Factors associated with adolescent utilization of alcohol treatment services

An innovative inpatient protocol for alcohol withdrawal prevention in a 16-year-old adolescent: a case report

BACKGROUND

Alcohol cessation in youth with daily drinking poses a risk of severe and life-threatening alcohol withdrawal. If unsupervised, alcohol withdrawal in heavy users can cause severe complications, such as seizures, delirium tremens, and death. We present the case of a teenager admitted at our pediatric center for the prevention of alcohol withdrawal using an innovative protocol, including a fixed-dosage benzodiazepine regimen.

CASE DESCRIPTION

A 16-year-old Caucasian male, known to have anxiety and an attention deficit disorder, was electively admitted for medical stabilization and surveillance of alcohol withdrawal. He had been previously diagnosed with alcohol use disorder and had a past history of withdrawal symptoms. He was prescribed a course of thiamine, folic acid, as well as a fixed-dosage benzodiazepine taper over 5 days. His withdrawal symptoms were evaluated using a standardized Clinical Institute Withdrawal Assessment for Alcohol scale. During his stay, he reported minimal symptoms, as well as a score on the Clinical Institute Withdrawal Assessment for Alcohol scale consistently lower than 5. His mood, motivation, eating habits and sleeping patterns significantly improved during his stay. He developed no medical complications and demonstrated pride in his successes. He was successfully transferred to a long-term rehabilitation center.

CONCLUSIONS

A withdrawal prevention protocol was developed on the basis of existing literature. It included a soothing environment, basic laboratory work evaluating the medical complications of alcohol use, as well as medication aiming to prevent and reduce potential withdrawal symptoms. The patient responded well to the fixed-dosage taper with minimal symptoms and discomfort. Although alcohol use in adolescents is frequent, alcohol withdrawal in this population is rarely seen in a pediatric hospital setting. Nonetheless, given the lack of existing guidelines regarding alcohol withdrawal in adolescents, standardized protocols could be greatly beneficial for the prevention of this condition in this population.

Widening Gaps and Disparities in the Treatment of Adolescent Alcohol and Drug Use Disorders

INTRODUCTION

The overall prevalence of alcohol use disorders and drug use disorders in adolescents has been declining in recent years, yet little is known about treatment use for these disorders among adolescents. This study aimed to examine the patterns and demographics of treatment of alcohol use disorders, drug use disorders, and both conditions among U.S. adolescents.

METHODS

This study used publicly available data for adolescents aged 12-17 years from the annual cross-sectional surveys of the National Survey on Drug Use and Health, 2011-2019. Data were analyzed between July 2021 and November 2022.

RESULTS

From 2011 to 2019, fewer than 11%, 15%, and 17% of adolescents with 12-month alcohol use disorders, drug use disorders, and both conditions received treatment, respectively, with significant decreases in treatment use for drug use disorders (OR=0.93; CI=0.89, 0.97; p=0.002). Overall, treatment use in outpatient rehabilitation facilities and self-help groups was most common but decreased over the course of the study period. Extensive disparities in treatment use were further identified on the basis of adolescents' gender, age, race, family structure, and mental health.

CONCLUSIONS

To improve adolescent treatment use for alcohol and drug use disorders, assessments and engagement interventions that are gender specific, developmentally appropriate, culturally sensitive, and contextually informed are especially needed.

Trends and Disparities in Treatment for Co-occurring Major Depression and Substance Use Disorders Among US Adolescents From 2011 to 2019

IMPORTANCE

Major depression and substance use disorders (SUD) commonly co-occur among adolescents, yet little is known about treatment use among adolescents with both conditions. Given the reciprocal influence of these conditions on each other and low prevalence of treatment overall, current information on quantification and trends in treatment of co-occurring depression and SUD is critical toward assessing how the field is performing in reaching youth in need of these services, and among youth with sociodemographic risk factors.

OBJECTIVE

To examine temporal trends and sociodemographic disparities in the treatment of co-occurring major depression and SUD among US adolescents.

DESIGN, SETTING, AND PARTICIPANTS

This survey study used publicly available data for adolescents aged 12 to 17 years from the annual cross-sectional surveys of the National Survey on Drug Use and Health from 2011 to 2019 to assess co-occurrence of major depressive episodes (MDE) and SUD through time and prevalence of treatment for either or both of these conditions. Data were analyzed between October 2020 and February 2021.

EXPOSURES

Survey years, adolescent age, gender, race and ethnicity, type of insurance, annual household income, family structure, and residential stability.

MAIN OUTCOMES AND MEASURES

Presence and treatment of co-occurring 12-month MDE and SUD.

RESULTS

In total, 136 262 adolescents participated in the 2011 to 2019 surveys, among whom 69 584 (51.1%) were boys and 66 678 (49.0%) were girls, 46 548 (34.1%) were aged 16 to 17 years, and 18 173 (13.8%) were Black, 28 687 (23.2%) were Hispanic, and 74 512 (53.6%) were White. From 2011 to 2019, the annual prevalence of co-occurring MDE and SUD remained stable, at between 1.4% and 1.7%. Among adolescents with co-occurring MDE and SUD, the prevalence of treatment use for MDE only increased significantly from 28.5% in 2011 to 42.5% in 2019 (odds ratio [OR], 1.07; 95% CI, 1.02-1.11; P = .005), whereas the prevalence of treatment use for SUD only decreased from 4.8% to 1.5% (OR, 0.92; 95% CI, 0.85-0.99; P = .04). Overall, the prevalence of treatment use for both conditions fluctuated between 4.5% and 11.6%, without a significant linear trend over time (OR, 0.95; 95% CI, 0.87-1.03; P = .24). Extensive disparities in treatment use were found among boys for SUD and both conditions, older adolescents for MDE, Hispanic adolescents for co-occurring conditions (adjusted OR, 0.52; 95% CI, 0.27-0.98; P = .04), and Asian, Native Hawaiian, or Pacific Islander adolescents for MDE (adjusted OR, 0.24; 95% CI, 0.10-0.58; P = .002) and co-occurring conditions (adjusted OR, 0.04; 95% CI, 0.01-0.33; P = .003). Moving households 3 or more times in the past 12 months was associated with higher odds that adolescents received treatment for both conditions (adjusted OR, 2.52; 95% CI, 1.26-5.05; P = .009).

CONCLUSIONS AND RELEVANCE

This survey study found that from 2011 to 2019, less than 12% of adolescents with major depression and SUD received treatment for both conditions from 2011 to 2019. Findings from this study call for expanded service provision for adolescents with co-occurring conditions, improved coordination between service delivery systems, and enhanced policy and funding support for adolescents with unmet treatment needs.

Addressing Key Gaps in Existing Longitudinal Research and Establishing a Pathway Forward for Firearm Violence Prevention Research

The main purpose of this article and this special section is to encourage greater attention to the key gaps that exist in our understanding of the epidemiology of adolescent firearm violence and to provide a pathway forward for future longitudinal research that will inform prevention efforts. This increased attention is especially salient given: (a) firearms are the leading cause of death for adolescents and emerging adults in the United States, with the majority of these deaths due to interpersonal violence; (b) significant health and social disparities with regards to the populations that are most affected by interpersonal firearm violence have been documented; and, (c) limitations in federal research funding during the past 30 years have created a deficit of knowledge about key risk and protective factors necessary to inform evidence-based prevention efforts. We discuss the implications of the articles in this special edition for existing and novel prevention programs. We also identify key considerations for future epidemiological research, including the need for a greater focus on collecting longitudinal data among nationally representative samples enriched with subgroups of at-risk youth, the need to examine the role of protective factors and mediating variables within existing and novel theoretical models of firearm risk behaviors, the need to examine key factors across all levels of the socio-ecological model, and the need to incorporate novel and innovative research designs, methods and analyses.

Rates and correlates of risky firearm behaviors among adolescents and young adults treated in an urban emergency department

Firearm violence is a leading cause of death for urban adolescents and young adults (A/YAs). Little is known about patterns of risky firearm behaviors (RFBs) that may increase firearm-related fatality and non-fatal injury risk. To inform prevention efforts, we examined the rates and correlates of RFBs, including firearm carriage in risky situations (e.g., while drunk/high), discharge in risky situations (e.g., fleeing police), and firearm aggression (e.g., firearm threats/use against a partner/non-partner), among a sample of A/YAs (age-16-29) seeking medical or injury related care (7/2017-6/2018) at a Level-1 urban Emergency Department (ED). In total, 1312 A/YAs completed the survey (mean-age 23.2; 29.6%-male; 50.5%-Black; 56.3%-public assistance), with 102 (7.8%) engaging in RFBs. Among those engaging in RFBs, 42% reported firearm ownership, 68.6% firearm carriage in high-risk situations, 39.2% firearm discharge in risky situations, and 41.2% reported partner/non-partner firearm aggression. Regression identified RFBs correlates, including older age (AOR = 1.09), male sex (AOR = 1.63), Black race/ethnicity (AOR = 2.01), substance misuse (AOR = 2.75), attitudes favoring firearm use/retaliation (AOR = 1.38), peer firearm ownership/carriage (AOR = 3.26), higher levels of community violence exposure (AOR = 1.05), and active parole/probation (AOR 2.38). Higher coping skills were protective for RFBs (AOR = 0.83). Overall, we found that A/YAs seeking urban ED treatment reported elevated RFB rates, emphasizing the need for novel prevention initiatives, especially those incorporating tailored content addressing substance use, retaliatory violence, and peer delinquency/norms, while enhancing self-efficacy for avoiding RFBs and providing access to external resources within a resiliency-based framework. Such prevention approaches may be a critical step towards addressing the public health problem of firearm violence. Primary Funding Sources: NIH/NIDA K23DA039341; NIH/NCATS UL1TR000433.

Arrests Among High-Risk Youth Following Emergency Department Treatment for an Assault Injury

INTRODUCTION

Violence is a leading cause of morbidity and mortality for youth, with more than 600,000 emergency department visits annually for assault-related injuries. Risk for criminal justice involvement among this population is poorly understood. The objective of this study was to characterize arrests among high-risk, assault-injured, drug-using youth following emergency department treatment.

METHODS

Youth (aged 18-24 years) with past 6-month drug use who were seeking emergency department treatment for either an assault or for non-violence reasons were enrolled (December 2009-September 2011) in a 2-year longitudinal study. Arrests in the 24 months following the emergency department visit were analyzed in 2016-2017 using survival analysis of objective Law Enforcement Information Network data. Hazard ratios quantifying the association between risk factors for arrest were estimated using Cox regression.

RESULTS

In the longitudinal cohort, 511 youth seeking emergency department care (assault injury group n=299, comparison group n=212) were aged ≥18 years and were included for analysis. Youth in the assault injury group cohort had a 47% higher risk of arrest than the comparison group (38.1% vs 25.9%, RR=1.47, p<0.05). In unadjusted analyses, male sex, assault injury, binge drinking, drug use disorder, and community violence exposure were all associated with increased risk of arrest during the follow-up period. Cox regression identified that male sex (hazard ratio=2.57), drug use disorder diagnosis (hazard ratio=1.42), assault injury at baseline (hazard ratio=1.63), and community violence exposure (hazard ratio=1.35) increased risk for arrest.

CONCLUSIONS

Drug-using assault-injured youth have high rates of arrest. Emergency department and community interventions addressing substance use and violence involvement may aid in decreasing negative violence and criminal justice outcomes among high-risk youth.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01152970.

Associated factors of readiness to change in young adult risky drinkers

BACKGROUND

Readiness to change alcohol use has been associated with a number of predictors including emotional distress, drinking severity, and consequence severity, as well as with static demographic factors such as gender and race/ethnicity.

OBJECTIVE

To examine the relationships among these variables and readiness to change alcohol use in young adults.

METHODS

Structural equation modeling was used to test pathways of readiness to change in 1,256 young adult patients (78% male/22% female) ages 18-29 who were provided screening, brief intervention and referral to treatment (SBIRT) as part of a Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Capacity Expansion Project.

RESULTS

The strongest relationships were between emotional distress, drinking severity, and consequence severity with readiness to change. Results indicated that participants with more severe alcohol problems demonstrated higher levels of readiness to change alcohol use and therefore, may be more amenable to behavior change. Additionally, females, Hispanic/Latino, and Black non-Hispanic (Black) participants demonstrated higher levels of readiness to change when compared to other groups.

CONCLUSION

These results lend support to the concept that young adults are using alcohol to modulate their emotions. Furthermore, resultant severity of consequences from drinking may play an important role in their readiness to change risky drinking. This may be especially true for females, who reported greater emotional distress, and for Hispanic/Latinos and Blacks, who reported greater drinking severity with greater emotional distress. Caregivers may be better equipped to address young adult alcohol use with this added understanding.

Treatment Utilization Among Adolescent Substance Users: Findings from the 2002 to 2013 National Survey on Drug Use and Health

BACKGROUND

Adolescent substance users face serious health and social consequences and benefit from early diagnosis and treatment. The objectives of this study were to observe trends in treatment utilization; examine correlates of treatment utilization and treatment types/settings among adolescent substance users with and without substance use disorder (SUD); and assess gender differences.

METHODS

National Survey on Drug Use and Health data were pooled across 2002 to 2013, with a combined sample of 79,885 past-year substance users ages 12 to 17 (17,510 with SUD and 62,375 without SUD). Treatment was defined as receiving treatment or counseling for use of alcohol or any drug, not counting cigarettes. Trends were assessed by joinpoint linear regression, and multivariable logistic regression assessed odds ratios of treatment utilization.

RESULTS

Percentages of past-year treatment use did not change in 2002 to 2013. Treatment utilization was more prevalent among adolescents with SUD than without (11.4% vs. 1.4%) and among males than females. Among adolescents with and without SUD, criminal justice involvement and perceiving a need for treatment increased adolescent treatment utilization, while SUDs other than alcohol abuse, older age, and talking to parents increased treatment use among adolescents with SUD, and polysubstance use and male gender increased treatment among those without SUD. Treatment gaps persisted among non-Hispanic Blacks for both groups with and without SUD, male Hispanics with SUD, female non-Hispanic Asians without SUD, and private insurance coverages. Gender differences were observed in SUD, race/ethnicity, and insurance coverage. Most adolescents received treatment for both alcohol and drug use, and self-help group and outpatient rehabilitation facility were the most used treatment settings.

CONCLUSIONS

Treatment utilization among adolescents with past-year substance use remained low and unimproved in 2002 to 2013. Treatment gaps among minority populations, insurance coverage, and in educating adolescents on seeking relevant treatment must be addressed. Using screening processes such as Screening, Brief Intervention, and Referral to Treatment, health professionals can help prevent lifelong SUD by recognizing and addressing substance misuse early.

Predictors of readiness to change young adult drug use in community health settings

This study evaluated readiness to change drug use in young adult patients aged 18-25 years who were provided screening and brief intervention as part of a Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Capacity Expansion Project. Non-treatment-seeking young adults at risk for drug problems (n = 1,560) were assessed for readiness to change. Structural equation modeling examined latent constructs: emotional distress, age, drug use severity, criminal behavior, gender, and race/ethnicity. Drug use severity fully mediated the relationship between emotional distress and readiness. In addition, females and young adults with more severe drug problems may be more amenable to behavior change.

Health insurance and treatment of adolescents with co-occurring major depression and substance use disorders

OBJECTIVE

The goals of this study were to identify treatment rates among adolescents with co-occurring major depressive episode (MDE) and substance use disorder (SUD), and to examine the role of health insurance in the treatment of these disorders.

METHOD

Seven years of cross-sectional data (2004-2010) were pooled from the National Survey on Drug Use and Health to derive a nationally representative sample of 2,111 adolescents who had both a past-year MDE and SUD and whose insurance status was known. The associations of public and private insurance with MDE and SUD treatment were examined using multinomial logistic regressions that controlled for health status and sociodemographic variables.

RESULTS

Less than one-half (48%) of adolescents received any form of MDE treatment in the past year, and only 10% received any form of SUD treatment. Only 16% of adolescents who received MDE treatment also received SUD treatment. Relative to no insurance, public insurance was associated with an increased likelihood of receiving MDE treatment alone, but not with an increased likelihood of receiving both MDE and SUD treatment. Involvement in the criminal justice system was the major factor affecting the likelihood that an adolescent would receive both MDE and SUD treatment, as opposed to either no treatment or treatment for MDE alone.

CONCLUSIONS

Exceptionally low rates of SUD treatment were observed in this high-risk sample. Study findings highlight a missed opportunity to assess and to treat SUD among adolescents with co-occurring MDE and SUD who have received some form of MDE treatment in the past year.

Diagnostic Profiles among Urban Adolescents with Unmet Treatment Needs: Comorbidity and Perceived Need for Treatment

The goal of this study was to document comorbidity profiles of psychiatric disorder and perceived need for treatment among urban adolescents with unmet behavioral health needs. Participants were 303 community-referred adolescents and their primary caregivers. Adolescents included both boys (54%) and girls and were primarily Hispanic (58%), African American (23%), and multiracial (13%). Home-based interviews with both adolescents and caregivers were used to assess DSM-IV diagnoses and perceived treatment needs. Most adolescents (80%) were diagnosed with multiple disorders and most families (66%) reported a need to treat more than one disorder. Latent class analysis of endorsed DSM-IV disorders identified five distinct diagnostic profiles: Parental Concern, Adolescent Distress, Basic Externalizers, Severely Distressed, and Comorbid Externalizers. Diagnostic profiles were compared on perceived treatment need and related psychosocial risk characteristics. Implications for behavioral health care policy and practice for youth with unmet treatment needs are discussed.

Preventing alcohol use with a voluntary after-school program for middle school students: results from a cluster randomized controlled trial of CHOICE

There are many mandated school-based programs to prevent adolescent alcohol and drug (AOD) use, but few are voluntary and take place outside of class time. This cluster randomized controlled trial evaluates CHOICE, a voluntary after-school program for younger adolescents, which reduced both individual- and school-level alcohol use in a previous pilot study. We evaluated CHOICE with 9,528 students from 16 middle schools. The sample was 51% female; 54% Hispanic, 17% Asian, 15% white, 9% multiethnic and 3% African American. Fifteen percent of students attended CHOICE. All students completed surveys on alcohol beliefs and use at baseline and 6-7 months later. We conducted intention-to-treat (ITT) school-level analyses and propensity-matched attender analyses. Lifetime alcohol use in the ITT analysis (i.e., school level) achieved statistical significance, with an odds ratio (OR) of 0.70 and a NNT of 14.8. The NNT suggests that in a school where CHOICE was offered, 1 adolescent out of 15 was prevented from initiating alcohol use during this time period. Although not statistically significant (p = .20), results indicate that past month alcohol use was also lower in CHOICE schools (OR = 0.81; NNT = 45). Comparisons of attenders versus matched controls yielded results for lifetime use similar to school-wide effects (OR = 0.74 and NNT = 17.6). Initial results are promising and suggest that a voluntary after-school program that focuses specifically on AOD may be effective in deterring alcohol use among early adolescents; however, further research is needed as program effects were modest.

Two approaches to tailoring treatment for cultural minority adolescents

At this time, compared with mainstream (Caucasian) youth, cultural minority adolescents experience more severe substance-related consequences and are less likely to receive treatment. Although several empirically supported interventions (ESIs), such as motivational interviewing (MI), have been evaluated with mainstream adolescents, fewer published studies have investigated the fit and efficacy of these interventions with cultural minority adolescents. In addition, many empirical evaluations of ESIs have not explicitly attended to issues of culture, race, and socioeconomic background in their analyses. As a result, there is some question about the external validity of ESIs, particularly in disadvantaged cultural minority populations. This review seeks to take a step toward filling this gap, by addressing how to improve the fit and efficacy of ESIs like MI with cultural minority youth. Specifically, this review presents the existing literature on MI with cultural minority groups (adult and adolescent), proposes two approaches for evaluating and adapting this (or other) behavioral interventions, and elucidates the rationale, strengths, and potential liabilities of each tailoring approach.

Voluntary After-School Alcohol and Drug Programs for Middle School Youth : If You Build It Right, They Will Come

Few after-school programs target alcohol and other drug (AOD) use because it is difficult to encourage a diverse group of youth to voluntarily attend. The current study describes attendance at a voluntary after-school program called CHOICE, which targeted AOD use among middle school students. Over 4,000 students across eight schools completed surveys and 15% participated in CHOICE. Analyses indicated that there were some differences between CHOICE participants and non-participants. For example, African American and multiethnic students were more likely to attend. Past month alcohol users were more likely to initially attend, and marijuana users were more likely to continue attendance. Thus, CHOICE reached students of different racial/ethnic groups and attracted higher risk youth who may not typically obtain prevention services.

Racial/ethnic differences in treatment for substance use disorders among U.S. adolescents

OBJECTIVE

This study examined differences in treatment rates for substance use disorders (SUD) among adolescents of white, black, Hispanic, Asian, Native American/Alaska Native, and Native Hawaiian/Pacific Islander race/ethnicity.

METHOD

Eight years of cross-sectional data (2001-2008) were pooled from the National Survey on Drug Use and Health to derive a nationally representative sample of 144,197 adolescents (aged 12-17 years); 12,634 adolescents were identified with SUD in the previous year. Weighted probit regressions were estimated with year fixed effects to examine whether racial/ethnic minorities had lower rates of treatment in any setting, in medical settings (i.e., hospital, rehabilitation facility, mental health clinic, and/or doctor's office), and in self-help programs. Initial models controlled for demographics and health status. Additional models further adjusted for family income and health insurance status.

RESULTS

Among adolescents with SUD, unadjusted treatment rates ranged from 8.4% among blacks to 23.5% among Native Hawaiian/Pacific Islanders. After adjusting for demographics and health status, blacks (RD = -3.9%, 95% CI = -6.4%, -1.3%) and Hispanics (RD = -2.3%, 95% CI = -4.1%, -0.4%) were significantly less likely to receive SUD treatment than whites (adjusted treatment rate 10.7%). These differences were exacerbated after adjusting for family income and insurance status. Lower treatment rates for black and Hispanic adolescents persisted when examining SUD treatment rates in medical settings and self-help programs. Treatment rates for other racial/ethnic groups did not generally differ from whites.

CONCLUSION

Results highlight exceptionally low treatment rates for SUD among all adolescents, with blacks and Hispanics experiencing the lowest treatment rates across all racial/ethnic groups.

Prevalence and characteristics of substance abuse treatment utilization by U.S. adolescents: national data from 1987 to 2008

OBJECTIVE

Although many adolescents use and abuse illicit drugs, few of those who could benefit from substance abuse treatment ever receive these services. The present study examines the prevalence of utilization of substance abuse treatment in national samples of adolescents over the past 22 years and identifies characteristics associated with receipt of these services.

METHOD

Monitoring the Future data on lifetime utilization of substance abuse treatment was available for 12th grade students who reported any lifetime illicit drug use from 1987 to 2008 (N=25,537). After describing the prevalence of treatment utilization over this time period, logistic regression was used to examine potential predictors of treatment utilization.

RESULTS

The overall prevalence of treatment utilization has remained relatively unchanged over the past 22 years. In multivariable models, adolescents reporting a greater frequency of lifetime use of marijuana or cocaine were more likely to receive substance abuse treatment. Additionally, substance abuse treatment utilization was more likely in those who received other mental health services.

CONCLUSION

Despite increased evidence for the effectiveness of substance abuse treatment, utilization of these services by adolescents has remained low and relatively stable over the past 22 years. Attempts to increase utilization of substance abuse treatment services would likely benefit from building on existing connections with mental health treatment.

Motivation for reducing substance use among minority adolescents: targets for intervention

Motivation to change substance use is considered to be one of the most important predictors of client readiness for alcohol and other drug treatment and ability to benefit from treatment. Enhancing motivation to change substance use is an important emphasis of many substance use intervention programs. The specific factors predicting motivation to change substance use remain largely unidentified and poorly understood, particularly among racial/ethnic minority youth. This study examines the influence of adolescent and parental factors on motivation to change substance use among 310 alcohol-using and/or drug-using racial/ethnic minority adolescent males. The analytic plan involved the use of structural equation modeling. Adolescents' motivation to change substance use was influenced directly and indirectly by parental factors, as well as by adolescent substance use severity and externalizing disorders. Findings have implications for treatment with racial/ethnic minority youth, as parental factors may be exceptionally useful targets for interventions aimed at enhancing motivation to reduce substance use among these at-risk youth.

The association of self-reported neighborhood disorganization and social capital with adolescent alcohol and drug use, dependence, and access to treatment

AIMS

This research examines adolescent perceptions of neighborhood disorganization and social capital to determine if they are associated with adolescent alcohol or drug (AOD) use, AOD dependence, and access to AOD treatment.

DESIGN

This is a secondary analysis of data from the 1999 and 2000 National Survey on Drug Use and Health (NSDUH). The NSDUH is a cross-sectional survey of a random sample of the non-institutionalized United States population and is conducted in respondents' homes.

PARTICIPANTS

Youth between the ages of 12 and 17, yielding a sample size of 38,115 respondents.

MEASUREMENTS

Neighborhood disorganization was self-reported by youth in response to eight items; 10 items measured social capital. AOD use was also self-reported. AOD dependence was assessed by a series of questions regarding symptoms and impairment that is consistent with the criteria specified in the DSM-IV.

RESULTS

A little more than half of the youth reported never using alcohol or drugs (54.3%), 41.1% reported lifetime AOD use, and 4.6% were AOD dependent. Two percent reported receiving AOD treatment. Medium and high levels of social capital were negatively associated with AOD use and dependence. Social capital was unrelated to access to AOD treatment. Neighborhood disorganization was positively associated with AOD use, dependence, and access to treatment.

CONCLUSIONS

After controlling for individual- and family-level characteristics, neighborhood disorganization and social capital were associated with AOD use and dependence. The findings suggest that subjective measures of social context may be an important component of the complex biopsychosocial model of adolescent AOD addiction and treatment utilization.

Equity of access to treatment, and barriers to treatment for illicit drug use in Australia

AIMS AND DESIGN

This study investigated equity of access to treatment and barriers to treatment for illicit drug use, using Andersen's behavioural model of health service utilization.

SETTING AND PARTICIPANTS

The study involved 492 drug users who had received treatment and 193 who had not.

MEASUREMENTS

Participants were interviewed to gather data relating to 19 predisposing, need and enabling variables.

FINDINGS

Never-treated participants exhibited less need for treatment than those who had received treatment. They experienced less negative emotion, used their main drug less often, had fewer drug-related health problems and fewer drug-using friends, were less likely to have blood-borne virus infections and were more likely to be using drugs for 'fun'. They also had more negative attitudes towards drug treatment staff, were less likely to believe that appropriate treatment was available and less likely to believe that professional help was necessary to get off drugs. Prevalence of physical and mental health problems was high in both groups.

CONCLUSIONS

The study documented significant unmet treatment need and identified several sources of inequity and barriers to treatment that would be amenable to policy and service development. Drug user organizations and peer educators and motivational interventions in primary care settings should be utilized to market the nature and benefits of treatment effectively, and to address the causes of drug users' negative attitudes towards treatment.

Adolescent self-selection of service formats: implications for secondary interventions targeting alcohol use

A novel motivational enhancement based secondary alcohol intervention has been shown to increase quit attempts for youth with heavier alcohol use histories (Brown et al., 2005). In the present study, we examined rates of self-selection into the three formats of this alcohol intervention: group, individual, and website; and examined differences between intervention participants and the general school population and across the three formats. Over four years, students at four schools were surveyed (n=6000) and were provided the opportunity to participate in Project Options (PO). Youth who were selected into PO (n=1147) were younger and more likely to identify as African American or Multiple/Other ethnicity than the school populations. More teens in PO reported lifetime alcohol use (65% vs. 60%); however, the school population reported more current (past 30 day) drinking. Boys were more likely to utilize the group format and minority youth were more likely to select the individual format. Findings highlight the utility of multiple intervention formats to engage youth in early intervention for alcohol problems.

Alcohol use disorders and the use of treatment services among college-age young adults

OBJECTIVES

This study examined the utilization of and the perceived need for alcohol treatment services among college-age young adults (18-22 years) according to their educational status: full-time college students, part-time college students, noncollege students (currently in school with the highest grade level below college), and nonstudents (N=11,337). This breakdown of young adults had not been addressed previously.

METHODS

Secondary analyses were conducted on data from the 2002 National Survey on Drug Use and Health.

RESULTS

Full-time college students (21%) were as likely to have an alcohol use disorder as nonstudents (19%), but were more likely than part-time college students (15%) and noncollege students (12%). Only 4% of full-time college students with an alcohol use disorder received any alcohol services in the past year. Of those with an alcohol use disorder who did not receive treatment services, only 2% of full-time college students, close to 1% of part-time college students, and approximately 3% of young adults who were not in college reported a perceived need for alcohol treatment. Full-time college students were less likely than noncollege students to receive treatment for alcohol use disorders. All young adults with an alcohol use disorder were very unlikely to perceive a need for alcohol treatment or counseling.

CONCLUSIONS

College-age adults have a high prevalence of alcohol use disorders, yet they are very unlikely to receive alcohol treatment or early intervention services or to perceive a need for such services. Underutilization of alcohol-related services among college-age young adults deserves greater research attention.

Influence of religious affiliation in alcohol use among adolescents in Trinidad, Tobago, and St. Lucia: a follow-up study

OBJECTIVE

This study examined the effects of religious affiliation and other demographic variables in alcohol use and attitudes among adolescents in Trinidad, Tobago and St. Lucia.

METHOD

The study used a stratified random sample design of 380 male and 455 female students belonging to the 3 major ethnic groups in Trinidad, Tobago and St. Lucia (Afro-Trinidadian, Indo-Trinidadian, and Mixed group).

RESULTS

MANOVA showed an effect for religion, with Hindu adolescents having higher levels of regular alcohol use.

CONCLUSIONS

This finding supports the existing research in Trinidad and developed countries on the effect of various religious denominations of alcohol use and attitudes.

Alcohol use disorders and the use of treatment services among college-age young adults

OBJECTIVES

This study examined the utilization of and the perceived need for alcohol treatment services among college-age young adults (18-22 years) according to their educational status: full-time college students, part-time college students, noncollege students (currently in school with the highest grade level below college), and nonstudents (N=11,337). This breakdown of young adults had not been addressed previously.

METHODS

Secondary analyses were conducted on data from the 2002 National Survey on Drug Use and Health.

RESULTS

Full-time college students (21%) were as likely to have an alcohol use disorder as nonstudents (19%), but were more likely than part-time college students (15%) and noncollege students (12%). Only 4% of full-time college students with an alcohol use disorder received any alcohol services in the past year. Of those with an alcohol use disorder who did not receive treatment services, only 2% of full-time college students, close to 1% of part-time college students, and approximately 3% of young adults who were not in college reported a perceived need for alcohol treatment. Full-time college students were less likely than noncollege students to receive treatment for alcohol use disorders. All young adults with an alcohol use disorder were very unlikely to perceive a need for alcohol treatment or counseling.

CONCLUSIONS

College-age adults have a high prevalence of alcohol use disorders, yet they are very unlikely to receive alcohol treatment or early intervention services or to perceive a need for such services. Underutilization of alcohol-related services among college-age young adults deserves greater research attention.

Where have they been? Service use of regular substance users with and without abuse and dependence

OBJECTIVE

To present lifetime rates of service use for psychological and substance use related problems among regular substance users and to examine factors associated with service use.

METHOD

Data come from a prospective-longitudinal, epidemiological study of a community sample of adolescents and young adults (n = 2548, age 14-24 years at baseline) in Munich, Germany. The Munich-Composite International Diagnostic Interview (M-CIDI) was used at baseline and at two follow-ups to assess substance use and service use.

RESULTS

Cumulated lifetime incidence of any substance abuse or dependence was 43.7%. Of those with abuse and dependence 23% had ever used any services for psychological or substance use related problems. Illicit substance users especially those with dependence had the highest rates of lifetime service use (52.1%). Psychotherapists and counseling services were contacted most frequently among regular substance users over their lifetimes. Utlilisation rates of substance abuse services were low (2%). Comorbid anxiety disorders and distressing life events were associated with increased lifetime service use.

CONCLUSIONS

Only a minority of adolescents and young adults with substance use disorders have ever sought professional help. Specialized substance abuse services play only a minor role. The core role of psychotherapists and non-substance abuse specialized services needs critical research attention. Linkages between psychotherapists and the substance use service system should be strengthened to detect and intervene at early developmental stages of abuse and dependence.

ADAPTIVE FUNCTIONING, PSYCHOPATHOLOGY AND SERVICE USE AMONG 18-YEAR-OLD BOYS WITH DRUNKENNESS-RELATED ALCOHOL USE

AIMS

To study the associations between drunkenness frequency and adaptive functioning, psychopathology and service use among 18-year-old Finnish boys in a nation-wide population-based study.

METHODS

Information about drunkenness frequency within the previous six months was collected from the Finnish boys born in 1981 (n = 2306) at the boys' obligatory military call-up in 1999. Self-report questionnaires were used to study demographic factors, adaptive functioning, risk behaviour, life events, and mental health service use. Psychopathology and adaptive functioning was assessed with the Young Adult Self-Report (YASR) questionnaire.

RESULTS

Of the boys, 85% reported drunkenness within the previous 6 months. Most of the subjects were occasionally drunk: 39% reported drunkenness less than a month, and 35% less than once a week, while 10% reported being frequently drunk once a week or more often. Occasional drunkenness was associated with better adaptive functioning and psychosocial well-being in general. Refraining from drunkenness was associated with suicidal ideation and internalizing problems in the YASR scale. Frequent drunkenness associated with daily smoking, illicit drug use, and externalizing problems in the YASR scale, especially delinquent behaviour. In the multivariate analysis, number of friends, having a regular relationship and cigarette smoking had a linear association with frequency of drunkenness, while drunkenness-related alcohol use was less common among those with poor friendship quality. Among the participants, entering substance use treatment was rare (0.2%). Frequent drunkenness was found to be common among mental health service users.

CONCLUSIONS

Among late-adolescent boys, occasional drunkenness is a normative alcohol use pattern and associates with social competence and good psychosocial functioning. Late-adolescent boys refraining from drunkenness in addition to those with frequent drunkenness may be in a need of mental health assessment. As entering substance use treatment is infrequent, establishing integrated services with multi-professional co-operation for late-adolescent males with frequent drunkenness is emphasized.

Substance abuse counseling services in secondary schools: a national study of schools and students, 1999-2003

This study focuses on (a) American 8th-, 10th-, and 12th-grade students' access to, and use of, substance abuse counseling services via schools and (b) associations between such access and student substance use prevalence. From 1999 through 2003, student data were obtained from the Monitoring the Future study; and school data were obtained through the Youth, Education, and Society study, resulting in nationally representative data from 113,008 students in 855 public and private schools. Results indicate that in contrast to relatively stable student heavy-drug use prevalence rates, internal counseling availability and participation decreased significantly over time, as did reported student referral to external counseling. Availability of internal counseling, as well as student participation in both internal and external referrals, differed significantly by school characteristics--school level, grade size, sector, population density, school socioeconomic status, majority student body race/ethnicity, and geographical region. Student use of counseling services did not show any relationships with school-level heavy drinking rates; however, student participation in external counseling referrals was positively associated with school-level prevalence rates for the use of illicit drugs other than marijuana and showed indications of a similar relationship with marijuana prevalence rates. The decreasing access to, and use of, counseling, the lower probability of counseling availability in middle schools, and the lack of association between heavy-alcohol use rates and counseling services, all suggest missed opportunities and a greater need for counseling services to reduce high-risk drug use.

Factors that impact adolescents' intentions to utilize alcohol-related prevention services

The current study is the first to examine factors that may be associated with middle school students' intentions to use alcohol-related prevention services. Youth (N = 1506; 46% male; 11-14 years old) completed surveys on their intentions to use alcohol-related services, beliefs about services, previous use of services, and substance use. Students who reported stronger positive beliefs reported greater intentions to use services. Girls, younger students, and whites also reported stronger interest in using services than boys, older students, and youth of mixed ethnicity, respectively. Adolescents who reported current use of substances were less willing to use prevention services. Current research highlights the importance of creating prevention services for this age group that are developmentally relevant and that focus on features that will attract youth, such as utilizing an interactive discussion format. Beginning to understand what motivates adolescents to seek help can facilitate the creation of better prevention programs.

Use of substance abuse services by young uninsured american adults

OBJECTIVES

This study examined the prevalence and correlates of substance abuse service use among uninsured young adults aged 18 to 34 years (N=24,282).

METHODS

Data were drawn from the 1999 National Household Survey on Drug Abuse. Logistic regression was used to identify correlates of substance abuse service use among persons who met DSM-IV criteria for dependence.

RESULTS

Among uninsured young adults (N=5,067), 66 percent lacked any health care coverage for at least one year. In this uninsured group, 72 percent were past-year users of alcohol or drugs (N=2,335). Among past-year alcohol users (N=2,273), 12 percent met criteria for alcohol dependence; among past-year drug users (N=864), 21 percent met dependence criteria. Eighty-seven percent of the uninsured young adults with alcohol or drug dependence did not receive any substance abuse treatment services in the previous year. In the uninsured substance-dependent group, women, blacks, and Hispanics were less likely than men and whites to use substance abuse services. Among those with substance dependence, uninsured persons were more likely than privately insured persons to receive substance abuse services from the self-help or human service (nonmedical) sector.

CONCLUSIONS

Racial, ethnic, and gender disparities in the use of substance abuse services are notable among young adults who lack health insurance.

Developmental considerations for substance use interventions from middle school through college

This article summarizes a symposium organized by Dr. Elizabeth D'Amico and presented at the 2004 Annual Meeting of the Research Society on Alcoholism in Vancouver, Canada. The four presentations illustrate the importance of creating substance use interventions that are developmentally appropriate for youth. They represent innovative approaches to working with preteens, teenagers, and young adults. Dr. D'Amico's paper describes her research on the development of a voluntary brief intervention targeting alcohol use among middle school students. Findings indicated that by using school and community input, she was able to obtain a diverse a sample of youth across grades, sex, ethnicity, and substance use status. Dr. Ellickson's paper describes her research on Project ALERT, a school-based prevention program for middle school youth. Her findings indicate that Project ALERT worked for students at all levels of risk (low, moderate, and high) and for all students combined. Dr. Wagner's Teen Intervention Project was a randomized clinical trial to test the efficacy of a standardized Student Assistance Program for treating middle and high school students with alcohol and other drug problems. The study provided a unique opportunity to begin to examine how development may impact response to an alcohol or other drug intervention. Dr. Turrisi's paper examined processes underlying the nature of the effects of a parent intervention on college student drinking tendencies. Findings suggested that the parent intervention seems to have its impact on student drinking by reducing the influence of negative communications and decreasing the susceptibility of influences from closest friends. Dr. Kim Fromme provided concluding remarks.

Psychiatric, Family, and Ethnicity-Related Factors That Can Impact Treatment Utilization Among Hispanic Substance Abusing Adolescents

There is great significance to improving our understanding of predictors of treatment utilization among Hispanic substance abusing youth. One hundred and ten Hispanic substance abusing adolescents and their parents participated in a study of treatment utilization. Analyses showed that adolescents with lower numbers of externalizing disorders (χ2 = 4.18, df = 1, p < .05) and parents with better parenting strategies (χ2 = 8.73, df = 2, p < .05), predicted overall treatment utilization (residential + outpatient). Better parenting practices and higher parental years in the U.S. predicted more utilization of outpatient services and lower parenting stress predicted more utilization of residential services. Without specialized engagement strategies, adolescents and families most in need may be the least likely to engage in recommended treatment.