Understanding motivation for substance use treatment: the role of social pressure during the transition to adulthood

Delving into the Elements Impacting Treatment Acceptance among patients with Substance Use Disorder using Health Belief Model: a qualitative study

BACKGROUND

Substance abuse has become a significant public health issue in Iraq, fueled by economic slowdown, and high unemployment rates. Treatment acceptance among Iraqi patients with substance use disorder remains poorly understood.

OBJECTIVES

The study aimed to explore in-depth the factors influencing treatment acceptance among patients with substance use disorder (SUD).

METHODS

This qualitative study included face-to-face semi-structured interviews with patients having SUD relying on the Health Belief Model. Convenience sampling was employed to interview patients from the two specialized treatment centers in Baghdad between Nov. 2023 through Feb 2024. Thematic analysis was used to identify recurring themes and sub-themes.

RESULTS

Thirty-three patients from both genders (27 male and 6 female) were recruited in this study. Most (60.6%) of participants had primary school education and 63.6% of them were low-income workers. Ninety-one percent abused Crystal (Methamphetamine). Interviews showed patients have good adherence to treatment. Four domains of the Health Belief Model were strongly connected with the patient motivation to initial engagement and adherence to treatment. The patients perceived benefits for treatment (improving physical and mental health and restoration of family relationships), cues to action (a national program about cured cases and influences of family, friends and legal issues), good subjective norm (support from family during hospitalization), and facilitating conditions (maintaining privacy, availability of free treatment, and governmental financial assistance to recovered patients). On the other hand, perceived barriers were an obstacle to seeking treatment including lack of awareness about treatment centers, fear of legal consequences, and psychological barriers. Additionally, patients had high susceptibility to relapse which prevents long-lasting recovery from substance abuse due to high accessibility and affordability of drugs.

CONCLUSION

The majority of patients adhered to their treatment plans well due to perceived benefit of treatment, perceived severity of SUD, positive subject norms, and alarming cues to action The HBM successfully explains the factors that influence treatment acceptance among patients with SUD. Increasing treatment acceptability among patients with SUD requires addressing existing barriers (lack of awareness about treatment centers, addiction enjoyment, and fear of legal consequences) and improving the facilitating factors. Extensive awareness campaigns and providing accessible treatment facilities can increase treatment acceptance. Health officials can enable more patients to make responsible choices of getting treatment and overcoming addiction by establishing additional drug-abuse treatment centers across the nation. Finally, the findings of this study can help health authorities in the region to identify potential factors affecting patients with SUD willingness to accept treatment.

"Just as expensive as sending him to college:" barriers and perceptions of treatment in justice-involved youth

BACKGROUND

Justice-involved youth have higher rates of substance use disorders (SUDs) than the general population. Many do not connect with or complete treatment, leading to recidivism. This qualitative study explores perceptions and barriers to treatment in this population.

RESULTS

Justice-involved youth participating in a larger study focused on access to SUD treatment were interviewed about available treatment and justice system involvement. Twenty-one dyads (youth and a guardian) and 3 individual guardians (total N = 45) were interviewed by phone. Inclusion criteria were youth aged 14-17 involved in the justice system that screened positive for SUD. Youth sample was 43% male. Thematic analysis guided the process. The study was Indiana University Institutional Review Board approved (#1802346939). Data was interpreted within the ecological system theory. Youth barriers included willingness to engage in treatment, time constraints/scheduling conflicts, and low perceived usefulness of treatment. Major guardian themes included high cost of treatment, lack of communication by the justice system about treatment, youth unwillingness or disinterest to engage in treatment, and limited program availability.

CONCLUSIONS

The barriers to treatment for justice-involved youth are multifaceted and occur across the spectrum of levels of the ecological system, which include parents, peers, social systems, and cultural elements. Many youth and guardians suggested improvements for their interactions with the juvenile justice system. Further examination is needed of current policy implementation to address these concerns.

Patterns of demoralization and anhedonia during early substance use disorder treatment and associations with treatment attrition

BACKGROUND

Although depressive symptoms represent a promising therapeutic target to promote recovery from substance use disorders (SUD), heterogeneity in their diagnostic presentation often hinders the ability to effectively tailor treatment. We sought to identify subgroups of individuals varying in depressive symptom phenotypes (i.e., demoralization, anhedonia), and examined whether these subgroups were associated with patient demographics, psychosocial health, and treatment attrition.

METHODS

Patients (N = 10,103, 69.2 % male) were drawn from a dataset of individuals who presented for admission to SUD treatment in the US. Participants reported on their demoralization and anhedonia approximately weekly for the first month of treatment, and on their demographics, psychosocial health, and primary substance at intake. Longitudinal latent profile analysis examined patterns of demoralization and anhedonia with treatment attrition as a distal outcome.

RESULTS

Four subgroups of individuals emerged: (1) High demoralization and anhedonia, (2) Remitting demoralization and anhedonia, (3) High demoralization, low anhedonia, and (4) Low demoralization and anhedonia. Relative to the Low demoralization and anhedonia subgroup, all the other profiles were more likely to discontinue treatment. Numerous between-profile differences were observed with regard to demographics, psychosocial health, and primary substance.

LIMITATIONS

The racial and ethnic background of the sample was skewed towards White individuals; future research is needed to determine the generalizability of our findings to minoritized racial and ethnic groups.

CONCLUSIONS

We identified four clinical profiles that varied in the joint course of demoralization and anhedonia. Findings suggest specific subgroups might benefit from additional interventions and treatments that address their unique mental health needs during SUD recovery.

Youth Wellness Hubs Ontario: Development and initial implementation of integrated youth services in Ontario, Canada

AIM

The need for youth-friendly early intervention services to meet the mental health, substance use, primary care, and other social needs of adolescents and young adults is well-documented. This article describes Youth Wellness Hubs Ontario, a province-wide initiative in Ontario, Canada to build and implement a one-stop-shop model of integrated youth services.

METHODS

We describe the development of Youth Wellness Hubs Ontario, in the context of global youth mental health system transformation, as well as pan-Canadian youth mental health system change. We also describe Youth Wellness Hubs Ontario's values and services.

RESULTS

The demonstration phase of Youth Wellness Hubs Ontario was initiated in 2017-2018. Youth Wellness Hubs Ontario is co-created with youth for youth aged 12-25 years old across diverse community contexts. Youth Wellness Hubs Ontario centres engagement and equity, and offers developmentally-appropriate services in an integrated, community-based walk-in format. As an initiative committed to continuous learning and quality improvement, Youth Wellness Hubs Ontario offers evidence-based and evidence-generating services, and measurement-based care. Youth Wellness Hubs Ontario is supported by backbone resources with expertise in implementation science, health equity, Indigenous practices, youth and family engagement, evaluation, and knowledge translation. In 2020 Youth Wellness Hubs Ontario secured sustainable funding for the first 10 locations and scale-up began in 2021, with 10 additional locations in development.

CONCLUSIONS

Youth Wellness Hubs Ontario demonstrates the feasibility of integrated mental health and substance use early intervention services, offered in the context of a broad range of health and social services.

Influences of poly-victimization on adolescents' pre-treatment cognitive motivations and post-treatment outcomes

INTRODUCTION

Substance use treatment outcomes are challenging to predict: myriad potentially relevant factors influence outcomes, including age, sex, motivations, and history of victimization.

METHODS

The current study seeks to assess these factors in adolescents through an evaluation of the relationship between distinct victimization profiles, sex, and cognitive factors related to substance use treatment outcomes-specifically motivation, self-efficacy, and reasons for quitting-and the relationship between these factors and posttreatment outcomes. We report sex differences in the prevalence of specific types of victimization; females are more likely than males to report poly-victimization alongside higher levels of traumagenic characteristics such as fearing for your life, chronic abuse, abuse by a trusted individual, or negative reactions to disclosure.

RESULTS

Adolescents who endorsed high levels of poly-victimization and high traumagenic characteristics reported a) higher motivation for treatment, b) more reasons for quitting substance use, c) lower self-efficacy, and d) fewer adjusted days abstinent posttreatment relative to their peers. We report several sex differences: emergent poly-victimization profiles are different for males and females, class membership has a differential proportion, and, last, associations between class membership and pre-treatment cognitive motivations and posttreatment outcomes vary by sex.

CONCLUSION

Clinicians working with adolescents who report poly-victimization should aim to leverage their motivation and reasons for quitting, as these factors are traditionally associated with positive outcomes. Last, interventions aimed at fostering self-efficacy may also be particularly important to improve long-term outcomes, specifically among adolescents with a history of poly-victimization.

In what ways do emerging adults with substance use problems experience their communities as influencing their personal recovery processes?

Applying the multiple psychological sense of community concept (MPSOC), this study explored how emerging adults with substance use problems experience the influences of various senses of community and communities on their personal recovery processes. Semi-structured interviews with 21 emerging adults from different urban contexts in Norway were analysed using a collaborative, seven-step, deductive, and reflexive thematic approach. MPSOC is shown to be a key concept for achieving a broad, in-depth understanding of emerging adults' senses of community and personal experiences of community influences on recovery processes from substance use. Positive and negative senses of community in geographical, relational, substance use-related and ideal communities influence the potentials and challenges in emerging adults' recovery processes. Supportive and motivating community relationships, meaningful activities with peers, and distance from recovery-impeding communities were identified as important recovery components. To promote recovery and prevent substance use in emerging adults, community approaches and tools applied in substance use treatment have to take into account and utilise multidimensional and age group-specific aspects of belonging.

Navigating Opioid Agonist Therapy among Young People who use Illicit Opioids in Vancouver, Canada

BACKGROUND

Opioid agonist therapy (OAT) has been shown to reduce opioid use and related harms. However, many young people are not accessing OAT. This study sought to explore how young people navigated OAT over time, including periods of engagement, disengagement, and avoidance.

METHODS

Semi-structured, in-depth qualitative interviews were conducted between January 2018 and August 2020 with 56 young people in Vancouver, Canada who reported illicit, intensive heroin and/or fentanyl use. Following the verbatim transcription of longitudinal interviews, an iterative thematic analysis was used to extrapolate key themes.

RESULTS

Young people contemplating OAT expressed fears about its addictiveness. Many experienced pressure from providers and family members to initiate buprenorphine-naloxone, despite a desire to explore other treatment options such as methadone. Once young people initiated OAT, staying on it was difficult and complicated by daily witnessed dosing requirements and strict rules around repeated missed doses, especially for those receiving methadone. Most young people envisioned tapering off OAT in the not-too-distant future.

CONCLUSIONS

Findings underscore the importance of working collaboratively with young people to develop treatment plans and timelines, and suggest that OAT engagement and retention among young people could be improved by expanding access to the full range of OAT; updating clinical guidelines to improve access to safer prescription alternatives to the increasingly poisonous, unregulated drug supply; addressing treatment gaps arising from missed doses and take-home dosing; and providing a clear pathway to OAT tapering.

Successful outcomes with low-threshold intervention for cannabis use disorders in Norway - an observational study

AIMS

Cannabis is the most commonly used regulated drug by European youths. Yet, few cannabis-specific interventions have been examined in Europe. The Cannabis Cessation Program (CCP) was developed in Sweden in the 1990s and has been implemented in some Norwegian municipalities. The present study aimed to examine outcomes of this intervention in the Norwegian setting.

METHOD

The respondents (N = 102) were recruited in four community-based CCPs in Norway. We examined their changes in cannabis use, other substance use, mental distress, well-being, sense of coherence (SoC), and social networks, from baseline (T0) to post-treatment (T1) and up to a 3-month follow-up period (T2). Changes were evaluated with pair-wise t-tests.

RESULT

Seventy-six participants (75%) completed the 8-week program, according to plan. All participants reported a significant reduction in cannabis use at T1 (average reduction ~16 days per month) and at T2 (N = 59; ~13 days per month). Among those that completed the program, 67% was abstinent from cannabis at T1 and 37% was abstinent at T2. An intention-to-treat analysis showed that 50% (51/102) and 22% (22/102) were abstinent from cannabis use at T1 and T2, respectively. In parallel to abstinence, we observed a substantial reduction in mental distress and an increase in well-being and SoC. Respondents socialized with fewer friends with current substance use, but drug-free social networks were not expanded.

CONCLUSION

Our findings suggested that the CCP was a valuable, low-threshold manual-based intervention for cannabis use disorders. It showed considerable potential for reducing individuals' cannabis use.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov no. NCT04989205. Registered 12 July 2021, i.e., the study was retrospectively registered.

Adolescents with substance abuse problems in outpatient treatment: A one-year prospective follow-up study

Aim:

There is a lack of knowledge about how adolescents with substance abuse problems manage after taking part in treatment. It is also difficult to perform traditional follow-up studies with this group. This article presents the outcome of a prospective study of 455 adolescents who underwent outpatient treatment, based on data taken from official registers. It aims to describe and analyse indications of continued use of substance (CUS) and how various risk and protective factors predict outcomes after initiated treatment at a Maria clinic in Sweden.

Design:

The study is based on structured interviews at intake, and the data that indicated CUS were taken from several different national registers. The analyses included descriptive data and bivariate associations, logistic regressions and a CHAID analysis.

Results:

Almost two thirds of the adolescents have no indication of CUS at one-year follow-up. The ten studied risk factors independently were weak predictors of CUS and it was instead the accumulation of risk factors that were linked to a negative outcome.

Conclusion:

The majority of adolescents who start outpatient treatment for substance abuse problems return to a lesser extent in registers that may indicate a continued problem with alcohol and drugs one year later. A concentration of more than five risk factors appears to be associated with a registration. The study also provides an example of an alternative method for following up adolescents with alcohol and drug abuse problems.

Family involvement in treatment and recovery for substance use disorders among transition-age youth: Research bedrocks and opportunities

This article presents a narrative review and conceptual framework for research on family involvement across the continuum of substance use disorder (SUD) services for transition-age youth (ages 15-26). Though families are powerful resources for enhancing treatment and recovery success among youth with SUDs, they are not routinely included in clinical practice. This article summarizes youth SUD prevalence and service utilization rates and presents developmental and empirical rationale for increasing family involvement in services. It then describes key research issues on family involvement across the SUD services continuum: Problem Identification, Treatment Engagement, Active Treatment, Recovery Support. Within each phase, it highlights bedrock research findings and suggests promising opportunities for advancing the scientific knowledge base on family involvement. The main goals are to endorse family-oriented practices for immediate adoption in routine care and identify areas of research innovation that could significantly enhance the quality of youth SUD services.

Understanding the service needs of youth with opioid use: A descriptive study of demographics and co-occurring substance use and mental health concerns

INTRODUCTION

Opioid misuse among youth is a significant concern given its potential negative consequences; yet youth who use opioids continue to face challenges in seeking treatment. The goal of this study was to understand the demographics, mental health, and substance use and co-occurring concerns of service-seeking youth with opioid use to inform future services and research.

METHODS

This study characterized 1769 youth between 14 and 24 years old seeking services at an urban treatment facility in Toronto, Ontario (ON) between 2008 and 2019. Youth who could adequately read English, had no immediate psychiatric service needs, provided research consent, and responded to a question about opioid use history were eligible. Participants provided information on demographics, substance use, mental health, and treatment motivation.

RESULTS

Youth who use opioids were more likely to report challenges with social determinants of health, use more substances, initiate substance use earlier, and use some substances at a higher frequency than youth who do not use opioids. Youth with opioid use reported more co-occurring mental health and substance use concerns than youth with no opioid use. They also endorsed more trauma and a likely PTSD diagnosis. Not being in employment, education, or training and using a higher number of substances positively predicted youth opioid use. In terms of treatment motivation, youth who use opioids endorsed more internal forms of motivation than youth who do not use opioids.

CONCLUSIONS

Youth who use opioids have complex social and co-occurring mental health and substance use needs that may be addressed with integrated community-based services. Future research should focus on developing evidence-based opioid treatment programs in this context and other innovative platforms.

Redemption from plight: a qualitative study on reasons behind treatment decisions among Iranian male opioid users

BACKGROUND

Opioid use remains a significant cause of harm to individual health. Perceived motives are of the main factors that help lead a patient into seeking treatment voluntarily to obviate that harm. The current study expands on the literature by exploring when and how male users of opioids become motivated to voluntarily seek treatment services.

METHODS

In a qualitative study in Isfahan city from January 2018 to March 2019, 55 male participants who had already started a variety of treatment services to withdraw their dependence on opioids were recruited. Selection of participants was based on a maximum variation purposive sampling strategy. Each participant took part in a unstructured interview to identify his motives for seeking opioid use treatment. Interviews were undertaken in eight different treatment centers. An inductive thematic analysis method was used to analyze the interviews.

RESULTS

The findings highlight that Iranian male opioid users have different motivations to seek treatment. To be precise, the findings illuminate three global themes and six themes as treatment-seeking motives among the participants including; motives related to family (reason for family and reason of family), quality of life (adverse effects on personal lifestyle and health) and economic motives (financial failure and job failure).

CONCLUSIONS

The findings can improve our understanding of the motives for seeking treatment from the perspective of opioid patients who entered themselves into treatment. Particularly, these findings could help policymakers and treatment providers to better understand opioid-use patient's perceived concerns and fears as motives for treatment-seeking.

Prevalence and Correlates of Depressive Symptomology among Young Adults Who Use Prescription Opioids Non-medically

Non-medical prescription opioid (NMPO) use and depression frequently co-occur and are mutually reinforcing in adults, yet NMPO use and depression in younger populations has been under-studied. We examined the prevalence and correlates of depressive symptomology among NMPO-using young adults. The Rhode Island Young Adult Prescription Drug Study (RAPiDS) recruited young adults in Rhode Island who reported past 30-day NMPO use. We administered the Center for Epidemiologic Studies Short Depression Scale (CES-D 10), and used modified Poisson regression to identify the independent correlates of depressive symptomology (CES-D 10 score ≥10). Over half (59.8%, n = 119) screened positive for depressive symptomology. In modified Poisson regression analysis, diagnostic history of depressive disorder and childhood verbal abuse were associated with depressive symptomology. Participants with depressive symptomology were more likely to report using prescription opioids non-medically to feel less depressed or anxious, to avoid withdrawal symptoms, and as a substitute when other drugs are not available. Among young adult NMPO users, depressive symptomology is prevalent and associated with distinct motivations for engaging in NMPO use and represents a potential subgroup for intervention. Improving guidelines with tools such as screening for depressive symptomology among young adult NMPO users may help prevent NMPO-related harms.

Exploring recovery capital among adolescents in an alternative peer group

BACKGROUND

Recovery support models (RSMs) integrate peer supports and continuing care to promote sustained recovery for adolescents with substance use disorder. RSMs aim to build recovery capital (RC), the personal, social, and environmental resources required to sustain recovery. The Alternative Peer Group (APG) is an RSM that integrates pro-recovery peers and social activities into clinical practice. APGs aim to build adolescents' RC and help them establish pro-recovery social networks. The Recovery Capital for Adolescents Model (RCAM) is a proposed framework for identifying assets to enhance and barriers to address in supporting adolescents' recovery. The RCAM has never been directly applied in APG research so little is known about the process of building RC while participating in an APG.

METHODS

This study is a secondary analysis of semi-structured interviews with APG participants. Using a deductive analytic approach, the RCAM was systematically applied to participants' narratives to examine the model's utility for identifying recovery barriers and resources that promote adolescent recovery.

FINDINGS

This study's findings confirmed the RCAM's utility for identifying specific recovery assets and barriers to recovery faced by adolescents. APG participants' narratives generally reflected the RCAMs RC domains (financial, human, social and community) as proposed and added details to refine the model. Specific strategies employed by the APG to enhance RC and address recovery barriers are presented and illustrated with qualitative exemplars.

CONCLUSIONS

The RCAM is a useful model for identifying the multiple, interrelated factors inherent to adolescents' recovery experience and potential pathways of RC resource-building.

The service-seeking profiles of youth reporting a legal mandate or perceived coercion for substance use treatment

INTRODUCTION

There is paucity of research on treatment-related coercion in youth: most research focuses on adult populations and legally mandated treatment. This study aims to examine the service-seeking profiles of youth with substance misuse issues who report a legal mandate or perceived coercion to enter treatment.

METHODS

Differences between youth who were legally mandated and not legally mandated, and differences between youth reporting high and low perceived coercion, were examined for demographic characteristics, mental health and substance use profiles, motivation, and readiness to change.

RESULTS

Compared to participants reporting low perceived coercion, those experiencing high perceived coercion reported more substance use problems, greater mental health needs, and greater external and introjected motivation. Legally mandated youth reported fewer mental health issues, lower identified motivation, and greater readiness to change than those reporting no legal mandate.

DISCUSSION

Many youth who present for substance use services report experiencing a sense of coercion, which suggests the potential importance of considering youth-centered strategies for involving youth in treatment planning and the development of treatment goals. Youth seeking treatment also have multiple intersecting needs which may benefit from a collaborative and integrative approach.

Youths Perceived Parental Influence on Substance Use Changes and Motivation to Seek Treatment

Drug and alcohol use among youth has serious consequences for the physical and mental health of youth and strains their relationships with family and friends. While the task of dealing with substance-related issues often falls on families, particularly parents, very little research has explored the importance of family as a motivator for seeking treatment. This paper reports on a qualitative study of youth seeking substance abuse treatment at a large urban psychiatric hospital. Following primarily self-determination theory, the study examines youths' descriptions of how their parents motivated them to (1) change their substance use behaviors and (2) seek treatment. The sample consisted of 31 youth ages 17 to 25 engaged in outpatient services with various substance use concerns. Youth described complex and evolving relationships with their parents along their journey to enter treatment. Implications for service delivery and important insights for engaging youth and their parents are discussed.

Screening adolescents for substance use: The role of NPs in school settings

NPs have a key role in screening for adolescent substance use in school settings. This article provides evidence-based information on the prevalence and consequences of adolescent substance use, discusses standardized substance use screening and brief interventions using the CRAFFT tool, and suggests relevant practice and policy implications.

Transitional-aged youth perceptions of influential factors for substance-use change and treatment seeking

There is an evident disparity between the number of youth who report experiencing problematic substance use and the number who seek treatment. To address this disparity, it is important to understand the reasons youth do and do not seek substance use treatment. Using qualitative data obtained from semistructured interviews with 31 youth aged 17-25 years presenting for treatment at a mental health hospital, the current study identifies themes in the factors that youth identify as having influenced them to seek or delay treatment. In alignment with self-determination theory, youth identified internal factors, such as wanting to better their academic, social, or financial situation, and external factors, such as familial pressure, as motivating them to seek treatment. Factors beyond those encompassed by self-determination theory were also revealed as having influenced youth decisions to seek treatment for substance abuse. These predominantly included structural factors, including satisfaction with previous treatment, accessibility of services, and availability of clinicians. These findings provide important insight for first-contact professionals and service providers looking to enhance youth motivation to seek and engage in treatment. Limitations and opportunities for future research are discussed.

Temporary stages and motivational variables: Two complementary perspectives in the help-seeking process for mental disorders

INTRODUCTION

Help-seeking for mental disorders is a complex process, which includes different temporary stages, and in which the motivational variables play an especially relevant role. However, there is a lack of instruments to evaluate in depth both the temporary and motivational variables involved in the help-seeking process. This study aims to analyse in detail these two sets of variables, using a specific instrument designed for the purpose, to gain a better understanding of the process of treatment seeking.

MATERIAL AND METHODS

A total of 152 patients seeking treatment in mental health outpatient clinics of the NHS were individually interviewed: 71 had Obsessive-Compulsive Disorder, 21 had Agoraphobia, 18 had Major Depressive Disorder), 20 had Anorexia Nervosa, and 22 had Cocaine Dependence. The patients completed a structured interview assessing the help-seeking process. Disorder severity and quality of life was also assessed.

RESULTS

The patients with agoraphobia and with major depression took significantly less time in recognising their mental health symptoms. Similarly, patients with major depression were faster in seeking professional help. Motivational variables were grouped in 3 sets: motivators for seeking treatment, related to the negative impact of symptoms on mood and to loss of control over symptoms; motivators for delaying treatment, related to minimisation of the disorder; and stigma-associated variables.

CONCLUSIONS

The results support the importance of considering the different motivational variables involved in the several stages of the help-seeking process. The interview designed to that end has shown its usefulness in this endeavour.

Initiation of Addiction Treatment and Access to Services: Young Adults' Accounts of Their Help-Seeking Experiences

Substance addiction in young adults is particularly problematic. Yet, much remain at stake in understanding the specifics of this population's access to services. The objective of this study is to explore young adults' initiation of substance misuse treatment. Our study sample was composed of 35 individuals aged 18 to 30 with problematic psychoactive substance use who have been identified in criminal courts, hospital emergency departments, and Health and Social Services Centers in Québec (Canada). A thematic analysis was performed on the 62 semi-structured interviews conducted with participants. Three components emerged. First, personal elements-expectations, individual motivations, perceptions of use, and capacity to control it-influence initiation of substance misuse treatment. Second, family and peers have noticeable influences. Finally, system characteristics and prior care experiences also shape the process. Consideration should be given to tailor interventions that can reach young adults and encourage them to initiate appropriate care.

Treatment motivation among caregivers and adolescents with substance use disorders

Substance use disorders (SUDs) in adolescence have negative long-term health effects, which can be mitigated through successful treatment. Caregivers play a central role in adolescent treatment involvement; however, studies have not examined treatment motivation and pressures to enter treatment in caregiver/adolescent dyads. Research suggests that internally motivated treatment (in contrast to coerced treatment) tends to lead to better outcomes. We used Self-determination theory (SDT) to examine intersecting motivational narratives among caregivers and adolescents in SUD treatment. Relationships between motivation, interpretation of caregiver pressures, adolescent autonomy, and relatedness were also explored. Adolescents in SUD treatment and their caregivers (N_Dyads=15) were interviewed about treatment experiences. Interviews were coded for treatment motivation, including extrinsic (e.g., motivated by punishment), introjected (e.g., motivated by guilt), and identified/integrated motivation (e.g., seeing a behavior as integral to the self). Internalization of treatment motivation, autonomy support/competence (e.g., caregiver support for adolescent decisions), and relatedness (e.g., acceptance and support) were also coded. Four dyadic categories were identified: agreement that treatment was motivated by the adolescent (intrinsic); agreement that treatment was motivated by the caregiver (extrinsic); agreement that treatment was motivated by both, or a shift towards adolescent control (mixed/transitional); and disagreement (adolescents and caregivers each claimed they motivated treatment; conflicting). Autonomy support and relatedness were most prominent in intrinsic dyads, and least prominent in extrinsic dyads. The mixed/transitional group was also high in autonomy support and relatedness. The extrinsic group characterized caregiver rules as an unwelcome mechanism for behavioral control; caregivers in the other groups saw rules as a way to build adolescent competence and repair relationships, and adolescents saw rules as indicating care rather than control. Adolescents with intrinsic motivations were the most engaged in treatment. Results suggest the importance of intrinsically motivated treatment, and highlight autonomy support and relatedness as mechanisms that might facilitate treatment engagement.

Cultural Adaptation and Psychometric Properties of the Persian Version of the Circumstances, Motivation, and Readiness Scale

BACKGROUND

Treatment motivation has always been an important issue in substance abuse treatment. In recent decades, several instruments have been developed to measure this concept.

OBJECTIVES

In this study, cultural adaptation and psychometric properties of the Persian version of the circumstances, motivation and readiness scale (CMR) are illustrated in a sample of Iranian addicts.

MATERIALS AND METHODS

The translation process followed Beaton et al.'s (2000) guideline for the cross-cultural adaptation of self-administered questionnaires, including the steps of translation, synthesis, back translation, expert committee review, and pre-testing. The final version of the Persian CMR was assessed for internal consistency and construct validity (n = 203).

RESULTS

There was one eliminated item in the cross-cultural adaptation process. Also, four items that had low correlation with the total score were excluded from the questionnaire during the initial analysis. Using the remaining items, Principle axis factoring with Promax rotation was performed and three factors, circumstance, motivation, and readiness, were identified. The secondary order three factor model provided a good statistical and conceptual fit for the data. Internal consistency met the criterion for a reliable measure (Cronbach's alpha = 0.840). The α range for these identified factors was 0.597 to 0.837.

CONCLUSIONS

Although the CMR was originally designed for use in TC treatment, this study suggests that it is also applicable, with some modifications, in short-term residential camps. Also, it is concluded that the Persian translation of the CMR can be applied for studies among Persian addicts.

Risky sexual behaviors among sexually active first-year students matriculating at a historically Black college: Is a positive self-image an instigator?

A sample of 498 sexually active first-year students matriculating at a historically Black college in North Carolina was used to determine correlates of risky sexual behaviors. In an Ordinary Least Squares regression, the self-esteem element "I take a positive attitude toward myself" (B = 1.12, p = .05), non-condom use because of partner issues (B = .53, p = .05) and being drunk or high (B = 1.20, p = .001), oral sex (B = 1.74, p = .001), anal sex (B = .61, p = .04), and bisexuality (B = .85, p = .03) all increased the number of these behaviors. Higher scores on the condom usage scale (B = -.38, p = .002) were found to decrease the number of risky sexual behaviors. Illicit drug use was an underpinning of the surprisingly positive relationship between positive self-image and risky sexual behaviors. It was concluded that school-based social workers, mental health care professionals, and community-based prevention providers can play a critical role in the training of peer facilitators, development, and supervision of peer-driven risk-reduction programs to address the complex interplay among self-esteem, sex, and substances.

Mental Health Literacy in Emerging Adults in a University Setting: Distinctions Between Symptom Awareness and Appraisal

Despite the high prevalence of mental health concerns in university populations, students are unlikely to seek formal help. The current study examined help-seeking behaviors among emerging adults in a university setting using a mental health literacy framework. Responses from 122 university undergraduates were examined. Students ranged in age from 17 to 25 years ( M = 20.67 years, SD = 2.03 years). Quantitative data were collected to determine students’ knowledge and use of campus services and to compare students’ awareness and appraisal of common mental health symptoms. Narrative data were collected to identify the key symptoms that are appraised to be “early warning signs” versus “early action signs,” and to identify barriers and facilitators to help-seeking. Mental health symptoms were more likely to be assessed as warning signs than signs warranting action. Lack of knowledge and stigma were barriers to help-seeking, while urging from family and friends, increased knowledge, and confidentiality were identified as facilitators to help-seeking. Emerging adults in a university setting tend to make distinctions between warning and action signs. Although demonstrating good awareness of the signs of declining mental health, students may respond reactively rather than proactively to symptoms.

Six Month Outcomes of a Peer-Enhanced Community Reinforcement Approach for Emerging Adults with Substance Misuse: A Preliminary Study

Little substance use disorder (SUD) treatment research with emerging adults ages 18-25 has been done in community settings, and it is well-known that peers influence emerging adult substance use. The purpose of this study was to develop and test the feasibility of a peer-enhanced behavioral treatment for emerging adults with substance use problems. Emerging adults (n=35) received a peer-enhanced version of the Community Reinforcement Approach (Peer-CRA), in which their peers (n=34) were trained to provide alcohol-specific social support. Both identified clients and peers were interviewed at treatment intake, and again three and six months later. Six month outcomes included days of abstinence adjusted for controlled environment days, social costs due to substance use, and binge drinking days in the past 90 days. Treatments were delivered with high fidelity, and a high proportion of participants were retained in treatment and follow-up assessments. Growth curve analyses revealed that emerging adults and their peers significantly increased their days of abstinence and reduced their binge drinking over time. Larger randomized trials should a) test whether peer-enhanced treatments are efficacious relative to treatment as usual, b) investigate whether secondary benefits exist for non-treatment seeking peers supporting another's treatment, and c) examine whether proposed mechanisms of change (i.e., peer support and peer reductions in substance use) account for any differences in outcomes.

Predictors of substance use among young adults transitioning away from high school: a narrative review

BACKGROUND

Young adulthood has been shown to be a time of increased substance use. Yet, not enough is known about which factors contribute to initiation and progression of substance use among young adults specifically during the transition year away from high school.

OBJECTIVES

A narrative review was undertaken to increase understanding of the predictors of changes in use of tobacco, alcohol, cannabis, other illicit drugs, and mental health problems among young adults during the transition period after high school.

METHODS

A review of academic literature examining predictors of the use of tobacco, alcohol and cannabis, and co-morbidities (e.g., co-occurring substance use and/or mental health issues) among young adults transitioning from high school to post-secondary education or the workforce.

RESULTS

Twenty six studies were included in the review. The majority of the studies (19) examined substance use during the transition from high school to post-secondary settings. Seven studies examined substance use in post-secondary settings. The studies consistently found that substance use increases among young adults as they transition away from high school. During the transition away from high school, common predictors of substance use include substance use in high school, and peer influence. Common predictors of substance use in post-secondary education include previous substance use, peer influence, psychological factors and mental health issues. Conclusions/Importance: Further research on social contextual influences on substance use, mental health issues, gender differences and availability of substances during the transition period is needed to inform the development of new preventive interventions for this age group.

Listening to youth: Adolescents' reasons for substance use as a unique predictor of treatment response and outcome

National efforts have focused on improving adolescent substance use disorder (SUD) treatment outcomes, yet improvements remain modest. Because adolescents are noteworthy for heterogeneity in their clinical profiles, treatment might be enhanced by the identification of clinical subgroups for which interventions could be more effectively tailored. Some of these subgroups, such as those based on abstinence motivation, substance involvement, and psychiatric status are promising candidates. This study examined the unique predictive utility of adolescents' primary reason for alcohol and other drug use. Adolescent outpatients (N = 109; 27% female, aged 14-19) were assessed at treatment intake on their reason for substance use, as well as demographic, substance use, and clinical variables, and reassessed at 3, 6, and 12 months. Reason for use fell into two broad domains: using to enhance a positive state (positive reinforcement [PR]; 47% of youth) and using to cope with a negative state (negative reinforcement [NR]; 53% of youth). Compared with PR patients, NR patients were significantly more substance involved, reported more psychological distress, and had a more extensive treatment history. It is important to note that NR patients showed a significant treatment response, whereas PR patients showed no improvement. PR-NR status also uniquely predicted treatment response and outcome independent of a variety of other predictors, including abstinence motivation, self-efficacy, coping, and prior treatment. Adolescents' primary reason for substance use may provide unique clinical information that could inform treatment planning and patient-treatment matching.

Treatment engagement in adolescents with severe psychiatric problems: a latent class analysis

Motivation is considered a pivotal factor in treatment, but a better understanding of this topic is needed. Drieschner et al. (Clin Psychol Rev 23:1115-1137, 2004) proposed to distinguish treatment motivation and treatment engagement. This study aimed to discover whether it is possible to identify classes of adolescents with severe psychiatric problems having comparable profiles of treatment engagement. To this end, professionals filled out the Treatment Engagement Rating Scale 5 times for 49 adolescents (mean age 18.3 years; SD = 1.6) during the first year of case management treatment. Using a longitudinal latent class analysis, the number of profiles of treatment engagement was investigated and described. Results identified three profiles: high (19 clients, 39%), medium (20 clients, 41%) and low (10 clients, 20%). Adolescents with a high engagement profile were at first equally, and later on more engaged in treatment than clients with a medium engagement profile. Adolescents with a low engagement profile made the least effort to engage, except after 30 weeks. Adolescents with a low engagement profile were often substance-dependent males with the lowest scores on the Global Assessment of Functioning Scale after a year. Only adolescents with a high engagement profile improved on global functioning. In conclusion, it is possible to identify different treatment engagement profiles by asking one question about level of global treatment engagement. Frequent assessment of engagement of the individual client as well as including a behavioural component into assessment and treatment may help to improve case management treatment for adolescents with medium and low engagement profiles.

Willingness and appropriateness of peers participating in emerging adults' substance misuse treatment

This study investigates the feasibility of adapting empirically-supported family treatments for emerging adult peer dyads. Data were collected (n=84) from emerging adults and their peers. Peers completed measures of substance use, willingness to participate in their friends' treatments, and an adapted version of the Significant Other Behavior Questionnaire (SBQ), which measures concerned significant others' (CSO) responses to another's use such a punishing, supporting, or withdrawing from the user. Peers were more likely to support sobriety or enable use, versus punishing use or withdrawing from their friends. Overall, peers were quite willing to assist in treatment, but heavily using peers were less enthusiastic. For some emerging adults, their current peers may represent untapped resources to integrate into treatment, and providing peer-enhanced treatments may expand the reach of services to non-treatment seeking populations.

To enforce or engage: the relationship between coercion, treatment motivation and therapeutic alliance within community-based drug and alcohol clients

Three fundamental clinical issues are consistently associated with treatment engagement and outcomes in substance using populations; coercion, motivation and therapeutic alliance. It is accepted that these factors play an integral role in the success of substance use treatment and particularly that higher motivation and therapeutic alliance are advantageous to treatment outcomes. The impact of coercion on engagement and treatment outcome, on the other hand, is less clear, and the relationship between these three issues has not been adequately explored. The current study aimed to address this gap, by examining the presenting characteristics of clients attending a community drug and alcohol counselling service in relation to coercion, motivation, therapeutic alliance and substance use, as well as the effect that these variables had on treatment outcomes 15 weeks later. A total of 77 clients recruited from the Central Coast Drug and Alcohol Service participated in the study, completing a phone assessment upon treatment entry and 15 weeks post-baseline. Results indicated that facets of motivation and therapeutic alliance played a significant role in client's substance use upon presentation for treatment, although coercion did not. Coercion was not associated with substance use outcomes at 15 week follow up. However, due to a relatively small sample completing post-baseline assessments (n=33), further research is needed to examine the predictive effects of these variables in community drug and alcohol clients.

Navigating the transition from pediatric to adult eating disorder programs: perspectives of service providers

OBJECTIVE

This study aims to conduct qualitative research on the perspectives of service providers regarding the transition process from pediatric to adult specialized eating disorder tertiary care programs.

METHOD

Two focus groups with a diverse group of clinicians in pediatric and adult eating disorder programs and five qualitative interviews with clinicians in the community were conducted.

RESULTS

Three themes were identified as challenges during the transition process: (1) illness related factors (ambivalence and denial); (2) the interruption of normative adolescent developmental processes by the illness; and, (3) the impact of decreased parental involvement in the adult compared to pediatric eating disorder programs.

DISCUSSION

These themes were compared with empirical evidence on other chronic mental or physical health concerns for the purpose of identifying ways to facilitate a more successful service transition for young adults with anorexia nervosa. Future research and clinical implications are delineated.