995, AGFI= .983, RMSEA=.018). The model explained 40% of the variance in substance use frequency scores among adolescent outpatients.
Several implications were identified regarding methodology, research, and clinical practice. In light of the findings is the clinical importance of linking adolescents to continuing care services, such as self-help groups following treatment discharge. The results suggested that attending self-help groups following treatment was beneficial for some adolescents in the short-term, particularly those with greater severity. A second implication is that environmental risk factors played an important role in substance use decisions following treatment. These findings suggested that attending self-help groups might be a potential strategy to decrease these risks, which in turn decreased substance use. Third, these findings highlighted the importance of examining post-treatment factors, which typically account for the majority of the variance in outcomes (Catalano et al., 1990–91; Latimer et al., 2000). Lastly, findings suggested that adolescent females responded similarly to substance abuse treatment and self-help groups when compared to males despite poorer initial clinical indicators.
While the current study identified post-treatment factors that appear to underlie substance use relapse among adolescent outpatients, little is known regarding the way each of these factors was differentially associated with subgroups characterized by distinct substance use trajectories. Consideration of how these factors changed during the early recovery period is key to understanding how substance abuse treatments and continuing care strategies may impact adolescents differentially.
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