Publication Date

2013-08-09

Availability

Open access

Embargo Period

2013-08-09

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Nursing (Nursing)

Date of Defense

2013-07-16

First Committee Member

Daniel A. Santisteban

Second Committee Member

Brian E. McCabe

Third Committee Member

Rosa M. Gonzalez-Guarda

Fourth Committee Member

Janet York

Abstract

The association between impulsivity and substance abuse has important implications in the clinical substance abuse treatment field. Adolescents who are characteristically more impulsive by nature of their developmental may be more at risk for treatment failure. The inclination by which individuals devalue future rewards in favor of more immediate rewards with lower monetary values is a type of impulsivity that has received much attention in the substance abuse research field. Identified as temporal discounting (TD) or delay discounting, this phenomenon is not only a factor that influences substance abuse, but also may be a factor that leads to failure in substance abuse treatment. Another important factor that has been shown to influence treatment outcome is the therapeutic relationship between a provider and a client. The purpose of this study was to examine the relationship between TD, working alliance and treatment experiences among substance-abusing adolescents enrolled in outpatient drug abuse treatment. For this study, a descriptive within-subjects repeated measures design was used. Data was collected from a convenience sample of Hispanic adolescents 14-17 years of age meeting DSM-IV-TR criteria for substance abuse or dependence. Participants were recruited from a larger 60 month National Institute on Drug Abuse funded parent study that examined Culturally Informed and Flexible Family-based Treatment of Adolescents and Traditional Family Therapy among adolescents. Variables included participant age, working alliance, whether participants attended weekly therapy sessions for at least the first 5 weeks (retention), number of sessions in which subjects participated in therapy 8 weeks after enrollment (dosage), and the change in TD from the time of enrollment and (T1) to approximately 5 weeks after enrollment T2). Working alliance was measured at 5 weeks after initiation of therapy. It was hypothesized that TD would be inversely related to age, inversely related to working alliance, inversely related to treatment retention after 5 weeks of therapy, inversely related to the number of therapy session in the first 8 weeks of therapy, and that TD would decrease after 5 weeks of therapy. Statistical analysis including linear and logistic regressions as well as analysis of variance was used. No significant relationships were found between TD and the independent variables of age, treatment retention, dosage, the change is TD from T1 to T2, and working alliance. Although statistically significant findings were not achieved in this study, the research has clinical relevance. Analyzing treatment methodologies and differences in alliance and retention among a Hispanic adolescent population provides data that has not heretofore been reviewed. Impulsivity is linked to risk behaviors. Further research is needed to identify how treatment methodologies may be refined to address temporal discounting and impulsivity among Hispanic adolescents thereby improving treatment retention and decreasing the substance abuse to improve long term outcomes among this vulnerable population.

Keywords

temporal discounting; delay discounting; treatment retention; impulsivity; Hispanic; adolescent; working alliance; substance abuse

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