Publications

2005
Trace, S. W., Kelly, J. F., & Moos, R. H. (2005). The influence of partner status, relationship quality and relationship stability on outcomes following intensive substance-use disorder treatment. Journal of Studies on Alcohol and Drugs , 66 (4), 497-505. Publisher's VersionAbstract

 

OBJECTIVE: Addiction treatment studies examining the influence of patients' partners suggest that partner behaviors affect patients' substance-use outcomes. We examine the influence of having a partner at treatment entry as well as the influence of the general quality of support and substance-using status of the partner, on outcomes following treatment for substance-use disorder. We also examine the influence of relationship stability on treatment outcomes and examine baseline partner behaviors that may predict relationship stability.

METHOD: A prospective, intact-group design was utilized with data analyzed using logistic regression. Participants (N = 3,014) from 15 intensive substanceuse disorder treatment programs were assessed at treatment entry and 1-year postdischarge.

RESULTS: Although patients with partners possessed a more favorable clinical profile, their outcomes were no better than those of their single counterparts. However, patients whose relationships lasted through the first year posttreatment had better outcomes than patients whose relationships ended. Relationships with more positive partner behaviors and fewer negative partner behaviors at intake were more likely to remain intact over the course of the first year posttreatment. Positive partner behaviors did not enhance patients' outcomes directly, but partner interpersonal stressors and patients' belief that their partner had a substance-use problem had a significant, deleterious impact on patients' substance-use outcomes.

CONCLUSIONS: Clinicians should routinely assess the quality of patients' relationships with partners. If deleterious partner behaviors exist, empirically supported interventions (e.g., behavioral couples therapy) could be utilized to reduce these behaviors and ultimately reduce relapse risk.

 

Kelly, J. F., Myers, M. G., & Brown, S. A. (2005). The effects of age composition of 12-step groups on adolescent 12-step participation and substance use outcome. Journal of Child & Adolescent Substance Abuse , 15 (1), 63-72. Publisher's VersionAbstract

Youth substance use disorder treatment programs frequently advocate integration into 12-Step fellowships to help prevent relapse. However, the effects of the predominantly adult composition of 12-step groups on adolescent involvement and substance use outcome remain unstudied. Greater knowledge could enhance the specificity of treatment recommendations for youth. To this end, adolescents (N = 74; M age = 15.9, 62% female) were recruited during inpatient treatment and followed up 3 and 6 months later. Greater age similarity was found to positively influence attendance rates and the perceived importance of attendance, and was marginally related to increased step-work and less substance use. These preliminary findings suggest locating and directing youth to meetings where other youth are present may improve 12-step attendance, involvement, and substance use outcomes.

Kelly, J. F., Finney, J. W., & Moos, R. (2005). Substance use disorder patients who are mandated to treatment: Characteristics, treatment process, and 1- and 5-year outcomes. Journal of Substance Abuse Treatment , 28, 213-23. Publisher's VersionAbstract

A substantial number of patients with substance use disorders (SUDs) are mandated to treatment by the justice system. However, little is known about their characteristics and how they fare during treatment and in the longer term compared with nonmandated, justice-system-involved patients and patients not involved in the justice system. This prospective study (n=2,095) examined differences in pretreatment characteristics, treatment perceptions and satisfaction, during-treatment changes, and 1- and 5-year outcomes among these three types of patients and tested whether differences in pretreatment characteristics or during-treatment changes could help explain posttreatment outcome similarities or differences. Mandated patients had a less severe clinical profile at treatment intake, yet this did not account for their observed similar/better outcomes, which appeared because of the similar therapeutic gains made during treatment. Treatment perceptions and satisfaction were also comparable across groups. These findings appear to support the idea that judicial mandates can provide an opportunity for offenders with SUDs to access and benefit from needed treatment.

2004
Kelly, J. F., & Tracy, S. W. (2004). Relapse prevention for substance use disorders: Adapting the adult-based paradigm for youth. In H. Steiner (Ed.), The handbook of mental health interventions in children and adolescents: An integrated developmental model (1st ed. pp. 704-732) . New York (NY): Jossey-Bass.
Kelly, J. F., Humphreys, K. N., & Youngson, H. (2004). Mutual aid groups. In S. Harrison & V. Carver (Ed.), Alcohol and drug problems: A practical guide for counsellors (3rd ed. pp. 169-197) . Toronto: Centre for Addiction and Mental Health.
Kelly, J. F. (2004). Toward an addictionary: Implication for patients, programs & policy. The Addictions Newsletter, American Psychological Association, Division 50 Addictions , 11 (7).
Kelly, J. F. (2004). Evidence for adolescent participation in Alcoholics Anonymous and Narcotics Anonymous: Further steps needed. The Brown University Digest of Addiction Theory and Application , 23, 31.
Kelly, J. F. (2004). Toward an addictionary: A proposal for more precise terminology. Alcohol Treatment Quarterly , 22 (2), 79-87. Publisher's VersionAbstract

A confusing array of terms is used to describe alcohol-and other drug-related problems and individuals with such problems. The terms used to describe these phenomena should be explicit, precisely defined, and used consistently to aid unambiguous clinical and scientific communication and promote clearer appraisal of, and generalizations from, empirical findings. Furthermore, because our terminology has implications for patients (e.g., stigma), programs (e.g., treatment access), and policy (e.g., appropriation of healthcare funding), we should think more critically about our choice of terms and what may be communicated by their use. Specific language is suggested along with a simple algorithm to facilitate the consistent use of terms such as “misuse,” “abuse” and “dependence,” as well as “alcohol,” “drug,” and “substance use disorders.”

Tonigan, J. S., & Kelly, J. F. (2004). Beliefs about AA and the use of medications: A comparison of three groups of AA-exposed alcohol dependent persons. Alcoholism Treatment Quarterly , 22 (2), 67-78. Publisher's VersionAbstract

This study investigated client attitudes about AA participation and the use of medications for drinking and emotional problems. The sample (N = 133) was Project MATCH clients recruited in Albuquerque, New Mexico, who were interviewed 10 years after outpatient alcohol treatment. Three self-selected AA-exposed groups of clients were identified in the 10-year interviews, and perceptions of AA and medications were divided according to whether clients reported continuous AA participation for 10 years, limited AA attendance, or no AA attendance over 10 years. Planned comparisons showed that the three groups of AA-exposed clients did not differ in their perceptions about AA and the use of medications to prevent drinking, alcohol craving, and to alleviate emotional problems. In general, client perceptions were not favorable about the use of such medications. Secondary analyses, however, suggested that current AA members may be modestly more favorable about the use of such medications, but this finding requires replication.

2003
Kelly, J. F. (2003). Self-help for substance use disorders: History, effectiveness, knowledge gaps and research opportunities. Clinical Psychology Review , 23 (5), 639-663. Publisher's VersionAbstract

Scientific evidence suggests substance-use disorder (SUD)-focused self-help group involvement is a helpful adjunct to SUD treatment, yet significant knowledge gaps remain. The principal aim of this review is to highlight areas of knowledge deficit and their implications for research and practice. To accomplish this, evidence regarding whether self-help group involvement is effective, for whom, and why, is reviewed. The appropriateness of self-help groups for certain subpopulations is considered with respect to psychiatric comorbidity, religious orientation, gender, and age. An increasingly rigorous body of evidence suggests consistent benefits of self-help group involvement. Regarding subpopulations, current evidence suggests non- or less-religious individuals benefit as much from self-help groups as more religious individuals and women become as involved and benefit as much as men. However, participation in, and effects from, traditional self-help groups for dually diagnosed patients may be moderated by type of psychiatric comorbidity. Some youth appear to benefit, but remain largely unstudied. Dropout and nonattendance rates are high, despite clinical recommendations to attend. Clinicians can significantly influence the effectiveness of self-help, but optimal methods and duration of facilitation efforts need testing. Greater understanding of the reasons why many do not attend or drop out would benefit facilitation efforts.

Kelly, J. F., McKellar, J. D., & Moos, R. H. (2003). Major depression in patients with substance use disorders: Relationship to 12‐step self‐help involvement and substance use outcomes. Addiction , 98 (4), 499-508 . Wiley Online Library. Publisher's VersionAbstract

 

Aims: Many patients treated for substance use disorders (SUDs) who become involved in 12-Step self-help groups have improved treatment outcomes. However, due to high rates of psychiatric comorbidity and major depressive disorder (MDD), among SUD patients in particular, concerns have been raised over whether these benefits extend to dual diagnosis patients. This study examined the influence of comorbid MDD among patients with SUDs on 12-Step self-help group involvement and its relation to treatment outcome.

Design: A quasi-experimental, prospective, intact group design was used with assessments completed during treatment, and 1 and 2 years postdischarge.

Participants: A total of 2161 male patients recruited during in-patient SUD treatment, of whom 110 had a comorbid MDD diagnosis (SUD-MDD) and 2051 were without psychiatric comorbidity (SUD-only).

Findings: SUD-MDD patients were initially less socially involved in and derived progressively less benefit from 12-Step groups over time compared to the SUD-only group. However, substance use outcomes did not differ by diagnostic cohort. In contrast, despite using substantially more professional out-patient services, the SUD-MDD cohort continued to suffer significant levels of depression.

Conclusions: Treatment providers should allocate more resources to targeting depressive symptoms in SUD-MDD patients. Furthermore, SUD-MDD patients may not assimilate as readily into, nor benefit as much from, traditional 12-Step self-help groups such as Alcoholics Anonymous, as psychiatrically non-comorbid patients. Newer, dual-diagnosis-specific, self-help groups may be a better fit for these patients, but await further study.

 

Kelly, J. F., & Moos, R. H. (2003). Dropout from 12-step self-help groups: Prevalence, predictors, and counteracting treatment influences. Journal of Substance Abuse Treatment , 24 (3), 241-250. Publisher's VersionAbstract

Attendance at 12-step self-help groups is frequently recommended as an adjunct to professional substance use disorder (SUD) treatment, yet patient dropout from these groups is common. This study assessed the prevalence, predictors, and treatment-related factors affecting dropout in the first year following treatment for 2,778 male patients. Of these, 91% (2,518) were identified as having attended 12-step groups either in the 90 days prior to, or during, treatment. At 1-year followup 40% had dropped out. A number of baseline factors predicted dropout. Importantly, patients who initiated 12-step behaviors during treatment were less likely to drop out. Further findings suggest patients at highest risk for dropout may be at lower risk if treated in a more supportive environment. Clinicians may decrease the likelihood of dropout directly, by screening for risk factors and focusing facilitation efforts accordingly, and indirectly, by increasing the supportiveness of the treatment environment, and facilitating 12-step involvement during treatment.

2002
Cohen, L. M., Myers, M. G., & Kelly, J. F. (2002). Assessment of nicotine dependence among substance abusing adolescent smokers: A comparison of the DSM-IV criteria and the modified Fagerström Tolerance Questionnaire. Journal of Psychopathology and Behavioral Assessment , 24 (4), 225-233 . Springer. Publisher's VersionAbstract

Nicotine dependence has been found to be a significant factor in adolescent smoking persistence. However, measures of this construct are primarily adult-derived, limiting their utility as bases for characterizing nicotine dependence and formulating youth intervention strategies. This issue is of particular importance among substance abusing youth who have substantially higher rates of cigarette smoking than do adolescents in the general population. The objectives of this preliminary study were to examine the construct validity of the DSM-IV nicotine dependence criteria and the modified Fagerström Tolerance Questionnaire (mFTQ) and to compare the DSM-IV diagnostic criteria for nicotine dependence with the mFTQ in a sample of 67 adolescent smokers in treatment for substance abuse. Results revealed that more participants were classified as nicotine dependent using DSM-IV criteria than by mFTQ scores. Little evidence was found for construct validity of these measures and convergence between the two measures was low. Findings also suggested that the present measures do not capture optimally broad dimensions of adolescent nicotine dependence.

Whitney, S. D., Kelly, J. F., Myers, M. G., & Brown, S. A. (2002). Parental substance use, family support and outcome following treatment for adolescent psychoactive substance use disorders. Journal of Child and Adolescent Substance Abuse , 11 (4), 67-81. Publisher's VersionAbstract

Families are found to play an important role in adolescent substance abuse. This study examined family variables that may influence adolescent substance use during the 6 months following inpatient treatment: (1) parental substance use; (2) family aftercare attendance; and, (3) adolescent ratings of family helpfulness. It was hypothesized that the effects of parental substance use on adolescent use would be mediated by family aftercare attendance and family helpfulness ratings. Adolescent inpatients (N = 103; Mage = 16) were assessed during treatment and 6 months later. Results revealed no relationship between either parental substance use and family aftercare attendance or reports of family helpfulness. More frequent family aftercare attendance and higher ratings of helpfulness were associated with less adolescent use during follow-up. Findings highlight the importance of family behaviors on adolescent substance abuse treatment outcome.

Kelly, J. F., Myers, M. G., & Brown, S. A. (2002). Do adolescents affiliate with 12-step groups? A multivariate process model of effects. Journal of Studies on Alcohol and Drugs , 63 (3), 293-304. Publisher's VersionAbstract

 

OBJECTIVE: Research with adolescents has revealed salutary effects for 12-step attendance on substance use outcomes, but no studies have examined the effects of 12-step affiliation, or active involvement, beyond simple measures of attendance. Prior research with adults has shown that measures of affiliation are more predictive than measures of attendance. This study (1) assessed attributes that may influence 12-step attendance and affiliation; (2) tested whether 12-step affiliation in the first 3 months posttreatment possessed unique predictive power above that attributable to attendance alone; and (3) examined the extent to which motivation, coping and self-efficacy measured at 3 months mediated the relation between 12-step affiliation and substance use outcome in the ensuing 3 months.

METHOD: Adolescent inpatients (N = 74, 62% female), who were aged 14-18 years (mean [SD] = 15.9 [1.19] years), were interviewed during treatment and at 3 and 6 months postdischarge.

RESULTS: More severely substance-involved youth were more motivated for abstinence and more likely to attend and affiliate with 12-step groups. A high degree of collinearity between 12-step attendance and affiliation suggested that those attending were also likely to be those actively involved. As a consequence, affiliation did not predict outcome over and above frequency of attendance. Motivation was found to influence the relationship between 12-step affiliation and future substance use outcome.

CONCLUSIONS: Given the widespread treatment recommendations for adolescent 12-step involvement, more study is needed to determine what kinds and what aspects of 12-step groups and fellowships are helpful to adolescent change efforts and what alternatives should be developed.

 

2000
Myers, M. G., Brown, S. A., & Kelly, J. F. (2000). A cigarette smoking intervention for substance-abusing adolescents. Cognitive and Behavioral Practice , 7 (1), 64-82. Publisher's VersionAbstract

Families are found to play an important role in adolescent substance abuse. This study examined family variables that may influence adolescent substance use during the 6 months following inpatient treatment: (1) parental substance use; (2) family aftercare attendance; and, (3) adolescent ratings of family helpfulness. It was hypothesized that the effects of parental substance use on adolescent use would be mediated by family aftercare attendance and family helpfulness ratings. Adolescent inpatients (N = 103; Mage = 16) were assessed during treatment and 6 months later. Results revealed no relationship between either parental substance use and family aftercare attendance or reports of family helpfulness. More frequent family aftercare attendance and higher ratings of helpfulness were associated with less adolescent use during follow-up. Findings highlight the importance of family behaviors on adolescent substance abuse treatment outcome.

Myers, M. G., Brown, S. A., & Kelly, J. F. (2000). A smoking intervention for substance abusing adolescents: Outcomes, predictors of cessation attempts, and post-treatment substance use. Journal of Child & Adolescent Substance Abuse , 9 (4), 77-91 . Taylor & Francis. Publisher's VersionAbstract

Tobacco use is prevalent among youth with alcohol and other drug problems, yet this issue has been afforded limited research or clinical attention. The present study reports on findings for a cigarette smoking intervention for youth treated for substance abuse. Thirty-five adolescents, ages 13 to 18 (40% female), completed a cigarette-focused intervention and were followed-up at three months post-treatment. Six of the adolescents were abstinent from smoking at follow-up, while 17 had attempted cessation during the post-treatment period. Of baseline predictors examined, duration of smoking and intentions to quit predicted cessation attempts. Smoking cessation efforts had no negative impact on substance use outcomes. Findings were interpreted to provide support for the feasibility and utility of tobacco intervention in the context of adolescent substance abuse treatment.

Kelly, J. F., Myers, M. G., & Brown, S. A. (2000). A multivariate process model of adolescent 12-step attendance and substance use outcome following inpatient treatment. Psychology of Addictive Behaviors , 14 (4), 376-389. Publisher's VersionAbstract

A common recommendation for youth treated for substance abuse is to attend 12-step groups. However, little is known regarding the effects of this adult-derived prescription on substance use outcomes for teens. This study examined (a) the relation between 12-step attendance and substance use outcome in the 6 months postdischarge from inpatient care and (b) a process model of how 12-step attendance during the first 3 months postdischarge affects proximal outcomes of motivation, coping, and self-efficacy, measured at 3 months, and how these, in turn, affect ultimate substance use outcome in the following 3 months. Adolescent inpatients (N = 99) were assessed during treatment and 3 and 6 months postdischarge. Results revealed modest beneficial effects of 12-step attendance, which were mediated by motivation but not by coping or self-efficacy. Findings suggest that closer attention be paid to motivational factors in the treatment of adolescent substance abuse.

1998
Greenfield, S. F., Weiss, R. D., Muenz, L. R., Vagge, L. M., Kelly, J. F., Bello, L. R., & Michael, J. (1998). The effect of depression on return to drinking: A prospective study. Archives of General Psychiatry , 55 (3), 259-265. Publisher's VersionAbstract

 

Background  The effect of depression on return to drinking among individuals with alcohol dependence is controversial. From February 1, 1993, to April 15, 1996, we consecutively recruited 40 women and 61 men hospitalized for alcohol dependence and followed them up monthly for 1 year to assess the effect of depression on drinking outcomes.

Methods  We conducted structured interviews during hospitalization and monthly following discharge for 1 year to determine whether depression at treatment entry affected the likelihood of return to drinking and whether this effect differed between sexes. Using survival analysis, we examined the effect of depressive symptoms and a diagnosis of current major depression at treatment entry on times to first drink and relapse during follow-up.

Results  A diagnosis of current major depression at the time of hospitalization was associated with shorter times to first drink (hazard ratio, 2.03; 95% confidence interval [CI], 1.28-3.21; P=.003) and relapse (hazard ratio, 2.12; 95% CI, 1.32-3.39; P=.002). There was no significant difference between women and men in this effect. Depressive symptoms as measured by the Beck Depression Inventory did not predict time to first drink or relapse in women or men.

Conclusions  A diagnosis of current major depression at entry into inpatient treatment for alcohol dependence predicted shorter times to first drink and relapse in women and men. Our results differ from earlier reports that men and women differ in the effect of depression on return to drinking.

ALTHOUGH DEPRESSION and alcohol dependence commonly coexist in community and treatment-seeking populations, there is no clear consensus on appropriate assessment and treatment of patients who present with symptoms of both disorders. To make appropriate treatment decisions, clinicians must know the likely effects of depression on drinking outcomes. Although previous studies have demonstrated the course of depressive symptoms during abstinence from alcohol, information regarding the effect of depression on the likelihood of return to drinking is sparse and contradictory. 

 

 

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