Page 123 - Age of onset of disruptive behavior of residentially treated adolescents -Sjoukje de Boer

like MDFT or MST work better for young people who have high risk of dropout. Moreover, it is important to realize that there will probably always be an unreachable group. It is important to bring this group to a minimum.
Cannabis usage
Research indicated that in The Netherlands about half of all youngsters age 17
or 18 have used cannabis (Verdurmen et al., 2011), and among groups of troubled
youth the prevalence is even higher (Van Laar et al., 2014). As there is a strong relation between substance use and disruptive behavior (Disney et al., 1999; Grant et al., 2015;
Kendler et al., 2003), it was not surprising that many youngsters admitted to De Fjord
used cannabis. The use of cannabis in itself was not a reason for expulsion, on the 7 contrary, relapse prevention was an important part of the treatment. Not surprisingly,
we found that cannabis use prior to treatment was related to dropout. It was already
known that individuals using cannabis after discharge had almost 6 times higher likelihood at worsening of symptoms (SCL-90-R) at one-year follow-up (Boon & De
Boer, 2007). Also, individuals who had not used cannabis after discharge were over 11
times more likely to improve their (SCL-90-R) symptoms at one-year follow-up (Boon
& De Boer, 2007). Cannabis use is thus a crucial determinant that has an influence on
the outcome. Therefore, reduction or prevention of cannabis use is of clinical relevance. Treatment and relapse prevention of cannabis use should be an important
focus during treatment of youth with severe disruptive behavior and psychiatric disorders, as well as for other groups of vulnerable youth. Ideally, such interventions
are not only effective in reducing cannabis use, but also in terms of symptom reduction. For youth with a combination of psychiatric problems, disruptive behavior
and substance use, community care and multidimensional interventions such as MDFT
(Liddle et al., 2001) and MST (Henggeler et al., 1992) can be very beneficial.
Strengths and Limitations
There are several limitations to this study. Most of them were related to the observational design of the study. It has been shown that treatment works for behavioral problems (in specific Conduct Disorder) (Bennett & Gibbons, 2000; Eyberg et al., 2008; Frick et al., 2014; McCart et al., 2006; Serketich & Dumas, 1996). As we did
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