Interventions For Substance Abuse Amongst Young People
Despite the fact that young people are most often the healthiest group of people in the population (Emmelkamp, and Vedel, 2006), there is concern about the extent to which this group engages in risk-taking behaviours, including the consumption of drugs and alcohol and the abuse of these substances.Such activities expose them to problems ranging from the individual health level to the costs incurred during rehabilitation (Berglund, Thelander & Jonsson, 2003).Rehabilitation needs often include mental health and psychiatric solutions due to the mental health and social problems caused by drinking and the consumption of illegal drugs.
In the UK, the use of psychoactive substances has become a major activity among the youth population.
For example, it has been shown that 50% of young people in the age bracket 16-24 years have used an illicit drug on at least one occasion in their lives. This project also exposed that the most commonly used drug is cannabis which is used by 40% of youths aged 16-19 years and a shocking 47% of 20-24 year olds. Amphetamine then follows which is used by 18-14% of the above age groups. Between 2011 and 2012, 20,688 young people accessed substance misuse services, with the majority of this number accessing services for abuse of cannabis (64%) or alcohol (29%) (National Drug Treatment Monitoring System, 2012). Over half of the users were aged 16 to 18 (53%), whilst the rest were aged under 16 (National Drug Treatment Monitoring System, 2012). About two thirds (64%) of the young people who accessed specialist substance misuse services in 2010-11 were male. Overall, females accessing substance misuse services for young people are younger with 19% of males aged under 15 years compared to 27% of females. Almost half of the young people entering specialist substance misuse services are recorded as being in mainstream education, such as schools and further education colleges, followed by a further 19% in alternative education, such as schooling delivered in a pupil referral unit or home setting. A further 19% are recorded as not in education or employment. However, it should be noted that education and employment status was reported for only new young people entering specialist services during the year. Therefore, the total will be lower than that of all young people (National Drug Treatment Monitoring System, 2012). Referrals to drug and alcohol treatment services commonly come from youth offending teams, although around 14% of referrals come from mainstream education institutions and 7% are made up of self-referrals. Perhaps surprisingly referrals from the Child and Adolescent Mental Health service (CAHMS) make up only 3% of referrals (National Drug Treatment Monitoring System, 2012).
These figures paint a perhaps surprising picture. For example, more young people are referred to specialist drug and alcohol services from mainstream education than specialist educational centres, suggesting that substance abuse could be far rifer amongst young people as might be expected. It could be argued that failure of school authorities to take a more effective preventative approach to drug and alcohol abuse may be contributing to the overall problem. These figures also suggest that immediate attention and intervention must be offered to young people to reduce negative outcomes associated with such high drug use.
The statistics reveal that there is a high rate of drug and substance abuse among young people in the UK. The high of level concern about the use of illicit drugs and substances has an effect on health, educational and political discussions in the UK. The government’s national strategy for ten years on drug misuse views young people as a critical priority group in need of quick prevention and treatment intervention (Keegan and Moss, 2008) and recognises the need to improve our understanding of the role played by illicit drugs and substances in the lives of such young people. Educators, health practitioners and policy makers should have comprehensive understanding when it comes to discussions involving the abuse of illicit drugs. For example, the Government must take into account factors such as a lack of understanding amongst young people as to the laws that govern different classes of illegal drugs.
Abuse of alcohol and other drugs leads to the destruction of cognitive and emotional development in young people and exposes them to an increased possibility of accidental injury or even death. Finally, there is also a risk of users becoming drug dependent. Abuse of drugs and alcohol by young people can also lead to such negative consequences as coronary heart diseases, lung cancer, AIDS, violent crime, child abuse and unemployment (Gurnack, Atkinson & Osgood, 2002). As a result, individuals indulging in the use of alcohol and other drugs incur tremendous costs in their individual lives, their family lives and even their future careers. Society is also not exempt as it pays a price in different ways. For instance, society incurs extra costs in health care, drug and alcohol treatment, law enforcement and supporting the seriously affected families who have been rendered helpless by the situation.
There are many reasons why young people become involved in substance abuse. From a sociology perspective it has been argued that the recreational abuse of drugs has become ‘normalised’ (Parker, Measham and Aldridge, 1995) among certain groups of young people. However, Shiner and Newburn (1997) have argued that this theory is reductionist and simplifies the reasons behind a young person’s choice to abuse drugs. In reality, the reasons as to why a young person may begin to abuse drugs can range from having poor adult role models who may also use drugs and alcohol as a way of coping or even a genetic predisposition toward poor self-regulatory behaviours (Spooner and Hall, 2002). Evidence shows that adolescent alcohol and drug abuse is not influenced by a single factor but a large number of factors which are not necessarily confined to any single part of the an adolescent’s world (Connors, Donovan & DiClemente, 2001).
The environment in which a person lives is very instrumental when it comes to the kind of life that people lead, especially young people. If the environment is for example characterized by pronounced unemployment then young people in such an environment will indulge in activities that make them forget even for a moment the realities of the unemployment situation.If, for example, in their immediate environment young people face the situation of a large supply of drugs and everyone around them is abusing drugs or alcohol, then it is easy for such young people to adopt this kind of lifestyle and become drink or drug abusers. The above explanation shows that the kind of environment a young person stays in has a very direct influence on the habits that are finally adopted by this group of young people.
Young people naturally have the tendency to try new things and to find out how it feels doing something new. Young people in the United Kingdom are not an exception and most of them usually try drinking and drugs just to explore and find out what the experience is like. This however results in the young people becoming victims of the consequences that follow (Woo and Keatinge, 2008).
The Defence Mechanism
A good number of young people use drugs specifically to assist them in easing trauma that may result from unsatisfactory relationships and also physical or emotional abuse that may arise from families or homes that lack happiness.
Promotion and Availability
There is always a great amount of pressure from advertisement of alcohol over the media. The colourful nature of these promotions is often very enticing and mostly misleading. In the promotions or commercials, alcohol is glamorised hence the young people are influenced to indulge and as a result end up facing the dire consequences.
This review will analyse the different interventions utilised when working with young people who abuse drugs and alcohol. These include those carried out by mental health workers, religion-orientated interventions, community based interventions and more psychiatric, medication based interventions. Motivational based interventions are also discussed.
Aims and Objectives
The aim of this project will be to review and critically evaluate the literature regarding different interventions for young people who abuse drugs and alcohol in the UK. To achieve this aim the project has set the following objectives:
To critically examine the interventions for young people (aged 16 to 21) who use drugs and alcohol in UK, with the aim of providing recommendations to improve the care given to the youths who are addicted or at risk of substance abuse.
To use secondary data to identify the importance of different interventions in dealing with young people (age 16 to 21) who use drugs and alcohol in the UK.
Interventions for young people aged 16 to 21 who use drugs and alcohol has elicited varied opinions from professionals involved in their care. This has been a result of the often complex and varied needs of young people with substance abuse issues, such as mental health issues (Weaver et al., 2003), social exclusion (Fakhoury and Priebe, 2006) and involvement with the criminal justice system (Hamdi and Knight, 2012; Lundholm et al., 2013). Therefore, there is often disagreement on where the intervention should focus primarily.
Various strategies have been advanced to address the involvement of young adults in drugs and substance abuse. For example, medication by mental health nurses in cases of addiction (Bennett and Holloway, 2005). However, due to the variety of interventions available for treating young people with substance abuse disorder, it is important to continuously review the literature in this area and pin point the most effective interventions for treating this group of individuals.
[Client must write some words here on why they have chosen this topic (this is essential according to the assignment brief).]
In preparation for this critical literature review, a number of sources including journals, articles and health text books were used. The search was conducted using computerised databases which enabled access to literature on interventions for young people who abuse drugs and alcohol. Examples of such databases are given below:
The Department of Health
NHS Evidence (National Institute for Health and Clinical Excellence, 2012).
PsycINFO (American Psychological Association, 2013).
PubMed (National Center for Biotechnology Information, 2013).
Google Scholar (Google, 2013).
net (EMAP Publishing, 2013).
Nursing and Midwifery Council publications (Nursing and Midwifery Council, 2010).
Royal College of Psychiatrists useful resources (Royal College of Psychiatrists, 2013).
Royal College of Nursing library services (Royal College of Nursing, 2013).
These databases contained numerous useful sources such as journal articles, recommendations, guidelines and reviews that were used to gather evidence relevant to interventions for young people who abuse drugs and alcohol. Search terms used included; ‘drugs and substance abuse’, ‘alcohol abuse’, ‘effects of alcohol abuse’, and ‘intervention measures for drugs and substance abuse’. It was not uncommon for a search to produce many results. Therefore, for any search that produced more than 50 results, the first 50 results were observed to pick out the most relevant and interesting studies. The remaining results were not looked at because of time constraints. In addition to searching for relevant sources through online databases, reference lists within articles were also utilised to search for other relevant sources.
For an effective review of the subject area, there was a need to select relevant articles to achieve the set objectives. Therefore, only sources relevant to intervention for young people who abuse drugs and alcohol, papers published in the English language and papers published after the year 1999 were selected. Although sources pertaining to studies carried out in the USA were still considered relevant, a priority was given to sources from the UK. If a source had used an adult sample but was still considered relevant and useful then it was considered for inclusion.
General papers on drugs and substance abuse not specific to youths, papers published in languages other than English and published before the year 1999 were not included.
An example search strategy when using one of these sources, the British Nursing Index, is given below.
Search Strategy Example: British Nursing Index (BNI).
Through citing the term ‘intervention for young people who abuse drugs and alcohol’, 5,000 articles were gathered without limiters. Limiters such as ‘role of mental health nurses’ and ‘only book and journals concerned with drugs and substance abuse’ were applied to the second search, which reduced the output to 2,034 books and journals. In the third search, additional limiters such as year of publication (2000-2012) were applied, which then reduced the number of books and journals to 734. After all further limiters were applied, such as articles that only used an age group of 16 to 21 years as participants, 70 journals and books were chosen for further analysis. Only 23 articles were considered relevant for this review and analysis due to their in depth exploration of the subject and their meeting of inclusion and exclusion criteria.
Interventions for substance abuse serve a number of purposes including reducing use of illicit or non-prescribed drugs and curbing problems related to drug misuse, including health, social, psychological and legal problems and last but not least tackling the dangers associated with drug misuse, including the risks of HIV, hepatitis B and C and other blood-borne infections and the risks of drug-related death.
Prevention and intervention are usually categorised into primary (direct prevention), secondary (early identification of the problem and subsequent treatment) and tertiary levels (late identification and treatment). Furthermore, interventions are now often categorised into population wide interventions, selective interventions aimed at only high risk groups and early interventions for at-risk groups (Cuijpers, 2003). The nature of interventions has also evolved over the years. Twenty to thirty years ago the emphasis was on providing young people with information and buffering moral values whereas in the more modern era, a social dimension has been added and young people are taught resistance skills to avoid peer pressure (Gilvarry, 2000).
Alcohol related deaths are rife in the UK, with 8,748 alcohol related deaths in the UK in 2011 (Office for National Statistics, 2013). However, there were 1,883 noted drug related deaths in 2010, a decrease of 299 from 2009 (Ghodse et al. 2012). These statistics reflect the importance of interventions for drug abusers, which could be protecting some individuals from the most extreme consequence of substance abuse.
Mental Health Interventions
Research has evidenced that Major Depressive Disorder (American Psychiatric Association, 1994) is often co-morbid in young people who abuse drugs and alcohol (Sutcliffe et al., 2009; Marshall and Werb, 2010; Marmorstein, Iacono and Malone, 2010). Due to the potentially devastating effects of depression at both the individual (Galaif et al., 2011; Petrie and Brook, 2011) and societal level (Sobocki et al., 2006), substance abuse is viewed as something that must be dealt with swiftly and effectively. This co-morbidity of mental illness and substance abuse means that mental health nurses are often involved in interventions with young people. Mental illness is a psychological anomaly that is generally associated with distress or disability that is usually not considered to be a component of an individual’s normal development (Nursing and Midwifery Council, 2008). Despite the fact that standard guideline criteria are used all over the world to define mental illness, diagnosis and intervention is often incredibly complex, especially when substance abuse is also a factor.
Community services are offered to people with such problems through assessment by different psychiatrists and clinical psychologists, or sometimes social workers. All these professionals use methods of observation and inquiries through asking questions to help establish any given patient’s condition. Mental health nurses are often at the front line in providing care and support in both hospitals and the community. In the United Kingdom, mental health nurses play a great role in taking care of young people with mental disorders and mental illnesses that may have developed as a result of substance abuse (Department of Health, 2012). They offer counselling services in order to help people focus on their goals or outcomes; help people develop strategies that support self-care and enable individuals and their families to take responsibility for and participate in decisions about their health. They provide a range of services including education, research and knowledge sharing and evidence informed practices.
They also perform the role of addiction counsellors in order to provide intake co-ordination, assessment, treatment and follow-up care for youths with addictions, mental illness and mental health problems using common assessment tools. They can provide health promotion, prevention and early detection of problematic substance use; use core competencies and knowledge in addictions and a full range of withdrawal management services including detoxification services using best practice treatment protocols, outreach, prescribing, counselling, and harm reduction However, mental health nurses are often faced with challenges that hinder them from successfully achieving their goals. Challenges include non co-operation of the patients’ families and also the complex nature of patient problems (Nursing and Midwifery Council, 2008). In a comprehensive review, RachBeisel, Scott and Dixon (1999) found that there was a much higher prevalence of substance abuse amongst individuals with mental illness and that the course of mental illness was significantly negatively influenced by the abuse of illegal substances. These findings highlight a key issue in mental health interventions for young people who abuse substances, namely that it is important to determine the relationship between the substance abuse and mental illness before allocating a suitable intervention. For example, if a young person has developed a mental illness as a result of abusing substances, a mental health focused intervention may not be appropriate as it would not be treating the root of the problem or the reason why the young person started to use illegal substances in the first place.
Psychiatric and Medical Interventions
Psychiatric and medical based interventions refer to the treatment of substance abuse in a young person by a psychiatrist who is medically trained and able to provide an additional dimension of treatment than a psychologist or mental health worker is able to. An example of this is the prescription of methadone, a synthetic opiate that is used to help young people withdraw safely from heroin use. The National Institute for Health and Clinical Excellence (2007) recommend a psycho-social approach when treating individuals with substance abuse disorder and advocate the use of medication. However, use of medication with young people who are suffering from substance abuse disorders should be used with care due to the risk of dangerous side effects (Webster, 2005).
Motivational interventions are brief interventions used by professionals to enhance a young person’s motivation to change and stop abusing substances (Tevyaw and Monti, 2004). In a review of the effectiveness of motivational interviewing (Smedslund et al., 2011) it was found that although motivational interviewing techniques were more effective at reducing the extent of future substance abuse when compared to no intervention, the technique was no more effective when compared to other types of intervention. For example, motivational interviewing was no better at reducing extent of substance abuse that simply assessing a patient and providing feedback. The authors reviewed 59 studies that had been accessed from a range of online databases. This is a reasonable number of studies as the body of literature on motivational interviewing as an intervention for substance abuse is quite limited. However, the authors failed to collect evidence on other measures of efficacy such as a reduction in future criminal prosecution for drug offences or improvement in overall quality of life. The efficacy of motivational interviewing has been studied in young people in particular by McCambridge and Strang (2003). 200 young people from inner city London were randomly allocated to either a motivational interviewing condition or a non-intervention education control condition. All participants were aged between 16 and 20 and were using illegal drugs at the time of the study. The motivational interviewing intervention consisted of a brief, one hour face-to-face interview and self-reported changes in the use of cigarettes, cannabis, alcohol and other drugs was used as the outcome measure both immediately after the interview and at a three month follow up point. It was found that in comparison to the control group, young people who received motivational interviewing as a brief intervention reduced their use of cigarettes, alcohol and cannabis. Although these results initially seem in favour of motivational interviewing as an intervention for young people who have substance abuse issues, it should be noted that self-report measures are very open to bias and it is possible that the reported reduced use of drugs and alcohol was much higher than the actual reduction in use. This was reflected in a follow up study by the same authors 12 months later (McCambridge and Strang, 2005) where it was found that the difference in reduction in substance use between the experimental and control groups found after three months had completely disappeared. This result suggests that although motivational interviewing may be an effective short term intervention for treating young people with substance abuse issues, it has no enduring effectiveness over a long period of time. This may be due to a lack of follow-up support for young people and the brief nature of the intervention.
Community drug and alcohol services offer interventions such as comprehensive assessment and recovery care planning, support and care co-ordination, advice and information, stabilisation, counselling and relapse prevention and motivational interviewing (Nursing and Midwifery Council, 2008). Hepatitis B vaccinations, Hepatitis C testing and referral to treatment for these diseases, are also essential due to the risk of infections through needle sharing. Like most interventions, these community services are aimed at promoting recovery from addiction and enabling the achievement of individual goals, helping individuals to remain healthy, until, with appropriate support, they can achieve a drug-free life. This may involve stabilising service users on prescribed substitute medication to improve withdrawal symptoms and to reduce cravings. In their review of community-based interventions, Jones et al. (2006) found a limit on the effectiveness of such interventions, especially when it came to long term and enduring effect for reducing substance abuse. The results suggested that a change in community-based interventions was needed. Morgenstern et al. (2001) found a very high level of satisfaction among community based substance abuse counsellors who had received training in delivering cognitive behavioural therapy (CBT) to clients. This suggests that perhaps one way of increasing the effectiveness of community-based interventions would be to equip community-based workers with a wider range of skills with which they can help young people suffering from substance abuse. Supporting this recommendation was a study by Waldron and Kaminer (2004) who found that use of CBT was associated with clinically significant reductions in substance abuse amongst adolescents.
Some interventions are religious in nature. For instance, the United Methodist Church follows a holistic approach which stresses prevention, involvement, treatment, community organization, and advocacy of abstinence. The church could be argued to have a progressive role by offering a spiritual perception on the issue of substance abuse. Another popular religious based approach to tacking alcohol abuse in particular is the 12-step program offered by Alcoholics Anonymous. Individuals are commonly encouraged or possibly even required cut any acquaintances with friends who still use alcohol. The 12-step programme motivates addicts to stop consuming alcohol or other drugs and also it helps to scrutinize and modify the habits related to their cause of addiction. Numerous programs accentuate that recovery is a long-lasting process with no culmination. For drugs which are legal such as alcohol, complete abstinence is recommended rather than attempts at moderation which may cause relapses. Fiorentine and Hillhouse (2000) found that participants in a 12-step program stayed in future treatment for a much longer period of time and were much more likely to be able to complete a 24-week intervention programme. It was also found that a combination of a 12-step program and an alternative substance abuse intervention was more effective than either treatment alone. This suggests that providing young people with interventions in isolation may not be the most effective way of helping them overcome their substance abuse. However, literature on religious based interventions tends to focus on adults and although still applicable to the treatment of young people in many ways, young people may be put off by the religious nature of these 12-step programmes and may be intimidated by the group nature of the treatment. In support of this criticism, Engle and MacGowan (2009) found that only two out of 13 adolescent group treatments of substance abuse could be categorised as showing potential efficacy in treating young people with these problems.
It has been argued that the family has a central role in both increasing and reducing the risk of problem behaviours in young people such as substance abuse (Vimpani and Spooner, 2003). A review by Velleman, Templeton and Copello (2005) echoed this view that the family can have both a positive or negative impact on a young person’s risk of substance abuse. Kumpfer, Alvarado and Whiteside (2003) have identified that support for families based within the home, family education and skills training, improving parental behaviour and time-limited family therapy are all highly effective forms of family-based interventions for young people with substance abuse issues. However, as research has shown that the family can also play a role in increasing risk of substance abuse, professionals must be confident that family therapy is suitable and not run the risk of worsening a young person’s relationship with their family and in turn worsening their substance abuse.
Education about the use of drugs and alcohol within schools has been advocated as a preventative intervention for young people at risk of substance abuse disorder. Fletcher, Bonell and Hargreaves (2008) found that interventions focused around encouraging a positive school environment and improving young peoples’ relationships was associated with a reduction in risky substance abuse. However, part of this conclusion was based on the review of observational studies, which are open to bias and subjectivity.
CONCLUSIONS AND FUTURE RECOMMENDATIONS
This essay has reviewed a number of sources regarding the efficacy and suitability of certain interventions for young people with substance abuse issues. A key limitation of much of the literature is the tendency to put emphasis on drugs as a generic material with very little distinction is made between different types of illicit substances. With the very varied effects of different drugs on the user, it could be argued that the specific reasons for a young person’s drug usage will have an impact on the effects that a drug has. For example, stimulant drugs will most likely be used for nervous system arousal, while other drugs such as alcohol and cannabis are sedatives and cause nervous system depression. These kinds of drugs can be termed as instrumental drugs since the reasons behind their usage correspond to the effect of the different kind of drug that is used (Brick, 2008). Therefore, it might be useful for professionals to base their interventions on the types of substance abused.
From the above literature review it is evident that there is need for mental healthcare especially to help young people who are adversely affected by the use of drugs and other substance abuse. Some youths suffer from psychiatric disorders as a result of indulgence in drugs and substance abuse. Others experience mental problems that need serious rehabilitation measures taken in order to counter such problems hence emphasis should be laid on the care that is to be given to the young people affected by any of the above problems caused by the abuse of drugs and other substances. Therefore, mental health interventions remain an important intervention for young people.
A number of recommended adjustments in healthcare to cater for young people struggling with abuse have been identified. For example, there should be an increased application of various musical strategies in helping patients suffering from various mental health conditions as a result of substance abuse (Connors, Donovan & DiClemente, 2001), as this kind of intervention appears to be lacking in use with young people.
Another main limitation in research that aims to measure the effectiveness of intervention measures is the lack of control that researchers have. It would be considered unethical if young people with drug abuse problems were randomly allocated to intervention procedures, especially if one was chosen as a control condition and was not believed to be effective in treating substance abuse issues. This means that it can be difficult to compare intervention methods. Another limitation lies in the types of measure researchers’ use to measure effectiveness of intervention methods. For example, a self-report measure may be used to assess whether young people have either stopped or at least reduced their intake of illicit substances. This type of questionnaire may also be used to see if the young people are seeing a positive result from receiving an intervention. However, self-report measures are open to social desirability bias meaning that many young people may fabricate their answers in order to either please the professionals who are involved with helping them or to conceal ongoing substance abuse.
The review has also emphasized the causes or triggers of alcohol and drug abuse among young people in the United Kingdom showing that the environment a young person stays in is one of the greatest factors that lead to indulgence in alcohol, drug and substance abuse. Other factors like enjoyment, peer pressure, promotions in the media and rebellion are also causes of alcohol, drug and substance abuse among the youth in the United Kingdom (Gurnack, Atkinson and Osgood, 2002). More focus on these root causes could help improve prevention and reduce the need for later intervention, which has a poor track record of success.
Finally, there is need according to the literature review to improve media perception of mental health patients in order to help alleviate the conditions of psychiatric disorders that are caused by the indulgence of young people in alcohol, drug and substance abuse (Berglund and Thelander, 2003). This doesn’t indicate failure in the mental nursing services but it just implies that mental health workers and psychiatrists need reinforcement in order to positively contribute to successful intervention (Califano, 2007). This suggestion is based on the need for a more holistic approach when it comes to treating young people with substance abuse issues, where the effect on all areas of their life including their mental health must be taken into account during intervention.
Strengths of this Critical Literature Review
Secondary data was reviewed in this project, which provided larger scope on choices of information for the project. In addition this review was able to identify key areas for improvement of health condition interventions for youths affected by substance abuse.
Limitations of this Critical Literature Review
This literature review was small in scale, since word and time limits were set. Although 23 articles were selected for review, this number could have been improved. This could have provided a greater depth of understanding of the study area. In addition, limited time implicated how the review was to be carried out. The review was to be carried out in a period of less than three months during which time more than 23 articles were to be accessed and critically analysed.
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TitleFirst AuthorPublication Year
1Drug treatment and twelve-step program participation: the additive effects of integrated recovery activities.Fiorentine2000
2A critical review of adolescent substance abuse group treatments.Engle2009
3Co-occuring severe mental illness and substance use disorders: A review of recent research.RachBeisel1999
4Statistics for young people in specialist drug and alcohol services in England 2011-12National Drug Treatment Monitoring System2012
5Substance abuse in young people.Gilvarry2000
6The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: results from a multi-site cluster randomised trial.McCambridge2004
7The role of the family in preventing and interviewing with substance use and misuse: a comprehensive review of family intervention, with a focus on young people.Velleman2005
8School effects on young people’s drug use: a systematic review of intervention and observational studies.Fletcher2008
9A review of community-based interventions to reduce substance misuse among vulnerable and disadvantaged young people.Jones2006
10Motivational enhancement and other brief interventions for adolescent substance abuse: foundations, applications and evaluations.Tevyaw2004
11Motivational interviewing for substance abuse.Smedslund2011
12On the learning curve: the emerging evidence supporting cognitive-behavioural therapies for adolescent substance abuse.Waldron2004
13Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: within treatment and posttreatment findings.Morgenstern2001
14Family-based interventions for substance use and misuse prevention.Kumpfer2003
15Deterioration over time in effect of Motivational Interviewing in reducing drug consumption and related risk among young people.McCambridge2005
16Drug misuse: psychosocial interventions: full guideline.National Institute for Health and Clinical Excellence2007
17Substance abuse treatment and the stages of change: Selecting and planning interventions.Connors2001