Issues in the evaluation of chemical dependency treatment programs for adolescents

To summarize, six issues have been identified in this article that need to be considered before adequate assessment of relative efficacy of treatment programs can be attempted, starting at the front door of treatment. First, the differential referral sources that bring these youngsters to treatment must be considered, with their differential perspectives and definitions of problem behavior. Second, the differential characteristics of the patient population must be assessed. This involves, primarily, systematic and thorough medical and psychiatric diagnosis, but it also includes careful assessment of genetic, familial, social, legal, and developmental characteristics that subcategorize these youngsters. As indicated, when this is done the typical adolescent referred for treatment is likely to have a lifetime diagnosis of attention deficit disorder, conduct disorder, some drug use diagnosis (most likely alcohol and marijuana), past legal problems, a family in turmoil (which has included personal, physical, and possibly sexual abuse to the youngster and also genetic loading for alcoholism), or some learning disability. Third, the differential characteristics of treatment programs must be adequately described and catalogued. No such assessment instruments currently exists. The differential characteristics based on philosophy, treatment strategies, personnel selection, patient admission criteria, treatment techniques employed, length and type of treatment, and length and type of aftercare, all must be assessed. Fourth, the presence or absence of differential treatment strategies responsive to the particular needs of individual adolescents must be categorized. In addition to the overall philosophic flexibility of the program, the capability of responding to particular issues such as the presence of major depressive disorder, learning disability, sexual abuse, or the need for a careful neurologic assessment for subtle temporal lobe issues, must be identified in the program. Fifth, the differential response of the youngster to the treatment process as it is progressing must be able to be assessed and considered as a variable. For example, the ability of the youngster to participate in group confrontational sessions and honestly review his or her past behavior is a measurable variable that to date is ignored in program evaluation. Essentially the only variable currently assessed is treatment completion or failure to complete treatment. Sixth, appropriate outcome variables need to be identified and used. While abstinence is a laudable theoretic goal of treatment, the reality falls somewhat short of that goal.(ABSTRACT TRUNCATED AT 400 WORDS)