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The aim of this study was to measure the reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling (PG). Participants were 263 male and 23 female patients seeking treatment for PG and a matched non-psychiatric control sample of 259 men and 24 women. A Spanish translation of a 19-item measure of DSM-IV diagnostic criteria for PG (Stinchfield 2003) was administered along with other validity measures. The DSM-IV diagnostic criteria were found to be internally consistent with a coefficient alpha of .95 in the combined sample. Evidence of satisfactory convergent validity included moderate to high correlations with other measures of problem gambling. Using the standard DSM-IV cut-score of five, the ten criteria were found to yield satisfactory classification accuracy results with a high hit rate (.95), high sensitivity (.92), high specificity (.99), low false positive (.01), and low false negative rate (.08). Lowering the cut score to four resulted in modest improvements in classification accuracy and reduced the false negative rate from .08 to .05. The Spanish translation of a measure of DSM-IV diagnostic criteria for PG demonstrated satisfactory psychometric properties and a cut score of four improved diagnostic precision.

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Clinicians working with adolescents are routinely faced with the issue that alcohol and other drug (AOD) involvement may be part of the clinical picture either as a primary problem or a contributing factor to other problems or disorders. Fortunately, assessment research in this area has produced several behaviorally oriented and psychometrically sound tools from which to choose for problem identification, referral and treatment of youth suspected of AOD abuse. The aim of this paper is to provide an overview of several issues related to the clinical utility of such assessment tools.

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The purpose of this study was to compare rates of gambling among Minnesota public school students between 1992, 1995, and 1998. The three samples included 75,806 students in the 9th and 12th grades in 1992; 73,897 9th and 12th grade students in 1995; and 78,564 9th and 12th grade students in 1998. Students were administered the Minnesota Student Survey, a 121-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple behavioral domains, including gambling behaviors. The same questionnaire, with minor revisions to the gambling items, was administered in 1992, 1995, and 1998 to students in their classrooms by the Minnesota Department of Education. The results showed two opposite trends. On the one hand, fewer students gambled in 1998 than in 1995 and 1992. On the other hand, there was a small, but growing number of 12th grade students who gambled frequently. In terms of trends over time for specific games, the lottery showed a significant decline in the number of 9th grade students who played at all. There was also a significant increase in the number of 12th grade students who played the lottery weekly or more often. The findings that frequent lottery gambling has increased among 12th grade students and that underage gambling continues among these students, are both cause for concern. This is the first generation of youth to be exposed to widespread accessability to legalized gambling venues and gambling advertising. Legalized gambling may be a new "rite of passage" for some of today's youth. It will be important to continue to monitor youth gambling and to provide information and resources to assist youth in making healthy decisions about their gambling behavior.

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This study measured the outcome of four state-supported outpatient gambling treatment programs in Minnesota. The programs were developed specifically for the treatment of pathological gamblers and offered multiple modalities of treatment including individual, group, education, twelve-step work, family groups, and financial counseling. The therapeutic orientation was eclectic with an emphasis on the twelve steps of Gamblers Anonymous (GA) and a treatment goal of abstinence. The sample included 348 men and 220 women treated between January 1992 and January 1995. A pretest-posttest design was utilized with multidimensional assessments obtained at intake, discharge, six-months, and twelve-months post-discharge. Variables assessed included a range of clinical and outcome variables. At six month follow-up, 28% reported that they had abstained from gambling during the six months following discharge and an additional 20% had gambled less than once per month. Almost half of the sample (48%) showed clinically significant improvement in gambling frequency at six month follow-up. Outcome variables of gambling frequency, SOGS scores, amount of money gambled, number of friends who gamble, psychosocial problems, and number of financial problems, all showed statistically significant improvements from pretreatment to follow-up. The treatment programs yielded outcome results similar to those reported for alcohol and drug abuse treatment programs.

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A structural equation model incorporating substance abuse problem severity, psychosocial risk and protection, and treatment variables examined adolescent drug abuse treatment outcome pathways across 6- and 12-month follow-up points. Findings on resiliency factors and an empirical method adapted from previous research were used to select and assign 10 psychosocial factors to either a multiple protective factor index or a risk factor index. Gender, substance abuse problem severity, treatment modality, treatment length, and aftercare participation were also examined as outcome predictors. The findings suggest that treatment intensity decisions may be better informed by pretreatment psychosocial risk level rather than by substance abuse problem severity. The present study also suggests that drug-abusing adolescents who receive sufficiently long treatment, participate in aftercare, and possess at least 1 individual or interpersonal protective factor during their recovery process have the best chance to maintain gains made during treatment.

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AIMS: The treatment outcome of drug-abusing adolescents treated with a 12-Step approach. DESIGN: The study compares drug use outcome data at 6 and 12 months post-treatment among three groups of adolescents: those who completed treatment, those who did not and those on a waiting list. Also, among treatment completers, residential and outpatient samples were compared on outcome. SETTING: The treatment site is located in the Minneapolis/St Paul area of Minnesota. PARTICIPANTS: Two hundred and forty-five drug clinic-referred adolescents (12-18 years old), all of whom met at least one DSM-III-R substance dependence disorder. One hundred and seventy-nine subjects received either complete or incomplete 12-Step, Minnesota Model treatment and 66 were waiting list subjects. MEASUREMENTS: In addition to demographics and clinical background variables, measures included treatment involvement, treatment setting and drug use frequency at intake and follow-up. FINDINGS: Absolute and relative outcome analyses indicated that completing treatment was associated with far superior outcome compared to those who did not complete treatment or receive any at all. The percentage of treatment completers who reported either abstinence or a minor lapse for the 12 months following treatment was 53%, compared to 15 and 28% for the incompleter and waiting list groups, respectively. CONCLUSIONS: Favorable treatment outcome for drug abuse was about two to three times more likely if treatment was completed. Also, there were no outcome differences between residential and outpatient groups. Alcohol was the most common drug used during the follow-up period, despite cannabis being the preferred drug at intake.

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A vulnerability model of adolescent substance abuse treatment outcome provided the basis for selection of demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of adolescents (N = 225) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 months posttreatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-month follow-up. Peer substance use at intake and 6-month posttreatment both predicted substance use frequency outcomes at 12-month follow-up. Alcohol and marijuana use frequencies at 6-month follow-up also predicted continued use for these substances throughout the remainder of the 1st posttreatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st posttreatment year. Elevated psychological substance dependence at 6-month follow-up was a unique risk factor for subsequent marijuana use. Findings support conceptual models that attempt to explain adolescent substance abuse treatment outcome in terms of relationships among demographic, individual, interpersonal, and treatment factors.

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The development and initial psychometric properties of a new parent questionnaire for assessing adolescent drug abuse are described. The Personal Experience Inventory-Parent Version (PEI-PV) is intended to provide a standardized parent report as a companion measure to the adolescent self-report instrument, the Personal Experience Inventory. The PEI-PV addresses problems associated with the child's drug abuse and psychosocial factors and parenting practices that may underlie their drug involvement. Reliability and validity data are reported for two groups of mothers, 205 of whom had a child referred for an evaluation for drug treatment and 185 from a community sample. The structure and scope of the PEI-PV was supported by scale intercorrelation data; most scales had a proportion of unique, reliable variance greater than 20%. Estimates of the scale's internal consistency were found to be comparable to those of established parent questionnaires, and the observed differences between the clinic-referred and community samples were consistent with expectations. Significant convergence of mothers' reports to those of their child was obtained for nearly three-quarters of the PEI-PV scales, including moderate agreement between mother and child on the drug involvement severity scales. However, mothers tended to underreport their child's level of drug involvement and resulting problems compared to the child's self-report. The study results suggest that the PQ is associated with favorable evidence that the scales measure what they are intended to measure.

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This study examines the prevalence of gambling and measures the relationships between gambling behavior and a number of demographic, psychosocial, and behavioral variables among Minnesota public school students. The sample includes 78,582 male and female Minnesota public school students enrolled in the 9th and 12th grades. Students were administered the 1998 Minnesota Student Survey, a 121-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple health-related content domains, including gambling behavior. The majority of students were found to have gambled at least once during the past year, however, most students did not report gambling frequently, nor did they report problems associated with their gambling. Boys reported gambling more often than girls, and older students gambled more often than younger students. A larger percentage of Mexican/Latin American, African American, American Indian, and mixed race students gambled at weekly and daily rates than Asian American and Caucasian students. Variables associated with gambling frequency included antisocial behavior, gender (being a male), alcohol and tobacco use, age, feeling bad about the amount of money they bet, a desire to stop gambling, and increased sexual activity. Gambling appears to be related to other risk-taking behaviors and may be a part of the adolescent experimentation with adult behaviors.

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OBJECTIVE: The aims of this study are to compare DSM-IV criteria for alcohol and cannabis use disorders with its predecessor, DSM-III-R, and to examine the validity of the new criteria in an adolescent drug clinic sample. METHOD: During evaluation, a sample of 772 adolescents (63% boys, 77% white) were administered a structured interview of diagnostic symptoms and additional problem severity measures. Independent staff ratings of problem severity and treatment referral were collected as well. RESULTS: Compared to its predecessor, DSM-III-R, application of the DSM-IV criteria for alcohol and cannabis users resulted in more abuse assignments and fewer dependence assignments. The shift in assignments appeared to be largely due to a lowering of the abuse threshold, rather than to a tightening of the dependence criteria. The external validity data generally supported the DSM-IV abuse and dependence distinction in adolescents, and the newer criteria were as valid as the older criteria. CONCLUSIONS: In contrast to DSM-III-R, the DSM-IV system yields more abuse cases and fewer dependence cases among adolescent alcohol and cannabis abusers. Validity evidence for the new criteria are defensible, yet the findings are seen as a starting point for discussing the need for tailoring substance use disorder criteria for adolescents.

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The purpose of this study was to evaluate the efficacy of the Physician in Residence (PIR) program at the Hazelden Residential Program of New York City as a substance abuse training approach using standardized patients (SP) and self-report ratings. Using an objective rating scale, two experienced drug counselors evaluated four videotaped interviews carried out by housestaff pre- and post-enrollment in the PIR program. In addition, housestaff completed self-report ratings regarding their knowledge, attitudes, and skills of substance abuse. Of the 23 housestaff who completed both pre- and post-PIR program videotape sessions, significant improvements were noted in both observer and self-reported ratings. Overall, self-report ratings showed a greater percent improvement than the counselor ratings. The PIR program may be an efficacious approach to teach substance abuse clinical skills to housestaff.

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Although the Minnesota Model of treatment for alcohol and drug addiction is a common treatment approach, there are few published reports of its effectiveness. This study describes the Minnesota Model treatment approach as practiced at Hazelden, a private residential alcohol and drug abuse treatment center located in Center City, Minnesota (a founding program of the Minnesota Model) and presents recent outcome results from this program. This study includes 1,083 male and female clients admitted to Hazelden for treatment of a psychoactive substance-use disorder between 1989 and 1991. The outcome study is a one group pretest/posttest design. Data collection occurred at admission to treatment and at 1-month, 6-month, and 12-month posttreatment. At 1-year follow-up, 53% reported that they remained abstinent during the year following treatment and an additional 35% had reduced their alcohol and drug use. These results are similar to those reported by other private treatment programs. The Minnesota Model has consistently yielded satisfactory outcome results, and future research needs to focus on the therapeutic process of this common treatment approach.

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The purposes of this study were to examine the prevalence of gambling among youth, compare rates of gambling between 1992 and 1995, and determine what levels of gambling frequency may be considered common and uncommon. The two samples included 122,700 Minnesota public school students in the 6th, 9th, and 12th grades in 1992; and 75,900 9th and 12th grade students in 1995. Students were administered the Minnesota Student Survey, a 126-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple content domains, including gambling behaviors. The same questionnaire, with minor revisions to the gambling items, was administered in both 1992 and 1995 to students in their classrooms by the Minnesota Department of Education. There were slight decreases in overall gambling rates from 1992 to 1995. The majority of students gambled at least once during the past year. However, most did not play any game on a weekly/daily rate and did not report any problems associated with their gambling. Gender, grade, and race effects were found for gambling frequency. Boys gambled more often than girls, and 9th and 12th grade students gambled more often than 6th grade students. Asian American and White students reported lower rates of gambling frequency than Mexican/Latin American, African American, and American Indian students. From a statistical standpoint (i.e., beyond the 97.7 percentile), it may be considered in the uncommon range for girls to play two or more games at a weekly/daily rate, and for boys to play four or more games at a weekly/daily rate. Variables associated with gambling frequency included antisocial behavior, gender, and alcohol use frequency. Although the finding that gambling did not increase from 1992 to 1995 is encouraging, this is the first generation of youth to be exposed to widespread accessibility to gambling venues and gambling advertising and it will be important to continue monitoring the prevalence of youth gambling.

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This study is a preliminary examination of the reliability of adolescent self-reported pretreatment alcohol and other drug (AOD) use frequency. Assessments of self-reported pretreatment AOD use were conducted at admission and discharge (approximately a 1-month time period) at an adolescent drug misuser treatment program. The sample consisted of 197 male and female adolescents. There were statistically significant increases between admission and discharge assessments of pretreatment AOD use frequency. The greatest discrepancy was found for alcohol use, in which three-fourths (76%) of the sample reported a higher level of pretreatment alcohol use frequency at discharge assessment as compared to their admission assessment. Over one-third (35%) of the sample was found to have a significantly higher level of pretreatment alcohol use frequency at discharge assessment. The cause of this response discrepancy is unknown, but if it represents underreporting at admission, it may cause diagnostic and referral errors, as well as attenuate effect sizes in treatment outcome studies.

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Recent research has indicated high rates of substance abuse among adolescents with emotional and behavioral disorders. Moreover, adolescents in clinical and correctional settings found to have comorbid disorders involving substance abuse experience higher morbidity and mortality rates when compared to adolescents having one or no condition. The present study examines the ability of the Problem-Oriented Screening Instrument for Teenagers (POSIT) to identify DSM-III-R-defined psychoactive substance use disorders among 342 adolescents aged 12-19 years. Participants were sampled from school, clinical, and correctional settings. Optimal-scale cut scores for drug abuse diagnosis classification were derived by a minimum loss function method that minimized false classifications. When using the optimal cut score of two for the total sample, the standard POSIT substance use/abuse scale obtained a drug abuse diagnosis classification accuracy of 84% with sensitivity and specificity ratios of 95% and 79%, respectively. The internal validity of the standard 17-item substance use/abuse scale was subsequently examined by principle component analysis, item analysis, and coefficient alpha. The internal validity analyses were conducted to determine if a shortened scale could be developed and yet retain acceptable classification accuracy. When using the optimal cut score of two for the total sample, the revised 11-item scale obtained a drug abuse diagnosis classification accuracy of 85% with sensitivity and specificity ratios of 91% and 82%, respectively. The results suggest that the POSIT can serve as a useful first-gate instrument to identify adolescents in need of further drug abuse assessment.

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The purpose of this study was to examine the utility of the Personal Experience Inventory (PEI) as a measure of change in adolescent drug misuse. One year test-retest reliability of the PEI Problem Severity Scales was measured in a sample of drug-misusing adolescents who did not receive treatment during the 1-year test-retest interval (n = 37). The five PEI Problem Severity Scales demonstrated satisfactory 1 year temporal stability coefficients, ranging from .86 to .89. The utility of the PEI as a measure of change was demonstrated by using the 1-year test-retest reliability data to measure both statistically significant and clinically significant change between admission and 1-year follow-up in a sample of drug-misusing adolescents who received treatment (n = 45). The PEI was useful in identifying which treatment clients exhibited statistically significant improvement, statistically significant deterioration, and no reliable change.

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Youth gambling was investigated in a prospective sample of 532 Minnesota adolescents and young adults. Of particular interest was the possible impact among the study sample of a recent state lottery and of reaching the legal age for gambling on changes in the rate and type of gambling. Overall rates of gambling involvement and pathological gambling did not change across the 1.5 year interval. However, a preference for certain types of gambling activities (e.g., lottery, casino machines) significantly increased, whereas more informal and unregulated games (e.g., betting on games of personal skill) significantly decreased. Also, access to gambling activities by underage youths was high, suggesting the need for tighter controls of legalized games and greater awareness of this problem by the gaming industry and public health officials.

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This study examined the problem of follow-up contact bias in adolescent substance abuse treatment outcome research. The sample consisted of 299 male and female adolescents at an AA-oriented hospital-based inpatient substance abuse treatment program. Six-month and 12-month follow-up data were collected from adolescents and their parents with a sequence of standard and supplementary follow-up data collection procedures. Standard efforts were implemented first and subjects contacted were assigned to the easy-to-contact group. Those subjects not contacted with the initial standard efforts were included in the supplementary effort. Subjects contacted with supplementary efforts constituted the difficult-to-contact group. The difficult-to-contact group exhibited consistently poorer outcomes compared to the easy-to-contact group across most outcome variables and for both follow-up periods. Outcome results from extant studies with a significant number of noncontacted subjects may represent overestimates of outcome and may not be generalizable to the noncontacted group.

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The Personal Experience Inventory (PEI) is a recently developed self-report inventory that measures problem severity and psychosocial risk factors associated with adolescent alcohol and other drug involvement. Although previous studies have provided initial support for the psychometric properties of the PEI, this validity evidence was based on uncontrolled studies. The present study examined the concurrent validity of the PEI on a new sample using more controlled research procedures. Results indicated that the PEI Basic Problem Severity scales were significantly related to groups defined by DSM-III-R criteria for substance use disorders and by treatment referral recommendations. Also, the main PEI Problem Severity scale, the Personal Involvement scale, correctly classified a significantly greater proportion of participants into referral subgroups than would be expected given the base rates for the sample. This evidence provides additional support for the validity of the PEI as a problem severity measure of adolescent alcohol and other drug use.

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