Substance abuse

Journal of Psychoactive Drugs, 45 (1), 28–38, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 0279-1072 print / 2159-9777 online
DOI: 10.1080/02791072.2013.763560

Substance Abuse Treatment for
Adolescents: How are Family Factors
Related to Substance Use Change?
Karine Bertrand, Ph.D.a ; Isabelle Richer, Ph.D.b ; Natacha Brunelle, Ph.D.c ; Isabelle Beaudoin, Ph.D.d ;
Annie Lemieux, M.Sc.e & Jean-Marc Ménard, M.A.f

Abstract — Parental involvement in adolescents’ substance abuse treatment is highly recommended, even though the mechanisms explaining how this favors youths’ recovery are not well understood. The present study examines the association between (1) changes in adolescents’ substance use and parenting practices, as measured by adolescent self-disclosure and parental warmth; (2) changes in mothers’ mental health and their parenting practices, and (3) parental use of services offered by substance abuse treatment centres, parenting practices and adolescent substance use. In total, 147 adolescents and 69 mothers participated in this study. Participants were assessed upon adolescent admission into treatment, as well as at three- and six-month follow-up. Results show an association between improved maternal mental health and greater parental warmth, as perceived by adolescents. In addition, greater parental use of treatment services was found to be associated with greater adolescent self-disclosure and greater reduction of adolescent substance use. Finally, greater adolescent self-disclosure and parental warmth were both associated with lower adolescent substance use. These findings underscore the need to facilitate parents’ access to and involvement in treatment of adolescents. The parent-adolescent relationship and the mental health of parents are essential aspects to consider for interventions. Keywords — adolescence, maternal mental health, parenting practices, substance abuse, treatment

Adolescent substance use is a preoccupying and increasingly common phenomenon (Johnstone, O’Malley
& Bachman 2003; Guyon & Desjardins 2003). In Québec,
Canada, 5.9% of high school students show signs of atrisk psychotropic drug use, while 6.0% exhibit problematic use requiring specialized intervention (Cazale, Fournier &
Dubé 2009). American studies report similar prevalences
(Merikangas et al. 2010; Sussman, Skara & Ames 2008;

Kessler et al. 2005). This reality is all the more worrisome because early onset of drug problems has been associated with increased risk of continued use in adulthood (Flanzer
2005). Despite high levels of risky adolescent drug use in both general and clinical populations, studies of adolescent substance abuse treatment did not really emerge until the past decade. Even though the effectiveness of some approaches has been documented, the factors involved in

a Professor, Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada. b Adjunct Professor, Department of Community Health Sciences,
Université de Sherbrooke, Longueuil, Québec, Canada. c Professor, Department of Psychoeducation, Université du Québec à, Trois-Rivières, Canada. d Scientific Professional, Department of Community Health
Sciences, Université de Sherbrooke, Longueuil, Québec, Canada.

e Statistician, Department of Psychoeducation, Université de
Sherbrooke, Longueuil, Québec, Canada. f Clinical Coordinator, Domrémy Mauricie/Centre du Québec,
Rehabilitation centre, Trois-Rivières, Québec, Canada.
Please address correspondence to Karine Bertrand, Ph.D., Université de Sherbrooke, Department of Community Health Sciences (Addiction programs) Longueuil Campus, 150 Place Charles-Le Moyne, room 200,
Longueuil, Québec, J4K 0A8, Canada; phone: 450-463−1835 ext. 61604; email: [e-mail]

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adolescents’ process of change, such as therapeutic success, are not very well known (Dennis et al. 2004). Positive family influence is an important dimension that should be better documented since it has been identified as a
“best practice” (Health Canada 2001) and a key element in adolescent rehabilitation (Dowel & Ogles 2010; Gauthier,
Bertrand & Nolin 2010; Carr 2009; Diamond & Josephson
2005; Kumpfer & Alvarado 2003; Frensch & Cameron
2002). The relationship between the role of family involvement on changes in adolescent rehabilitation trajectories is still poorly understood (Dowel & Ogles 2010; Diamond &
Josephson 2005). In a meta-analysis of this topic, Dowel and Ogles (2010) determined that duration of family therapy did not influence the rehabilitation processes of youths undergoing treatment. Empirical evidence shows that various family therapy treatment modalities as well as types of family involvement in the treatment of adolescents are both effective (Tremblay, Bertrand & Ménard 2005). Yet, substance abuse treatment centres often offer family services without necessarily having qualified personnel on staff or the resources to implement evidence-based family therapy models that are proven effective. A better understanding of the associations between family factors and changes in consumption among adolescents in substance abuse treatment would help define the various types of family interventions more clearly. The scientific literature suggests that parental practices and parents’ mental health are choice therapeutic targets to consider, regardless of treatment modalities used. activities, interests, and/or behaviors). Stattin and Kerr’s study (2000) supported the relevance of spontaneous adolescent self-disclosure to ensure adequate parental monitoring. Indeed, adolescent self-disclosure reveals adolescents’ deviant behaviors more than behavioral types of monitoring such as parental control or parental solicitation
(Kerr, Stattin & Burk 2010; Stattin & Kerr 2000). Parental practices, such as behavioral control and parents’ responsiveness, are related to adolescent self-disclosure and parental knowledge, which, in turn, predict adolescents’ substance use (Soenens et al. 2006) and antisocial behaviors (Keijsers et al. 2010; Vieno et al. 2009). Among all variables, adolescent self-disclosure was found to have the strongest relationship with parental knowledge (Keijsers et al. 2010; Kerr, Stattin & Burk 2010; Soenens et al.
2006).
A strong parent-child relationship is also an important protective factor when it comes preventing substance abuse problems during adolescence (Kumpfer & Alvarado
2003), and even in young adults (Davis & Spillman 2011).
A positive and protective relationship is characterized by a high degree of parental warmth, (e.g. show of interest in the child’s activities and friends), an expression of enthusiasm for and pride in the child’s accomplishments, and a demonstration of affection and love (Amato 1990).
A mutual attachment between mothers and their adolescent reduces the risk of drug use in adolescence (Brook et al.
2000). As well, young adults (Montgomery, Fisk & Craig
2008) and adolescents (Martins et al. 2008) with Ecstasy use problems do not assess their parents as being as warm as do other types of users.
To date, studies have mostly focused on documenting associations between parental practices and substance use among adolescents. However, parental practices tend to be examined cross-sectionally only. In any case, the longitudinal study by Luyckx and colleagues (2011) demonstrates that a marked decline in parental monitoring is associated with adolescents’ higher alcohol use. Conversely, few studies have looked into how improvement of parental practices, rather than their deterioration, could be associated with a decrease in substance use by adolescents who are already struggling with substance use problems. In light of these observations, it is of great interest to see if amelioration in parental practices can influence the process of change in adolescents undergoing treatment for substance abuse. ADOLESCENT DRUG USE AND PARENTING
PRACTICES
Several authors have showed an association between inadequate parenting practices and the risk of substance abuse at adolescence (Choquet et al. 2008; Broman,
Reckase & Freedman-Doan 2006; Petraitis, Flay & Miller
1995). Two categories of parenting practices have been associated with drug use during adolescence, namely, parental monitoring and parental warmth.
Parental monitoring refers to a parent’s knowledge of his or her child’s activities, associations, and whereabouts to ensure that the child’s behavior is not harmful to his or her development and safety. Inadequate and poor parental monitoring has been associated with both elevated levels of substance consumption (McVie & Holmes
2005) and poorer prognoses regarding treatment outcomes
(Clark, Thatcher & Maisto 2005). A marked decline in parental monitoring also has an influence on adolescents’ increased alcohol use (Luyckx et al. 2011). To be adequately informed of their child’s whereabouts, parents can rely on various sources of information, namely parental control or parental solicitation (e.g. asking their child for information) and child self-disclosure (e.g. the child confiding in the parent, revealing information about his or her
Journal of Psychoactive Drugs

ADOLESCENT DRUG USE AND PARENTAL
PSYCHOLOGICAL DISTRESS
Parents suffering from mental health problems generally have fewer good parenting practices than other parents
(Molen et al. 2011; Herman-Stahl et al. 2008; DelBello &
Geller 2001; Oyserman et al. 2000; Goodman & Gotlib
1999). These parental practices are, in turn, associated
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with greater drug and alcohol use (Luyckx et al. 2011;
Herman-Stahl et al. 2008; McVie & Holmes 2005) or with more frequent behavior problems (Molen et al. 2011) in adolescents. Researchers who have focused on determining the consequences that result from parents’ mental health problems have effectively demonstrated that adolescents of parents struggling with these types of problems, especially depression, have more behavioral problems, including substance abuse problems (Molen et al. 2011; Weissman et al.
2006; Dembo et al. 2000). As a result, adolescents are confronted with consequences that follow from their parents’ problems. Also, other studies have demonstrated an indirect relationship between parents’ psychological distress and development of substance use problems among adolescents, through lack of parental involvement (e.g. time spent on child schoolwork concerns and showing acceptance and warmth) (Molen et al. 2011; HermanStahl et al. 2008; Von Sydow et al. 2002; Petraitis, Flay
& Miller 1995). On the other hand, a study of mothers with serious mental illness who were responsible for at least one child of minor age showed that when symptoms of mental illness decline, the mothers’ parental practices improve (Kahng et al. 2008). One study also shows that improvements in maternal mental health have a positive influence on the recovery process of adolescents undergoing substance abuse treatment (Loon, Granic & Engels
2011).
Most of these studies were carried out with mothers of adolescents. In the United States, almost two-thirds of women with mental health problems are mothers (Becker et al. 2005). Therefore, it seems important to focus on the impact of these women’s problems on their children.
Furthermore, Herman-Stahl and colleagues (2008) compared the impact of psychological distress of each parent on adolescent substance use. Their results also indicate that maternal mental health problems are more strongly associated with adolescent psychoactive substance use than is paternal psychological distress.
Briefly, these results suggest that improvements in mothers’ mental health could thus enhance their ability to become more involved in their relationships with their adolescents, and show more affection, which, in turn, could help support adolescents’ efforts to overcome their substance abuse problems. Similarly, Nicholson (2010) suggests adopting a family-centred approach when functioning issues arise in adolescents’ families in which mothers are struggling with mental health problems. Nonetheless, interrelationships between changes in parents’ mental health problems and in their parenting practices are still poorly understood. Intervention programs designed for parents of adolescents with substance use problems tend to be aimed at improving parental practices, without necessarily taking into account parents’ mental health problems. Journal of Psychoactive Drugs

PARENTAL INVOLVEMENT AND THERAPEUTIC
SUCCESS AMONG YOUTHS IN TREATMENT FOR
SUBSTANCE ABUSE
Although parental influence upon adolescent treatment outcome is now recognized, only a few studies have examined the impact of parents’ contributions to adolescents’ efforts in treatment. In general, adolescents who enter treatment because of pressure from their parents initially lack motivation (Battjes et al. 2003). Based on a sample of adolescents admitted to 20 treatment programs in the United
States, one study identified family support as a predictor of adolescent treatment retention (Broome, Joe & Simpson
2001). Moreover, treatment outcome is more positive when parents are engaged in treatment of their children’s problems, regardless of the type of problem (Yatchmenoff
2005). However, other authors have found that the frequency of parent-child contacts during treatment increases the risk of short-term relapse (Crane 2009; Harrison &
Asche 2001). These findings demonstrate a certain ambiguity concerning the effects of parental involvement on their children’s recovery.
In fact, it is specifically the intensity of parental involvement in treatment, as measured by parental presence, that positively influences maintaining abstinence once treatment has ended (Carr 2009; Liddle 2004). Parentchild contact is not enough to have positive effects on adolescents’ substance use. Indeed, it seems that parents’ involvement in treatment improves their parental practices
(Liddle et al. 2004; Booth & Kwiatkowski 1999). As noted above, these practices are then associated with fewer substance use problems (Hogue & Liddle 2009; Liddle et al.
2001; Liddle & Dakof 1995). Active involvement of parents in treatment is thus considered one of the best practices in treating adolescents with substance use disorders (Plant
& Panzarella 2009). Nonetheless, we need to better document how the intensity of services received by parents is associated with changes in their parental practices and how their child’s substance use improves.

OBJECTIVES AND HYPOTHESES
Therefore, the influence of family involvement and various family-related variables on adolescent treatment outcome should be further explored with particular focus on parenting skills and parents’ mental health.
The study’s specific objectives are as follows:
1) To verify to what extent changes in parenting practices, as perceived by adolescents admitted into substance abuse rehabilitation centres, are associated with changes in the adolescents’ substance use, the hypothesis being that an improvement in parenting practices will be associated with a decrease in substance use.
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2) To verify to what extent changes in maternal psychological distress are associated with parenting practices and adolescent substance use, the hypothesis being that a reduction in maternal psychological distress will be associated with improved parenting practices and a decrease in adolescent substance use. 3) To verify to what extent parental use of services offered by treatment centres is associated with parenting practices and adolescent substance use, the hypothesis being that greater parental use will be associated with improved parenting practices and reduced adolescents’ substance use.

study results (Cahill, Barkham & Stiles 2010; Dinger et al.
2008; Wright et al. 2007).
In addition, the mothers of 96 adolescents (out of the
147) also took part in the study, and 69 did so at two assessment times. Their ages ranged from 29 to 54 years old
(M = 42.56 years; S.D. = 5.17 years). Nearly all mothers in the sample were of French-Canadian origin (91.8%).
Analyses were carried out on this subsample of 147 adolescents and 69 mothers. No significant differences were observed between this subsample and the 199 teenagers, with respect to sociodemographic variables or substance use at admission.
The two centres also offer family sessions at the beginning of the treatment process, as well as group sessions centred on parenting skills development. Individual and couple sessions are also available for parents, depending on their specific needs. All youths and one of their parents signed informed consent forms so that they could take part in the study. The study was approved by an ethics committee accredited by the division of the provincial health department (Québec, Canada) in charge of evaluating studies of minors. METHOD
Sample and Procedure
Clinicians responsible for admission of the youths performed the recruitment procedures. After consenting to share their name and phone number with the research team, participants were contacted by a trained research staff member who scheduled appointments to complete the questionnaires. The project complied with standard ethical rules concerning research on human subjects. The protocol was approved by the ethics and research committee “Comité d’éthique de la recherche en toxicomanie”
(CÉRT), accredited by Ministère de la santé et des services sociaux du Québec (Canada).
Study participants (n = 199; 13–18 years old; mean
(M) = 15.5 years; standard deviation (SD) = 1.13 years) were recruited between November 2005 and November
2006 from two substance abuse treatment programs providing services in French, in Quebec, Canada: an outpatient program (n = 97) and a residential one (n =
102). The proportions of boys (60%) and girls (40%) as well as the adolescents’ family structures were similar for both programs. Family structure was divided into three categories: (1) nuclear family (outpatient centre: 26.8%; residential centre: 36.3%); (2) blended family (outpatient centre: 45.4%; residential centre: 44.1%); and (3) singleparent family (outpatient centre: 26.8%; residential centre:
18.6%). For both centres, 1% of the data was missing.
The vast majority of youth in the sample were of FrenchCanadian origin (87.4%). The rest were mostly of French origin (6%). Most participants lived outside large urban centres, and our sample is representative of this population
(Statistics Canada 2007a,b).
Of the 199 adolescents who took part in this longitudinal study conducted in natural settings, 147 completed the questionnaires at least two different times: at admission into treatment (T0), and at the three-month (T1) or six-month (T2) follow-up. The natural settings made it possible to examine the contribution of several variables to the recovery process during substance abuse treatment. This type of design can help increase the external validity of
Journal of Psychoactive Drugs

Instruments and Variables
Psychoactive substance use was measured three times: at treatment admission (T0), at three-month follow-up (T1), and at six-month follow-up (T2). Information on maternal psychological distress and parenting practices, as reported by the adolescents and their mothers, was gathered at treatment admission (T0) and at six-month follow-up (T2).
Substance use was measured using total number of days of use of illicit drugs and alcohol in the 30 days prior to evaluation. This indicator is recommended to document changes in the consumption of adolescents undergoing substance abuse treatment (Tomlinson, Brown & Abrantes
2004). The measure was taken from the Indice de gravité d’une toxicomanie pour les adolescents (IGT-ADO; a substance abuse severity index for adolescents), an instrument adapted from the Addiction Severity Index (ASI; McLellan et al. 1980) and validated in its French version (Landry et al. 2002). Parental use of services offered by the rehabilitation centres was measured using the number of sessions parents attended. The mean number of sessions attended was 3.15 (SD = 5.69; range: 0–28) and more than 80% of the mothers went to at least at one session.
Changes in substance use were determined using the differences in the total number of days of illicit drug and alcohol use at T0 and T2. For 18 participants, T2 data was not available. The differences between the scores obtained at admission and those obtained at the three-month followup were therefore used; this procedure was justified since the decrease in drug use was greater between treatment entry and three-month follow-up, and the progress made could still be seen at six-month follow-up (Table 1).
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TABLE 1
Mean and Standard Deviation of the Number of Days of Use
Variables
Number of Days of Use
Alcohol
Cannabis
Hallucinogen
Methamphetamine or Speed
Cocaine
Inhalant/Solvent/Volatile substance
Heroin/Opiate/Analgesic/Narcotic
Benzodiazepine
Barbiturate
Substance Use (Total Number of Days of Substance Use)

Mothers’ mental health was measured using a validated French version of the Psychiatric Symptom Index
(IDPESQ; Préville et al. 1987). Results on each construct
(anxiety, depression, irritability, cognitive problems) were added to compute a global score which showed excellent internal consistency (α = 0.92 and 0.93). Changes in maternal mental health were measured using the differences between scores obtained at treatment entry (T0) and those obtained at six-month follow-up (T2).
Parenting practices were assessed using the adolescent and parent versions of Stattin and Kerr’s questionnaire
(2000). For the purposes of this study, the adolescent selfdisclosure and adolescent’s perception of parental warmth constructs were used. Both scores showed good internal consistency (parental warmth: α = 0.86 and 0.83; child self-disclosure: α = 0.72 and 0.75). The decision to use the adolescents’ perceptions was based on several arguments:
(1) adolescents are in the best position to assess exactly what information they choose to disclose to their parents;
(2) what matters the most is not what parents objectively offer but, rather, what the adolescent perceives to be offered
(Soenens et al. 2006); and (3) the adolescent- and motherreported parenting practices scores are correlated. Bilateral correlations showed a significant link between adolescents’ perceptions of parental practices and mothers’ self-reports, and the same can be said of adolescent disclosure (r =
0.55, p < 0.001) and perception of parental warmth (r =
0.32, p < 0.05). Changes in parenting practices were measured using the differences between the scores obtained at treatment entry (T0) and those obtained at the six-month follow-up (T2).

T1 (n = 136)
M (SD)
1.94 (3.82)
5.15 (8.91)
0.29 (1.51)
0.74 (2.57)
0.07 (0.38)
0.00 (0.00)
0.11 (0.85)
0.40 (3.10)
0.07 (0.77)
8.78 (13.82)

T2 (n = 117)
M (SD)
2.87 (4.83)
5.80 (9.10)
0.74 (3.23)
1.41 (4.42)
0.21 (0.95)
0.15 (1.41)
0.09 (0.93)
0.21 (1.47)
0.02 (0.19)
11.51 (15.90)

services, a variable path diagram was tested via structural equation modelling (SEM) (Kline 2005), using MPlus software (Muthén & Muthén 1998). To provide sufficient statistical power, appropriate sample size should be ten times the number of free model parameters (Kline
2005). Since the sample size is 147, the model tested should include no more than 14 parameters. To confirm the model’s good fit, several statistical indices were verified, namely, the Root Mean Square Error of Approximation
(RMSEA; Brown & Cudeck 1993), the Comparative Fit
Index (CFI; Bentler 1990), and χ2 . Hu and Bentler (1999) recommend a RMSEA < 0.06, although they consider a criterion of 0.08 to be entirely acceptable in the case of relatively small samples (n < 500), as is the case for our study.
For a good model, Hu and Bentler (1999) suggest an ideal
CFI of > 0.96 and, at the very least, 0.90. As for the χ2 value, although it is affected considerably by sample size, it should, ideally, be small enough so as not to reach the p < 0.05 significance threshold (Bollen 1989).
RESULTS
Changes in Teenagers’ Substance Use, Mother’s
Mental Health and Parenting Practices
Paired t-tests were performed to assess whether adolescents had reduced their consumption and if their mothers’ health and parental practices had improved between time of youths’ admission to treatment and the six-month follow-up. Paired t-tests show that adolescents’ substance use diminished significantly (t(136) = − 7.63, p <
0.001) between admission (M = 23.25; S.D. = 19.68) and the three-month follow-up evaluation (M = 8.78; S.D. =
13.82). Substance use also decreased significantly (t(117)
= − 5.55, p < 0.001) between admission (M = 24.58; S.D.
= 20.2) and the six-month follow-up (M = 11.51; S.D. =
15.90). A slight increase in substance use (t(106) = 1.72,

Data Analysis Strategy
To develop a model incorporating the relationships among changes in maternal mental health, parenting practices, substance use and the degree of parental use of
Journal of Psychoactive Drugs

T0 (n = 147)
M (SD)
2.72 (4.09)
13.92 (11.74)
1.49 (3.75)
3.54 (6.23)
0.62 (2.19)
0.14 (1.27)
0.14 (1.65)
0.65 (3.72)
0.04 (0.42)
23.25 (19.68)

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TABLE 2
Evolution of Parental Practices and Mothers’ Psychological Distress Between Admission and Six-Month
Follow-Up
Variables
Self-Disclosure (n = 96)
Parental Warmth (n = 104)
Mothers’ Psychological Distress (n = 69)

T0 M(SD)
1.88 (0.93)
2.69 (0.86)
0.86 (0.56)

α
0.72
0.86
0.93

p = 0.089) was observed between the three-month followup (M = 9.43; S.D. = 14.1) and the six-month follow-up
(M = 12.00; S.D. = 16.4). The mean and standard deviation for each substance measured at each time wave are presented in Table 1. Cannabis was the most frequently used substance, followed by methamphetamines, alcohol, and hallucinogens.
The mean decrease in substance use (in terms of the number of days of drug and alcohol use) between initial assessment time and three-month follow-up (n = 117) is
−11.60 (SD = 19.15); between initial assessment time and six-month follow-up (n = 30), the mean decrease is −13.07
(SD = 25.46). The variable created to conduct the analyses incorporates these two means: −12.77 (SD = 24.25).
Mothers’ psychological distress diminished significantly between admission (M = 0.86; SD = 0.56) and the six-month follow-up (M = 0.71; SD = 0.50).
Furthermore, paired t-tests show that adolescents’ perceptions of self-disclosure increased significantly between admission (M = 1.88; SD = 0.93) and six-month followup (M = 2.40; SD 0.97). However, perceptions of parental warmth did not change between admission and the sixmonth follow-up (Table 2).

α
0.75
0.83
0.92

Difference
0.52 (1.25)
0.01 (1.06)
−0.15 (0.57)

P Value
0.00
0.95
0.03

distress and changes in parental warmth between treatment admission and six-month follow-up (β = −0.273, p <
0.05). This finding suggests that improvement in maternal mental health (e.g. decrease in anxiety, depression, irritability symptoms, and cognitive problems) is associated with improvement in parental warmth, as perceived by the adolescents. A statistically significant inverse relationship was also observed between changes in parental warmth and adolescent drug use (β = −0.201, p < 0.05), with these findings highlighting the association between improvement in mothers’ ability to relate and lower incidences of adolescent substance use. No direct relationship was observed between evolution of maternal mental health and adolescent substance use.
In addition, the results bring to light a direct link between greater parental use of services provided by the centres and a decrease in adolescent substance use (β =
−0.177, p < 0.05) (see Figure 1). This relationship is also observed indirectly, via an improvement in adolescent self-disclosure. Parents who attended more sessions also reported greater improvements in their ability to communicate with their adolescents in ways that encourage him/her to confide in them. In return, a marked improvement in adolescent self-disclosure was significantly and negatively associated with substance use (β = −0.255, p <
0.01). Finally, a reciprocal relationship between changes in parental warmth and adolescent self-disclosure suggests that improvements observed in these two parenting practices are interrelated (β = −0.484, p < 0.001).

Explanatory Model of Adolescents’ Substance Use,
Incorporating Parental Practices, Mothers’ Mental
Health, and Parents’ Use of Treatment Services
All variables studied were incorporated into an explanatory model of the decrease in adolescent substance use. The retained model examined the relationships between changes in adolescent substance use and changes in the following variables: maternal mental health, adolescent self-disclosure, parental warmth and degree of parental use of services, measured by the number of sessions attended. Parenting practices served as proximal variables with respect to substance use, and maternal mental health and parental use of services served as distal variables. The statistical indices demonstrated the model’s good fit with the data (χ2 = 4.35, df = 3, p = 0.23; CFI = 0.98; RMSEA
= 0.05). The overall model accounted for 21.2% of the variance in the decrease in adolescent substance use.
The results showed a statistically significant inverse relationship between reduction of maternal psychological
Journal of Psychoactive Drugs

T2 M(SD)
2.40 (0.97)
2.69 (0.90)
0.71 (0.50)

DISCUSSION
The main objectives of this innovative study were to understand how changes in parenting practices and maternal mental health, as well as parental use of services provided by rehabilitation centres were associated with changes in the drug use of adolescents in treatment. To our knowledge, no study has yet examined the relationships between evolving processes of parenting practices, mothers’ mental health and substance use among adolescents in treatment. 33

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FIGURE 1
Path Diagram (N = 147)

R2 = 7.4 %
Change in mothers’ psychological distress

β = –0.273*

β = –0.201*

Change in parental warmth Change in adolescents’ substance use

β = 0.484***

Number of sessions attended by parents

β = –0.255**

β = 0.276***

R2 = 21.2%

Change in adolescent selfdisclosure
R2 = 7.6% β = –0.177*

∗p

< 0.05;

∗∗ p

< 0.01;

∗∗∗ p

< 0.001

Links Among Improvements in Mothers’ Mental
Health, Better Parental Practices, Greater Parental
Use of Treatment Services, and a Decrease in
Adolescents’ Substance Use
Mothers’ mental health improvement following their adolescents’ treatment was positively associated with parental warmth, as reported by their adolescents (selfdisclosure), which, in turn, was associated with greater reduction in adolescent drug use. These findings confirm the working hypothesis, and corroborate results highlighted by some authors (Molen et al. 2011; Herman-Stahl et al.
2008; Von Sydow et al. 2002; Petraitis, Flay & Miller
1995), that the relationship between maternal mental health and adolescent substance use is indirect since it depends, first and foremost, on parental warmth. These results evoke the importance of identifying mental health problems of parents of adolescents in substance use treatment and taking these problems into account during interventions.
Targeting parental practices without evaluating and dealing with psychological distress could result in parents having to contend with failure. Indeed, serious psychological distress could obstruct acquisition of new parenting skills.
The results also bring to light a unidirectional relationship between improved adolescent self-disclosure and decreased adolescent substance use. This finding corroborates the working hypothesis and supports the direct link observed in other studies between incidence of adolescents’ deviant behaviors and parents’ inability to facilitate adolescent self-disclosure (Kerr, Stattin & Burk 2010; Soenens

Journal of Psychoactive Drugs

et al. 2006; Stattin & Kerr 2000). It may be that the different treatment modalities available, such as individual or couple counselling and skills enhancement group therapy, enable parents to develop communication skills that result in their adolescents’ confiding in them and, therefore, in effective parental monitoring. It may also be that improvements in adolescents’ skills during treatment also influence mothers’ parenting practices, although our findings do not allow us to test this hypothesis. Indeed, the skills developed by the adolescents during therapy (i.e. communication, introspection, emotional control) may help foster parental warmth and self-disclosure (Soenens et al. 2006). It would therefore be interesting to document how adolescents and their mothers relate to one another by examining the reciprocal relationship between changes in parenting practices and changes in adolescent substance use (Luyckx et al. 2011;
Stattin & Kerr 2000).
Parental use of services is also associated with a decrease in adolescent drug use and an improvement in adolescent self-disclosure, suggesting that services available to parents are an important ingredient in the rehabilitation process of adolescents. These services appear to help parents adopt parenting practices that improve parent-child communication and encourage adolescents to confide in their parents (Plant & Panzarella 2009; Booth &
Kwiatkowski 1999). It may be that, through the changes shown by both parent and adolescent, the bond of trust is being rebuilt. Parents’ involvement in formal treatment seems to bring about a mutual recognition of their

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willingness to change. Family sessions may encourage the family unit to start moving towards a common goal, namely, the improved well-being of every family member.
Thus, in line with the systemic theories of substance abuse, the adolescent stops being identified as “the patient,” and no longer feels that he or she is the only one bearing the burden of the problem.
Information regarding the importance of parental presence related to adolescents’ substance abuse treatment outcome implies some involvement of parents. Around 80% of mothers who took part in our study had participated in at least one therapy session. However, fewer than 60% of the mothers of the 199 adolescents seen during the project were involved at least once in treatment. Therefore, it is important to develop knowledge about the barriers parents face when accessing services (Booth & Kwiatkowski 1999; Carr
2009; Plant & Panzarella 2009). Churchill (2011) notes that barriers which limit access to services the most are related to isolation, finances, mobility, work hours and parenting demands. A few studies also show that people of ethnic origins that differ from that of the majority are stigmatized and treated differently (Buser 2009), which causes these individuals problems when they attempt to access and use these services (Anglin et al. 2008; McGuire & Miranda
2008). In a society dominated by Caucasians, it could be especially stigmatizing for people from other nationalities to consult these services (Buser 2009; McGuire & Miranda
2008). Other authors suggests that offering special cultureand language-based services would be effective, in terms of both accessibility for minorities and their retention in treatment (Burlew et al. 2011; Fortuna, Alegria & Gao 2010;
Plant & Panzarella 2009).

of improvements in parenting practices may also lead to enhanced treatment efficacy.
This study nonetheless has some limits that must be kept in mind when interpreting the results. First, because of the study design, no causal links among the variables can be established. Furthermore, only mothers’ mental health and parenting practices were studied, leaving out information pertaining to fathers. Thirdly, no control group was used, so it cannot be excluded that adolescent drug use may have improved even if drug treatment was not attended. Moreover, although our study sample is representative of Québec’s overall population, it is not representative of the English-speaking or multi-ethnic population. This finding limits generalization of our findings. In the light of this information, it is particularly important to replicate this study in more heterogeneous populations.
Applications of Findings
It is important to underscore the significance and the impact of parental involvement on the outcome of adolescents’ substance abuse treatment and to provide parents’ with services aimed at lowering their psychological distress and improving their parenting practices. Parents suffering from significant psychological distress must therefore be identified and referred to appropriate health services.
As well, parents must be able to foster a family atmosphere that encourages the adolescent to engage in self-disclosure.
Studies on the subject indicate that parents must be warm, accepting, and empathic vis-à-vis the needs of the child in order to favor self-disclosure (Soenens et al. 2006).
Moreover, the adolescent’s trust in his or her parents is an important component in the initiation of self-disclosure
(Soenens et al. 2006; Kerr, Stattin & Trost 1999). Finally, this study tends to show that the parental skills parents learn are important to support adolescents’ rehabilitation.
To succeed, the greater the parents’ involvement, in terms of number of sessions, the more significant are the benefits. The study design does not allow us to identify a predetermined amount of exposure to treatment that would be required to realize therapeutic gains. Perhaps attaining the therapeutic goals linked to improving parents’ mental health and skills should guide the intensity of the services offered. Moreover, all therapeutic strategies that actively foster parents’ involvement should be used since treatment drop out is a major clinical challenge associated with families affected by substance abuse (Plant & Panzarella
2009).

Strengths and Limitations
A literature review of parenting practices reveals the importance of gaining a better understanding of the factors that influence adolescent self-disclosure and improvement of the parent-child relationship through greater parental warmth (Dennis et al. 2004). There is some indication that a decrease in parents’ psychological distress may allow greater parental cognitive and emotional investment in the parent-child relationship (Kahng et al. 2008). Furthermore, educating parents about the best approaches to adopt with their adolescent may help them establish a climate that is more amenable to self-disclosure. These questions are all the more relevant with respect to adolescents in treatment because identification of the underlying determinants

REFERENCES
Amato, P. 1990. Dimensions of the family environment as perceived by children: A multidimensional scaling study. Journal of Marriage and the Family 52 (3): 613–20.

Journal of Psychoactive Drugs

Anglin, D.M.; Alberti, P.M.; Link, B.G. & Phelan, J.C. 2008. Racial differences in beliefs about the effectiveness and necessity of mental health treatment. American Journal of Community Psychology 42
(1–2): 17–24.

35

Volume 45 (1), January – March 2013

Bertrand et al.

Substance Abuse Treatment for Adolescents

on high-risk youth’s troubled behavior: A three-wave longitudinal study. Journal of Psychoactive Drugs 32 (1): 55–65.
Dennis, M.; Godley, S. H.; Diamond, G.; Tims, F.M.; Babor,T.;
Donaldson,J.; Liddle, H.; Titus, J. C.; Kaminer, Y.; Webb, C.;
Hamilton, N. & Funk, R. 2004. The Cannabis Youth Treatment
(CYT) Study: Main findings from two randomized trials. Journal of Substance Abuse Treatment 27 (3): 197–213.
Diamond, G. & Josephson, A. 2005. Family-based treatment research:
A 10–year update. Journal of the American Academy of Child and
Adolescent Psychiatry 44 (9): 872–87.
Dinger, U.; Strack, M.; Leichsenring, F.; Wilmers, F. & Schauenburg,
H. 2008. Therapist effects on outcome and alliance in inpatient psychotherapy. Journal of Clinical Psychology 64 (3): 344–54.
Dowell, K.A. & Ogles, B.M. 2010. The effects of parent participation on child psychotherapy outcome: A meta-analytic review. Journal of
Child & Adolescent Psychology 39 (2): 151–62.
Flanzer, J. 2005. The status of health services research on adjudicated drug-abusing juveniles: Selected findings and remaining questions.
Substance use & Misuse 40 (7): 887–911.
Fortuna, L.R.; Alegria, M. & Gao, S. 2010. Retention in depression treatment among ethnic and racial minority groups in the United States.
Depression and Anxiety 27 (5): 485–94.
Frensch, K.M. & Cameron, G. 2002. Treatment of choice or a last resort?
A review of residential health placements for children and youth.
Child and Youth Forum 31 (5): 307–39.
Gauthier, B.; Bertrand, K. & Nolin, P. 2010. Famille et traitement de la toxicomanie chez les adolescents: étude de cas. Enfances, Familles,
Générations 13: 129–50.
Goodman, S.H. & Gotlib, I.H. 1999. Risk for psychopathology in the children of depressed mothers: A developmental model for understanding mechanisms of transmission. Psychological Review 106
(3): 458–90.
Guyon, L. & Desjardins, L. 2003. L’alcool, les drogues et les jeux de hasard chez les élèves du secondaire. In: B. Perron & J. Loiselle
(Eds.) Enquête Québécoise sur le Tabagisme chez les Élèves du
Secondaire. Québec: Gouvernement du Québec.
Harrison, P.A. & Asche, S.E. 2001. Outcomes monitoring in Minnesota:
Treatment implications, practical limitations. Journal of Substance
Abuse Treatment 21 (4): 173–83.
Health Canada. 2001. Best Practices: Treatment and Rehabilitation for
Youth with Substance Use Problems. Minister of Public Works and
Government Services Canada. Ottawa: Publications Health Canada.
Herman-Stahl, M.A.; Ashley, O.S.; Penne, M.A.; Bauman, K.E.;
Williams, J.; Sanchez, R.P.; Loomis K.M.; Williams, M.S. &
Cfroerer, J.C. 2008. Moderation and mediation in the relationship between mothers’ or fathers’ serious psychological distress and adolescent substance use: Findings from a national sample. Journal of
Adolescent Health 43 (2): 141–50.
Hogue, A. & Liddle, H.A. 2009. Family-based treatment for adolescent substance abuse: Controlled trials and new horizons in services research. Journal of Family Therapy 31 (2): 126–54.
Hu, L. & Bentler, P.M. 1999. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.
Structural Equation Modeling: A Multidisciplinary Journal 6 (1):
1–55.
Johnstone, L.D.; O’Malley, R.M. & Bachman, J.G. 2003. Monitoring the Future. National Results on Adolescent Drug Use. Overview of Key Findings 2002. Rockville, MD: National Institute on Drug
Abuse.
Kahng, S.K.; Oyserman, D., Bybee, D. & Mowbray, C. 2008. Mothers with serious mental illness: When symptoms decline does parenting improve? Journal of Family Psychology 22 (1): 162–66.
Keijsers, L.; Brange, S.J.T.; VanderValk, I.E. & Meeus, W. 2010.
Reciprocal effects between parental solicitation, parental control, adolescent disclosure, and adolescent delinquency. Journal of
Research on Adolescence 20 (1): 88–113.

Battjes, R.J.; Gordon, M.S.; O’Grady, K.E.; Kinlock, T.W. & Carswell, M.A.
2003. Factors that predict adolescent motivation for substance abuse treatment. Journal of Substance Abuse Treatment 24 (3): 221–32.
Becker, M.A.; Noether, C.D.; Larson, M.J.; Gatz, M.; Brown, V.;
Heckman, J. & Giard, J. 2005. Characteristics of women engaged in treatment for trauma and co-occuring disorders: Findings from a national multi-site study. Journal of Community Psychology 33 (4):
429–43.
Bentler, P.M. 1990. Comparative fit indices in structural models.
Psychological Bulletin 107 (2): 238–46.
Bollen, K.A. 1989. Structural Equations with Latent Variables. New York:
Wiley.
Booth, R.E. & Kwiatkowski, C.F. 1999. Substance abuse treatment for high-risk adolescents. Current Psychiatry Reports 1 (2): 185–90.
Broman, C.L.; Reckase, M.D. & Freeman-Doan, C.R. 2006. The role of parenting in drugs use among black, latino, and white adolescents.
Journal of Ethnicity in Substance Abuse 5 (1): 39–50.
Brook, J. S.; Whiteman, M.; Finch, S. & Cohen, P. 2000. Longitudinally foretelling drug use in the late twenties: Adolescent personality and social-environmental antecedents. Journal of Genetic Psychology
161 (1): 37–51.
Broome, K.M.; Joe, G.W. & Simpson, D.D. 2001. Engagement models for adolescents in DATOS-A. Journal of Adolescent Research 16
(6): 608–23.
Brown, M. & Cudeck, R. 1993. EQS Structural Equations Program
Manual. Los Angeles: Multivariate Software Inc.
Burlew, K.; Larios, S.; Suares-Morales, L.; Holmes, B.; Venner, K. &
Chavez, R. 2011. Increasing ethnic minority participation in substance abuse clinical trials: Lessons learned in the National Institute on Drug Abuse’s Clinical Trials Network. Cultural Diversity and
Ethnic Minority Psychology 17 (4): 345–56.
Buser, J.K. 2009. Treatment-seeking disparity between African
Americans and Whites: Attitudes toward treatment, coping resources, and racism. Journal of Multicultural Counseling and
Development 37 (2): 94–104.
Cahill, J.; Barkham, M. & Stiles, W.B. 2010. Systematic review of practice-based research on psychological therapies in routine clinic settings. British Journal of Clinical Psychology 49 (4): 421–53.
Carr, A. 2009. The effectiveness of family therapy and systemic interventions for child-focused problems. Journal of Family Therapy 31 (1):
3–45.
Cazale, L.; Fournier, C. & Dubé, G. 2009. Consommation d’alcool et de drogues. In: G. Dubé (Ed.) Enquête Québécoise sur le Tabac, l’Alcool, la Drogue et le Jeu chez les Élèves du Secondaire, 2006.
Québec: Institut de la Statistique du Québec.
Choquet, M.; Hassler, C.; Morin, D.; Falissard, B. & Chau, N. 2008.
Perceived parenting styles and tobacco, alcohol and cannabis use among French adolescents: Gender and family structure differentials. Alcohol & Alcoholism 43 (1): 73–80.
Churchill, H. 2011. Parental Rights and Responsibilities: Analysing
Social Policy and Lived Experiences. Bristol: Policy Press.
Clark, D. B.; Thatcher, D. L. & Maisto, S. A. 2005. Supervisory neglect and adolescent alcohol use disorders: Effects on AUD onset and treatment outcome. Addictive Behaviors 30 (9): 1737–50.
Crane, A.N. 2009. Residential treatment for adolescents with substance use disorders: An investigation of treatment outcomes and family variables. Dissertation, Ohio University.
Davis, S.J. & Spillman, S. 2011. Reasons for drug abstention: A study of drug use and resilience. Journal of Psychoactive Drugs 43 (1):
14–19.
Delbello, M.P. & Geller, B. 2001. Review of studies of child and adolescent offspring of bipolar parents. Bipolar Disorders – An International Journal of Psychiatry and Neurosciences 3 (6): 325–34.
Dembo, R.; Wothke, W.; Seeberger, W; Shemwell, M.; Pacheco, K.;
Rollie, M.; Schmeidler, J.; Klein, L.; Hartsfield, A. & Livingston,
S. 2000. Testing a model of the influence of family problem factors

Journal of Psychoactive Drugs

36

Volume 45 (1), January – March 2013

Bertrand et al.

Substance Abuse Treatment for Adolescents

Montgomery, C.; Fisk, J.E. & Craig, L. 2008. The effects of perceived parenting style on the propensity for illicit drug use: the importance of parental warmth and control. Drug and Alcohol Review 27 (6):
640–49.
Muthén, L. K. & Muthén, B.O. 1998. MPlus User’s Missing Data
175 Guide – Computer Software Manual. Los Angeles: Muthén &
Muthén.
Nicholson, J. 2010. Parenting and recovery for mothers with mental disorders. In: B.L. Levin & M.A. Becker (Eds.) A Public Health
Perspective of Women’s Mental Health. New York: Springer.
Oyserman, D.; Mowbray, C.T.; Meares, P.A. & Firminger, K.B. 2000.
Parenting among mothers with a serious mental illness. American
Journal of Orthopsychiatry 70 (3): 296–315.
Petraitis, J.; Flay, B.R. & Miller, T.Q. 1995. Reviewing theories of adolescent substance use: Organizing pieces of the puzzle. Psychological
Bulletin 117 (1): 67–86.
Plant, R.W. & Panzarella, P. 2009. Residential treatment of adolescents with substance use disorders: Evidence-based approaches and best practice recommendations. In: C.G. Leukefeld; T.P. Gullotta &
M. Staton-Tindall (Eds.) Adolescent Substance Abuse: EvidenceBased Approaches to Prevention and Treatment. New York:
Springer.
Préville, M.; Boyer, R.; Potvin, L.; Perrault, C. & Légaré, G. 1987.
La détresse psychologique: détermination de la fiabilité et de la validité de la mesure utilisée dans l’enquête Santé Québec. In:
Gouvernement du Québec. Les Cahiers de Recherche de l’Enquête de Santé Québec. Québec: Gouvernement du Québec, Ministère de la Santé et des Services Sociaux.
Soenens, B.; Vansteenkiste, M.; Luyckx, K. & Goossens, L. 2006.
Parenting and adolescent problem behavior: An integrated model with adolescent self-disclosure and perceived parental knowledge as intervening variable. Developmental Psychology 42 (2): 305–18.
Statistique Canada. 2007a. Région de la Capitale-Nationale, Québec
(Code2403) (tableau). Profils des Communautés de 2006.
Recensement de 2006. Produit n◦ 92–591-XWF au Catalogue de Statistique Canada. Ottawa. Diffusé le 13 mars 2007. Available at http://www12.statcan.ca/census-recensement/2006/dp-pd/prof/
92–591/index.cfm?Lang=F.
Statistique Canada. 2007b. Région de la Mauricie et du Centre-duQuébec, Québec (Code2404) (tableau). Profils des communautés de 2006, Recensement de 2006, produit n◦ 92–591-XWF au catalogue de Statistique Canada. Ottawa. Diffusé le 13 mars 2007.
Available at http://www12.statcan.ca/census-recensement/2006/dppd/prof/92-591/index.cfm?Lang=F.
Stattin, H. & Kerr, M. 2000. Parental monitoring: A reinterpretation. Child
Development 71 (4): 1072–85.
Sussman, S.; Skara, S. & Ames, S.L. 2008. Substance abuse among adolescents. Substance Use and Misuse 43 (12–13): 1802–28.
Tremblay, J.; Bertrand, K. & Ménard, J-M. 2005. Implication des
Membres de l’entourage dans le Processus de Réadaptation des
Personnes Alcooliques et Toxicomanes. Montréal: Comité permanent de Lutte à la Toxicomanie.
Tomlinson, K.L.; Brown, S.A. & Abrantes, A. 2004. Psychiatric comorbidity and substance use treatment outcomes of adolescents.
Psychology of Addictive Behaviors 18 (2): 160–69.
Vieno, A.; Nation, M.; Pastore, M. & Santinello, M. 2009. Parenting and antisocial behavior: A model of the relationship between adolescent self-disclosure, parental closeness, parental control, and adolescent antisocial behavior. Developmental Psychology 45 (6):
1509–19.
Von Sydow, K.; Lieb, R.; Pfister, H.; Hofler, M. & Wittchen, H.U. 2002.
What predicts incident use of cannabis and progression to abuse and dependence. A 4-year prospective examination of risk factors in a community sample of adolescents and young adults. Drug and
Alcohol Dependence 68 (1): 147–59.

Kerr, M.; Stattin, H. & Burk, W.J. 2010. A reinterpretation of parental monitoring in longitudinal perspective. Journal of Research on
Adolescence 20 (1): 39–64.
Kerr, M.; Stattin, H. & Trost K. 1999. To know you is to trust you:
Parent’s trust is rooted in child disclosure of information. Journal of Adolescence 22 (6): 737–52.
Kessler, R.C.; Chiu, W.T.; Demler, O. & Walters, E.E. 2005. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archive of
General Psychiatry 62 (6): 617–27.
Kline, R.B. 2005. Principles and Practices of Structural Equation
Modeling. Second Edition. New York: Guilford Press.
Kumpfer, K. L. & Alvarado, R. 2003. Family-strengthening approaches for the prevention of youth problem behaviors. American
Psychologist 58 (6–7): 457–65.
Landry, M.; Guyon, L.; Bergeron, J. & Provost, G. 2002. Développement et validation d’un instrument d’évaluation de la toxicomanie chez les adolescents. Alcoologie et Addictologie 24 (1): 7–13.
Liddle, H.A. 2004. Family-based therapies for adolescent alcohol and drug use: Research contributions and future research needs.
Addiction 99 (S2): 76–92.
Liddle, H.A. & Dakof, G.A. 1995. Efficacy of family therapy for drug abuse: Promising but not definitive. Journal of Marital Family
Therapy 21 (4): 511–43.
Liddle, H.A.; Rowe, C.L.; Dakof, G.A.; Ungaro, R.A. & Henderson,
C. 2004. Early intervention for adolescent substance abuse:
Pretreatment to posttreatment outcomes of a randomized controlled trial comparing multidimensional family therapy and peer group treatment. Journal of Psychoactive Drugs 36 (1): 49–63.
Liddle, H.A.; Dakof, G.A.; Parker, K.; Diamond, G.S.; Barrett, K. &
Tejeda, M. 2001. Multidimensional family therapy for adolescent drug abuse: Results of a randomized clinical trial. American Journal of Drug and Alcohol Abuse 27 (4): 651–88.
Loon, L.M.A.; Granic, I. & Engels, R.C.M. 2011. The role of maternal depression on treatment outcome for children with externalizing behavior problems. Journal of Psychopathology and Behavioral
Assessment 33 (2): 178–86.
Luyckx, K.; Tildesley, E.A.; Soenens, B.; Andrews, J.A.; Hampson, S.E.;
Peterson, M. & Duriez, B. 2011. Parenting and trajectories of children’s maladaptive behaviors: A 12-year prospective community study. Journal of Clinical Child & Adolescents Psychology 40 (3):
468–78.
Martins, S.S.; Storr, C.L.; Alexandre, P.K. & Chilcoat, H.D. 2008.
Adolescent ecstasy and other drug use in the national survey of parents and youth: The role of sensation-seeking, parental monitoring and peer’s drug use. Addictive Behaviors 33 (7): 919–33.
McLellan, A.T.; Luborsky, L.; O’Brien, C.P. & Woody, G.E. 1980. An improved diagnostic instrument for substance abuse patients: The
Addiction Severity Index. Journal of Nervous & Mental Diseases
168 (1): 26–33.
McGuire, T.G. & Miranda, J. 2008. New evidence regarding racial and ethnic disparities in mental health: Policy implications. Health
Affairs 27 (2): 393–403.
McVie, S. & Holmes, L. 2005. Family functioning and substance use at ages 12 to 17. The Edinburgh Study of Youth Transition and Crime
(No. 9). Edinburgh: The University of Edinburgh.
Merikangas, K.R.; He, J.-P.; Burstein, M.; Swanson, S.A.; Avenevoli,
S.; Cui, L.; Benjet, C.; Georgiades, K. & Swendsen, J. 2010.
Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescent
Supplement. Journal of the American Academy of Child and
Adolescent Psychiatry 49 (10): 980–89.
Molen, E.; Hipwell, A.E.; Vermeiren, R. & Loeber, R. 2011. Maternal characteristics predicting young girls’ disruptive behavior. Journal of Clinical Child and Adolescent Psychology 40 (2): 179–90.

Journal of Psychoactive Drugs

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Volume 45 (1), January – March 2013

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Substance Abuse Treatment for Adolescents

Weissman, M.M.; Pilowsky, D.J.; Wickramaratne, P.J.; Talati, A.;
Wisniewski, S.R.; Fava, M.; Hugues, C.W.; Garber, J.; Malloy, E.;
King. C. A.; Cerda, G.; Sood, B.A.; Alpert, J.E.; Trivedi, M.H.
& Rush, A.J. 2006. Remissions in maternal depression and child psychopathology. Journal of the American Medical Association 295
(12): 1389–98.

Journal of Psychoactive Drugs

Wright, J.; Sabourin, S.; Mondor, J.; Mcduff, P. & Mamodhousen, S. 2007.
The clinical representativeness of couple therapy outcome research.
Family Process 46 (3): 301–16.
Yatchmenoff, D.K. 2005. Measuring client engagement from the client’s perspective in nonvoluntary child protection services. Research on
Social Work Practice 15 (2): 84–96.

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References: Amato, P. 1990. Dimensions of the family environment as perceived by children: A multidimensional scaling study Hamilton, N. & Funk, R. 2004. The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized trials Diamond, G. & Josephson, A. 2005. Family-based treatment research: A 10–year update Dowell, K.A. & Ogles, B.M. 2010. The effects of parent participation on child psychotherapy outcome: A meta-analytic review Flanzer, J. 2005. The status of health services research on adjudicated drug-abusing juveniles: Selected findings and remaining questions. Fortuna, L.R.; Alegria, M. & Gao, S. 2010. Retention in depression treatment among ethnic and racial minority groups in the United States. Frensch, K.M. & Cameron, G. 2002. Treatment of choice or a last resort? A review of residential health placements for children and youth. Gauthier, B.; Bertrand, K. & Nolin, P. 2010. Famille et traitement de la toxicomanie chez les adolescents: étude de cas Goodman, S.H. & Gotlib, I.H. 1999. Risk for psychopathology in the children of depressed mothers: A developmental model for understanding mechanisms of transmission Guyon, L. & Desjardins, L. 2003. L’alcool, les drogues et les jeux de hasard chez les élèves du secondaire Harrison, P.A. & Asche, S.E. 2001. Outcomes monitoring in Minnesota: Treatment implications, practical limitations Health Canada. 2001. Best Practices: Treatment and Rehabilitation for Youth with Substance Use Problems Cfroerer, J.C. 2008. Moderation and mediation in the relationship between mothers’ or fathers’ serious psychological distress and adolescent substance use: Findings from a national sample Hogue, A. & Liddle, H.A. 2009. Family-based treatment for adolescent substance abuse: Controlled trials and new horizons in services Hu, L. & Bentler, P.M. 1999. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Johnstone, L.D.; O’Malley, R.M. & Bachman, J.G. 2003. Monitoring the Future Kahng, S.K.; Oyserman, D., Bybee, D. & Mowbray, C. 2008. Mothers with serious mental illness: When symptoms decline does parenting Keijsers, L.; Brange, S.J.T.; VanderValk, I.E. & Meeus, W. 2010. Bentler, P.M. 1990. Comparative fit indices in structural models. Bollen, K.A. 1989. Structural Equations with Latent Variables. New York: Wiley. Booth, R.E. & Kwiatkowski, C.F. 1999. Substance abuse treatment for high-risk adolescents Broman, C.L.; Reckase, M.D. & Freeman-Doan, C.R. 2006. The role of parenting in drugs use among black, latino, and white adolescents.