Problem behavior with alcohol and drugs first occurs in adolescence (Johnston, Bachman, & O'Malley, 1981), and may be the most prevalent health problem in that period. It is a contributing factor in adolescent mortality from such causes as drunk driving and suicide (Medina, Wallace, Ralph, & Goldstein, 1982).
Given the magnitude of the problem it is surprising that there are relatively few outcome studies of treatment programs for adolescents who are chemically dependent (CD). Newcomb and Bentler (1989) report that relapse rates from treatment programs range from 35 to 70%, and that there is little information to indicate whether inpatient or outpatient programs are more effective and which outcomes are attributable to treatment.
Braukmann et al. (1985) reported a variety of behaviors including drug and alcohol use in a special group home which was compared to control homes. All of the youth had been ordered into care by a juvenile court. The experimental program consisted of teaching relationship skills, and was not specifically designed to reduce drug and alcohol use. The authors reported a decrease in drug and alcohol abuse in the treatment program as compared to pre-treatment levels, and compared to the control group homes. For the experimental program, pre-treatment alcohol use averaged 4.4 days/month, and during treatment it averaged 1.5 days/month; the control group averaged 6.7 days/month.
Friedman and Glickman (1986) found that adolescent CD programs that employed counselors with longer tenure, a larger number of volunteers, increased delivery of mental relaxation techniques, freer client expression, and more practical problem solving, were associated with higher completion of treatment. No information was offered regarding program success rates.
Friedman, Utada, and Glickman (1986) studied a social skills activities intervention for court-referred delinquent high school students. They found that while graduation rates and personal adjustment appeared to be increased by the program, there was no reduction of drug use.
Query (1985) studied American Indian and European American adolescents in a four to six-week inpatient CD program, following up on 104 of the 134 patients after discharge. They found that after treatment 27% of European Americans but all American Indians continued alcohol use; 46% of American Indians and 41% of European Americans did not use marijuana or hashish.
Little is known about the behavioral changes associated with recovery from drug and alcohol dependence, but there is much larger literature on CD adults in treatment (Kandel, 1978). Newcomb and Bentler (1989) describe adolescent CD in terms of risk factors which include family structure, peer group, personality, and behavioral determinants. Contributing psychological factors include low self-esteem, delinquent behavior, need for excitement, and psychiatric problems such as depression. They note, ". . . the correlates and etiology of drug use would not seem to be an important research priority" (p. 245).
Krug and Henry (1974) studied differences among 563 adolescents who included drug users and nonusers. Drug use was measured by self-report on a questionnaire, with any drug use qualifying an individual as a drug user. Users differed from nonusers in manifesting higher dominance, radicalism, self-indulgence, and aggression combined with lower social inhibition and conscience development.
Several studies describe adolescent CD in behavioral terms as part of a syndrome of "problem behavior" (Jessor, 1988; Donovan, Jessor, & Costa, 1988; Jessor, Chase, & Donovan, 1980; Wright, 1985; Spotts & Shontz, 1985; McKenry, Tishler, & Kelley, 1983). These studies show marked patterns of problem behaviors among CD adolescents, including increased sexual precociousness, more suicide attempts and depression, and general avoidance of consequences of the individual's actions. …