Drug trajectories among youth undergoing treatment: The influence of psychological problems and delinquency

Do adverse experiences predict unemployment and need of psychiatric help after treatment for drug use disorders?

Background: This study prospectively examined the association between adverse experiences (physical abuse, sexual abuse and parental substance use problems [SUPs]), not being employed, in education or training (NEET) and being in need of acute psychiatric help among patients receiving treatment for substance use disorders. Methods: A total of 580 adolescents and early adults aged 15-25 years enrolled in treatment for drug use disorders were included in the analyses. Treatment data were linked to participants' register data on employment, education and acute contact to psychiatric services for the following two years. Multivariable logistic regression models were used to examine associations between the three adverse experiences, NEET and need of acute psychiatric help, adjusting for confounders such as age, gender, ethnicity, treatment response and treatment condition. Results: More than half of the participants were NEET two years after treatment enrolment. After controlling for demographics and treatment conditions, NEET was predicted by parental substance use problems (odds ratio [OR] = 1.89, 95% confidence interval [CI] 1.31- 2.70), exposure to physical abuse (OR = 1.48, 95% CI 1.03-2.13) and non-abstinence (abstinence was negatively associated with NEET, OR = 0.53, 95% CI 0.37-0.76). Being exposed to two (OR = 3.17, 95% CI 1.93-5.21) and three types of adverse experiences (OR = 3.14, 95% CI = 1.47-6.70) predicted NEET more strongly than exposure to one type. One out of 10 participants sought acute care from psychiatric services at least once within two years after treatment. Only sex and ethnic minority status were associated with contacting psychiatric services acutely. Conclusion: The present study suggests that adverse experiences, such as being exposed to parental problematic substance use and physical abuse, may be important predictors for NEET after treatment for SUDs.

Criminal thinking and psychosocial characteristics among young adults entering residential substance use treatment

Background and aim: Young adults with substance use (SU) problems face a high risk of co-occurring problems, including criminality. The aim of the present study was to assess the psychosocial characteristics, SU problems, and criminal thinking young adults entering SU treatment have, and whether the SU characteristics, sex and age are associated with criminal thinking scores. Methods: The sample was 407 young adults aged 16-29 years who underwent an entry assessment between January 2011 and December 2016 at a residential SU treatment institution in Norway. All study data were extracted from electronic health records, including survey information from the Achenbach System of Empirically Based Assessment and the Psychological Inventory of Criminal Thinking Styles. Results: In the present sample, severe SU, high rates of psychosocial problems, and criminal thinking were reported. Almost three-quarters (72.67%) of young adults reported high levels of criminal thinking (≥60). However, male participants were more likely to report high levels of criminal thinking compared to female participants (p=0.031). In bivariate regression models, only sex and having stimulants/opioids as primary drug were associated with mean levels of criminal thinking. The same was true in the multiple regression model. Conclusion: Young adults in residential SU treatment are a multi-problem high-risk/high-need group of people. Due to the elevated levels of criminal thinking, we recommend that young adults in SU treatment should be screened for criminogenic treatment needs, such as criminal thinking, regardless of justice involvement.

Criminality among Young People With Substance Use Problems in Sweden: A One-Year Follow-Up Study

Swedish drug policy has a strong focus on minor drug violations. This longitudinal study analyses the association between criminality and substance use problems among young people who have received outpatient treatment and risk factors that predict continued problems with criminality. Research on this target group is under development in Sweden, but there are few follow-up studies. The study indicates that about one-quarters of the young people who begin outpatient treatment have been convicted of crimes at 1-year follow-up. Most of them who had been convicted with offences also have ongoing problems with substance use and three-quarters of the young people had been charged with a drug-related offence. More than five risk factors give an elevated risk of continued criminality. Interventions meeting the needs of young people, moving away from the current emphasis on penal law principles, may also contribute to reduced criminality in this target group.

Moderators of Substance Use Disorder Treatment for Adolescents

OBJECTIVE

This brief review covers the current state of the literature on moderators of adolescent substance use disorder (SUD) treatment. These moderators provide information on "for whom" a specific treatment may work best.

METHOD

We used Google Scholar, PubMed, PsycInfo, and manual search of relevant reference lists to identify eligible peer-reviewed publications from January 2005 to December 2019.

RESULTS

We summarize 21 published studies (including meta-analyses, randomized clinical trials, and correlational work) testing moderators and/or predictors of adolescent SUD treatment outcomes. Conclusions are, thus, limited by the relatively small number of studies. Results suggest that, for adolescents with co-occurring externalizing pathology or those higher in SUD severity, more intensive treatment appears to be more effective. Other findings were often inconsistent (e.g., examining sex or race/ethnicity as a moderator) between studies, making it challenging to provide clear recommendations for personalizing SUD treatment choice.

CONCLUSIONS

Future research may need to shift focus from exploring often unchangeable moderators (e.g., race/ethnicity) to factors that are potentially modifiable with treatment. Additionally, testing models that include mediators of treatment effects-that is, factors that help to explain "how" treatment works-along with moderators (moderated-mediation) may provide the most benefit in understanding both "for whom" and "how" to tailor SUD treatment to optimally meet an adolescent's personal needs.

Trajectories of heroin use: A 15-year retrospective study of Mexican-American men who were affiliated with gangs during adolescence

BACKGROUND

Heroin use is a public health concern in the United States. Despite the unique etiology and patterns of heroin use among U.S. Latinos, long-term heroin trajectories and health consequences among Latinos are not well understood. This study aims to document the distinct heroin use trajectories for a group of street-recruited (non-treatment), young adult Mexican American men living in a disadvantaged community who were affiliated with gangs during their youth.

METHODS

One-time interviews conducted between 2009-2012 in San Antonio, TX collected retrospective data from a sample of 212 Mexican American young adult men who reported using heroin at least once. Group-based trajectory modeling was applied to determine discrete developmental trajectories of heroin use. ANOVA, Chi square tests, and multinomial logistic regression examined current (past year) social and health indicators among each trajectory group.

RESULTS

Five discrete heroin trajectories groups were identified: low use (n = 65); late accelerating (n = 31); early decelerating (n = 26); late decelerating (n = 38); and stably high (n = 52). Varying social and health consequences were found among the trajectory groups.

CONCLUSION

This study describes the unique heroin use trajectories and social and health outcomes among a high-risk subgroup of Mexican American men. The findings suggest that early intervention and intervention available in easy to access non-treatment spaces may be especially useful for groups of people who use relatively less heroin.

Multidimensional Predictors of Treatment Outcome in Usual Care for Adolescent Conduct Problems and Substance Use

This study investigated baseline client characteristics that predicted long-term treatment outcomes among adolescents referred from school and community sources and enrolled in usual care for conduct and substance use problems. Predictor effects for multiple demographic (age, sex, race/ethnicity), clinical (baseline symptom severity, comorbidity, family discord), and developmental psychopathology (behavioral dysregulation, depression, peer delinquency) characteristics were examined. Participants were 205 adolescents (52 % male; mean age 15.7 years) from diverse backgrounds (59 % Hispanic American, 21 % African American, 15 % multiracial, 6 % other) residing in a large inner-city area. As expected, characteristics from all three predictor categories were related to various aspects of change in externalizing problems, delinquent acts, and substance use at one-year follow-up. The strongest predictive effect was found for baseline symptom severity: Youth with greater severity showed greater clinical gains. Higher levels of co-occurring developmental psychopathology characteristics likewise predicted better outcomes. Exploratory analyses showed that change over time in developmental psychopathology characteristics (peer delinquency, depression) was related to change in delinquent acts and substance use. Implications for serving multiproblem adolescents and tailoring treatment plans in routine care are discussed.