Targeting Youth’s Motivation to Change Substance Use Behaviors: Feasibility and Preliminary Outcomes from an Open Trial of the Free Talk Program in a Short-Term Juvenile Detention Facility

Juvenile offenders who use substances are at an increased risk for multitude of negative outcomes, including substance use problems in adulthood and recidivism. Interventions that are effective in community settings or long-term juvenile justice settings may not be well suited for implementation in short-term juvenile detention facilities. Free Talk (FT; D’Amico, Chan Osilla, & Hunter, 2010) is a brief motivational intervention that targets motivation to change substance use. The current study aimed to determine whether youth participating in FT within a short-term juvenile detention center reported expected changes in motivation to change substance use. Additionally, we aimed to assess whether individual differences at baseline, like depression and substance use, were associated with variance in treatment outcome. The youth (N=49) detained in a short-term juvenile detention facility participated in FT. Motivation was assessed at baseline and following the last session using the University of Rhode Island Change Assessment (URICA; DiClemente, Schlundt, & Gemmel, 2004) and the Modified Contemplation Ladder (Biener & Abrams, 1991; Slavet et al., 2006). At post-treatment, participants reported statistically significant decreases in motivation on the URICA but did not report significant changes in motivation on the Contemplation Ladder. Although motivation decreased overall, results indicate higher levels of baseline substance use and baseline depression predicted greater increases in motivation. Although findings did not provide support for including FT as part of a general curriculum within short-term detention centers, results suggest that FT may be beneficial for those who report problematic substance use or depressive symptoms. Results are discussed in terms of feasibility and suggested adaptations

Targeting Youth\u27s Motivation to Change Substance Use Behaviors: Feasibility & Preliminary Outcomes from an Open Trial of the Free Talk Program in a Short-Term Juvenile Detention Facility

Background: Trauma exposure in adolescents is associated with increased rates of externalizing behaviors, substance use disorder and conduct disorder. Youth who are involved in the juvenile justice system have elevated levels of mental health difficulties and the many detained youth who have experienced trauma may be a group with particularly high needs. Objective: The purpose of this study was to determine the frequency of trauma exposure and correlates of such exposure in a sample of justice-involved youth. Methods: Staff administered the Massachusetts Youth Screening Inventory (MAYSI-2) to N=41 detained youth upon their arrival at a juvenile justice facility. In the current study, we examined associations between the trauma exposure subscale and the subscales for substance use, suicidal ideation, depression/anxiety, thought disturbance, and anger/irritability. The thought disturbance subscale has only been validated for boys. Results: 59.2% of youth in the sample endorsed trauma exposure on the MAYSI-2. As hypothesized, we found significant positive correlations between trauma exposure and several MAYSI-2 subscales including substance use (r=.35, p\u3c.05), anger/irritability (r=.49, p\u3c.001), and depression/anxiety (r=.64, p\u3c.001). The thought disturbance subscale yielded a significant positive correlation with the trauma exposure subscale for boys (r=.48, p\u3c.01). Discussion: Detained youth are a group with heightened psychological needs compared to the general population. Results suggest that those youth who have been exposed to trauma may be a group with particularly high level of needs. Trauma-focused programs and policies can be implemented to mitigate not only posttraumatic stress but also substance use, anger/irritability, depression/anxiety that correlate with trauma exposure

Do Externalizing Problems Impact Change In Post-Traumatic Stress Symptoms For Youth In a School-Based Group Intervention

Trauma exposure places youth at an increased risk for post-traumatic stress symptoms (PTSS) and externalizing problems. Trauma-focused therapies help treat these symptoms, but many youth with these symptoms are still unable to receive treatment. Offering trauma-focused therapies in a group format is one way to extend therapeutic services to more youth who need them. Providing group interventions to youth in the school setting can further minimize barriers for youth who need therapeutic services. Despite the relationship between trauma exposure and externalizing behavior problems, and the disruptive nature of externalizing problems, the impact of externalizing problems on outcomes in group treatment for PTSS has yet to be examined. This study uses multilevel modeling to examine whether PTSS symptom change during group therapy for youth with PTSS differs as a function of youth’s self-reported externalizing problems or as a function of youth’s exposure to other youth’s externalizing problems within their therapy group. Results show that youth’s own level of externalizing problems at baseline did not yield a significant effect on PTSS symptom change from pre- to post-treatment; however, youth who were part of groups with higher levels of externalizing problems experienced less change in PTSS from baseline to post-intervention. While youth with higher levels of externalizing problems themselves still report experiencing reductions in PTSS from group therapy, the presence of these youth in group sessions may impede therapeutic progress of other groups members. The clinical implications of these findings for treatment of PTSS in youth with externalizing behavior problems will be discussed

The Indirect Effects of Proximal Stressors Associated With Posttraumatic Stress Symptoms

Sexual minority women (SMW) are at risk for sexual victimization and stressors specifically related to their minority identity (e.g., discrimination). However, SMW experience posttraumatic stress disorder (PTSD) at rates beyond what may be explained by elevated risk for sexual victimization alone. This study aimed to examine the impact of stigma on PTSD symptoms among SMW survivors of sexual victimization. Results indicate that in relation to minority-specific distal stressors (i.e., heterosexist experiences), both minority-specific and general proximal stressors (i.e., internalized heterosexism, negative posttraumatic cognitions) indirectly affected PTSD symptom severity among this cross-sectional sample of sexually victimized SMW

Evaluating Measures of Externalizing Personality Pathology Traits in Black and White American Adolescents in a Program for at-Risk Youths

Adolescent personality assessment measures can aid in the identification of traits that are associated with various types of maladjustment. Externalizing personality pathology traits (e.g., antisocial, borderline, and narcissistic personality disorder features) are particularly relevant for many problematic outcomes, yet measures that assess these traits have not been validated extensively in diverse samples. The present study aimed to examine the properties of measures of externalizing personality pathology traits in a sample of White (n = 184) and Black (n = 99) adolescents participating in a residential program for at-risk youth. The fit of the proposed structure for these measures was tested in the sample as a whole and in each racial group separately. Associations between these measures and the count of disciplinary infractions received while in the program were also tested. Measures were found to have less than optimal fit in this sample, especially among Black adolescents. Suggestions for future research and clinical use of these measures are discussed

Confirming Eight-Factor Structure of the Substance Use Motives Measure in a Sample of US College Students

The 2020 National Survey on Drug Use indicates nearly three quarters of individuals ages 18-25 have used substances in the past year. Research suggests individuals who use substances to cope with negative mood states are typically more substance-involved, report more psychological distress, and have a more extensive treatment history. Additionally, the high rate of polysubstance use among substance using adults in the U.S. highlights the need for broadband measures that can adequately capture use, consequences, and motivations for use of multiple substances. However, most measures assessing motives for use are typically substance specific. Recently, Biolcati and Passini (2019) developed a brief, but comprehensive model of broad substance use motives (i.e., Substance Use Motives Measure, SUMM) based on well-established motives questionnaires (e.g., DMQ-R, MMQ). They found support for their proposed eight-factor model in an online sample of Italian citizens (ages 18–60). No studies to date have examined the psychometric properties of the SUMM with an English-speaking or US college student sample. The current study evaluates the factor structure of the SUMM in a sample of 143 college students (74.8% female, 77.6% White, and 94.4% non-Hispanic/Latinx) at a large, southeastern university in the United States. Results of a confirmatory factor analysis showed support for the previously identified eight-factor structure for the SUMM, with acceptable model fit and internal consistency of each factor found. Findings support using the SUMM as a broad measure of substance use motives, but more research is needed to assess measurement invariance across different groups and to evaluate external, concurrent, and convergent validity using other well-established measures of substance use motives, severity, and psychiatric symptomatology

Parenting Practices and Callous Unemotional Traits Predict Behavioral Infractions At Military-Style Youth Challenge Academics

Behavioral infractions may impede adolescents’ ability to benefit from programing in residential settings since such infractions may limit program participation. Identifying adolescents who are at risk of behavioral infractions can help to target supports to these youth. The current study tested hypothesized links between callous-unemotional (CU) traits, parenting practices, and disciplinary infractions. Participants were 292 adolescents attending a military-style residential program (M age = 16.76, SD = 0.731; 82.9% male; 66.2% White and 33.8% Black). Participants completed the Inventory of Callous-Unemotional Traits (ICU; Frick, 2004) and the Alabama Parenting Questionnaire (APQ; Frick, 1991). Disciplinary infractions were accessed via program archival records. Black adolescents reported higher CU traits than did White adolescents and received a higher number of infractions during the program. There were no racial group differences in reports of parenting practices. A Poisson regression that included race suggested that CU traits (IRR = 1.015, p \u3c .001), negative parenting (IRR = 1.011, p \u3c .001), and positive parenting (IRR = 0.995, p = .012) each significantly predicted behavioral infractions in hypothesized directions. Study limitations, implications, and future research directions are discussed

Functional Outcomes From Psychotherapy for People With Posttraumatic Stress Disorder: A Meta-Analysis

People with posttraumatic stress disorder (PTSD) experience a wide array of symptoms, often accompanied by significant functional and quality of life impairments. Evidence-based psychotherapies are effective for alleviating symptoms in this group, but functional outcomes following psychotherapy are understudied. This study aimed to synthesize existing work on functional outcomes of psychotherapy to conduct a meta-analytic investigation examining whether people with PTSD experience significant improvements in functioning and quality of life following a course of psychotherapy. A literature search was conducted for studies reporting results of randomized clinical trials of psychotherapies for people diagnosed with PTSD that included a functional or quality of life outcome measured at pre- and post-intervention. Both between-groups and within-groups analyses were conducted using a random effects model. Fifty-six independent samples were included. Results suggest that, on average, people with PTSD experience significant, moderate improvement in functional outcomes after a course of psychotherapy. Taken together, this meta-analysis represents a substantial advance in our understanding of functional outcomes of psychotherapy for people with PTSD. Findings suggest that psychotherapy is one vehicle through which functional outcomes may be improved for this group, though notably to a lesser degree than symptom improvement