Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature
Open accessAbstract
Most substance use begins in adolescence. Both childhood trauma and associated post-traumatic stress disorder (PTSD) increase risk for early substance use, which is associated with greater eventual severity of substance use disorders (SUDs). When co-occurring, PTSD and SUD can reinforce and exacerbate each other, necessitating integrated treatment approaches. To systematically review existing literature on interventions for prevention or treatment of SUDs among adolescents (aged 10–24) with a history of trauma, with or without PTSD, we searched databases (PubMed, PsycInfo, CINAHL, Cochrane CENTRAL) using search terms related to substance use, trauma, adolescents, and interventions. Searches identified 8134 unique articles, 68 of which prompted full-text screening. Authors extracted data, applied the Effective Public Health Practice Project Quality Assessment Tool to evaluate the evidence, and synthesized findings. Thirty three articles met eligibility criteria, including 13 RCTs. Twenty studies (10 RCTs) evaluated interventions for substance use and co-occurring problems among youth with a history of trauma, predominantly via individual therapy based on cognitive-behavioral principles, although group therapy, case management, and other approaches have also been studied. Interventions with exposure-based components were infrequent but had robust results and minimal adverse outcomes. Thirteen studies examined differential response of youth with a history of trauma to standard SUD treatments, compared to youth without a history of trauma, with mixed findings. Youth with a history of trauma face elevated risk of SUDs and may respond differently to SUD treatments. Several promising interventions have been recently developed. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2023.
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Claims the paper makes
86 of 181 cited sources checked · 40 supported · 1 flagged · accuracy not yet measured
- Premisecitation
Childhood trauma and associated PTSD raise the risk that a young person will begin using substances early.
“Both childhood trauma and associated post-traumatic stress disorder (PTSD) increase risk for early substance use”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [12] Dube SR, Felitti VJ, Dong M et al (2003) Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics 111:564–572. https://doi.org/10.1542/peds.111.3.564 source
The Results (p. 8) report that adverse childhood experiences were associated with a higher likelihood of initiating illicit drug use in early adolescence. The paper does not establish that associated PTSD independently increases that risk; the cited evidence supports the childhood-trauma portion, not the PTSD portion. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [13] Buckingham ET, Daniolos P (2013) Longitudinal outcomes for victims of child abuse. Curr Psychiatry Rep 15. https://doi.org/10.1007/s11920-012-0342-3 source
- Premisecitation
Post-traumatic stress symptoms account for about one third of the effect of physical and sexual abuse on adolescent substance use.
“post-traumatic stress symptoms mediate approximately one-third of the effect of physical and sexual abuse on SU in adolescents [18]”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [18] Grummitt L, Kelly E, Barrett E et al (2021) Targets for intervention to prevent substance use in young people exposed to childhood adversity: a systematic review. PLoS ONE 16:1–29. https://doi.org/10.1371/journal.pone.0252815 source
- Premisecitation
The youth SUD treatment literature has not shown that treating only one co-occurring mental health or SUD condition produces benefits for the other.
“youth SUD treatment literature has not found “spillover benefits” from treating only one co-occurring MH or SUD condition [22]”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [22] Ramchand R, Griffin BA, Slaughter ME et al (2014) Do improvements in substance use and mental health symptoms during treatment translate to long-term outcomes in the opposite domain? J Subst Abuse Treat 47:339–346. https://doi.org/10.1016/j.jsat.2014.06.012 source
The Discussion (page unavailable) reports little evidence that improvement in one domain during adolescent substance-use treatment predicted better 12-month outcomes in the other. But the Introduction (page unavailable) notes some evidence that effective mental-health treatment may prevent subsequent substance-use disorders. The claim’s categorical statement that the youth literature has found no spillover benefits overstates the source. (LLM, conf=0.85)
Experimental — accuracy not yet measured
- Premisecitation
Childhood trauma is an important risk factor for later SUDs.
“Childhood trauma is a significant risk factor for subsequent development of SUDs [12, 13]”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [12] Dube SR, Felitti VJ, Dong M et al (2003) Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics 111:564–572. https://doi.org/10.1542/peds.111.3.564 source
- cites [13] Buckingham ET, Daniolos P (2013) Longitudinal outcomes for victims of child abuse. Curr Psychiatry Rep 15. https://doi.org/10.1007/s11920-012-0342-3 source
- Premisecitation
Abused youth may feel different from peers and therefore gravitate to fringe social groups where substance use is more accepted.
“Youth who have been abused may “feel different” from peers, leading them to prefer fringe social circles, in which SU may be more accepted [20].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [20] Brady KT, Back SE (2012) Childhood trauma, posttraumatic stress disorder, and alcohol dependence. Alcohol Res 34:408–413 source
The Prevalence section says it is possible that children who have been abused feel “different” and withdraw toward fringe groups where alcohol use is more accepted. The citing sentence preserves that tentative explanation but broadens “alcohol use” to substance use generally, which the passage does not establish. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Premisecitation
Childhood trauma raises the risk of later cognitive, psychological, and social difficulties.
“childhood trauma increases the risk for a variety of subsequent cognitive, psychological, and social problems”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [5] Cook A, Spinazzola J, Ford J et al (2005) Complex trauma in children and adolescents. Psychiatr Ann 35:390–398. https://doi.org/10.3928/00485713-20050501-05 source
- cites [6] Villalta L, Smith P, Hickin N, Stringaris A (2018) Emotion regulation difficulties in traumatized youth: a meta-analysis and conceptual review. Eur Child Adolesc Psychiatry 27:527–544. https://doi.org/10.1007/s00787-018-1105-4 source
The Introduction says traumatic experiences in young people can elicit posttraumatic symptoms and disrupt emotion regulation. The section on PTSD conceptualization also describes interpersonal-relationship and self-perception problems in severely traumatized patients. The paper does not establish the broader claim that childhood trauma increases the risk of subsequent cognitive, psychological, and social problems as a whole; its Discussion notes that limited longitudinal data constrain causal inferences. (LLM, conf=0.83)
Experimental — accuracy not yet measured
- Premisecitation
Youth who experience several traumatic events in childhood are at greater risk of more severe and comorbid psychological problems.
“Youth who experience multiple traumatic events throughout childhood face an even greater risk for higher severity and comorbidity of psychological problems [10, 11].”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [10] Cloitre M, Garvert DW, Brewin CR et al (2013) Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis. Eur J Psychotraumatol 4. https://doi.org/10.3402/ejpt.v4i0.20706 source
The Results (Sociodemographic, trauma history, and symptom characteristics; page unavailable) find more types of childhood interpersonal violence in the complex PTSD class, which also had greater difficulties with affect, self-concept, relationships, and functioning. But the clinic sample was adults, not youth, and the paper does not establish that multiple childhood traumas increase comorbidity of psychological problems. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [11] Hyland P, Murphy J, Shevlin M et al (2017) Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms. Soc Psychiatry Psychiatr Epidemiol 52:727–736. https://doi.org/10.1007/s00127-017-1350-8 source
The results (p. 7) associate more forms of childhood interpersonal trauma with greater risk of CPTSD rather than PTSD, although the Discussion (p. 8) calls the evidence tentative. The study interviewed adults aged 24 (Participants and procedures, p. 3); it does not establish higher severity or comorbidity of psychological problems among youth. (LLM, conf=0.88)
Experimental — accuracy not yet measured
- Premisecitation
Starting substance use in early adolescence is strongly linked to later SUD development and severity.
“onset of use during early adolescence is strongly associated with subsequent development of SUDs and SUD severity [15, 16]”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [15] Conrod PJ, Nikolaou K (2016) Annual research review: on the developmental neuropsychology of substance use disorders. J Child Psychol Psychiatry Allied Discip 57: 371–394. https://doi.org/10.1111/jcpp.12516 source
The Introduction (page unavailable) says early onset of substance use is associated with future SUD risk, and the Dual-process models section says earlier onset robustly predicts substance abuse and dependence. The copy does not establish that onset in early adolescence is associated with greater SUD severity; its discussion of severe SUD concerns frequent, heavy use over time. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [16] Gray KM, Squeglia LM (2018) Research review: what have we learned about adolescent substance use? J Child Psychol Psychiatry Allied Discip 59:618–627. https://doi.org/10.1111/jcpp.12783 source
The Results > Epidemiology passage (page unavailable) says that initiating alcohol or drug use during adolescence significantly increases the likelihood of a substance use disorder; it also reports a four- to sixfold higher rate of lifetime alcohol dependence among those who begin drinking before age 15. The passage does not link early initiation to greater SUD severity, so that part of the attributed claim is unsupported. (LLM, conf=0.87)
Experimental — accuracy not yet measured
- Premisecitation
Early substance use is linked to more severe substance use disorders later.
“which is associated with greater eventual severity of substance use disorders (SUDs)”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [15] Conrod PJ, Nikolaou K (2016) Annual research review: on the developmental neuropsychology of substance use disorders. J Child Psychol Psychiatry Allied Discip 57: 371–394. https://doi.org/10.1111/jcpp.12516 source
The Introduction says early onset of substance use is associated with future risk of SUD. It separately links frequent, heavy use over time—not early onset itself—to a diagnosis of severe SUD. The review therefore supports the later-disorder link but not the claim about greater eventual severity. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [16] Gray KM, Squeglia LM (2018) Research review: what have we learned about adolescent substance use? J Child Psychol Psychiatry Allied Discip 59:618–627. https://doi.org/10.1111/jcpp.12783 source
The Results > Epidemiology passage says that initiating alcohol or drug use during adolescence increases the likelihood of developing a substance use disorder, and that drinking before age 15 is associated with a higher rate of lifetime alcohol dependence. It does not say that people who develop a disorder have more severe disorders because they started using early. No page number is available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Premisecitation
More than one quarter of adult SUDs can be attributed to childhood adversity.
“over a quarter of SUDs in adulthood can be attributed to childhood adversity [3]”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [3] Kessler RC, McLaughlin KA, Green JG et al (2010) Childhood adversities and adult psychopathology in the WHO world mental health surveys. Br J Psychiatry 197:378–385. https://doi.org/10.1192/bjp.bp.110.080499 sourceExperimental — accuracy not yet measured
- Premisecitation
Interpersonal violence exposure, including physical abuse, sexual abuse, and domestic violence, raises later psychological risk more than other forms of adversity.
“Exposure to interpersonal violence, such as physical abuse, sexual abuse, and domestic violence, particularly increases the risk of later psychological problems compared to other adversity [1, 9].”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [1] McLaughlin KA, Koenen KC, Hill ED et al (2013) Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. J Am Acad Child Adolesc Psychiatry 52. https://doi.org/10.1016/j.jaac.2013.05.011 source
The Results report higher conditional probabilities of PTSD after several forms of interpersonal violence, including sexual assault and physical abuse, than after many other traumatic events; the Discussion likewise describes a comparatively high probability for interpersonal violence. The study examines PTSD in adolescents, not later psychological problems generally, and the cited passages do not establish that witnessing domestic violence carries the same elevated risk or that violence causes the difference. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [9] Elliott JC, Stohl M, Wall MM et al (2014) The risk for persistent adult alcohol and nicotine dependence: the role of childhood maltreatment. Addiction 109:842–850. https://doi.org/10.1111/add.12477 source
The Results (page unavailable) link childhood physical and sexual abuse to persistence of alcohol and nicotine dependence after controlling for other childhood adversities. But the paper does not establish increased risk of psychological problems generally or a greater effect than other adversities. The Methods (page unavailable) classify witnessing serious fights at home—potential domestic violence—as an other adversity, not as one of the abuse exposures tested. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Premisecitation
Youth with a trauma history may start using substances earlier than peers without trauma.
“Youth with a history of trauma may begin using substances at earlier ages than non-traumatized peers [14]”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [14] Andersen SL, Teicher MH (2009) Desperately driven and no brakes: developmental stress exposure and subsequent risk for substance abuse. Neurosci Biobehav Rev 33:516–524. https://doi.org/10.1016/j.neubiorev.2008.09.009 source
- Premisecitation
Trauma exposure raises SUD risk even when PTSD does not develop.
“Trauma exposure, even without development of PTSD, increases risk of SUDs”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [18] Grummitt L, Kelly E, Barrett E et al (2021) Targets for intervention to prevent substance use in young people exposed to childhood adversity: a systematic review. PLoS ONE 16:1–29. https://doi.org/10.1371/journal.pone.0252815 source
The Introduction (page not provided) reports increased substance use disorder risk among young people exposed to childhood adversity. The Results, under Mediation analyses (page not provided), say post-traumatic stress symptoms mediated about one third of the effect of physical and sexual abuse on substance use. The review does not specifically establish SUD risk among trauma-exposed people who did not develop PTSD. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Findingcitation
BBTI reduced cannabis problems at 3-month follow-up, with Cohen's d of 0.75.
“reducing cannabis problems (Cohen’s d=0.75)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [62] Short NA, Zvolensky MJ, Schmidt NB (2021) A pilot randomized clinical trial of brief behavioral treatment for insomnia to reduce problematic cannabis use among trauma-exposed young adults. J Subst Abuse Treat 131: 108537. https://doi.org/10.1016/j.jsat.2021.108537 source
- Findingcitation
Compared with a general health promotion control, the Voices intervention significantly improved alcohol use at 6-month follow-up.
“significant improvements (compared to general health promotion control group), in cannabis and alcohol use at 6-month follow-up”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [63] Tolou-Shams M, Dauria EF, Folk J et al (2021) VOICES: an efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history. Drug Alcohol Depend 228. https://doi.org/10.1016/j.drugalcdep.2021.108934 source
The Methods identify GirlHealth as a general health-promotion control, and the Discussion says alcohol-use reductions followed a pattern similar to cannabis-use reductions through six months after the intervention. But the Data analyses section says alcohol use was too infrequent to analyze separately over time. The significant result in Primary outcomes was for a combined alcohol-or-drug-use measure, not alcohol use alone. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Findingcitation
Compared with a general health promotion control, the Voices intervention significantly improved cannabis use at 6-month follow-up, from 57% to 39%, with an intervention-by-time effect F(3,281)=2.92, p=0.03.
“significant improvements (compared to general health promotion control group), in cannabis and alcohol use at 6-month follow-up (for cannabis, 57% at baseline to 39% at follow-up, with significant intervention x time effect (F(3, 281)= 2.92, p=0.03).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [63] Tolou-Shams M, Dauria EF, Folk J et al (2021) VOICES: an efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history. Drug Alcohol Depend 228. https://doi.org/10.1016/j.drugalcdep.2021.108934 source
- Findingcitation
In the Voices trial, both intervention and control groups showed significant improvement over time in substance use consequences.
“Both groups had significant improvements over time in SU consequences, PTSD symptoms, general psychiatric symptoms, and delinquent behaviors, with no significant between-group differences.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [63] Tolou-Shams M, Dauria EF, Folk J et al (2021) VOICES: an efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history. Drug Alcohol Depend 228. https://doi.org/10.1016/j.drugalcdep.2021.108934 source
- Findingcitation
In a secondary analysis of a D-CPT trial among older adolescents with PTSD and no substance dependence at baseline, phase-based D-CPT was not linked to any increase in substance urges, actual use, or other dysfunctional behaviors.
“phase-based D-CPT (i.e., preparation and emotional regulation skill-building over ~11 sessions, followed by trauma processing over ~15 sessions) was not associated with any increase in urges or actual use of substances or other dysfunctional behaviors [55].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [55] Fischer A, Rosner R, Renneberg B, Steil R (2022) Suicidal ideation, self-injury, aggressive behavior and substance use during intensive trauma-focused treatment with exposure-based components in adolescent and young adult PTSD patients. Borderline Personal Disord Emot Dysregulat 9:1–13. https://doi.org/10.1186/s40479-021-00172-8 source
- Findingcitation
BBTI did not significantly change actual cannabis use.
“although no significant change in actual cannabis use”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [62] Short NA, Zvolensky MJ, Schmidt NB (2021) A pilot randomized clinical trial of brief behavioral treatment for insomnia to reduce problematic cannabis use among trauma-exposed young adults. J Subst Abuse Treat 131: 108537. https://doi.org/10.1016/j.jsat.2021.108537 source
- Premisecitation
TF-CBT may be used less often in youth with co-occurring SUDs because clinicians worry that exposure-based therapy could destabilize them.
“TF-CBT may be underutilized among youth with co-occurring SUDs, due to clinical hesitations that exposure-based therapies may destabilize patients with co-occurring SUDs [20, 29].”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [20] Brady KT, Back SE (2012) Childhood trauma, posttraumatic stress disorder, and alcohol dependence. Alcohol Res 34:408–413 source
The Psychosocial Interventions section (page not provided) says clinicians previously delayed trauma interventions for patients with substance use disorders because they feared treatment before sustained abstinence would increase relapse risk. It does not establish that TF-CBT is underutilized among youth, and it describes relapse risk rather than patient destabilization more broadly. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [29] Danielson CK, Adams Z, McCart MR et al (2020) Safety and efficacy of exposure-based risk reduction through family therapy for co-occurring substance use problems and posttraumatic stress disorder symptoms among adolescents: a randomized clinical trial. JAMA Psychiat 77:574–586. https://doi.org/10.1001/jamapsychiatry.2019.4803 source
- Findingcitation
BBTI produced a large improvement in sleep at 3-month follow-up, with Cohen's d of 1.34 on the insomnia index.
“BBTI had large effects in improving sleep (Cohen’s d= 1.34 on insomnia index)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [62] Short NA, Zvolensky MJ, Schmidt NB (2021) A pilot randomized clinical trial of brief behavioral treatment for insomnia to reduce problematic cannabis use among trauma-exposed young adults. J Subst Abuse Treat 131: 108537. https://doi.org/10.1016/j.jsat.2021.108537 source
- Findingcitation
Among boys in the same study, sexual abuse, chronic physical and emotional abuse, and high physical abuse were associated with faster relapse compared with youth with low baseline victimization.
“among boys, sexual abuse, chronic physical and emotional abuse, and high physical abuse were all associated with faster relapse (compared to youth with low levels of baseline victimization)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [67] Davis JP, Christie NC, Dworkin ER et al (2020) Influences of victimization and comorbid conditions on latency to illicit drug use among adolescents and young adults. Drug Alcohol Depend 206: 107721. https://doi.org/10.1016/j.drugalcdep.2019.107721 source
- Findingcitation
WHC participants had significant reductions in heavy episodic drinking from baseline to 3 months.
“significant improvements from baseline to 3-months in SU (37–51% reductions in heavy episodic drinking, methamphetamine use, cannabis use)”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [59] Myers B, Carney T, Browne FA, Wechsberg WM (2019) A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study. BMJ Open 9:1–11. https://doi.org/10.1136/bmjopen-2018-024776 source
- Findingcitation
Among WHC participants, only those who received case management had significant reductions in heavy episodic drinking.
“only participants who received case management had significant reductions in heavy episodic drinking and cannabis use”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [59] Myers B, Carney T, Browne FA, Wechsberg WM (2019) A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study. BMJ Open 9:1–11. https://doi.org/10.1136/bmjopen-2018-024776 source
- Findingcitation
WHC participants had a significant reduction in PTSD symptoms from 32.9 to 21.7 at 3 months.
“PTSD symptoms (reduced from 32.9 to 21.7, t=9.4 [df=55], p<0.0001)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [59] Myers B, Carney T, Browne FA, Wechsberg WM (2019) A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study. BMJ Open 9:1–11. https://doi.org/10.1136/bmjopen-2018-024776 source
- Findingcitation
Three large studies found a history of abuse, particularly physical abuse, associated with faster relapse or greater persistence of substance use after treatment.
“Three large studies found history of abuse, particularly physical abuse, associated with faster relapse or greater persistence of SU after treatment [67–69].”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [67] Davis JP, Christie NC, Dworkin ER et al (2020) Influences of victimization and comorbid conditions on latency to illicit drug use among adolescents and young adults. Drug Alcohol Depend 206: 107721. https://doi.org/10.1016/j.drugalcdep.2019.107721 source
The Methods report a large sample of 5,956 adolescents and young adults in treatment for illicit drug use. The Results (Aim 2) associate high physical abuse with a faster return to use among males, supporting the relapse portion of the claim. But the association varied by gender and victimization profile, and sexual abuse—not physical abuse—had the highest hazard among males; this paper does not support emphasizing physical abuse as the principal finding. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [68] Grella CE, Joshi V (2003) Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. Child Maltreat 8:7–18. https://doi.org/10.1177/1077559502239610 source
- cites [69] Shane P, Diamond GS, Mensinger JL et al (2006) Impact of victimization on substance abuse treatment outcomes for adolescents in outpatient and residential substance abuse treatment. Am J Addict 15:s34–s42. https://doi.org/10.1080/10550490601003714 source
- Findingcitation
In the Voices trial, both intervention and control groups showed significant improvement over time in delinquent behaviors.
“Both groups had significant improvements over time in SU consequences, PTSD symptoms, general psychiatric symptoms, and delinquent behaviors, with no significant between-group differences.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [63] Tolou-Shams M, Dauria EF, Folk J et al (2021) VOICES: an efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history. Drug Alcohol Depend 228. https://doi.org/10.1016/j.drugalcdep.2021.108934 source
- Findingcitation
WHC participants had significant reductions in cannabis use from baseline to 3 months.
“significant improvements from baseline to 3-months in SU (37–51% reductions in heavy episodic drinking, methamphetamine use, cannabis use)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [59] Myers B, Carney T, Browne FA, Wechsberg WM (2019) A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study. BMJ Open 9:1–11. https://doi.org/10.1136/bmjopen-2018-024776 source
- Findingcitation
Among adolescents receiving community-based treatment for illicit substance use disorders, polyvictimization was associated with faster relapse among girls.
“polyvictimization was associated with faster relapse among girls”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [67] Davis JP, Christie NC, Dworkin ER et al (2020) Influences of victimization and comorbid conditions on latency to illicit drug use among adolescents and young adults. Drug Alcohol Depend 206: 107721. https://doi.org/10.1016/j.drugalcdep.2019.107721 source
The Discussion reports that females in the high-victimization class had a higher hazard of relapse than females in the low-victimization class, supporting the cited sentence’s central point. But Methods > Participants and procedures describes a sample aged 12–29 and says treatment type varied by site; it does not establish the narrower claim that the finding was specifically among adolescents receiving community-based treatment. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Findingcitation
In the Voices trial, both intervention and control groups showed significant improvement over time in PTSD symptoms.
“Both groups had significant improvements over time in SU consequences, PTSD symptoms, general psychiatric symptoms, and delinquent behaviors, with no significant between-group differences.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [63] Tolou-Shams M, Dauria EF, Folk J et al (2021) VOICES: an efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history. Drug Alcohol Depend 228. https://doi.org/10.1016/j.drugalcdep.2021.108934 source
- Findingcitation
In the Voices trial, both intervention and control groups showed significant improvement over time in general psychiatric symptoms.
“Both groups had significant improvements over time in SU consequences, PTSD symptoms, general psychiatric symptoms, and delinquent behaviors, with no significant between-group differences.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [63] Tolou-Shams M, Dauria EF, Folk J et al (2021) VOICES: an efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history. Drug Alcohol Depend 228. https://doi.org/10.1016/j.drugalcdep.2021.108934 source
- Findingcitation
WHC participants had a significant reduction in probable depression from 85.7% to 53.6% at 3 months.
“depression (proportion with probable depression reduced from 85.7% to 53.6% χ2=3.94 [df=1], p=0.047)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [59] Myers B, Carney T, Browne FA, Wechsberg WM (2019) A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study. BMJ Open 9:1–11. https://doi.org/10.1136/bmjopen-2018-024776 source
- Findingcitation
Among WHC participants, only those who received case management had significant reductions in cannabis use.
“only participants who received case management had significant reductions in heavy episodic drinking and cannabis use”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [59] Myers B, Carney T, Browne FA, Wechsberg WM (2019) A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study. BMJ Open 9:1–11. https://doi.org/10.1136/bmjopen-2018-024776 source
- Findingcitation
WHC participants had significant reductions in methamphetamine use from baseline to 3 months.
“significant improvements from baseline to 3-months in SU (37–51% reductions in heavy episodic drinking, methamphetamine use, cannabis use)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [59] Myers B, Carney T, Browne FA, Wechsberg WM (2019) A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study. BMJ Open 9:1–11. https://doi.org/10.1136/bmjopen-2018-024776 source
- Interpretationreasoning
The review's findings extend prior systematic reviews of interventions for adolescents with substance use co-occurring with other mental health problems and reviews of trauma/substance use interventions focused on adults.
“Our findings extend prior systematic review findings focusing on outcomes of interventions for adolescents with SU co-occurring with other MH problems [75–79] and reviews of interventions for trauma/SU that focused on adult populations [25, 80].”
Quote in the paperSubstantial claim3 of 7 sources checked- cites [75] Zaso MJ, Park A, Antshel KM (2020) Treatments for adolescents with comorbid ADHD and substance use disorder: a systematic review. J Atten Disord 24:1215–1226. https://doi.org/10.1177/1087054715569280 source
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- cites [77] Özgen H, Spijkerman R, Noack M et al (2021) Treatment of adolescents with concurrent substance use disorder and attention-deficit/hyperactivity disorder: a systematic review. J Clin Med 10:1–37. https://doi.org/10.3390/jcm10173908 source
- cites [78] Salvo N, Bennett K, Cheung A et al (2012) Prevention of substance use in children/adolescents with mental disorders: a systematic review. J Can Acad Child Adolesc Psychiatry 21:245–252
- cites [79] Deady M, Teesson M, Kay-Lambkin FJ (2014) Treatments for co-occurring depression and substance use in young people: a systematic review. Curr Drug Abuse Rev 7:3–17. https://doi.org/10.2174/1874473707666141015220608 source
- cites [25] Roberts NP, Roberts PA, Jones N, Bisson JI (2015) Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: a systematic review and meta-analysis. Clin Psychol Rev 38:25–38. https://doi.org/10.1016/j.cpr.2015.02.007 source
- cites [80] Torchalla I, Nosen L, Rostam H, Allen P (2012) Integrated treatment programs for individuals with concurrent substance use disorders and trauma experiences: a systematic review and meta-analysis. J Subst Abuse Treat 42:65–77. https://doi.org/10.1016/j.jsat.2011.09.001 source
- Findingcitation
Family therapy was superior to treatment as usual, particularly among youth with a history of abuse.
“and superior to TAU control, particularly among youth with a history of abuse [72].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [72] Slesnick N, Prestopnik JL (2005) Ecologically based family therapy outcome with substance abusing runaway adolescents. J Adolesc 28:277–298. https://doi.org/10.1016/j.adolescence.2005.02.008 source
- Findingcitation
The most effective preventive interventions identified, Middle School Success and expanded foster care, targeted prosocial skills and/or parenting quality.
“The most effective preventive interventions identified, Middle School Success and expanded foster care, targeted prosocial skills and/or parenting quality [42, 65].”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [42] Kim HK, Leve LD (2011) Substance use and delinquency among middle school girls in foster care: a three-year follow-up of a randomized controlled trial. J Consult Clin Psychol 79:740–750. https://doi.org/10.1037/a0025949 source
- cites [65] Kessler RC, Pecora PJ, Williams J et al (2008) Effects of enhanced foster care on the long-term physical and mental health of foster care alumni. Arch Gen Psychiatry 65:625–633. https://doi.org/10.1001/archpsyc.65.6.625 source
- Findingcitation
Two randomized controlled trials found family therapy equally effective at reducing substance use and improving family functioning among runaway youth with a history of abuse compared with youth without an abuse history.
“Two RCTs (n=124, n=242) found family therapy equally effective at reducing SU and improving family functioning among runaway youth with a history of abuse (compared to youth without abuse history) [73]”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [73] Slesnick N, Bartle-Haring S, Gangamma R (2006) Predictors of substance use and family therapy outcome among physically and sexually abused runaway adolescents. J Marital Fam Ther 32:261–281. https://doi.org/10.1111/j.1752-0606.2006.tb01606.x source
The Method section (page unavailable) says the paper pooled data from two randomized treatment studies. The Abstract and Discussion (pages unavailable) report similar substance-use reductions and improvement in family outcomes for abused and nonabused runaway adolescents receiving family therapy. The paper presents this as a pooled finding, not a separate finding from each trial, and the cited sample sizes of 124 and 242 are not established by the retrieved passages. (LLM, conf=0.85)
Experimental — accuracy not yet measured
- Premisecitation
A recent systematic review of 50 epidemiologic studies identified externalizing behavior, anger, use of substances to regulate emotions, PTSD symptoms, affiliation with peers who use substances, and parenting quality as consistently significant mediating factors linking childhood adversity to adolescent substance use problems.
“A recent systematic review of 50 epidemiologic studies linking childhood adversity to adolescent SU problems identified externalizing behavior, anger, use of substances to regulate emotions, PTSD symptoms, affiliation with peers who use substances, and parenting quality as consistently significant mediating factors [18].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [18] Grummitt L, Kelly E, Barrett E et al (2021) Targets for intervention to prevent substance use in young people exposed to childhood adversity: a systematic review. PLoS ONE 16:1–29. https://doi.org/10.1371/journal.pone.0252815 source
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
- Findingown data
Twenty studies, including 10 randomized controlled trials, evaluated interventions for substance use and co-occurring problems in youth with a trauma history.
“Twenty studies (10 RCTs) evaluated interventions for substance use and co-occurring problems among youth with a history of trauma”
Quote in the paperSubstantial claim - Findingcitation
The MBCT-dual trial found depression symptoms decreased from a mean of 24.09 to 18.35.
“and depression (M=24.09 to 18.35, t(22)=3.11, p<0.01)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [56] Fortuna LR, Porche MV, Padilla A (2018) A treatment development study of a cognitive and mindfulness-based therapy for adolescents with co-occurring post-traumatic stress and substance use disorder. Psychol Psychother Theory Res Pract 91:42–62. https://doi.org/10.1111/papt.12143 source
- Findingcitation
In the MBCT-dual single-arm trial, cannabis use fell from 16% of days to 9% at end of treatment.
“results indicated modest but clinically significant improvements in cannabis use (reduced from 16% of days to 9% at end of treatment, t(18)=2.63, p<0.05)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [56] Fortuna LR, Porche MV, Padilla A (2018) A treatment development study of a cognitive and mindfulness-based therapy for adolescents with co-occurring post-traumatic stress and substance use disorder. Psychol Psychother Theory Res Pract 91:42–62. https://doi.org/10.1111/papt.12143 source
- Findingcitation
Participants in the Stepped Collaborative Care intervention group had significantly less weapon carrying one year after injury.
“Participants in the intervention group did have significantly reduced weapon carrying one year after injury.”
Quote in the paperNot a substantial claim - Findingcitation
At 3-month post-treatment follow-up, Seeking Safety was significantly associated with better outcomes on 7 of 10 substance use scales, with medium to large effect sizes.
“at follow-up 3-months post-treatment, SS was significantly associated with better outcomes for 7 of 10 SU scales with medium to large effect sizes (Cohen’s d ranged from 0.37 to 1.17).”
Quote in the paperSubstantial claim - Findingcitation
The MBCT-dual trial found PTSD symptoms decreased from a mean of 26.13 to 17.86.
“reduction in symptoms of PTSD (from M=26.13 to 17.86, t(22)=3.95, p<0.01)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [56] Fortuna LR, Porche MV, Padilla A (2018) A treatment development study of a cognitive and mindfulness-based therapy for adolescents with co-occurring post-traumatic stress and substance use disorder. Psychol Psychother Theory Res Pract 91:42–62. https://doi.org/10.1111/papt.12143 source
- Findingcitation
In a randomized trial, young men receiving Mode Deactivation Therapy had significantly greater improvements than those receiving standard CBT on substance use risk factors, including anger expression and behavior problems, with large effects.
“Youth who received MDT, which is based on elements of CBT (analysis of triggers, thoughts, feelings, and behaviors), dialectical-behavioral therapy (DBT) (mindfulness), and acceptance-commitment therapy (ACT) (acceptance), in weekly individual sessions over 6–8 months, had significant improvements with large effects compared to youth receiving standard CBT on measures of SU risk factors, including”
Quote in the paperSubstantial claim - Findingcitation
The MBCT-dual trial found no change in alcohol use.
“no changes in alcohol”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [56] Fortuna LR, Porche MV, Padilla A (2018) A treatment development study of a cognitive and mindfulness-based therapy for adolescents with co-occurring post-traumatic stress and substance use disorder. Psychol Psychother Theory Res Pract 91:42–62. https://doi.org/10.1111/papt.12143 source
- Findingcitation
In a quasi-experimental study, maltreated mid-adolescents assigned to enhanced foster care were significantly less likely than those in usual foster care to meet criteria for SUD, depression, or anxiety several years later, with large effects.
“In a quasi-experimental study, mid-adolescents (ages 14–18) with a history of maltreatment who were assigned to enhanced foster care (e.g., caseworkers and parents were provided additional resources, leading to more stable placements), compared with usual foster care, were significantly less likely to meet criteria for a SUD (Cohen’s d=0.78), depression (Cohen’s d=0.95), or anxiety (Cohen’s d=0.91”
Quote in the paperSubstantial claim - Findingcitation
Two studies found early attrition from residential and inpatient programs was significantly related to a history of trauma, but not to PTSD.
“Two studies found early attrition from residential [45] and inpatient [33] programs significantly related to history of trauma, but not PTSD.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [45] Jaycox LH, Ebener P, Damesek L, Becker K (2004) Trauma exposure and retention in adolescent substance abuse treatment. J Trauma Stress 17:113–121. https://doi.org/10.1023/B:JOTS.0000022617.41299.39 source
- cites [33] Yildiz D, Ciftci A, Yalcin O (2020) The association between trauma history, trauma-related psychopathology and treatment completion at an adolescent inpatient substance abuse treatment center in Turkey. J Child Adolesc Subst Abus 29:58–67. https://doi.org/10.1080/1067828X.2020.1837319 source
- Findingcitation
BEAR participants and clinicians reported significant improvement in trauma-related distress.
“and trauma-related distress”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [64] Freedle LR, Altschul DB, Freedle A (2015) The role of sandplay therapy in the treatment of adolescents and young adults with co-occurring substance use disorders and trauma. J Sandplay Ther 24:127–145 source
- Findingcitation
Good counselor rapport was significantly associated with improved abstinence among youth who had experienced physical abuse.
“good counselor rapport was significantly associated with improved abstinence among youth who had experienced physical abuse”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [68] Grella CE, Joshi V (2003) Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. Child Maltreat 8:7–18. https://doi.org/10.1177/1077559502239610 source
- Findingcitation
Turning the Tides participants had significant improvement in avoidance symptoms.
“avoidance (−3.82, p=0.03)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [61] Bougard KG, Laupola TMT, Parker-Dias J et al (2016) Turning the tides: coping with trauma and addiction through residential adolescent group therapy. J Child Adolesc Psychiatr Nurs 29:196–206. https://doi.org/10.1111/jcap.12164 source
- Findingcitation
Females with high-severity victimization in residential treatment had greater persistence of substance use problems after discharge.
“females with high-severity victimization in residential treatment had greater persistence of SU problems after discharge”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [69] Shane P, Diamond GS, Mensinger JL et al (2006) Impact of victimization on substance abuse treatment outcomes for adolescents in outpatient and residential substance abuse treatment. Am J Addict 15:s34–s42. https://doi.org/10.1080/10550490601003714 source
- Findingcitation
BEAR participants and clinicians reported significant improvement in severity of substance use problems, with the clinician-rated substance use subscale falling from 2.39 to 1.48.
“participants and clinicians reported significant improvements in severity of SU problems (clinician-rated SU subscale reduced from 2.39 to 1.48, p=0.001)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [64] Freedle LR, Altschul DB, Freedle A (2015) The role of sandplay therapy in the treatment of adolescents and young adults with co-occurring substance use disorders and trauma. J Sandplay Ther 24:127–145 source
- Findingcitation
In a study of youth admitted to outpatient and residential programs mostly for marijuana use, females generally had greater histories of victimization than male peers.
“females generally had greater histories of victimization than male peers”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [69] Shane P, Diamond GS, Mensinger JL et al (2006) Impact of victimization on substance abuse treatment outcomes for adolescents in outpatient and residential substance abuse treatment. Am J Addict 15:s34–s42. https://doi.org/10.1080/10550490601003714 source
- Findingown data
After one year, Runaway Intervention Project participants' current alcohol or drug use decreased from 90% to 20%.
“After one-year, current alcohol or drug use had decreased from 90% to 20%”
Quote in the paperNot a substantial claim - Findingcitation
Physical abuse, but not other forms of abuse, was associated with lower rates of post-treatment abstinence.
“Physical abuse, but not other forms of abuse, was associated with lower rates of post-treatment abstinence”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [68] Grella CE, Joshi V (2003) Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. Child Maltreat 8:7–18. https://doi.org/10.1177/1077559502239610 source
- Findingcitation
Turning the Tides participants had significant improvement in PTSD symptoms from baseline to end of treatment.
“participants had significant improvements in PTSD symptoms (compared to baseline) (−1.82, p=0.02)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [61] Bougard KG, Laupola TMT, Parker-Dias J et al (2016) Turning the tides: coping with trauma and addiction through residential adolescent group therapy. J Child Adolesc Psychiatr Nurs 29:196–206. https://doi.org/10.1111/jcap.12164 source
- Findingcitation
One study found emotional abuse and neglect associated with early attrition, but not physical or sexual abuse.
“One study particularly found emotional abuse and neglect associated with early attrition, but not physical or sexual abuse [33].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [33] Yildiz D, Ciftci A, Yalcin O (2020) The association between trauma history, trauma-related psychopathology and treatment completion at an adolescent inpatient substance abuse treatment center in Turkey. J Child Adolesc Subst Abus 29:58–67. https://doi.org/10.1080/1067828X.2020.1837319 source
- Findingown data
Thirteen studies compared substance use treatment outcomes between youth with a history of victimization and/or PTSD symptoms and youth without such histories.
“Thirteen studies examined how SU treatment outcomes among youth with a history of victimization and/or PTSD symptoms differ from outcomes among youth without histories of victimization”
Quote in the paperSubstantial claim - Findingcitation
A third study found no differences in treatment completion rates among youth with a history of abuse.
“a third study of youth in intensive SU treatment (e.g., inpatient or intensive day programs), found no differences in treatment completion rates among youth with a history of abuse [43].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [43] Blood L, Cornwall A (1996) Childhood sexual victimization as a factor in the treatment of substance misusing adolescents. Subst Use Misuse 31:1015–1039. https://doi.org/10.3109/10826089609072285 source
- Findingcitation
Turning the Tides participants had no change in re-experiencing symptoms.
“but no change in re-experiencing symptoms”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [61] Bougard KG, Laupola TMT, Parker-Dias J et al (2016) Turning the tides: coping with trauma and addiction through residential adolescent group therapy. J Child Adolesc Psychiatr Nurs 29:196–206. https://doi.org/10.1111/jcap.12164 source
- Findingcitation
Turning the Tides participants had significant improvement in functional impairment.
“functional impairment (−8.27, p=0.02)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [61] Bougard KG, Laupola TMT, Parker-Dias J et al (2016) Turning the tides: coping with trauma and addiction through residential adolescent group therapy. J Child Adolesc Psychiatr Nurs 29:196–206. https://doi.org/10.1111/jcap.12164 source
- Findingcitation
Turning the Tides participants had significant improvement in hyperarousal symptoms.
“and hyperarousal (−2.82, p=0.01)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [61] Bougard KG, Laupola TMT, Parker-Dias J et al (2016) Turning the tides: coping with trauma and addiction through residential adolescent group therapy. J Child Adolesc Psychiatr Nurs 29:196–206. https://doi.org/10.1111/jcap.12164 source
- Findingcitation
In BEAR focus groups, youth spoke positively about the sandplay component.
“In focus groups youth spoke positively of the sandplay component.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [64] Freedle LR, Altschul DB, Freedle A (2015) The role of sandplay therapy in the treatment of adolescents and young adults with co-occurring substance use disorders and trauma. J Sandplay Ther 24:127–145 source
- Findingnone given
Victimization, particularly physical abuse, has also been repeatedly associated with earlier post-treatment relapse and persistence of substance use after treatment.
“Victimization, particularly physical abuse, has also been repeatedly associated with earlier post-treatment relapse and persistence of SU after treatment.”
Quote in the paperSubstantial claim - Findingcitation
One study found youth with high levels of victimization had better substance use frequency and problem outcomes in residential treatment than in outpatient treatment, even though both settings addressed victimization similarly.
“youth with high levels of victimization had better SU frequency and problem outcomes in residential treatment than outpatient treatment, even though both treatment settings addressed victimization similarly”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [44] Funk RR, McDermeit M, Godley SH, Adams L (2003) Maltreatment issues by level of adolescent substance abuse treatment: the extent of the problem at intake and relationship to early outcomes. Child Maltreat 8:36–45. https://doi.org/10.1177/1077559502239607 source
- Findingnone given
Three other interventions combined case management with either group therapy focused on psychoeducation and empowerment (Project Chrysalis, Runaway Intervention Program) or motivational interviewing and CBT (Stepped Collaborative Care), with positive but modest outcomes.
“Three other interventions combined case management with either group therapy focused on psychoeducation and empowerment (Project Chrysalis, Runaway Intervention Program), or motivational interviewing and CBT (Stepped Collaborative Care), with positive but modest outcomes.”
Quote in the paperNot a substantial claim - Findingnone given
MDT, an intensive skills-based treatment, had large effects on substance use risk factors such as anger.
“MDT, also an intensive skills-based treatment had large effects on SU risk factors (e.g., anger) but its long-term effects on SU remain to be studied.”
Quote in the paperSubstantial claim - Findingnone given
A history of abuse, but not PTSD symptoms, was found to be associated with early attrition in several studies.
“A history of abuse, but not PTSD symptoms, was found to be associated with early attrition in several studies.”
Quote in the paperSubstantial claim - Findingown data
All early interventions examined were fairly intensive, with 7 of 8 including more than 20 sessions over a number of months.
“All EIs examined were fairly intensive, with 7/8 including >20 sessions over a number of months.”
Quote in the paperSubstantial claim - Findingcitation
Youth with high traumatic stress had higher overall levels of use and substance use-related problems at all measurement points.
“youth with high traumatic stress had higher overall levels of use and SU-related problems at all measurement points [21]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [21] Williams JK, Smith DC, An H, Hall JA (2008) Clinical outcomes of traumatized youth in adolescent substance abuse treatment: a longitudinal multisite study. J Psychoactive Drugs 40:77–84. https://doi.org/10.1080/02791072.2008.10399763 source
- Findingcitation
In a study of mentoring as an adjunct to the community reinforcement approach among homeless youth, youth with a history of abuse attended more mentoring sessions.
“youth with a history of abuse attended more mentoring sessions [71].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [71] Bartle-Haring S, Slesnick N, Collins J et al (2012) The utility of mentoring homeless adolescents: a pilot study. Am J Drug Alcohol Abuse 38:350–358. https://doi.org/10.3109/00952990.2011.643985 source
- Findingnone given
The other individual therapy trials for this population, SS and MBCT-dual, had more modest outcomes.
“The other individual therapy trials for this population (SS and MBCT-dual) had more modest outcomes.”
Quote in the paperSubstantial claim - Findingcitation
In the same study, youth without a history of significant victimization had similar outcomes in both levels of care.
“while youth without a history of significant victimization had similar outcomes in both levels of care [44].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [44] Funk RR, McDermeit M, Godley SH, Adams L (2003) Maltreatment issues by level of adolescent substance abuse treatment: the extent of the problem at intake and relationship to early outcomes. Child Maltreat 8:36–45. https://doi.org/10.1177/1077559502239607 source
- Findingnone given
All existing group interventions have focused exclusively on girls or young women.
“Additionally, all existing group interventions have focused exclusively on girls/young women—group interventions tailored to boys/young men remain an important area needing attention.”
Quote in the paperSubstantial claim - Findingnone given
Only a few studies described a focus on family functioning, despite the strong focus on this process in both the childhood trauma and adolescent substance use treatment literatures.
“Only a few studies described focus on family functioning, despite the strong focus on this process in both the childhood trauma and adolescent SUD treatment literatures.”
Quote in the paperNot a substantial claim - Findingnone given
Only one intervention, Mode Deactivation Therapy, focused exclusively on males.
“Only one intervention, Mode Deactivation Therapy, focused exclusively on males.”
Quote in the paperNot a substantial claim - Findingnone given
Numerous promising interventions for substance use in youth with a history of trauma have been developed in recent years.
“Numerous promising interventions for SU in youth with a history of trauma have been developed in recent years.”
Quote in the paperSubstantial claim - Premisecitation
TF-CBT is a leading evidence-based treatment for PTSD and other trauma-related problems in children and adolescents.
“Trauma-focused cognitive-behavioral therapy (TF-CBT) is a leading evidence-based treatment for PTSD and other trauma-related problems in childhood and adolescence [26]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [26] Leenarts LEW, Diehle J, Doreleijers TAH et al (2013) Evidence-based treatments for children with trauma-related psychopathology as a result of childhood maltreatment: a systematic review. Eur Child Adolesc Psychiatry 22:269–283. https://doi.org/10.1007/s00787-012-0367-5 source
- Premisecitation
Insecurely attached youth tend to have greater post-traumatic distress because they use avoidant problem-solving under stress.
“Youth with insecure attachment are prone to greater post-traumatic distress, as when faced with stress they tend towards avoidant problem-solving”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Cohen JA, Mannarino AP, Zhitova AC, Capone ME (2003) Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abus Negl 27:1345–1365. https://doi.org/10.1016/j.chiabu.2003.08.001 source
- Premisecitation
The association between childhood trauma and SUDs is especially strong in girls.
“Relationships between childhood trauma and SUDs are particularly strong among girls [17].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] Simpson TL, Miller WR (2002) Concomitance between childhood sexual and physical abuse and substance use problems: a review. Clin Psychol Rev 22:27–77. https://doi.org/10.1016/S0272-7358(00)00088-X source
- Premisenone given
TF-CBT does not focus on substance use.
“but it does not focus on SU”
Quote in the paperSubstantial claim - Premisecitation
Youth with co-occurring substance use problems may respond less well to TF-CBT than youth without such problems.
“Youth with co-occurring SU problems may not respond as well to TF-CBT as youth without SU problems [27].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [27] Joiner VC, Buttell FP (2018) Investigating the usefulness of trauma-focused cognitive behavioral therapy in adolescent residential care. J Evidence Inf Soc Work 15:457–472. https://doi.org/10.1080/23761407.2018.1474155 source
- Premisecitation
Some traditional substance use treatments may worsen traumatic distress by reproducing abusive dynamics.
“Some traditional SU treatment approaches (e.g., asking clients to accept fault, blame, and powerlessness) may exacerbate traumatic distress by replicating the dynamics of abusive situations [21].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [21] Williams JK, Smith DC, An H, Hall JA (2008) Clinical outcomes of traumatized youth in adolescent substance abuse treatment: a longitudinal multisite study. J Psychoactive Drugs 40:77–84. https://doi.org/10.1080/02791072.2008.10399763 source
- Study design and conductown data
The Seeking Safety study was rated moderate quality, limited by unclear selection bias and moderate follow-up rates.
“Study quality was moderate, limited by unclear selection bias and moderate follow-up rates.”
Quote in the paperNot a substantial claim - Study design and conductown data
The Mode Deactivation Therapy study was rated weak, limited by lack of long-term follow-up with direct substance use measures after residential treatment and other methodological problems.
“However, the study quality was weak, limited by lack of long-term follow-up, such as direct measures of SU after leaving the residential setting, and other methodological limitations.”
Quote in the paperNot a substantial claim - Premisecitation
Earlier systematic reviews of SUD and PTSD treatments have mostly examined adults.
“Prior systematic reviews of treatments for SUDs and PTSD have focused largely on the treatment of adults [25].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [25] Roberts NP, Roberts PA, Jones N, Bisson JI (2015) Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: a systematic review and meta-analysis. Clin Psychol Rev 38:25–38. https://doi.org/10.1016/j.cpr.2015.02.007 source
- Study design and conductcitation
Validated study-type filters were used to restrict results to experimental and observational studies.
“Validated study-type filters were also applied to limit results to experimental and observational studies [39, 40].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [39] Harvard Countway Library (2021) Filters for non-randomized and observational designs. In: Systematic reviews and meta analysis. https://guides.library.harvard.edu/c.php?g=309982&p=2079546. Accessed Feb 14 2022
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [40] Harvard Countway Library (2022) Filters for controlled trials. In: Systematic reviews and meta analysis. https://guides.library.harvard.edu/c.php?g=309982&p=2079545. Accessed Feb 14 2022
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Several narrative reviews have offered guidance on treating adolescents with substance use and trauma.
“Although several narrative reviews have provided guidance about treatment of adolescents with SU and trauma [19, 36]”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [19] Cohen JA, Mannarino AP, Zhitova AC, Capone ME (2003) Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abus Negl 27:1345–1365. https://doi.org/10.1016/j.chiabu.2003.08.001 source
- cites [36] Cabanis M, Outadi A, Choi F (2021) Early childhood trauma, substance use and complex concurrent disorders among adolescents. Curr Opin Psychiatry 34:393–399. https://doi.org/10.1097/YCO.0000000000000718 source
- Study design and conductown data
The MBCT-dual study was rated weak in overall quality because of design and retention limitations.
“Overall quality was weak, due to limitations in design and retention.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [56] Fortuna LR, Porche MV, Padilla A (2018) A treatment development study of a cognitive and mindfulness-based therapy for adolescents with co-occurring post-traumatic stress and substance use disorder. Psychol Psychother Theory Res Pract 91:42–62. https://doi.org/10.1111/papt.12143 source
- Interpretationnone given
To the authors' knowledge, this is the first systematic review of intervention studies in adolescents with trauma and substance use.
“to our knowledge this is the first systematic review of the intervention literature in adolescents”
Quote in the paperSubstantial claim - Study design and conductown data
The Bounce Back Now study was rated weak overall because of low response rates.
“Overall quality was weak due to low response rates.”
Quote in the paperNot a substantial claim - Premisecitation
In most parts of the world, there is a lack of effective prevention, early intervention, or treatment programs for youth with co-occurring trauma and substance use.
“the lack of effective prevention, early intervention, or treatment programs for youth with co-occurring trauma and SU in most parts of the world [36]”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [36] Cabanis M, Outadi A, Choi F (2021) Early childhood trauma, substance use and complex concurrent disorders among adolescents. Curr Opin Psychiatry 34:393–399. https://doi.org/10.1097/YCO.0000000000000718 source
- Premisecitation
Youth with co-occurring trauma-related problems have higher dropout from some SUD treatment programs.
“Youth with co-occurring trauma-related problems have also been found to have higher attrition from some SUD treatment programs [33].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [33] Yildiz D, Ciftci A, Yalcin O (2020) The association between trauma history, trauma-related psychopathology and treatment completion at an adolescent inpatient substance abuse treatment center in Turkey. J Child Adolesc Subst Abus 29:58–67. https://doi.org/10.1080/1067828X.2020.1837319 source
- Study design and conductown data
The RRFT pilot randomized trial was rated moderate quality, limited by some baseline group differences and dosage differences.
“Study quality was moderate, limited by some group differences in baseline characteristics and dosage.”
Quote in the paperNot a substantial claim - Study design and conductown data
Because of methodological heterogeneity, the authors could not perform a quantitative meta-analysis.
“Methodological heterogeneity precluded quantitative meta-analysis.”
Quote in the paperSubstantial claim - Premisecitation
Evidence for effective medication treatment of trauma-related disorders in children and adolescents is still very limited.
“Evidence for effective pharmacologic treatment of trauma-related disorders in children/adolescents remains very limited”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [30] Huemer J, Erhart F, Steiner H (2010) Posttraumatic stress disorder in children and adolescents: a review of psychopharmacological treatment. Child Psychiatry Hum Dev 41:624–640. https://doi.org/10.1007/s10578-010-0192-3 source
- Study design and conductown data
The BEAR study was rated weak in quality because of a small sample and unclear selection bias, completion, and follow-up.
“Although study quality is weak, with a small sample, unclear selection bias, completion, and follow-up”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [64] Freedle LR, Altschul DB, Freedle A (2015) The role of sandplay therapy in the treatment of adolescents and young adults with co-occurring substance use disorders and trauma. J Sandplay Ther 24:127–145 source
- Interpretationcitation
Creative and expressive therapies may help improve engagement in intensive substance use disorder programs among youth with a history of trauma.
“it suggests that creative/expressive therapies may help improve engagement in intensive SUD programs among youth with a history of trauma.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [64] Freedle LR, Altschul DB, Freedle A (2015) The role of sandplay therapy in the treatment of adolescents and young adults with co-occurring substance use disorders and trauma. J Sandplay Ther 24:127–145 source
- Study design and conductcitation
Substance use after treatment was not assessed in the Turning the Tides study because of the restricted setting.
“SU after treatment was not assessed due to the restricted setting.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [61] Bougard KG, Laupola TMT, Parker-Dias J et al (2016) Turning the tides: coping with trauma and addiction through residential adolescent group therapy. J Child Adolesc Psychiatr Nurs 29:196–206. https://doi.org/10.1111/jcap.12164 source
- Study design and conductown data
There are relatively few high-quality randomized controlled trials evaluating these interventions.
“First, there are relatively few high-quality RCTs evaluating these interventions.”
Quote in the paperSubstantial claim - Interpretationreasoning
Early interventions for substance use in the context of trauma remain underdeveloped.
“Early interventions (EI) for SU in the context of trauma remain underdeveloped.”
Quote in the paperSubstantial claim - Premisereasoning
Implementation of integrated treatment programs for trauma and substance use disorders faces several barriers.
“Implementation of integrated treatment programs for trauma and SUDs faces several barriers.”
Quote in the paperSubstantial claim - Interpretationnone given
This review is the first, to the authors' knowledge, to systematically review interventions for prevention and treatment of substance use in adolescents aged 10-25 following trauma exposure.
“This is the first study, to our knowledge, to systematically review the existing body of research on interventions for prevention and treatment of SU in adolescents (ages 10–25) following exposure to trauma”
Quote in the paperSubstantial claim - Interpretationcitation
Mentoring may be a useful adjunct to other substance use treatment for homeless youth with histories of abuse.
“suggesting that mentoring may be a useful adjunct to other SU treatment for homeless youth with histories of abuse.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [71] Bartle-Haring S, Slesnick N, Collins J et al (2012) The utility of mentoring homeless adolescents: a pilot study. Am J Drug Alcohol Abuse 38:350–358. https://doi.org/10.3109/00952990.2011.643985 source
- Study design and conductnone given
In the comparison studies, exact treatment components were not well delineated.
“In these studies, exact treatment components were not well delineated.”
Quote in the paperNot a substantial claim - Interpretationreasoning
Group CBT interventions paired with individualized case management appear to be a promising scalable alternative to intensive individual therapies.
“Group CBT interventions when paired with individualized case management appear to be a promising scalable alternative to intensive individual therapies.”
Quote in the paperSubstantial claim - Interpretationcitation
Girls with a high history of victimization may need additional ongoing clinical attention to maintain treatment gains after substance use treatment.
“suggesting girls with high history of victimization may need additional ongoing clinical attention to maintain treatment gains after SU treatment [69].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [69] Shane P, Diamond GS, Mensinger JL et al (2006) Impact of victimization on substance abuse treatment outcomes for adolescents in outpatient and residential substance abuse treatment. Am J Addict 15:s34–s42. https://doi.org/10.1080/10550490601003714 source
- Premisereasoning
A variety of mechanisms linking trauma to the development of substance use disorders have been identified.
“A variety of mechanisms linking trauma to the development of SUDs have been identified.”
Quote in the paperNot a substantial claim
- May combine two claims. 96
- Classified as probably not a substantial claim. 20
- The quote only partly states this claim. 1
May combine two claims.
FindingcitationReported adverse effects included no adverse events in RRFT, discomfort in the group format of WHC due to privacy and stigma concerns, and increased use of as-needed medication following the residential-based Turning the Tides group intervention.
“these included no adverse events in RRFT [29], discomfort in group format of WHC due to concerns about privacy and stigma [59], and increased use of as needed medication following the residential-based Turning the Tides group intervention [61].”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [29] Danielson CK, Adams Z, McCart MR et al (2020) Safety and efficacy of exposure-based risk reduction through family therapy for co-occurring substance use problems and posttraumatic stress disorder symptoms among adolescents: a randomized clinical trial. JAMA Psychiat 77:574–586. https://doi.org/10.1001/jamapsychiatry.2019.4803 source
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [59] Myers B, Carney T, Browne FA, Wechsberg WM (2019) A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study. BMJ Open 9:1–11. https://doi.org/10.1136/bmjopen-2018-024776 source
Split into 2 atoms — 1 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured - cites [61] Bougard KG, Laupola TMT, Parker-Dias J et al (2016) Turning the tides: coping with trauma and addiction through residential adolescent group therapy. J Child Adolesc Psychiatr Nurs 29:196–206. https://doi.org/10.1111/jcap.12164 source
May combine two claims.
PremisecitationPotentially traumatic childhood experiences are common, and most adolescents have had at least one.
“Exposure to potentially traumatic experiences in childhood is common, with a majority of adolescents having experienced at least one potentially traumatic event [1–3].”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [1] McLaughlin KA, Koenen KC, Hill ED et al (2013) Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. J Am Acad Child Adolesc Psychiatry 52. https://doi.org/10.1016/j.jaac.2013.05.011 source
- cites [2] Nooner KB, Linares LO, Batinjane J et al (2012) Factors related to posttraumatic stress disorder in adolescence. Trauma Violence Abus 13:153–166. https://doi.org/10.1177/1524838012447698 source
- cites [3] Kessler RC, McLaughlin KA, Green JG et al (2010) Childhood adversities and adult psychopathology in the WHO world mental health surveys. Br J Psychiatry 197:378–385. https://doi.org/10.1192/bjp.bp.110.080499 source
The Results section reports that childhood adversities were common: 38.4%–39.1% of respondents reported at least one. The paper assessed a defined set of adversities occurring before age 18, not all potentially traumatic events among adolescents; it therefore does not support the claim that a majority of adolescents had experienced one. (LLM, conf=0.88)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationEarly life stress may alter mesocorticolimbic dopamine development and increase later addiction vulnerability.
“early life stress may affect development of the mesocorticolimbic dopamine system, leading to increased vulnerability to addiction later in life [20].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [20] Brady KT, Back SE (2012) Childhood trauma, posttraumatic stress disorder, and alcohol dependence. Alcohol Res 34:408–413 source
Classified as probably not a substantial claim.
PremisecitationIntegrated or at least coordinated simultaneous treatment is recommended for most cases.
“recommending integrated, or at least coordinated simultaneous treatment in most cases [22, 23]”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [22] Ramchand R, Griffin BA, Slaughter ME et al (2014) Do improvements in substance use and mental health symptoms during treatment translate to long-term outcomes in the opposite domain? J Subst Abuse Treat 47:339–346. https://doi.org/10.1016/j.jsat.2014.06.012 source
The Discussion recommends treating both substance-use and mental-health symptoms in an integrated manner and describes treatment planning and care coordination as a possible approach. But the recommendation concerns youth with co-occurring symptoms; the paper does not establish that it applies to most cases generally. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [23] Spencer AE, Valentine SE, Sikov J et al (2021) Principles of care for young adults with co-occurring psychiatric and substance use disorders. Pediatrics 147:S229–S239 source
May combine two claims.
PremisecitationYouth exposed to trauma have higher risk of PTSD, depression, anxiety, and SUDs, even after accounting for individual and family factors.
“youth who experience trauma face particularly elevated risk of developing post-traumatic stress disorder (PTSD), as well as depression, anxiety, and substance use disorders (SUDs), even when adjusting for co-occurring individual and family characteristics [7, 8].”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [7] Thornberry TP, Henry KL, Ireland TO, Smith CA (2010) The causal impact of childhood-limited maltreatment and adolescent maltreatment on early adult adjustment. J Adolesc Heal 46:359–365. https://doi.org/10.1016/j.jadohealth.2009.09.011 source
The Results report higher drug use and drug problems after maltreatment, and higher depressive symptoms after childhood-limited maltreatment; the Methods describe matching and adjustment for individual and family characteristics. The paper studies substantiated maltreatment rather than trauma generally, does not report PTSD or anxiety outcomes, and finds no significant effect of adolescent maltreatment on depressive symptoms. Passages are labeled by section in our copy; page numbers are unavailable. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [8] McLaughlin KA (2016) Future directions in childhood adversity and youth psychopathology. J Clin Child Adolesc Psychol 45:361–382. https://doi.org/10.1080/15374416.2015.1110823 source
The “Childhood Adversity and Psychopathology” section (page unavailable) reports elevated odds of mood, anxiety, and substance-use disorders after childhood adversity, including risk of disorder onset in youth. It does not specifically establish elevated PTSD risk or say that these associations persist after adjustment for co-occurring individual and family characteristics; the adjustment it mentions concerns earlier-onset mental disorders and adult outcomes. (LLM, conf=0.84)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationEvidence-based treatments for co-occurring PTSD and SUDs have developed slowly, and earlier reviews found only a few adolescent studies.
“Evidence-based treatments for co-occurring PTSD/SUDs have been relatively slow to develop, with prior reviews identifying only a couple studies among adolescents [24, 25].”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [24] Peters W, Rice S, Alvarez-Jimenez M et al (2022) Relative efficacy of psychological interventions following interpersonal trauma on anxiety, depression, substance use, and PTSD symptoms in young people: a meta-analysis. Early Interv Psychiatry 1–10. https://doi.org/10.1111/eip.13265 source
The Results (Study characteristics and Results from meta-analysis; page unavailable) identify only two youth intervention studies reporting substance-use outcomes, supporting the point that evidence is sparse. The paper does not say that evidence-based PTSD/SUD treatments developed slowly or that earlier reviews identified only a couple of adolescent studies; the two-study count is from this review. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [25] Roberts NP, Roberts PA, Jones N, Bisson JI (2015) Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: a systematic review and meta-analysis. Clin Psychol Rev 38:25–38. https://doi.org/10.1016/j.cpr.2015.02.007 source
May combine two claims.
FindingcitationIn the RRFT pilot randomized trial, PTSD, depression, and internalizing symptoms decreased more in the RRFT group than in treatment as usual, while externalizing symptoms decreased in both groups.
“PTSD, depression, and internalizing symptoms also reduced for RRFT group compared to TAU, while externalizing symptoms reduced for both groups [51].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [51] Danielson CK, McCart MR, Walsh K et al (2012) Reducing substance use risk and mental health problems among sexually assaulted adolescents: a pilot randomized controlled trial. J Fam Psychol 26:628–635. https://doi.org/10.1037/a0028862 source
The Results (Treatment Outcomes, Mental Health) report greater reductions with RRFT than TAU in parent-reported PTSD and adolescent-reported depression and internalizing symptoms, while externalizing symptoms declined similarly in both groups. The claim leaves PTSD unqualified: adolescent-reported PTSD also declined in both groups, with no significant difference in change between them. The paper also cautions that baseline differences complicate interpretation of the between-group results. (LLM, conf=0.86)
Experimental — accuracy not yet measured
May combine two claims.
Study design and conductown dataThe BBTI study was rated moderate quality, limited by high attrition.
“Quality was moderate, limited by high attrition.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [62] Short NA, Zvolensky MJ, Schmidt NB (2021) A pilot randomized clinical trial of brief behavioral treatment for insomnia to reduce problematic cannabis use among trauma-exposed young adults. J Subst Abuse Treat 131: 108537. https://doi.org/10.1016/j.jsat.2021.108537 source
The Discussion identifies attrition as a study limitation and says it contributed to poor adherence in the BBTI group. The paper does not rate its own quality as moderate; that appears to be the citing authors’ assessment. (LLM, conf=0.88)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationBBTI reduced trauma-related cravings at 3-month follow-up, with Cohen's d of 1.02.
“and trauma-related cravings (Cohen’s d=1.02) at 3-month follow-up”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [62] Short NA, Zvolensky MJ, Schmidt NB (2021) A pilot randomized clinical trial of brief behavioral treatment for insomnia to reduce problematic cannabis use among trauma-exposed young adults. J Subst Abuse Treat 131: 108537. https://doi.org/10.1016/j.jsat.2021.108537 source
The Results (Main hypotheses, Cravings; page not provided) report reduced craving reactivity to trauma imagery with Cohen’s d=1.02. But the Method (Data analysis) says cravings were assessed at baseline and post-treatment, and the Discussion describes the craving finding as one week post-treatment—not at the three-month follow-up. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe review protocol followed PRISMA guidelines and was registered with PROSPERO under ID CRD42022308037.
“The research protocol was developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [38] and registered with the International Prospective Register of Systematic Reviews (PROSPERO; ID# CRD42022308037).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [38] Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses : the PRISMA statement. PLoS ONE 6: e1000097. https://doi.org/10.1371/journal.pmed.1000097 source
May combine two claims.
FindingcitationIn the RRFT pilot with 10 participants, treatment satisfaction was high and outcomes for substance use, PTSD, depression, and ecological functioning were promising, while family functioning outcomes were modest; formal significance testing was not used because of the small sample, and overall study quality was weak.
“In the pilot (n=10), participants had high levels of treatment satisfaction, and promising outcomes for substance use, PTSD, depression, and ecological functioning, although family functioning outcomes were modest; the authors did not use formal significance testing due to the small sample size (weak overall study quality) [50].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [50] Danielson CK, McCart MR, de Arellano MA et al (2010) Risk reduction for substance use and trauma-related psychopathology in adolescent sexual assault victims: findings from an open trial. Child Maltreat 15:261–268. https://doi.org/10.1177/1077559510367939 source
May combine two claims.
PremisecitationAdolescent SUD treatments generally have modest effects, and relapse after stopping treatment is common.
“in general, effect sizes for these treatments are modest, and relapse after treatment discontinuation is common [32].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [32] Squeglia LM, Fadus MC, McClure EA et al (2019) Pharmacological treatment of youth substance use disorders. J Child Adolesc Psychopharmacol 29:559–572. https://doi.org/10.1089/cap.2019.0009 sourceExperimental — accuracy not yet measured
May combine two claims.
Study design and conductcitationThe Middle School Success study was rated moderate quality, limited by unclear validity of the substance use outcome measure.
“Study quality was moderate, limited by unclear validity of the SU outcome measure [42].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [42] Kim HK, Leve LD (2011) Substance use and delinquency among middle school girls in foster care: a three-year follow-up of a randomized controlled trial. J Consult Clin Psychol 79:740–750. https://doi.org/10.1037/a0025949 source
The Discussion (page unavailable) raises a measurement limitation: the alcohol-use measure relied only on frequency and might not have been sensitive enough to detect intervention effects. The paper does not rate the study as moderate quality or explicitly describe the validity of the overall substance-use outcome measure as unclear. (LLM, conf=0.78)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationThe largest and highest-quality study in this literature was a randomized trial of 124 middle adolescents, mostly girls, comparing RRFT, an integrated SUD and exposure-based PTSD treatment, with TF-CBT.
“The largest and strongest quality study in the current literature is an RCT of middle adolescents (n=124, Mage=15.4, 87% girls) that compared RRFT, an integrated SUD and exposure-based PTSD treatment (described above), to TF-CBT [29].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [29] Danielson CK, Adams Z, McCart MR et al (2020) Safety and efficacy of exposure-based risk reduction through family therapy for co-occurring substance use problems and posttraumatic stress disorder symptoms among adolescents: a randomized clinical trial. JAMA Psychiat 77:574–586. https://doi.org/10.1001/jamapsychiatry.2019.4803 source
The Abstract reports an RCT of 124 adolescents (mean age 15.4 years; 87.1% female) comparing integrated, exposure-based RRFT with treatment as usual consisting primarily of TF-CBT. The Discussion calls it the first full-scale RCT in this area, but the paper does not assess whether it was the highest-quality study in the literature; the comparator was not exclusively TF-CBT. (LLM, conf=0.86)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationMDD and PTSD predicted faster relapse among girls with certain victimization histories, but not among boys.
“MDD and PTSD predicted faster relapse among girls with certain victimization histories, but not among boys [67].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [67] Davis JP, Christie NC, Dworkin ER et al (2020) Influences of victimization and comorbid conditions on latency to illicit drug use among adolescents and young adults. Drug Alcohol Depend 206: 107721. https://doi.org/10.1016/j.drugalcdep.2019.107721 source
May combine two claims.
Findingown dataMost comparison studies examined outpatient adolescent substance use treatment programs; five focused on residential or long-term inpatient programs, and four examined shelter-based programs.
“Most studies examined outcomes of outpatient adolescent SU treatment programs [21, 43, 44, 67–70], five focused on residential or long-term inpatient programs [33, 43–45, 69], and four examined shelter-based treatment programs [71–74].”
Quote in the paperNot a substantial claim1 of 10 sources checked- cites [21] Williams JK, Smith DC, An H, Hall JA (2008) Clinical outcomes of traumatized youth in adolescent substance abuse treatment: a longitudinal multisite study. J Psychoactive Drugs 40:77–84. https://doi.org/10.1080/02791072.2008.10399763 source
- cites [43] Blood L, Cornwall A (1996) Childhood sexual victimization as a factor in the treatment of substance misusing adolescents. Subst Use Misuse 31:1015–1039. https://doi.org/10.3109/10826089609072285 source
- cites [44] Funk RR, McDermeit M, Godley SH, Adams L (2003) Maltreatment issues by level of adolescent substance abuse treatment: the extent of the problem at intake and relationship to early outcomes. Child Maltreat 8:36–45. https://doi.org/10.1177/1077559502239607 source
- cites [67] Davis JP, Christie NC, Dworkin ER et al (2020) Influences of victimization and comorbid conditions on latency to illicit drug use among adolescents and young adults. Drug Alcohol Depend 206: 107721. https://doi.org/10.1016/j.drugalcdep.2019.107721 source
The Methods (Participants and procedures; page unavailable) identify this as a study of adolescents and young adults receiving treatment for illicit drug use, with follow-up assessments. But treatment type varied by site, and our copy does not classify this study as outpatient or residential/inpatient or substantiate the cited counts of studies in each setting. The Introduction mentions both residential and outpatient treatment in a different study, not as a classification of this one. (LLM, conf=0.78)
Experimental — accuracy not yet measured - cites [68] Grella CE, Joshi V (2003) Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. Child Maltreat 8:7–18. https://doi.org/10.1177/1077559502239610 source
- cites [69] Shane P, Diamond GS, Mensinger JL et al (2006) Impact of victimization on substance abuse treatment outcomes for adolescents in outpatient and residential substance abuse treatment. Am J Addict 15:s34–s42. https://doi.org/10.1080/10550490601003714 source
- cites [70] Williams JK, Smith DC, Gotman N et al (2008) Traumatized youth and substance abuse treatment outcomes: a longitudinal study. J Trauma Stress 21:100–108 source
- cites [33] Yildiz D, Ciftci A, Yalcin O (2020) The association between trauma history, trauma-related psychopathology and treatment completion at an adolescent inpatient substance abuse treatment center in Turkey. J Child Adolesc Subst Abus 29:58–67. https://doi.org/10.1080/1067828X.2020.1837319 source
- cites [45] Jaycox LH, Ebener P, Damesek L, Becker K (2004) Trauma exposure and retention in adolescent substance abuse treatment. J Trauma Stress 17:113–121. https://doi.org/10.1023/B:JOTS.0000022617.41299.39 source
- cites [71] Bartle-Haring S, Slesnick N, Collins J et al (2012) The utility of mentoring homeless adolescents: a pilot study. Am J Drug Alcohol Abuse 38:350–358. https://doi.org/10.3109/00952990.2011.643985 source
May combine two claims.
FindingcitationIn the Voices trial, there were no significant between-group differences in substance use consequences, PTSD symptoms, general psychiatric symptoms, or delinquent behaviors.
“Both groups had significant improvements over time in SU consequences, PTSD symptoms, general psychiatric symptoms, and delinquent behaviors, with no significant between-group differences.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [63] Tolou-Shams M, Dauria EF, Folk J et al (2021) VOICES: an efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history. Drug Alcohol Depend 228. https://doi.org/10.1016/j.drugalcdep.2021.108934 source
May combine two claims.
Study design and conductown dataThe WHC results are limited by low intervention completion and lack of a control group.
“Results for this brief intervention are promising but limited by low intervention completion and lack of a control group.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [59] Myers B, Carney T, Browne FA, Wechsberg WM (2019) A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study. BMJ Open 9:1–11. https://doi.org/10.1136/bmjopen-2018-024776 source
May combine two claims.
FindingcitationOf the existing treatment literature, RRFT provides the strongest evidence for treatment of co-occurring trauma-related symptoms and substance use disorder, having a rigorous design and significant outcomes 18 months after treatment.
“Of the existing treatment literature, RRFT provides the strongest evidence for treatment of co-occurring trauma-related symptoms and SUD, having a rigorous design and significant outcomes 18-months after treatment [29].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [29] Danielson CK, Adams Z, McCart MR et al (2020) Safety and efficacy of exposure-based risk reduction through family therapy for co-occurring substance use problems and posttraumatic stress disorder symptoms among adolescents: a randomized clinical trial. JAMA Psychiat 77:574–586. https://doi.org/10.1001/jamapsychiatry.2019.4803 source
The Discussion describes this as the first full-scale randomized trial of integrated exposure-based treatment for adolescents with co-occurring substance use problems and PTSD symptoms. The results report significant substance-use and some PTSD symptom outcomes at 18 months, but the assessments were 18 months after baseline, not 18 months after treatment. The paper does not establish that RRFT has the strongest evidence across the broader treatment literature, and overall PTSD symptom improvement did not differ significantly from treatment as usual. (LLM, conf=0.88)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationSeveral group interventions have found significant reductions in pre-post substance use and mental health symptoms, but only two randomized controlled trials have evaluated group intervention effectiveness.
“Several group interventions have found significant reductions in pre-post SU and mental health symptoms, however only two RCTs have been conducted to evaluate group intervention effectiveness [49, 52, 59, 61, 63].”
Quote in the paperSubstantial claim3 of 5 sources checked- cites [49] Brown KJ, Block AJ (2001) Evaluation of project chrysalis: a school-based intervention to reduce negative consequences of abuse. J Early Adolesc 21:325–353. https://doi.org/10.1177/0272431601021003004 source
- cites [52] Saewyc EM, Edinburgh LD (2010) Restoring healthy developmental trajectories for sexually exploited young runaway girls: fostering protective factors and reducing risk behaviors. J Adolesc Heal 46:180–188. https://doi.org/10.1016/j.jadohealth.2009.06.010 source
The 'Longitudinal Improvements within Cases' section (page unavailable) reports significant decreases in emotional distress, alcohol use, and smoking after the Runaway Intervention Program. But this was one multicomponent program with only an optional group component; the Methods section (page unavailable) says it was not randomized. The paper does not establish that several group interventions had these results or that only two RCTs evaluated group interventions. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [59] Myers B, Carney T, Browne FA, Wechsberg WM (2019) A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study. BMJ Open 9:1–11. https://doi.org/10.1136/bmjopen-2018-024776 source
The Results and Discussion (pages not provided) report significant baseline-to-follow-up reductions in substance use and mental health symptoms after this group intervention. The paper describes its own study as single-arm and uncontrolled, but does not establish the claim that only two RCTs have evaluated group-intervention effectiveness. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [61] Bougard KG, Laupola TMT, Parker-Dias J et al (2016) Turning the tides: coping with trauma and addiction through residential adolescent group therapy. J Child Adolesc Psychiatr Nurs 29:196–206. https://doi.org/10.1111/jcap.12164 source
- cites [63] Tolou-Shams M, Dauria EF, Folk J et al (2021) VOICES: an efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history. Drug Alcohol Depend 228. https://doi.org/10.1016/j.drugalcdep.2021.108934 source
The Introduction (Current study; page unavailable) identifies VOICES as a randomized controlled trial of a group intervention. The Results (Primary and Secondary outcomes; pages unavailable) report reduced cannabis use in the VOICES group and significant decreases in psychiatric symptoms in both groups. The paper does not establish that several group interventions had these results or that only two RCTs had evaluated their effectiveness. (LLM, conf=0.84)
Experimental — accuracy not yet measured
May combine two claims.
Study design and conductcitationOnly two of the ten intervention randomized controlled trials were rated strong in global quality, while others were limited by low retention rates and use of substance use outcome measures without well-documented reliability and validity.
“Only two of the ten intervention RCTs were rated “strong” global quality [29, 54], while others were limited by low retention rates and use of SU outcome measures without well documented reliability and validity.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [29] Danielson CK, Adams Z, McCart MR et al (2020) Safety and efficacy of exposure-based risk reduction through family therapy for co-occurring substance use problems and posttraumatic stress disorder symptoms among adolescents: a randomized clinical trial. JAMA Psychiat 77:574–586. https://doi.org/10.1001/jamapsychiatry.2019.4803 source
The Abstract identifies this paper as a randomized clinical trial, and Strengths and Limitations describes rigorous methods and high retention (109 of 124 participants). The paper does not itself report a “strong” global-quality rating or establish that two of ten intervention trials received that rating; those are assessments made by the citing document. (LLM, conf=0.79)
Experimental — accuracy not yet measured - cites [54] Zatzick D, Russo J, Lord SP et al (2014) Collaborative care intervention targeting violence risk behaviors, substance use, and posttraumatic stress and depressive symptoms in injured adolescents a randomized clinical trial. JAMA Pediatr 168:532–539. https://doi.org/10.1001/jamapediatrics.2013.4784 source
May combine two claims.
PremisecitationClinicians who treat youth with co-occurring substance use disorder and PTSD often encounter difficulties prioritizing treatment components, managing family conflict, and coping with feelings of frustration and helplessness.
“Clinicians who treat youth with co-occurring SUD and PTSD often encounter difficulties prioritizing treatment components, managing family conflict, and coping with feelings of frustration and helplessness [84].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [84] Adams ZW, McCauley JL, Back SE et al (2016) Clinician perspectives on treating adolescents with co-occurring post-traumatic stress disorder, substance use, and other problems. J Child Adolesc Subst Abus 25:575–583. https://doi.org/10.1080/1067828X.2016.1153555 source
May combine two claims.
InterpretationcitationBBTI could be an effective standalone treatment or adjunct to other treatments but requires further replication.
“could be an effective standalone treatment or adjunct to other treatments but requires further replication [62].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [62] Short NA, Zvolensky MJ, Schmidt NB (2021) A pilot randomized clinical trial of brief behavioral treatment for insomnia to reduce problematic cannabis use among trauma-exposed young adults. J Subst Abuse Treat 131: 108537. https://doi.org/10.1016/j.jsat.2021.108537 source
The Discussion (page unavailable) describes BBTI as a potentially efficacious intervention for insomnia symptoms and cannabis-related problems in trauma-exposed cannabis users and explicitly calls for replication in a larger sample. The Methods’ Experimental conditions (page unavailable) describe BBTI delivered as the study intervention, but our copy does not establish its effectiveness as an adjunct to other treatments. (LLM, conf=0.86)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationA randomized controlled trial comparing motivational enhancement therapy, community reinforcement approach, and case management found all three treatments effective with medium to large effects, but with less reduction in substance use among youth with a history of physical abuse.
“Another RCT (n=270), comparing motivational enhancement therapy (MET), community reinforcement approach (CRA), and case management, found all three treatments effective with medium to large effects, but with less reduction in SU among youth with a history of physical abuse [74].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [74] Slesnick N, Guo X, Brakenhoff B, Bantchevska D (2015) A comparison of three interventions for homeless youth evidencing substance use disorders: results of a randomized clinical trial. J Subst Abuse Treat 54:1–13. https://doi.org/10.1016/j.jsat.2015.02.001 source
May combine two claims.
FindingcitationExposure therapy was the focus of only two interventions, RRFT and D-CPT; these trials had robust sustained PTSD outcomes and reported no adverse effects of exposure therapy, despite detailed monitoring, when exposure components followed an extensive safety and skill-building phase.
“Although exposure therapy was only the focus of two interventions (i.e., RRFT and D-CPT), these trials had robust sustained PTSD outcomes and did not report any adverse effects of exposure therapy, despite detailed monitoring, when exposure components were preceded by an extensive safety and skill-building phase [29, 55].”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [29] Danielson CK, Adams Z, McCart MR et al (2020) Safety and efficacy of exposure-based risk reduction through family therapy for co-occurring substance use problems and posttraumatic stress disorder symptoms among adolescents: a randomized clinical trial. JAMA Psychiat 77:574–586. https://doi.org/10.1001/jamapsychiatry.2019.4803 source
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [55] Fischer A, Rosner R, Renneberg B, Steil R (2022) Suicidal ideation, self-injury, aggressive behavior and substance use during intensive trauma-focused treatment with exposure-based components in adolescent and young adult PTSD patients. Borderline Personal Disord Emot Dysregulat 9:1–13. https://doi.org/10.1186/s40479-021-00172-8 source
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationBBTI was effective in improving sleep and reducing cannabis problems and trauma-related cravings in older adolescents.
“Brief behavioral therapy for insomnia (BBTI) was effective in improving sleep and reducing cannabis problems and trauma-related cravings in older adolescents”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [62] Short NA, Zvolensky MJ, Schmidt NB (2021) A pilot randomized clinical trial of brief behavioral treatment for insomnia to reduce problematic cannabis use among trauma-exposed young adults. J Subst Abuse Treat 131: 108537. https://doi.org/10.1016/j.jsat.2021.108537 source
The Results report reduced insomnia symptoms, cannabis-related problems, and trauma-cue-related cannabis cravings with BBTI. However, the Methods describe participants as trauma-exposed adults aged 18–30, not specifically older adolescents, and the Discussion calls the pilot findings tentative rather than establishing that BBTI was effective. (LLM, conf=0.88)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationRRFT, a skill-based individual and family-focused intervention that can be applied at either the early intervention or co-occurring SUD/PTSD treatment stage, has the strongest study quality and outcomes.
“RRFT, a skill-based individual and family-focused intervention, which can be applied at either the EI or co-occurring SUD/PTSD treatment stage, has the strongest study quality and outcomes [51].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [51] Danielson CK, McCart MR, Walsh K et al (2012) Reducing substance use risk and mental health problems among sexually assaulted adolescents: a pilot randomized controlled trial. J Fam Psychol 26:628–635. https://doi.org/10.1037/a0028862 source
The Method (Treatment Conditions; page unavailable) describes RRFT as a skills-based intervention delivered to adolescents and caregivers. The Discussion (page unavailable) considers its use for youth already receiving substance-use treatment and for those at elevated risk who do not meet diagnostic thresholds. The paper reports promising outcomes but does not compare RRFT’s study quality or outcomes with other interventions to establish that they are the strongest; it also cautions that baseline differences limit interpretation of its between-group results. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationOngoing studies are evaluating interventions adapted for indigenous youth, girls in the juvenile justice system, homeless youth, and unaccompanied refugee youth.
“Ongoing studies are evaluating interventions adapted for indigenous youth [95], girls in the juvenile justice system, homeless youth [96], and unaccompanied refugee youth [97].”
Quote in the paperNot a substantial claim3 of 3 sources checked- cites [95] Pearson CR, Kaysen D, Huh D et al (2020) A randomized comparison trial of culturally adapted HIV prevention approaches for Native Americans reducing trauma symptoms versus substance misuse: the healing seasons protocol. Contemp Clin Trials 95:1–6. https://doi.org/10.1016/j.cct.2020.106070 source
The Methods/design section describes an ongoing randomized trial of culturally adapted interventions for Native Americans, and Identification and recruitment of participants says it enrolls people aged 16 and older, with at least half intended to be aged 16–30. The interventions are adapted for Native Americans broadly, not specifically for youth; this citation supports only the indigenous-youth portion of the citing sentence. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [96] Slesnick N, Chavez L, Bunger A et al (2021) Housing, opportunities, motivation and engagement (HOME) for homeless youth at-risk for opioid use disorder: study protocol for a randomized controlled trial. Addict Sci Clin Pract 16:1–14. https://doi.org/10.1186/s13722-021-00237-7 source
- cites [97] Rosner R, Sachser C, Hornfeck F et al (2020) Improving mental health care for unaccompanied young refugees through a stepped-care approach versus usual care+: study protocol of a cluster randomized controlled hybrid effectiveness implementation trial. Trials 21: 1–13 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationcitationYouth who are members of LGBTQ or ethnic minority groups, as well as youth with experiences of immigration, foster care, homelessness, and the juvenile justice system, may use substances in the context of unique stressors and risk factors and thus may require tailored adaptations of existing evidence-based approaches.
“Youth who are members of LGBTQ [93] or ethnic minority groups [94], as well as youth with experiences with immigration, foster care, homelessness, and the juvenile justice system may use substances in the context of unique stressors and risk factors and thus may require tailored adaptations of existing evidence-based approaches.”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [93] Cleirigh CO, Dale SK, Elsesser S et al (2015) Sexual minority specific and related traumatic experiences are associated with increased risk for smoking among gay and bisexual men. J Psychosom Res 78:472–477. https://doi.org/10.1016/j.jpsychores.2015.02.004 source
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [94] Leinberger-Jabari A, Golob M, Begh R et al (2022) 126 Does culturally tailoring a smoking cessation intervention help more people to quit or reduce their smoking? A systematic review. BMJ Evidence Based Med 27:A9 source
May combine two claims.
PremisecitationSevere and chronic stress induces neurodevelopmental changes in networks underlying executive function and has been found predictive of risky substance use in adolescents.
“Severe and chronic stress induces neurodevelopmental changes in networks underlying executive function, the capacity to control and coordinate thoughts and behavior, and has been found predictive of risky SU in adolescents [91].”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [91] Silveira S, Shah R, Nooner KB et al (2020) Impact of childhood trauma on executive function in adolescence—mediating functional brain networks and prediction of high-risk drinking. Biol Psychiatry Cogn Neurosci Neuroimaging 5:499–509. https://doi.org/10.1016/j.bpsc.2020.01.011 source
The Discussion (page unavailable) links childhood trauma, altered functional brain networks and executive function, and reports that these measures predicted future high-risk drinking in adolescents. The claim overextends that finding to risky substance use generally and presents stress-induced neurodevelopmental change as established by this study, although its sample reported low-to-moderate childhood trauma and its findings are associations. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Classified as probably not a substantial claim.
InterpretationcitationBecause childhood trauma often occurs in the context of parent substance use disorders, community violence, and neighborhood disorder, multi-level preventive interventions addressing community, family, and individual risk factors may be more effective than individual-focused interventions.
“Since childhood trauma often occurs in the context of parent SUDs, community violence, and neighborhood disorder [92], development of multi-level preventive interventions that address risk factors on community, family, and individual levels may be more effective than individual-focused interventions.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [92] Cicchetti D, Handley ED (2019) Child maltreatment and the development of substance use and disorder. Neurobiol Stress 10: 100144. https://doi.org/10.1016/j.ynstr.2018.100144 source
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
May combine two claims.
Findingown dataThirty-three articles met the eligibility criteria, and 13 of them were randomized controlled trials.
“Thirty three articles met eligibility criteria, including 13 RCTs.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationBoth RRFT and TF-CBT reduced total PTSD symptoms at follow-up, and these reductions were maintained up to 18 months.
“Both RRFT and TF-CBT successfully reduced total PTSD symptoms at follow-up, which were maintained up to 18 months.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataPTSD outcomes for Seeking Safety were mixed: it outperformed treatment as usual on the sexual concerns and sexual distress subscales of the Trauma Symptom Checklist for Children, but not on the other eight subscales.
“PTSD outcomes were mixed, with SS significantly outperforming TAU on the sexual concerns and sexual distress subscales of the Trauma Symptom Checklist for Children, with no differences noted in the other 8 subscales.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationThe Bounce Back Now brief web-based intervention reduced PTSD and depression symptoms at 12-month follow-up compared with controls, but the trial lacked power to detect substance use changes.
“A brief web-based intervention based on behavioral principles, Bounce Back Now effectively reduced symptoms of PTSD and depression at 12-month follow-up compared to controls, but was underpowered to detect changes in SU”
Quote in the paperSubstantial claimMay combine two claims.
FindingcitationThe Runaway Intervention Program appeared effective in reducing alcohol and drug use and in reducing emotional distress and suicidal ideation, with measures approaching peer levels.
“Runaway Intervention Program appeared effective at reducing alcohol and drug use (Mean differencealcohol-6mo= 68%, p<0.001, Mean differencemarijuana-12mo= 77%, p<0.001) and reducing emotional distress and suicidal ideation (Mean differenceSI-6mo= 44%, p<0.001), with measures approaching levels of peers.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe Stepped Collaborative Care intervention did not significantly improve substance use or PTSD outcomes compared with treatment as usual, although substance use outcomes showed a pattern of improvement that may reflect insufficient power or intervention intensity.
“Intervention, compared to TAU, did not significantly improve SU or PTSD outcomes, although SU outcomes showed a pattern of improvement compared to TAU, which may result from underpowered study or insufficient intervention intensity.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationKinship caregivers received less financial support, parent training, and peer support, and had less input in service plans than foster parents.
“Kinship caregivers received less financial support, parent training, and peer support, and had less input in service plans than foster parents.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThirteen studies compared how youth with and without a trauma history responded to standard SUD treatments, and their findings were mixed.
“Thirteen studies examined differential response of youth with a history of trauma to standard SUD treatments, compared to youth without a history of trauma, with mixed findings.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationAdolescent pregnancy was more frequent in kinship care, behavioral problems and social skills were better in kinship care, and PTSD and depression did not differ between kinship and foster care.
“Adolescent pregnancy also occurred more frequently in kinship care, while behavioral problems and social skills were better in the kinship care group, and PTSD and depression did not differ between groups.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationAlthough TF-CBT reduced some substance use outcomes, RRFT produced significantly greater long-term reductions in any substance use, marijuana use, and polysubstance use, and better PTSD hyperarousal and avoidance outcomes.
“Although TF-CBT reduced some SU outcomes, RRFT had significantly better outcomes than TF-CBT at long-term reduction in any substance use (90% less SU days at 18-months, −10.6 vs −0.4 days; ER, 0.10; 95% CI: 0.04–0.24), marijuana use, and polysubstance use, and better outcomes on PTSD hyperarousal and avoidance subscales.”
Quote in the paperSubstantial claimMay combine two claims.
FindingcitationProject Chrysalis produced healthier substance use attitudes and small effects preventing initiation among youth abstinent at baseline, but did not significantly reduce use among youth already using substances at baseline.
“Project Chrysalis resulted in healthier attitudes about SU, and small effects at preventing initiation among youth who were abstinent at baseline, but did not significantly reduce use among youth who were using substances at baseline [49].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [49] Brown KJ, Block AJ (2001) Evaluation of project chrysalis: a school-based intervention to reduce negative consequences of abuse. J Early Adolesc 21:325–353. https://doi.org/10.1177/0272431601021003004 source
May combine two claims.
Findingown dataFour small studies of individual therapy using cognitive-behavioral techniques, three with trauma exposure components, found generally positive substance use and related outcomes but had methodological limitations.
“Four small studies examined outcomes of individual therapy, using a variety of cognitive-behavioral techniques, 3 including trauma exposure-based components, on SU and related outcomes, with generally positive outcomes but methodological limitations.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAcross the nine treatment studies of youth with current substance use or SUD and trauma/PTSD symptoms, results were generally positive for substance use and other mental health outcomes, with variable study quality and four studies rated moderate or higher.
“Overall, these studies had positive results for both SU and other MH outcomes, with variable study quality (4 moderate or higher).”
Quote in the paperSubstantial claimMay combine two claims.
FindingcitationIn a pilot randomized trial of RRFT with 30 participants, substance use frequency fell significantly from baseline to 6 months, while the treatment-as-usual group increased use over time.
“A subsequent pilot RCT of RRFT (n=30) showed significant reductions in SU frequency (2.5 days/90 days at 6-months vs 15.9/90 days at baseline), versus increased SU over time in the TAU group (standard trauma-focused therapy).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataInterventions that included exposure-based components were uncommon but showed strong results and few adverse outcomes.
“Interventions with exposure-based components were infrequent but had robust results and minimal adverse outcomes.”
Quote in the paperSubstantial claimMay combine two claims.
FindingcitationIn an observational study, kinship care was linked to higher risk of past-month substance use in early adolescence than foster care, but the difference was no longer significant after adjustment for individual, family, and caregiver characteristics.
“kinship care was associated with increased risk of past-month SU in early adolescence compared to foster care (RR=2.05, 95% CI: 1.09–3.28), although differences did not remain significant after adjusting for individual, family, and caregiver characteristics.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataEleven of the 13 comparison samples were predominantly male, but all included both sexes.
“Most samples (11/13) were predominantly male, but all included both sexes.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationIn a large multi-site study, youth with a history of abuse had greater baseline substance use severity, more co-occurring mental health problems, and greater overall service needs.
“youth with a history of abuse had greater baseline SU severity, more co-occurring mental health problems, and greater overall service needs [68].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [68] Grella CE, Joshi V (2003) Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. Child Maltreat 8:7–18. https://doi.org/10.1177/1077559502239610 source
May combine two claims.
Findingown dataTwelve of the 13 comparison studies had sample sizes of at least 100, and four had more than 800 participants.
“with sample sizes for 12/13 studies ≥100 and four exceeding 800”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataRunaway Intervention Project participants had improved health knowledge and health-related behaviors.
“girls had improved health knowledge and health-related behaviors”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataEleven of the 13 comparison studies were conducted in the US, one in Turkey, and one in Canada.
“Most studies were conducted in the US (11/13), as well as one each in Turkey and Canada.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThirteen studies compared substance use treatment outcomes for youth with a history of trauma versus youth without such history and found mixed results.
“Additionally, 13 studies compared outcomes of SU treatment for youth with a history of trauma versus youth without such history, and found mixed results.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenGroup therapies sometimes included women's empowerment frameworks.
“Group therapies also sometimes included women’s empowerment frameworks.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataOther less common components included mindfulness, creative and expressive techniques, contingency management, and addressing family relationships.
“Other less common components included mindfulness, creative/expressive techniques, contingency management, and addressing family relationships.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataTherapeutic components varied across studies, but often included psychoeducation about trauma and/or substance use, coping skills, cognitive therapy, social and communication skills, parenting support, and motivational principles.
“Therapeutic components varied across studies, but often included psychoeducation about trauma and/or SU, coping skills (e.g., relaxation skills, craving management, SU refusal skills), cognitive therapy, social/communication skills, parenting support, and motivational principles.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationIn a large study, both victimized and non-victimized youth had significant improvements in substance use frequency and problems sustained at one-year follow-up, with highly victimized youth making relatively larger treatment gains.
“both victimized and non-victimized youth had significant improvements in SU frequency and SU problems that were sustained at one-year follow-up, with highly victimized youth making relatively larger treatment gains [69].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [69] Shane P, Diamond GS, Mensinger JL et al (2006) Impact of victimization on substance abuse treatment outcomes for adolescents in outpatient and residential substance abuse treatment. Am J Addict 15:s34–s42. https://doi.org/10.1080/10550490601003714 source
May combine two claims.
Findingnone givenOverall, the treatment studies were shorter than prevention and early intervention studies, with most treatments occurring within three months.
“Overall, the treatment studies were shorter than prevention and EI studies, with most treatments occurring within three months.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationIn two prospective studies, youth with high traumatic stress had significant improvements in reduced substance use frequency and reduced substance use problems over 12 months, and these improvements did not differ markedly from youth without high traumatic stress.
“youth with high traumatic stress had significant improvements in reduced frequency of SU and reduced SU problems over 12 months, that did not differ markedly from youth without high traumatic stress [21, 70].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [21] Williams JK, Smith DC, An H, Hall JA (2008) Clinical outcomes of traumatized youth in adolescent substance abuse treatment: a longitudinal multisite study. J Psychoactive Drugs 40:77–84. https://doi.org/10.1080/02791072.2008.10399763 source
- cites [70] Williams JK, Smith DC, Gotman N et al (2008) Traumatized youth and substance abuse treatment outcomes: a longitudinal study. J Trauma Stress 21:100–108 source
May combine two claims.
Findingown dataOf the 20 studies evaluating interventions for youth with a history of trauma, most reported significant improvements in substance use and often also in PTSD and/or depression outcomes.
“Of the 20 studies evaluating interventions for youth with a history of trauma, most reported significant improvements on SU and often also PTSD and/or depression outcomes.”
Quote in the paperSubstantial claimMay combine two claims.
Findingnone givenOther flexible, lower-intensity interventions studied have included collaborative care, a web-based intervention after natural disaster, and a brief behavioral sleep intervention.
“Other flexible, lower-intensity interventions studied have included collaborative care, a web-based intervention after natural disaster, and a brief behavioral sleep intervention.”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
FindingcitationYouth who attended both more community reinforcement approach sessions and more mentoring sessions had the most substantial improvements in substance-related problems and internalizing symptoms.
“Youth who attended both more CRA and more mentoring sessions had the most substantial improvements in substance-related problems and internalizing symptoms”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [71] Bartle-Haring S, Slesnick N, Collins J et al (2012) The utility of mentoring homeless adolescents: a pilot study. Am J Drug Alcohol Abuse 38:350–358. https://doi.org/10.3109/00952990.2011.643985 source
May combine two claims.
Findingnone givenAll preventive interventions included a parent component, and most lasted over a year, except the web-based Bounce Back Now.
“All preventive interventions included a parent component and most were over a year (with the exception of web-based Bounce Back Now).”
Quote in the paperSubstantial claimMay combine two claims.
Findingnone givenLong-term preventive interventions focused on prosocial skills and parenting quality, individual therapy based on CBT principles for substance use and PTSD, and group interventions focused on skill development and empowerment have all been found effective.
“Long-term preventive interventions focused on prosocial skills and parenting quality, individual therapy based on CBT-principles for SU and PTSD, and group interventions focused on skill-development and empowerment have all been found effective.”
Quote in the paperSubstantial claimMay combine two claims.
Findingnone givenMany intervention effectiveness studies focused on females, whereas outcome studies of youth in substance use treatment showed a male-predominant population.
“Many of the intervention effectiveness studies focused on females, whereas the outcome studies of youth in SU treatment showed a male-predominant population.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationSubstance use can be a way to avoid distressing emotions and hyperarousal, but with PTSD it often takes increasing amounts to keep producing emotional numbing.
“SU can serve as a form of avoidance of distressing emotions and hyperarousal (i.e., “self-medication”), but in the context of PTSD, often requires escalating amounts to continue achieving the desired emotional numbing effects over time.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Cohen JA, Mannarino AP, Zhitova AC, Capone ME (2003) Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abus Negl 27:1345–1365. https://doi.org/10.1016/j.chiabu.2003.08.001 source
May combine two claims.
PremisecitationWithdrawal from substance use can worsen trauma-related hyperarousal and thereby reinforce further use.
“Withdrawal effects from SU can exacerbate trauma-related hyperarousal symptoms, further reinforcing SU.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] Cohen JA, Mannarino AP, Zhitova AC, Capone ME (2003) Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abus Negl 27:1345–1365. https://doi.org/10.1016/j.chiabu.2003.08.001 source
Classified as probably not a substantial claim.
PremisecitationCo-occurring PTSD and SUDs are recommended to be treated at the same time in an integrated model.
“it has been recommended that co-occurring PTSD and SUDs are best treated simultaneously in an integrated treatment model [19, 21].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [19] Cohen JA, Mannarino AP, Zhitova AC, Capone ME (2003) Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abus Negl 27:1345–1365. https://doi.org/10.1016/j.chiabu.2003.08.001 source
- cites [21] Williams JK, Smith DC, An H, Hall JA (2008) Clinical outcomes of traumatized youth in adolescent substance abuse treatment: a longitudinal multisite study. J Psychoactive Drugs 40:77–84. https://doi.org/10.1080/02791072.2008.10399763 source
May combine two claims.
PremisecitationWhen PTSD and SUD occur together, they can worsen each other, which calls for integrated treatment.
“When co-occurring, PTSD and SUD can reinforce and exacerbate each other, necessitating integrated treatment approaches.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [19] Cohen JA, Mannarino AP, Zhitova AC, Capone ME (2003) Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abus Negl 27:1345–1365. https://doi.org/10.1016/j.chiabu.2003.08.001 source
- cites [21] Williams JK, Smith DC, An H, Hall JA (2008) Clinical outcomes of traumatized youth in adolescent substance abuse treatment: a longitudinal multisite study. J Psychoactive Drugs 40:77–84. https://doi.org/10.1080/02791072.2008.10399763 source
May combine two claims.
PremisecitationYouth with PTSD often develop cognitive distortions such as self-blame and negative worldviews, and substance-related behaviors and consequences can further damage self-image and trust.
“Youth with PTSD also often develop cognitive distortions, including self-blame and negative perceptions about the world, and SU-related behaviors and their consequences (e.g., being shunned by non-using peers), may further worsen self-image (e.g., shame, powerlessness) and distrust of others [19].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Cohen JA, Mannarino AP, Zhitova AC, Capone ME (2003) Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Child Abus Negl 27:1345–1365. https://doi.org/10.1016/j.chiabu.2003.08.001 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataMethodological data were extracted by one author and checked by a second.
“Aspects pertaining to the methods were extracted by a single author and reviewed by a second author.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductreasoningThe Runaway Intervention Program study was rated weak overall, and without a control group it is unclear how much outcomes reflected the intervention rather than stabilization over time.
“Overall study quality was weak; given the absence of control group it remains unclear to what extent outcomes were influenced by the intervention, versus stabilization over time.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataInitial agreement between raters was good to very good, above 60%, and discrepancies were resolved by reexamining articles and the EPHPP tool until consensus.
“The authors had good to very good levels of initial agreement (i.e., >60%) and addressed discrepancies by reexamining the articles and EPHPP tool and discussing the rating in question until reaching consensus.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenResults were extracted independently by two authors, who discussed each article and involved other team members when needed.
“Results were extracted independently by two authors, who discussed each article, including additional team members as needed.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationTF-CBT usually includes psychoeducation, coping skills, trauma narration and processing, and an integration phase.
“TF-CBT typically includes psychoeducation, coping skills (e.g., relaxation, mood regulation, cognitive skills, parenting), trauma narration and processing, and a final integration phase [28].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28] Cohen JA, Mannarino AP, Deblinger E (2017) Treating trauma and traumatic grief in children and adolescents, second edition, 2nd edn. Guilford Press
Not checked in the free run.
May combine two claims.
Study design and conductreasoningThe RRFT versus TF-CBT trial had a strong design and treatment was delivered by community clinicians, but because the sample was mostly female, effectiveness in adolescent boys remains understudied.
“The study design was strong, and treatment was provided by community-based clinicians; however, given the female-predominant sample, effectiveness of this approach among adolescent boys remains understudied.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductcitationTwo authors independently rated each article's quality with the EPHPP Quality Assessment Tool, described as valid and reliable for assessing risk of bias across different designs.
“two authors independently rated the quality of each article using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool, a valid and reliable method for assessing risk of bias across a diversity of research designs [48].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [48] Thomas BH, Ciliska D, Dobbins M, Micucci S (2004) A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evidence Based Nurs 176–184. https://doi.org/10.1111/j.1524-475X.2004.04006.x source
May combine two claims.
Study design and conductown dataProject Chrysalis was rated weak, limited by selection bias and low follow-up rates.
“Study quality was weak, limited by selection bias and low follow-up rates.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataAt least two reviewers screened full texts to finalize eligibility decisions.
“Full texts of selected articles were screened by at least two reviewers to finalize decisions on eligibility (Figure 1).”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationSeveral evidence-based interventions exist for adolescent SUDs, including CBT and family therapies, often combined with motivational interviewing or contingency management.
“A variety of evidence-based interventions exist for SUDs in adolescence, including CBT (e.g., focusing on mood regulation, refusal skills, and relapse prevention) and family therapies (e.g., addressing family dysfunction contributing to the adolescent’s SUD), often combined with motivational interviewing and/or contingency management approaches [31].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [31] Chadi N, Bagley SM, Hadland SE (2018) Addressing adolescents’ and young adults’ substance use disorders. Med Clin North Am 102:603–620. https://doi.org/10.1016/j.mcna.2018.02.015 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataTwo authors independently screened titles and abstracts using selection criteria, and disagreements were resolved by consensus.
“Two authors independently assessed each article based on title and abstract using selection criteria, with disagreements resolved by consensus.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningYouth with a trauma history are at higher risk of SUDs and may respond differently to SUD treatments.
“Youth with a history of trauma face elevated risk of SUDs and may respond differently to SUD treatments.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductreasoningThe D-CPT secondary analysis may be limited by desirability bias and selection bias, and its overall quality was weak.
“these findings may be limited by desirability bias (youth might have underreported symptoms on diary cards in anticipation of reviewing them weekly with their therapists) and selection bias, as exclusion criteria might have eliminated youth most likely to engage in SU in response to distress of treatment (weak overall).”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductnone givenThe comparison studies were generally limited by possible selection bias, limited description of therapeutic components, and limited adjustment for confounders.
“Studies were generally limited by possible selection bias, limited description of therapeutic components, and limited adjustment for possible confounders.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataThe Turning the Tides study was rated weak in overall quality because of its non-randomized design and low retention.
“Overall quality was weak, due to non-randomized study design and low retention”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [61] Bougard KG, Laupola TMT, Parker-Dias J et al (2016) Turning the tides: coping with trauma and addiction through residential adolescent group therapy. J Child Adolesc Psychiatr Nurs 29:196–206. https://doi.org/10.1111/jcap.12164 source
May combine two claims.
Study design and conductown dataThe Runaway Intervention Project study was rated weak in overall quality because of a small sample, no comparison group, and no follow-up beyond the intervention.
“overall study quality was weak, with a small sample, no comparison group, and no follow-up outcomes beyond the end of the intervention.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationYouth with high traumatic stress may have greater substance use severity and, despite benefiting from treatment, may need greater clinical support to reach recovery levels similar to peers without high traumatic stress.
“suggesting that youth with high traumatic stress may have greater severity SU and despite benefitting from treatment, may need greater clinical support to reach similar levels of recovery to their non-high traumatic stress peers.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [21] Williams JK, Smith DC, An H, Hall JA (2008) Clinical outcomes of traumatized youth in adolescent substance abuse treatment: a longitudinal multisite study. J Psychoactive Drugs 40:77–84. https://doi.org/10.1080/02791072.2008.10399763 source
May combine two claims.
Study design and conductreasoningAlthough promising interventions have been developed, there are still relatively few high-quality randomized controlled trials to draw sufficient conclusions about optimal treatment approaches across developmental stages and comorbidity severity.
“Although a number of promising interventions have been developed in recent years, there are still relatively few high-quality RCTs to draw sufficient conclusions about optimal treatment approaches across different developmental stages and severity of comorbidities, so results should be interpreted with caution.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningAlthough some evidence suggests early treatment of other externalizing childhood disorders may prevent later substance use problems, it remains unclear whether addressing childhood traumatic stress effectively prevents later development of substance use disorders, since traumatic stress was not the focus of these interventions.
“Although there is some evidence that early treatment of other externalizing childhood disorders may prevent later SU problems [81], it remains unclear if addressing childhood traumatic stress effectively prevents later development of SUDs, since traumatic stress was not the focus of these interventions.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [81] Zonnevylle-Bender MJS, Matthys W, Van De Wiel NMH, Lochman JE (2007) Preventive effects of treatment of disruptive behavior disorder in middle childhood on substance use and delinquent behavior. J Am Acad Child Adolesc Psychiatry 46:33–39. https://doi.org/10.1097/01.chi.0000246051.53297.57 source
May combine two claims.
PremisecitationSubstance use and mental health treatment have historically been provided in separate locations, with different training and therapeutic approaches, and insufficient coordination.
“SU and MH treatment have historically been provided in separate locations, with different training and therapeutic approaches, and insufficient coordination [83].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [83] Hawkins EH (2009) A tale of two systems: co-occurring mental health and substance abuse disorders treatment for adolescents. Annu Rev Psychol 60:197–227. https://doi.org/10.1146/annurev.psych.60.110707.163456 source
May combine two claims.
PremisecitationYouth with PTSD and substance use disorder often present with many needs meriting clinical attention, including additional psychiatric comorbidities and other risks such as suicidality, aggression, high-risk sexual behavior, and potential revictimization.
“Youth with PTSD and SUD often present with many needs meriting clinical attention, including additional psychiatric comorbidities (e.g., conduct disorder, ADHD, depression, and anxiety) [21] and other risks such as suicidality [85, 86], aggression [87], high-risk sexual behavior [88], and potential revictimization.”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [21] Williams JK, Smith DC, An H, Hall JA (2008) Clinical outcomes of traumatized youth in adolescent substance abuse treatment: a longitudinal multisite study. J Psychoactive Drugs 40:77–84. https://doi.org/10.1080/02791072.2008.10399763 source
- cites [85] Makhija NJ (2007) Childhood abuse and adolescent suicidality: a direct link and an indirect link through alcohol and substance misuse. Int J Adolesc Med Health 19:45–51. https://doi.org/10.1515/ijamh.2007.19.1.45 source
- cites [86] Sellers CM, McRoy RG, O’Brien KHMM (2019) Substance use and suicidal ideation among child welfare involved adolescents: a longitudinal examination. Addict Behav 93:39–45. https://doi.org/10.1016/j.addbeh.2019.01.021 source
- cites [87] Aebi M, Mohler-Kuo M, Barra S et al (2017) Posttraumatic stress and youth violence perpetration: a population-based cross-sectional study. Eur Psychiatry 40:88–95. https://doi.org/10.1016/j.eurpsy.2016.08.007 source
May combine two claims.
InterpretationreasoningAlthough youth with a history of trauma did experience reductions in substance use outcomes after treatment, they tended to have higher baseline severity problems than youth without a history of trauma and may need higher-intensity treatment to reach the same post-treatment outcomes as peers.
“Although youth with a history of trauma did experience reductions in SU outcomes after treatment, they tended to have higher baseline severity problems than youth without a history of trauma and may need a higher intensity of treatment to reach the same post-treatment outcomes as peers.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningYouth with a history of victimization tend to have greater substance use and mental health severity than peers and more difficulty remaining engaged in substance use treatment and preventing relapse.
“In sum, these studies show that youth with a history of victimization tend to have greater severity SU and MH problems than peers and more difficulty both remaining engaged in SU treatment and preventing relapse”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningAdolescents with a history of abuse generally benefit from substance use treatment, but because of greater substance use and mental health severity they may benefit relatively more from higher-intensity treatments than non-abused peers.
“adolescents with a history of abuse overall benefit from SU treatment, although due to greater severity of SU and other MH problems may benefit relatively more from higher intensity treatments than their non-abused peers.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataThe collaborative care and web-based interventions were underpowered, so it remains unclear whether these interventions may be effective.
“The collaborative care and web-based interventions were underpowered, so it remains unclear if these interventions may be effective.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductreasoningThe review chose not to focus exclusively on youth meeting diagnostic criteria for PTSD and substance use disorder, as prior reviews have, because adolescents may benefit from clinical attention even if they do not meet these diagnostic thresholds.
“We chose not to focus exclusively on youth meeting diagnostic criteria for PTSD and SUD as prior reviews have, because adolescents may benefit from clinical attention even if not meeting these diagnostic thresholds.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductreasoningBecause the literature on this topic is relatively young, the review included both randomized and non-randomized studies.
“Due to the relatively young state of the literature on this topic, we included both randomized and non-randomized studies.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductreasoningIncluding both randomized and non-randomized studies increased comprehensiveness and showed emerging areas but resulted in including some weaker studies.
“While this increased the comprehensiveness of the review and shows emerging areas of study, it results in including some weaker studies.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningIn traditional substance-use-focused treatment, youth with a history of trauma often have greater attrition, faster relapse after treatment, and require more intensive treatment than peers to achieve the same clinical outcomes.
“In traditional SUD-focused treatment, youth with a history of trauma often have greater attrition, faster relapse after treatment, and require more intensive treatment than peers to achieve the same clinical outcomes.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductreasoningThe review included a broader range of studies to describe existing evidence for interventions across the spectrum from prevention to treatment.
“We have included a broader range of studies to describe the existing evidence for interventions across the spectrum from prevention to treatment.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationcitationA couple of studies included creative and expressive components that were reportedly popular, suggesting that including such techniques may increase retention among at least a subset of youth.
“A couple studies included creative/expressive components, which were reportedly popular, suggesting inclusion of creative/expressive techniques may be a method of increasing retention among at least a subset of youth [61, 64].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [61] Bougard KG, Laupola TMT, Parker-Dias J et al (2016) Turning the tides: coping with trauma and addiction through residential adolescent group therapy. J Child Adolesc Psychiatr Nurs 29:196–206. https://doi.org/10.1111/jcap.12164 source
- cites [64] Freedle LR, Altschul DB, Freedle A (2015) The role of sandplay therapy in the treatment of adolescents and young adults with co-occurring substance use disorders and trauma. J Sandplay Ther 24:127–145 source
May combine two claims.
Study design and conductnone givenDespite advances, there are still relatively few high-quality randomized controlled trials and a particular dearth of approaches for boys and young men.
“However, despite these advances, there are still relatively few high-quality RCTs, and a particular dearth of approaches for boys/young men.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Premisenone givenThe review excluded childhood interventions but recognizes that early childhood interventions may effectively improve mood regulation capacities and reduce risk of later substance use.
“We excluded childhood interventions; however, we recognize that early childhood interventions (e.g., attachment-focused therapies) may effectively improve mood regulation capacities and reduce risk of later SU.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningThe review authors attempted to balance the inclusion of weaker studies by including their assessment of study quality and limitations throughout the narrative and online supplements.
“We have attempted to balance this by including our assessment of study quality and limitations throughout the narrative and in the online supplements.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductreasoningAlthough most studies reported significant effects, many had relatively small samples, which may have led to overestimation of clinical effects.
“Although most studies reported significant effects, many had relatively small samples, which may have led to overestimation of clinical effects.”
Quote in the paperSubstantial claim
The paper relies on this without support.
Most substance use begins during adolescence.
“Most substance use begins in adolescence.”
The paper relies on this without support.
Family dysfunction can both cause and maintain PTSD and SUDs.
“Family dysfunction can both precipitate and perpetuate both PTSD and SUDs.”
The paper relies on this without support.
Adolescents with both PTSD and SUDs may not be well served by treatments that target only PTSD or only SUDs, even when those treatments are otherwise strong.
“Youth with co-occurring PTSD/SUDs may be underserved by even the strongest evidence-based treatments focused on PTSD or SUDs alone.”
The paper relies on this without support.
Youth with a history of trauma face an elevated risk of substance use disorder.
“Youth with a history of trauma face elevated risk of SUD.”
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- Consistentt(18) = 2.63reported p < .05 · recomputed p = .017
“t(18)=2.63, p < .05”
- Consistentt(22) = 3.95reported p < .01 · recomputed p < .001
“t(22)=3.95, p < .01”
- Consistentt(22) = 3.11reported p < .01 · recomputed p = .005
“t(22)=3.11, p < .01”
- ConsistentF(3, 281) = 2.92reported p = .03 · recomputed p = .034
“F(3, 281)= 2.92, p = .03”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Early-intervention study count changes from seven to eight
MinorThe results section identifies seven early-intervention studies, but the discussion uses eight as the denominator for those interventions.
“All EIs examined were fairly intensive, with 7/8 including >20 sessions over a number of months.”
“Seven studies enrolled youth at risk for SU problems, but did not exclusively consist of youth with a current SUD.”
Treatment modality counts account for only eight of nine studies
MinorThe reported four individual-therapy and four group-therapy studies add to eight, not the stated total of nine.
Reported 9 · recomputed 8
“Nine studies (4 RCTs) enrolled youth with current SU or SUD, and varying levels of PTSD symptoms, in individual therapy (n=4) or group therapy (n=4), which in some cases was combined with case management (n=2) or individual therapy (n=1).”
The review gives two different upper age limits
MinorThe discussion describes the reviewed population as ages 10-25, whereas the stated eligibility range ends at 24.
“adolescents (ages 10–25) following exposure to trauma”
“adolescents (defined as ages 10–24, to encompass most youth going through the biological and social-role changes traditionally associated with adolescence [37])”
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InfluentialElliott, J. C., Stohl, M., Wall, M. M., Keyes, K. M., Goodwin, R. D., Skodol, A. E., Krueger, R. F., Grant, B. F., & Hasin, D. S. (2014) · Addiction · doi:10.1111/add.12477 · Cited by 103 · see citing works
Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents
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“Due to these interrelationships, it has been recommended that co-occurring PTSD and SUDs are best treated simultaneously in an integrated treatment model [19, 21].”
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“RRFT , a skill-based individual and family-focused intervention, which can be applied at either the EI or co-occurring SUD/PTSD treatment stage, has the strongest study quality and outcomes [51].”
InfluentialWeb Intervention for Adolescents Affected by Disaster: Population-Based Randomized Controlled Trial
Ruggiero, K. J., Price, M., Adams, Z. W., Stauffacher, K., McCauley, J. L., Danielson, C. K., Knapp, R. G., Hanson, R. F., Davidson, T. M., Amstadter, A. B., et al. (2015) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2015.07.001 · Cited by 82 · cited 4× · see citing works
“Ten studies used a randomized controlled trial (RCT) design [29, 42, 49, 51, 53, 54, 57, 60, 62, 63], usually compared to treatment-as-usual (TAU).”
InfluentialPharmacological Treatment of Youth Substance Use Disorders
Squeglia, L. M., Fadus, M. C., McClure, E. A., Tomko, R. L., & Gray, K. M. (2019) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2019.0009 · Cited by 79 · cited 1× · see citing works
“However, in general, effect sizes for these treatments are modest, and relapse after treatment discontinuation is common [32].”
It can’t hurt, right? Adverse effects of psychotherapy in patients with depression
Moritz, S., Nestoriuc, Y., Rief, W., Klein, J. P., Jelinek, L., & Peth, J. (2018) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-018-0931-1 · Cited by 77 · cited 1× · see citing works
“Finally, psychotherapeutic interventions are not necessarily without any risk [90], but only a few included studies reported on any adverse effects during treatment; these included no adverse events in RRFT [29], discomfort in group format of WHC due to concerns about privacy and stigma [59], and…”
Silveira, S., Shah, R., Nooner, K. B., Nagel, B. J., Tapert, S. F., de Bellis, M. D., & Mishra, J. (2020) · Biological Psychiatry: Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2020.01.011 · Cited by 68 · cited 1× · see citing works
“Severe and chronic stress induces neurodevelopmental changes in networks underlying executive function, the capacity to control and coordinate thoughts and behavior, and has been found predictive of risky SU in adolescents [91].”
Slesnick, N., Guo, X., Brakenhoff, B., & Bantchevska, D. (2015) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2015.02.001 · Cited by 65 · cited 2× · see citing works
“Four studies have focused on specific SU treatments for homeless youth with and without histories of abuse [71–74].”
Treatment Processes and Outcomes Among Adolescents With a History of Abuse Who Are in Drug Treatment
Grella, C. E., & Joshi, V. (2003) · Child Maltreatment · doi:10.1177/1077559502239610 · Cited by 65 · see citing works
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“The most effective preventive interventions identified, Middle School Success and expanded foster care, targeted prosocial skills and/or parenting quality [42, 65].”
InfluentialFortuna, L. R., Porche, M. V., & Padilla, A. (2018) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1111/papt.12143 · Cited by 60 · cited 3× · see citing works
“Interventions aimed at a variety of comorbid targets, including SU and PTSD symptoms [29, 50, 61, 64], SU/ PTSD/depression [53, 54, 56], SU/sexual risks [59, 63], SU/ suicidality [49, 55], SU/delinquency [42, 60], SU/insomnia [62], and general mental and physical health outcomes including SU [52,…”
Draucker, C. B., & Mazurczyk, J. (2013) · Nursing Outlook · doi:10.1016/j.outlook.2012.12.003 · Cited by 53 · cited 1× · see citing works
“…SUD often present with many needs meriting clinical attention, including additional psychiatric comorbidities (e.g., conduct disorder, ADHD, depression, and anxiety) [21] and other risks such as suicidality [85, 86], aggression [87], high-risk sexual behavior [88], and potential revictimization.”
Funk, R. R., Mcdermeit, M., Godley, S. H., & Adams, L. (2003) · Child Maltreatment · doi:10.1177/1077559502239607 · Cited by 53 · see citing works
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“…of 50 epidemiologic studies linking childhood adversity to adolescent SU problems identified externalizing behavior, anger, use of substances to regulate emotions, PTSD symptoms, affiliation with peers who use substances, and parenting quality as consistently significant mediating factors [18].”
A Novel, Intensive Home‐Visiting Intervention for Runaway, Sexually Exploited Girls
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“…aimed at a variety of comorbid targets, including SU and PTSD symptoms [29, 50, 61, 64], SU/ PTSD/depression [53, 54, 56], SU/sexual risks [59, 63], SU/ suicidality [49, 55], SU/delinquency [42, 60], SU/insomnia [62], and general mental and physical health outcomes including SU [52, 58, 65, 66].”
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“for transitional age young women (n = 60, age range 18–25), with current illicit drug use or heavy alcohol use, histories of physical or sexual abuse, and high levels of depression symptoms [59].”
InfluentialEarly childhood trauma, substance use and complex concurrent disorders among adolescents
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“…SUD often present with many needs meriting clinical attention, including additional psychiatric comorbidities (e.g., conduct disorder, ADHD, depression, and anxiety) [21] and other risks such as suicidality [85, 86], aggression [87], high-risk sexual behavior [88], and potential revictimization.”
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“Interventions that focus on engaging men in treatment, and addressing risks that may be greater among men, such as anger management [89], require further development.”
Shane, P., Diamond, G. S., Lynn Mensinger, J., Shera, D., & Wintersteen, M. B. (2006) · The American Journal on Addictions · doi:10.1080/10550490601003714 · Cited by 35 · see citing works
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“Two RCTs (n = 124, n = 242) found family therapy equally effective at reducing SU and improving family functioning among runaway youth with a history of abuse (compared to youth without abuse history) [73], and superior to TAU con-trol, particularly among youth with a history of abuse [72].”
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“Our findings extend prior systematic review findings focusing on outcomes of interventions for adolescents with SU co-occurring with other MH problems [75–79] and reviews of interventions for trauma/SU that focused on adult populations [25, 80].”
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InfluentialÖzgen, H., Spijkerman, R., Noack, M., Holtmann, M., Schellekens, A., Dalsgaard, S., van den Brink, W., & Hendriks, V. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10173908 · Cited by 27 · see citing works
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“Our findings extend prior systematic review findings focusing on outcomes of interventions for adolescents with SU co-occurring with other MH problems [75–79] and reviews of interventions for trauma/SU that focused on adult populations [25, 80].”
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“…SUD often present with many needs meriting clinical attention, including additional psychiatric comorbidities (e.g., conduct disorder, ADHD, depression, and anxiety) [21] and other risks such as suicidality [85, 86], aggression [87], high-risk sexual behavior [88], and potential revictimization.”
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InfluentialSwart, J., & Apsche, J. (2014) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100992 · Cited by 20 · cited 5× · see citing works
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“Ongoing studies are evaluating interventions adapted for indigenous youth [95], girls in the juvenile justice system, homeless youth [96], and unaccompanied refugee youth [97].”
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Ramchand, R., Griffin, B. A., Slaughter, M. E., Almirall, D., & McCaffrey, D. F. (2014) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2014.06.012 · Cited by 18 · see citing works
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“Group therapy A moderate-quality RCT ( Voices ) adapted a trauma-informed and women’s’ empowerment-based group intervention, initially developed for incarcerated women, for use among justice-involved adolescent girls with SU and a history of trauma (n = 113, M age = 15.7) [63].”
InfluentialFischer, A., Rosner, R., Renneberg, B., & Steil, R. (2022) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-021-00172-8 · Cited by 18 · see citing works
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“Four studies have focused on specific SU treatments for homeless youth with and without histories of abuse [71–74].”
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- Authors
- Becker, T. D., Castañeda Ramirez, S., Bruges Boude, A., Leong, A., Ivanov, I., & Rice, T. R.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Becker, Timothy D.
- Venue
- European Child & Adolescent Psychiatry
- Published
- 2023-07-22
- Volume
- 33
- Issue
- 10
- Pages
- 3419-3438
- ISSN
- 1018-8827 (ISSN-L)
- 1435-165X
- PMC
- PMC11722781
- OpenAlex
- W4385074107
- Cited by
- 18
- References
- 91
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 7
- FWCI
- 0.70
- Type
- journal article
- Language
- en
- Open access
- green
- pmc.ncbi.nlm.nih.gov
- Licence
- Locations
- European Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- Funders
- American Academy of Child and Adolescent Psychiatry
- NIDA
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- substance use disorders, childhood trauma, post-traumatic stress disorder, adolescents, substance use prevention, addiction treatment, trauma-informed care, cognitive behavioral therapy, group therapy, case management, exposure therapy
- MeSH terms
- Adverse Childhood Experiences, Adolescent, Child, Humans, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Substance-Related Disorders, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read under definition version 3 (extract-v3) on 2026-09-28.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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