The Impact of Social Support and Self-Esteem on Adolescent Substance Abuse Treatment Outcome

7/29/2019 The Impact of Social Support and Self-Esteem on Adolescent Substance Abuse Treatment Outcome

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The!Impact!of!Social!Support!and!SelfEsteem!on!Adolescent!Substance!Abuse!Treatment!

Outcome!!

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Author&Below&please&list&the&author(s)&of&this&resource."

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Stephanie!S.!Richter,!Sandra!A.!Brown!and!Mariam!A.!Mott!!

Citation&Below&please&cite&this&resource&in&APA&style.&For&guidance&on&citation&format,&please&visit&

http://owl.english.purdue.edu/owl/resource/560/01/&

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Richter,!S.!S.,!Brown,!S.!A.,!&!Mott,!M.!A.!(1991).!The!impact!of!social!support!and!self!

! esteem!on!adolescent!substance!abuse!treatment!outcome.!Journal"of"Substance"

" Abuse,"3(4),"371385.!!

!

!

Summary&Below&please&provide&a&brief&summary&of&this&resource.&If&an&abstract&is&available,&feel&free&to&copy&and&paste&it&here.&

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! Although!poor!social!resources!and!low!selfesteem!have!been!Implicated!in!the!

development!of!teenage!drug!abuse,!the!role!of!these!factors!in!the!remission!of!adolescent!

addiction!remains!unclear!This!study!examines!social!support!characteristics!and!self

esteem!in!relation!to!outcome!following!adolescent!chemical!dependency!treatment.!

Adolescents!and!their!parents!completed!selfreport!questionnaires!and!a!research!

interview!during!treatment!and!at!6!and!12!months!post!treatment.!Two!types!of!outcome!

were!assessed!at!followup:!(I)!alcohol!and!drug!use,!and!(2)!functioning!in!major!life!

domains!(e!g!,!family,!school/work,!peers)!Results!indicate!that!the!quality!of!social!

resources!(Ie,!druguse!patterns!of!supports)!reported!during!treatment!was!related!to!alcohol!and!druguse!status!posttreatment,!with!abstainers!reporting!more!nonusing!

supports!than!teens!who!returned!to!heavy!drug!use.!Selfesteem!and!the!degree!of!

satisfaction!with!Social!support!during!treatment!were!negatively!correlated!with!the!

number!of!major!life!problems!during!the!6!months!following!discharge.!Altogether,!

inpatient!measures!of!selfesteem,!number!of!highquality!supports,!and!social!support!satisfaction!accounted!for!16%!of!the!variance!in!6month!substance!use!outcome!and!25%!

of!the!variance!in!psychosocial!functioning!6!months!posttreatment.!Sixmonth!social!


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!!!!!!!!!!!!!!!!!!!!!!!!!!P.!O.!Box!6448!!Reno,!NV!89513!!Phone:[email protected]!

support!and!selfesteem!measures!were!similarly!related!to!lyear!outcome.!The!

implications!of!these!findings!for!adolescent!drug!abuse!treatment!are!discussed!!"


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Journal of Substance Abuse, 3, 371-385 (1991)

The Impact of Social Support and Self-Esteemon Adolescent Substance Abuse Treatment Outcome

Stephanie S. RichterDepartment of Veterans Affairs Medical Center, San Diego, CA

Sandra A. BrownDepartment of Veterans Affairs Medical Center, San Diego, CAand Department of Psychiatry, University of California, San Diego

Mariam A. MoltDepartment of Psychiatry, University of California, San DiegoAlthough poor social resources and low self-esteem have been Implicated in thedevelopment of teenage drug abuse, the role of these factors in the remission ofadolescent addiction remains unclear This study examines social support charac-teristics and self-esteem in relation to outcome following adolescent chemical

dependency treatment. Adolescents and their parents completed self-report ques-tionnaires and a research interview during treatment and at 6 and 12months post-treatment 1 \ \ 0 types of outcome were assessed at follow-up: (I) alcohol and druguse, and (2) funct ioning in major life domains (e g, family, school/work, peers)Results indicate that the qual ity of social resources (Ie , drug-use patterns ofsupports) reported during treatment was related to alcohol- and drug-use statuspost-treatment, with abstainers reporting more nonusing supports than teens whoreturned to heavy drug use. Self-esteem and the degree of satisfaction with SOCIalsupport during treatment were negauvely correlated with the number ofmajor lifeproblems during the 6 months following discharge. Altogether, inpatient measuresof self-esteem, number of high-quality supports, and social support satisfactionaccounted for 16% of the variance in 6-month substance use outcome and 25% ofthe variance in psychosocial functioning 6 months post-treatment. Six-month SOCIalsupport and self-esteem measures were similarly related to l-year outcome. Theimplications of these fmdings for adolescent drug abuse treatment are discussed

Recent concern about the prevalence of alcohol and drug abuse amongteenagers has focused considerable attention on identifying environmental,psychological, and sociological factors associated with adolescent drug-takingbehavior. Mounting evidence underscores the importance of the social environ-This project was supported by grants from the National Insti tute on Alcohol Abuse andAlcoholism (AA07033) and the Research Sen ICe of the Department ofVeterans Affairs awarded to

Sandra A Brown Portions of this research were presented at the Western Psychological AssociationAnnual Convention, Los Angeles, April 1990.Correspondence and requests for reprint s should be sent to Sandra A. Brown, PsychologyService (116 B), Department of Veterans Affairs Medical Center, 3350 La Jolla VIllage Drive, SanDIego, CA 92161.

371


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372 5.5. Richter, 5.A. Brown, and M.A.Mottment in the development of teenage alcohol and drug use. Research suggeststhat social pressure and substance-using role models are important determi-nants of alcohol and drug involvement among youth. Donovan andJessor (1978)report that in a national study of adolescents the problem drinkers perceivedgreater approval, pressure, and models for drinking than did the non problemdrinkers. Social support for drug use has likewise been found to be the mostpowerful predictor of marijuana use among high school and college samples(jessor, Jessor, & Finney, 1973).

Although the process of social involvement is not yet fully understood, astrong relationship has consistently been found between adolescent alcohol- anddrug-use patterns and those of their parents and friends (e.g., Alexander &Campbell, 1967; Kandel, 1973; Smart & Fejer, 1972). In addition to modelingsubstance use and providing approval for drug-taking behavior, the members ofan adolescent's social network may influence alcohol and drug consumptionthrough indirect channels. Because the drinking and drug use patterns ofsignificant others are likely to impact on qualitative features of support such asconsistency and availability (see Holden, Brown, & Mott, 1988), the likelihoodthat an adolescent will turn to alcohol or drugs to cope with life stresses may begreater among adolescents whose social resources abuse substances. Rhodes andJason (1990) propose that social networks, social competencies, and communityresources play a critical role in offsetting the stressors of youth that mightotherwise lead to substance involvement and other problem behaviors. Inconsis-tencies in the literature (e.g., Shedler & Block, 1990) notwithstanding, numerousstudies linking poor social resources to adolescent substance abuse providesupport for this model . For example, teens who use drugs have been found toperceive significantly less love from their parents than do nonusers (Streit,.Halsted, & Pascale, 1974). A negative emotional climate in the home (Adler &Lotecka, 1973) and troubled relationships with parents (e.g., Greenwald &Luetgert, 1971;Prendergast& Schaefer, 1974; Tudor, Petersen, & Elifson, 1980)also have been associated with substance use among youths. The apparentconnection between unsatisfactory personal relationships and teenage drug useis consistent with the social stress model of adolescent substance abuse.Additional support for this model is provided by studies examining the roleof social competencies in adolescent drug involvement. Scherer, Ettinger, andMudrick (1972) report that a high need for social approval may place a teen atincreased risk for substance use by heightening vulnerability to social pressure.

Although conflicting findings have been reported (e.g., Eskilson, Wiley,Muehlbauer, & Dodder, 1986),many studies suggest that negative self-attitudesare similarly related to adolescent drinking and drug use. Teens in drug abusetreatment have been found to have significantly lower self-esteem than thegeneral high school population (Ahlgren & Norem-Hebeisen, 1979; Svobodny,1982).Lower levels of self-esteem also have been associated with higher levels ofsubstance use involvement among junior high and high school students (Pan-dina & Schuele, 1983). Self-attitudes may thus play an important role indetermining an adolescent's ability to effectively resist social pressure to drinkand use drugs as well as pressure to engage in other deviant activities.While poor social resources and negative self-attitudes have been related to


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Social Support, Self-esteem, and Teenage Recovery 373adolescent drinking and drug use, the role of these variables in the process ofteenage recovery from addiction remains little understood. The present studyinvestigates the impact of social support and self-esteem on substance useoutcome and psychosocial functioning following adolescent chemical depen-dency treatment. Those teens with the greatest drug use among their primarysocial supports and with the lowest social support satisfaction and self-esteemwere predicted to be most likely to return to pretreatment patterns of substanceabuse. The following relationships were hypothesized: (1)The number of socialsupports of high, moderate, and low quality (categorized according to thesupport's alcohol and drug use) reported during inpatient treatment will berelated to teen alcohol and drug use during the 6-month follow-up period, withabstainers reporting more high-quality supports and fewer low-quality sup-ports, compared with the reports of relapsers. (2) The degree of satisfactionwith social support during inpatient treatment will be related to substance useoutcome and psychosocial functioning during the 6-month follow-up period,with greater satisfaction being associated with abstinence and fewer life prob-lems. (3) Inpatient measures of self-esteem will be related to substance useoutcome and psychosocial functioning during the 6-month follow-up period,with higher self-esteem being associated with better treatment outcome andfewer problems in major life domains. (4) Quality of social support, socialsupport satisfaction, and self-esteem measured during inpatient treatment willcontribute significantly to prediction of substance use outcome and psychosocialfunctioning 6 months post-treatment. In our longitudinal replication, it wasanticipated that 6-month measures of social support and self-esteem similarlywould be related to substance use outcome and psychosocial functioning 1 yearfollowing treatment.

METHODSubjects

One hundred sixty adolescent inpatients in substance abuse treatment (64females, 96 males) and their parents participated. Teens were between the agesof 12 and 18 (M = 15.9, SD = 1.3) and were predominantly Caucasian (78%).They came from families whose socioeconomic status ranged from upper-lower-to upper-upper-class (M = 30.2, SD = 12.6) as measured by the Two-factorIndex of Social Position (Hollingshead, 1965). Although the majority (74%) ofthose studied were not currently practicing their religion, 33% of the adoles-cents identified themselves as Protestant, 28% as Catholic, 9% reported anotherreligious background, and 30% indicated no religious orientation.Participants were recruited from two inpatient chemical dependency treat-ment programs in San Diego, California. Of the adolescents initially recruitedfor participation in the study, 92% were followed up in the second phase of datacollection, 6 months following treatment (N = 147), and 90% of eligible teens'were again assessed 1 year after leaving the treatment program (N = 137).

I All teens for whom I year had elapsed smce leaving the treatment program were consideredeligible for follow-up at the I }ear time pomt.


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374 5.5. Richter, 5.A. Brown, and M.A.MottProcedure

Adolescents consecutively admitted to the treatment programs were invitedto participate in the study if they lived within 50 miles of the research facility,had a parental figure (typically the teen's biological parent) willing to indepen-dently participate in the research project, and met DSM-III-R (AmericanPsychiatric Association, 1987) criteria for substance abuse without evidencing anindependent Axis I psychiatric disorder that predated the onset of alcohol ordrug abuse. Ninety-eight percent of eligible teens and parents enrolled in thestudy. Participation was voluntary and was conducted in accordance with theethical guidelines of the university and treatment programs involved.As part of an ongoing longitudinal study, teens completed self-reportquestionnaires and a confidential structured research interview (Brown, Vik, &Creamer, 1989) 2 to 3 weeks following admission to chemical dependencytreatment and again at 6 and 12 months post-treatment. A separate andconfidential interview was conducted with the teen's parent at each datacollection time point using the resource-person version of the structuredinterview (Brown et al., 1989). Following data collection, parent and teenresponses were compared to establish a single reliable composite of the data. Incases of discrepancy in reports, a worst-case scenario was scored so as to avoidoverestimating the adolescent's functioning.Teens were paid $25 upon completion of the 6-month follow-up interviewand testing, and $50 for their participation 1 year post-treatment. Parentsreceived $10 and $20, respectively.Initial AssessmentSocial and demographic data were gathered during inpatient treatment by atrained research assistant using a 60-min. structured clinical interview (Brownet aI., 1989). Interview procedures standardized by Schuckit (1988) were em-ployed in obtaining detailed information regarding substance use among familymembers as well as the teen's exposure to alcohol- or drug-abusing relatives.The Customary Drinking and Drug Use Record (CDDR; Brown, Creamer, &Stetson, 1987) was utilized in obtaining adolescent alcohol- and drug-usehistories during the inpatient interview. The CDDR is based on DSM-III-Rcriteria (American Psychiatric Association, 1987) for substance abuse anddependence, the Quantity-Frequency-Variability Drinking Index (Cahalan &Cisin, 1968), and the Index of Drug Indulgence (Lu, 1974). This instrumentprovides a detailed assessment of drinking and drug use patterns, dependencysymptoms, and major life problems associated with alcohol and drug use.The abbreviated version of the Social Support Questionnaire (Pierce,Sarason, & Sarason, 1986) was used to assess the perceived number of socialsupports and the degree of satisfaction with available supports. Measures weretaken during inpatient treatment and at the 6-month follow-up interview. TheSocial Support Questionnaire (SSQ) has been shown to be a valid and stableinstrument with internal consistency estimates ranging from .96 to .98 (Sarason,Levine, Basham, & Sarason, 1983; Pierce et al., 1986). The short form has


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Social Support, Self-esteem, and Teenage RKovery 375comparable psychometric properties (Pierce et al., 1986), including similarinternal reliability (range = .89 to .93) and similar correlations with measures ofpersonality and social competence.

The abbreviated SSQ consists of six items describing situations in which socialsupport might be impor tant to a person. For each item, respondents areinstructed to list up to nine individuals to whom they can turn for support in themanner described and to indicate on a six-point Likert scale ranging from "verysatisfied" (6) to "very dissatisfied" (1) the degree of contentment with support inthat area. The number of different social supports is summed, and an averagesatisfaction rating is computed.

Drinking and drug use characteristics of identified supports were availablefor a subsample of adolescents (N = 69 for inpatient measures and N = 106 at 6months post-treatment). Using this additional information, social supports weredivided into three categories with regard to their alcohol- and drug-use lifestyle.Individuals who neither drank nor used drugs were classified as high-qualitysupports. Those who drank or used drugs on an infrequent or social basiswithout evidencing substance-use-related problems were considered moderate-quality supports. Probable or definite substance abusers were classified as low-quality supports.Self-esteem was measured during inpatient treatment and at the 6-monthfollow-up interview using the self-report questionnaire employed by Labouvieand McGee (1986). The questionnaire consists of 18 interrogative items aboutthe self (e.g., "How often do you feel that you are a good person?") and hasmoderate internal consistency (coefficient alpha = .74). Respondents indicatetheir feelings about each statement on a five-point Likert scale ranging from"never" to "almost always or always." Ratings are summed to produce a singleself-esteem score, with higher scores indicating greater self-satisfaction.Follow-up AssessmentAdolescents and parents were independently interviewed at 6 and 12monthspost-treatment. Detailed information regarding use of alcohol or drugs duringthe follow-up time period was obtained using a 60-min. structured clinicalinterview (Brown et al., 1989) and verbal administration of the CDDR at eachfollow-up time point.Two types of outcome were examined at 6 and 12 months post-treatment.Adolescent substance use outcome was categorized in a trichotomous fashionbased on both teen and paren t reports. Abstaining teens were compared withthose whose post-treatment alcohol or drug use was sporadic and time limited,as well as with those who returned to more severe levels of substance use. Teenswho refrained from use of any alcohol or drugs were classified as abstainers;those who used alcohol or drugs in a time-limited fashion (:5 30 days using)were classified as minor relapsers; and teens who returned to heavy substanceuse 30 days using) were classified as major relapsers. Of the 147 teensassessed 6 months post-treatment, 30% were abstainers, 27% were minorrelapsers (M = 5.20, SD = 6.16 days using), and 43% were major relapsers (M =


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376 5.5. Richter, 5.A. Brown, and M.A.Mott110.93, SD = 50.44 days using). Of the 137 teens assessed I }ear followingtreatment, 36% were abstainers, 26% were minor relapsers (M = 5.94, SD =8.03 days using), and 38% were major relapsers (At = 145.04, SD = 54.01 daysusing).The second type of treatment outcome assessed was psychosocial function-ing. The number of problems occurring in each of five major life domains(family, school/work, peers, emotional health, and the law) was determined byadministration of an inventory that includes the areas of Jessor's Problem-Behavior Theory (e.g., Donovan & Jessor, 1978), and Newcomb and Bentler'sDomain Theory (1988). Additionally, a series of questions from the follow-upinterview was used to determine whether the teen had experienced interperso-nal problems, periods of depression, episodes of anxiety, or other emotionalproblems requiring counseling or hospitalization. The inventory consists of 39items: 7 items assess functioning in the home environment (e.g., "Did you runaway from home overnight or longer?"); 9 items pertain to school- and work-related behavior (e.g., "Have you been suspended or expelled from school?"); 8items examine interpersonal functioning (e.g., "Have you been involved in anyfights?"); 4 items evaluate emotional health (e.g., "Have you had any emotional!psychological problems requiring professional help/therapy in the past 6months?"); and 11 items address legal problems (e.g., "Have you been involved inany illegal occupations, like fencing, selling drugs, prostitution?"). The totalnumber of behavioral, interpersonal, and emotional problems reported issummed to create a composite measure of psychosocial functioning post-treatment.Adolescents residing in an institution (e.g., an extended residential treatmentfacility) for one half or more of the follow-up time period were excluded fromanalyses (N = 18at 6 months post-treatment and N = 16at the l-year follow-up)because restrictions imposed by their living situations may bias post-treatmentmeasures of substance use and psychosocial functioning.

RESULTSPreliminary Analyses

Analyses of variance (ANOVAs) were conducted to determine whetherpretreatment sociodemographic, background, and drug use characteristicscould account for observed differences across the three substance use outcomegroups (abstainers, minor relapsers, and major relapsers). The outcome groupswere not significantly different on any of the demographic characteristicsassessed in the study (e.g., age, gender, ethnic background, socioeconomicstatus, religious background, religious practice). In addition, no significantdifferences were found across the groups on pretreatment drinking and druguse characteristics (e.g., age of first hard drug use, number of drugs tried,number of times of alcohol or hard drug use during the 3 months prior totreatment), family history of alcoholism and drug abuse, or percentage oflifetime exposure to alcohol or drug abuse within the family.ANOVAs also were conducted to determine whether the teens unavailable at


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Social Support, Self-esteem, and Teenage Recovery 377follow-up differed from adolescents for whom follow-up data were obtained. Nosignificant differences were found on the above variables between thoseassessed at 6 and 12months post-treatment and teens unavailable at the follow-up time points.

Quality of Social SupportTeens reported an average of 9.56 (SD = 3.37) social resources on the SSQ

during treatment. Multivariate analyses of variance (MANOVAs) using WiIk'slambda criterion were conducted to determine whether adolescent drug useoutcome groups differed in the quality of their social resource networks. Thefirst MANOVA examined the number of high-, moderate-, and low-qualitysocial supports reported during treatment and substance use outcome at the 6month follow-up. The overall MANOVA was significant (F(6, 130) = 2.30, P


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Social Support, Self-esteem, and Teenage Recovery 379Table 1. Correlation of Social Support Satisfaction and Self-esteem with Psychoso-cial Functioning of Adolescents following Substance Abuse Treatment

InpatientSocial support sansfactionSelf-esteem

6 month Follow-upSocial support satisfactionSelf-esteem

Number of Problems6 Months Post-treatment

-.19- 27

Number of Problems1 Year Post-treatment

- 24- 32

p.03

>.01

p.01

>.01

hoc comparisons using Tukey's method were conducted to determine whichoutcome group(s) differed significantly. No significant differences were foundacross the three outcome groups at the 6-month follow-up on inpatientmeasures of social support satisfaction (F(2, 118) = 2.17, P = .12). Significantdifferences were, however, found across the l-year drug use outcome groups on6-month measures of social support satisfaction (F (2, 106) = 4.35, P< .05), withabstainers and minor relapsers reporting significantly (p < .05) greater satisfac-tion with their social supports (M = 5.42, SD = 0.50, and M = 5.46, SD = 0.53,respectively) than major relapsers (M = 5.05, SD = 0.85).Pearson correlation coefficients were calculated to assess the relationshipbetween social support satisfaction and psychosocial functioning during thefirst and second 6-month periods following discharge from treatment. Asexpected, the degree of satisfaction with social support during treatment wassignificantly negatively correlated with the total number of problems occurringacross major life domains during the initial 6-month follow-up period (r =- .19,N = 121, P< .05).This same relationship was demonstrated at the l-yearfollow-up; the degree of satisfaction with social support reported 6 months post-treatment was significantly negatively correlated with the total number ofproblems occurring between the 6-month and l-year time points (r = - .24, N= 109, P < .05). Social support satisfaction was thus associated with betterpsychosocial functioning in major life domains during the follow-up timeperiods (see Table 1).

Self-esteemANOVAs were conducted to examine the relationship between self-esteem

and substance use outcome following treatment . Although no significantdifferences were found across the 6-month drug use outcome groups oninpatient measures of self-esteem (F(2, 108) = 1.51, P = .23), significantdifferences were found across the outcome groups at the I-year follow-up onfi-month measures of self-esteem (F(2, 106) = 8.35,P< .01). Post-hoc Tukey tests


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380 5.5. Richter, 5.A. Brown, and M.A.Moltindicate that abstainers and minor relapsers obtained significantly (p < .05)higher self-esteem scores (1\1 = 69.71, SD = 7.22, and M = 70.35, SD = 8.44,respectively) than major relapsers (AI = 63.62, SD = 8.38).Pearson correlation coefficients were calculated to examine the extent towhich measures of self-esteem were related to subsequent psychosocial function-ing. As hypothesized, the level of self-esteem during treatment was significantlynegatively correlated with the total number of problems occurring across majorlife domains during the first 6 months post-treatment (r = - .27,N = HI,P


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Social Support, Self-esteem, and Teenage Recovery 381Table 2. Multiple Regression of Inpatient Measures of Social Support and Self-esteem on fi-month Substance Use OutcomeVariables B 13High-qualitysocial supports -0.078 -0.22Social supportsatisfaction 0072 008Self-esteem -0.034* -0.32*P< 05

sr2 (Unique)

R2 = 16Adjusted R2 = .11.09 R = .40*

Table 3. Multiple Regression of 6-month Measures ofSocial Support and Self-esteemon I-year Substance Use OutcomeVariables B 13 sr2 (Uruque)High-qualitysocial supports -0.101** -0.33 .11Social support R2 = 24satisfaction -0.173 -0.14 Adjusted R2 = .22Self-esteem -0.024* -0.24 .05 R = .49***p


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382 5.5. Richter, 5.A. Brown, and M.A.Mollpercent of the variance in 6-year psychosocial functioning was accounted for bythe three 6-month measures. Self-esteem (sr = .07) contributed significantly toprediction of psychosocial functioning (p < .01), and the three independentvariables in combination contributed another .09 in shared variability (see Table5).

Gender DifferencesANOVAs were conducted to examine whether gender differences exist in therelationships of interest. A series of two-way ANOVAs were conducted with

6-month outcome group and gender as independent variables for inpatientmeasures of the number of high-quality supports, moderate-quality supports,low-quality supports, social support satisfaction, and self-esteem.

The only analysis that revealed a significant main effect for gender was theANOVA examining the number of low-quality supports (F(l, 63) = 4.55, P


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Social Support, and Recovery 383sures suggest the importance of high-quality support as an antecedent ofsuccessful treatment outcome.

Although inpatient measures of social support satisfaction and self-esteemwere not significantly different across the 6-month outcome groups, 6-monthmeasures of social support satisfaction and self-esteem were related to l-yearsubstance use outcome in the manner hypothesized. It is possible that crisesculminating in adolescent admission to alcohol and drug abuse treatment mayhave uniformly reduced social support satisfaction and self-esteem, therebyrestricting these measures during treatment. Inpatient measures of self-esteem,number of high-quality supports, and social support satisfaction in combinationwere, however, shown to have modest power as predictors of substance useoutcome and psychosocial functioning at the 6-month follow-up, and the samepattern of relationships was observed between 6-month measures and I-yearoutcome.Social resources and self-esteem are considered crucial to establishing andmaintaining the major lifestyle changes necessary for adolescent abstinence.Because the majority of adolescent relapse occurs in social settings with pressureto drink or use drugs (Brown et al., 1989), social resources for abstention may becritical to the coping process (Myers & Brown, 1990).Abstinent social resourcesnot only model abstention but also may demonstrate viable coping strategies foradolescents in high-risk settings, thereby enhancing the perceived acceptabilityof these options. Such supports may further decrease relapse risk by encourag-ing the adolescent to avoid social pressure situations, by providing emotionalsupport for decisions to abstain, and by reinforcing drug-refusal efforts.Self-esteem appears to playa similarly important role in the evolution ofdrugabuse and the maintenance of lifestyle changes following treatment. Within theframework of stress and coping models (e.g., Lazarus & Folkman, 1984), self-esteem may influence both primary and secondary appraisal. Teens with lowerself-esteem may perceive high risk for relapse settings as more threatening andthemselves as being less capable of generating or implementing adequatecoping strategies. Furthermore, the observed relationship between self-esteemand problems in major life domains suggests that the influence of self-esteem onappraisal may be generic rather than specific to drug abuse.The finding that short-term clinical course following adolescent drug abusetreatment is not related to sociodemographic, background, and pretreatmentdrug use characteristics is consistent with previous reports based on similarsamples of adolescents in drug abuse treatment (e.g., Brown et al., 1989).Whilehomogeneity of the sample and restriction of the range may contribute to thisresult, short-term adolescent drug abuse treatment outcome appears to be mostclosely linked to post-treatment social and environmental characteristics(Brown, in press).

The results of this study should be considered in l ight of certain limitations.For example, social support characteristics and self-esteem measured at onepoint in time were examined in relation to psychosocial functioning andsubstance use outcome over a subsequent 6-month time period. Because thesepersonal characteristics may fluctuate over time, unassessed changes in social


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384 5.5. Richter, 5.A. Brown, and M.A.Mottsupport or self-esteem occurring during each follow-up time period may haveinfluenced outcome.

Another consideration in substance abuse research is the validity of alcohol-and drug-use outcome data. A number of measures were taken in the presentstudy to enhance the accuracy of the self-report information obtained. Partici-pants were reassured of confidentiality, and repeat interviews were conductedby the same interviewer whenever possible. Different interviewers were usedwith each parent and teen pair to protect against accidental sharing ofinformation. Following data collection, teen reports were combined withinformation gathered in the separate and confidential parent interview toestablish a single, maximally reliable composite of the data, and alternative datasources (e.g., medical records) were consulted in cases of question.

These results have implications for adolescent chemical dependency treat-ment programs. For example, social support characteristics (e.g., number ofhigh-quality supports, degree of satisfaction with available support) and self-esteem measures could be util ized to identify adolescents at increased risk forrelapse and/or for experiencing serious problems post-treatment. These empiri-cal findings argue for the value of intervention efforts that focus on assistingteens (both as inpatients and following treatment) in establishing satisfyingsocial support networks comprised by individuals leading alcohol- and drug-free lifestyles while endeavoring to enhance the adolescent's self-esteem.Strategies of teenage social network restructuring (Catalano & Hawkins,1985), utilization of high-quality social supports in the therapeutic process, andexploration of the ways in which abstinent supports can be useful in potentialrelapse situations are all likely to enhance treatment success. Experiences thatresult in self-esteem enhancement may also prove efficacious with adolescents.Many treatment programs currently include opportunities for volunteer effortswith the disabled or elderly, physically challenging tasks, or the mastery of newskills. The relationship between the resultant self-esteem enhancement of theseexperiences and adolescent substance abuse treatment outcome now needs to beexplored.

REFERENCESAdler, P.T, & Lotecka, L. (1973) Drug use among high school students' Patternsand correlates.

International Journal of the AddictIOns,8, 537-548.Ahlgren, A , & Norem-Hebeisen, A.A. (1979). Self-esteem patterns distinctive of groups of drugabusing and other dysfunctional adolescents International Journal of the AddIctIOns, 14,759-777.Alexander, C.N. ]r , & Campbell, E.Q. (1967) Peer Influences on adolescent drinking. QuarterlyJournal ofStudies on Alcohol,28, 444-453.American Psychiatric Association. (1987) Dtagnosticand stausucal manual ofmental disorders (3d ed.,rev) Washington, DC: AuthorBrown, S.A. (in press). Adolescent substance abuse Recovery patterns. In] S. Baer, G A.Mariatt, &R.] McMahon (Eds ),Addictivebehmnors acrossthe life span: Prevention, treatment, and polzcyISsuesBeverly Hills, CA: Sage Publications.Brown, S.A , Creamer, VA., & Stetson, B.A (1987) Adolescent alcohol expectancies in relation topersonal and parental drinking patterns Journal ofAbnormal Psychology, 96, 117-121.Brown, SA, VII.., PW, & Creamer, V.A. (1989). Characteristics of relapse following adolescentsubstance abuse treatment. AddlCtwe Behatnors, 14, 291-300


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The Impact of Social Support and Self-Esteem on Adolescent Substance Abuse Treatment Outcome

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