Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose. The purpose of this study was to determine whether outpatient substance abuse treatments were equally efficacious in reducing the substance use frequency and substance-related problems for adolescent substance abusers varying on violence. Because a high percentage of clients referred to adolescent substance abuse treatment emanate from the juvenile justice system, the results of this study are relevant to social workers in the addictions field who often work collaboratively with criminal justice officials.

Methods. This study uses a subset of clients that were recruited to participate in a 12-month longitudinal adolescent substance abuse treatment efficacy study. For this study, only clients receiving outpatient care (N=94) that completed the baseline, 3-month and 6-month follow up assessments were selected for analysis. Using the General Conflicts Tactics Scale (GCTS), clients were categorized into low (n=18), moderate (n=60), and high (n=16) severity violence groups that varied on reported violent physical and verbal behavior. Repeated measures MANOVA was used to determine if there were any differences in treatment outcomes between these violence severity groups on substance use frequency, substance-related problems, and frequency of illegal activities. All analyses used Bonferroni adjustments and controlled for baseline severity, proportion of days spent in controlled environments averaged across time, and severity of victimization (i.e., severity of physical, sexual, emotional abuse).

Results. All participants experienced significant decreases in substance-related problems and substance use frequency, but the self-reported frequency of illegal behavior was mostly stable across time. A significant time by violence group interaction existed for substance use frequency (F (2,89) = 4.14, p<.05, partial h²=.085), which indicated that higher violence clients showed larger reductions in substance use frequency. A similar interaction approached significance for substance-related problems.

Implications for Policy and Practice. Several practice implications are supported by this study. First, outpatient adolescent substance abuse treatments may be especially effective in reducing substance use frequency for the most violent substance-abusing clients. Second, outpatient treatment appears to work equally well in reducing the substance-related problems of violent clients. Third, coordinated efforts in addition to substance abuse treatment are needed to reduce self-reported illegal behaviors among adolescent substance abusers. Finally, social work practitioners in the addictions can advocate for their unique role in reducing substance use frequency, as reductions in substance use frequency and substance-related problems were significant after controlling for time spent in controlled environments.

Conclusion. Outpatient substance abuse treatments appear to work equally well (and are sometimes superior) for clients with history of violence.