Mary Kay Dugan, M.A., Hyoshin Kim, Ph.D., Terry R. Johnson, Ph.D., and Robert Orwin, Ph.D.

1. Centers for Public Health Research and Evaluation 4500 Sand Point Way NE, Suite 100 Seattle, Washington 98105-3949 Effectiveness of Treatment Components in Reducing Drug Use in Adolescents and Young Adults: An analysis of the Job Corps Drug Treatment Enrichment Project (DTEP) Mary Kay Dugan, M.A., Hyoshin Kim, Ph.D., Terry R. Johnson, Ph.D., and Robert Orwin, Ph.D. Abstract Conclusions Introduction Results At the time of the follow-up interview, over one-third (37%) of all DTEP participants were abstinent of all drugs. The Center for Substance Abuse Treatment (CSAT) initiated an enriched drug treatment demonstration project (DTEP) in cooperation with the U.S. Department of Labor (DOL) Office of Job Corps. DTEP participants were Job Corps students (ages 16-24) who reported drug use (primarily marijuana) within the year preceding enrollment in the Job Corps program. The DTEP program was based on an integrated treatment model that provided counseling targeting drug use as well as counseling designed to address other related problems (e.g., anger/stress management). Analyses were conducted to determine which types of DTEP counseling were most effective in treating drug abuse by participants one-year post-program. DTEP treatment components were categorized into four types: 1) group counseling on drug abuse topics; 2) individual counseling on drug abuse topics; 3) group counseling on topics other than drug abuse; 4) individual counseling on topics other than drug abuse. Logistic regression models (controlling for individual social and demographic characteristics and prior drug use) were estimated to predict abstinence from drug use using the following variables: whether or not students received each of the four session types; number of days in group and individual counseling; number of days in group and individual counseling on drug abuse topics. The results showed that participants who received individual counseling on other topics, spent more days in individual counseling overall, and spent more days in individual counseling on drug abuse topics, were more likely to be abstinent from drugs at follow-up. Drug treatment programs in which practitioners provide individualized counseling to treat problems associated with drug abuse can have a positive effect on subsequent drug use of at-risk adolescents. Substance use by adolescents is widely recognized as a major public health concern. Substance use and abuse is associated with the three leading causes of mortality among adolescents: accidents (in particular automobile accidents), suicides, and homicides (Windle and Windle, 1999). Enhanced treatment services for youth have been established in the literature as important predictors of post‑treatment outcomes (McLellan et al., 1992; McLellan et al., 1998; Crome, 1999). In particular, treatment services that include employment training and vocational counseling have been demonstrated to be effective supplemental therapy in substance abuse treatment services (Higgins et al., 1991; Catalono et al., 1991). Furthermore, as part of a more comprehensive treatment approach, many now advocate for individualized treatment interventions for youth that focus on treating individual factors and that engage youth in a long‑term relationship (Crome, 1999). Research indicates that treatment services that pay inadequate attention to individual differences among substance abusing adolescents in terms of demographic, psychological, or social factors that are related to substance abuse may be ineffective in treating certain adolescents, suggesting that more tailored strategies that treat individual needs are the most effective (Wagner et al., 1999; Friedman, 1992). There has been very little research that examines the particular service mix that leads to the most successful outcomes (Wagner et al., 1999). While treatment services that provide both individual counseling and group therapy offer advantages to substance abusing youth, group counseling has been adopted in many settings because some view it as roughly comparable in effectiveness to individual counseling but considerably less expensive. Additional research is needed to examine the relationship among outcomes and specific elements of the treatment process, including treatment environment and delivery of services (Simpson et al., 1997). 1) Treatment components that include more general topics in the form of individualized counseling may be effective in addressing substance abuse issues. This finding suggests that counseling sessions devoted to other relevant topics may have enhanced the value of the core substance abuse sessions.  2) Individual sessions appeared to be more conducive to abstinence than group sessions, regardless of whether or not the sessions were directed at substance abuse issues. This finding suggests that group sessions may not be a viable substitute for individual sessions, at least for this population.  3) Drug treatment programs in which practitioners provide individualized counseling to treat problems associated with drug abuse can have a positive effect on subsequent drug use of at-risk adolescents. Background In 1992, the Center for Substance Abuse Treatment (CSAT) initiated an enriched drug treatment demonstration project in cooperation with the U.S. Department of Labor (DOL) Office of Job Corps. As a program that serves high‑risk youth in a residential employment training program for an average of seven months, CSAT recognized the potential of the Job Corps program to serve as a controlled environment in which adolescent substance abuse intervention services could be tested. This unique opportunity led to the development of the Drug Treatment Enrichment Project (DTEP) demonstration and evaluation. • Job Corps Program • Job Corps is designed to serve economically disadvantaged youth ages 16 to 24 through a comprehensive, competency‑based service philosophy and delivery system. • The primary focus of the Job Corps program is to provide educational and employment assessment services, basic education, and vocational skills training and work experience to participants. • This approach is complemented by health education, medical services, individual and group counseling, and structured residential and recreation programs. • The Drug Treatment Enrichment Project (DTEP) • The Job Corps Drug Treatment Enrichment Project (DTEP) was a drug treatment program that was pilot tested with a subgroup of Job Corps students. • Under the DTEP program, new personnel who were specialists in substance abuse, activities/program coordination, education, assessment, and a project assistant were hired. • This enhanced initiative included individual and group counseling, participation in life skills seminars, weekly case management meetings for substance abuse interventions, development of individual intervention plans, peer leadership programs, relapse intervention programs, after care treatment, remedial/enhanced education intervention plans, individual and group learning sessions, and tutorial programs for education. • The underlying DTEP philosophy was one of empowerment, which included helping people to take charge of their lives, and self-efficacy, which involved the belief in self-directed change. References Catalano, R.F., Hawkins, J.D., Wells, E.A., and Miller, J. “Evaluation of the effectiveness of adolescent drug abuse treatment, assessment of risks for relapse, and promising approaches for relapse prevention.” The International Journal of the Addictions, 25 (9A & 10A): 1085-1140, 1991. Crome, I.B. “Treatment interventions—looking towards the millennium.” Drug and Alcohol Dependence, 55: 247-263, 1999. Friedman, R.M. “Mental health and substance abuse services for adolescents: Clinical and service system issues.” Administration and Policy in Mental Health, 19(3): 159-178, 1992. Higgins, S.T., Delaney, D.D., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, F., and Fenwick, J.W. “A behavioral approach to achieving initial cocaine abstinence.” American Journal of Psychiatry, 148: 1218-1224, 1991. McLellan, A.T., Alterman, A.I., Cacciola, J.S., Metzger, D., and O’Brien, C.P. “A new measure of substance abuse treatment: Initial studies of the Treatment Survey Review.” J. Nerv. Ment. Dis., 180: 101-110, 1992. McLellan, A.T., Hagan, T.A., Levine, M., Gould, F., Meyers, K., Bencivengo, M., and Durell, J. “Supplemental social services improve outcomes in public addiction treatment.” Addiction, 93(10): 1489-1499, 1998. Simpson, D.D., Joe, G.W., Rowan‑Szal, G.A., and Greener, J.M. “Drug abuse treatment process components that improve retention.” Journal of Substance Abuse Treatment, 14(6): 565-572, 1997. Wagner, E.F., Brown, S.A., Monti, P.M., Myers, M.G., and Waldron, H.B. “Innovations in adolescent substance abuse intervention.” Alcoholism: Clinical and Experimental Research, 23(2): 236-249, 1999. Windle, M. and Windle, R.C. “Adolescent Tobacco, alcohol, and drug use: Current findings.” Adolescent Medicine: State of the Art Reviews, 10(1): 153-163, 1999. Methodology Services data were available for a total of 328 Job Corps students who participated in the DTEP intervention components. The analysis is based on the subgroup of students who met the following criteria: Acknowledgments • The student used drugs, including alcohol, in the 12 months before enrollment in the program. • The student had complete DTEP service records. • The student completed a follow-up interview at least six months after leaving Job Corps. This presentation was sponsored by the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services under the National Evaluation Data Services (NEDS) contract (#270-97-7016) to Caliber Associates. The analysis conducted for the project was based on data collected as part of the CSAT-DOL Office of Job Corps jointly sponsored demonstration of the introduction of enhanced substance abuse intervention. The opinions expressed herein are the views of the authors and do not necessarily reflect the official policy or position of the Federal Government. We wish to acknowledge our reliance upon the guidance and direction of Ron Smith, Ph.D., PEB, the Government Project Officer for the NEDS contract. We are particularly grateful to the staff of the Substance Abuse and Mental Health Services Administration (SAMSHA) who reviewed and commented on drafts of the final report for the project. Caliber Associates was the prime contractor of NEDS in partnership with Battelle; the Lewin Group; and National Opinion Research Corporation (NORC). Many individuals within the NEDS team contributed significantly to the final report for the project, including Patricia Devine, Richard Finkbiner, and Marsha Morahan. The present analysis focuses on one substance abuse outcome measured at the time of the follow-up interview: “abstinent” from drug use. Students were considered abstinent at follow‑up if they self-reported no illicit drug use since leaving Job Corps (measured 12 months post-program).  Logistic regression models were estimated to predict abstinence from drug use using the following variables: • Whether or not students received each of four counseling session types; • Number of days in group and individual counseling; and, • Number of days in group and individual counseling on drug abuse topics. The final statistical models included the following covariates: gender and ethnicity, whether they ever worked before enrollment, whether they had ever been arrested before enrollment, highest completed grade, whether they lived with their biological parents at enrollment, and the number of drugs they reported using in the 12-months prior to enrollment.  DTEP treatment components were categorized into four types: • Individual counseling on drug abuse topics (e.g.,“12 step,” “codependency,” “self help,” and “relapse prevention”) • Group counseling on drug abuse topics (Same topics as individual counseling sessions, except that sessions were within a group context.) • Individual counseling on topics other than drug abuse (e.g., confidentiality/trust; self-help; anger/ stress management, self-esteem, loss and grief, HIV awareness, and interactive skills. Sessions given by staff other than the Substance Abuse Specialist.) • Group counseling on topics other than drug abuse (Same topics as individual counseling sessions on other topics, except that sessions were within a group context.)