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

Looking beyond drugs: A scoping review of recovery in the context of illicit substance use among adolescents and young adults

BACKGROUND

Despite extensive literature exploring the harms associated with illicit substance use among young people who use drugs (YPWUD), the concept of "recovery" among this population has received significantly less attention. Addressing this literature gap can inform efforts to better support YPWUD as they pursue their goals.

OBJECTIVE

To examine the qualitative literature on how young people (< 30 years of age) understand and navigate substance use recovery and healing in the context of illicit substance use, including how interventions and caregivers are implicated in these processes.

METHODS

The design for this scoping review was guided by Arksey and O'Malley's framework and informed by Levac et al. refinements. We surveyed five bibliographic databases for English, peer-reviewed, empirical studies published between 1999 and 2023. Studies were independently reviewed by two reviewers. We charted, synthesized, and assessed studies for common themes.

FINDINGS

A total of 28 articles met the inclusion criteria for this scoping review. Studies show varied definitions and enactments of recovery as part of a continuum of substance use care, frequently extending beyond the notion of recovery as abstinence. Caregivers providing emotional, material, and social support are crucial to recovery; however, the challenges of supporting a young person's recovery are manifold, including misaligned expectations about recovery definitions and processes.

CONCLUSION

Findings underscore the need for recovery-oriented care that aligns with young people's diverse and shifting needs, goals, and contexts. Recovery programs must range from harm reduction to abstinence-based approaches across institutional and non-institutional settings and actively engage YPWUD and caregivers.

Individual Trajectories of Specialist Substance Use Disorder and Mental Health Treatment Utilization Among Young Adults With Substance Use Problems: A Cohort Study

OBJECTIVE

The aim of the study was to identify groups of young adults with distinct longitudinal patterns of use of treatment for substance use disorders and mental health (MH) problems and to investigate potential explanatory factors for different patterns of treatment use over time, including sociodemographic factors.

METHODS

The sample consisted of 447 young adults aged 16-29 years who entered long-term residential substance use disorder treatment facilities in Norway from 2011 to 2016. In this study, we obtained data collected by the Norwegian Patient Registry and Statistics Norway. These data were linked with the electronic health record data of the substance use disorder treatment facilities from which the participants were recruited. Growth mixture modeling was performed. The identified groups were further compared using analysis of variance or χ2 test.

RESULTS

Four groups of participants for total treatment use, substance use disorder treatment use, and MH treatment use were identified. Most participants from the overall sample were classified as members of a group characterized by a low and stable pattern of treatment use over time. A group with a high and stable pattern of treatment use was identified in total and MH treatment use. The proportion of participants with higher levels of substance use disorder treatment use at the end of the study period than at the beginning was larger (35%) than in the case of MH treatment use (14.2%). Younger age was associated with a decreasing pattern of MH treatment use and with an increasing pattern of substance use disorder treatment use over time. There were larger proportions of female participants in groups with a stable high use of MH treatment and in groups with an initially increasing trend of substance use disorder treatment use. Findings revealed that most participants across the identified groups were recipients of welfare benefits, had low educational attainment, and were not working.

CONCLUSIONS

Results demonstrated significant variation in trajectories of treatment use among young adults with substance use disorder. Differences in treatment use could indicate differences in symptom severity and complexity. In this study, treatment use was associated with socioeconomic factors, sex, and age. Integrative approaches, including interagency and interdisciplinary collaboration, will often be necessary to sufficiently address the multidimensionality of substance use disorder.

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.

A systematic review of virtual reality therapies for substance use disorders: Impact on secondary treatment outcomes

BACKGROUND AND OBJECTIVES

Virtual reality (VR) therapy may be an effective tool in treating urges and cravings in substance use disorder (SUD). Given the high co-occurrence of difficulties with mood, anxiety, and emotional dysregulation with SUD, this review sought to examine the extant literature on the efficacy of VR for SUD in improving these secondary treatment outcomes.

METHODS

A systematic literature review was conducted following PRISMA guidelines in PubMed, PsychInfo, and Embase. Studies were included if they utilized immersive VR, were conducted with individuals with substance use disorder/dependence/misuse, and included measures of mood, anxiety, depression, emotional dysregulation, or retention in treatment.

RESULTS

Seven articles met our inclusion criteria. Five studies were conducted on patients using nicotine and utilized a cue-exposure intervention. VR was effective at reducing substance use and cravings in the majority of studies. Results on the efficacy of VR for improving mood, anxiety, and emotional regulation were mixed. Work examining retention in treatment was limited.

DISCUSSION AND CONCLUSIONS

VR for SUD has the potential to improve mood and anxiety symptoms as well as retention in treatment for patients with SUD, particularly if the therapy targets these psychological symptoms. Future studies examining components of VR for SUD in individuals with drug use disorders, as well as examinations of targeted interventions for associated mood, emotional dysregulation, and retention in treatment, are necessary.

SCIENTIFIC SIGNIFICANCE

This is the first systematic review of the impact of VR on mood, anxiety, and emotional dysregulation for individuals with substance use.

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.

Are adolescents and young adults in substance use disorder treatment as engaged in the research recruitment process as those in general behavioral health treatment?

BACKGROUND AND OBJECTIVE

While prior research suggests that individuals with substance use disorders (SUD) are generally more difficult to engage in research, little is known about the research engagement of adolescents and young adults (AYA) in SUD treatment as it compares to peers seen in general behavioral health settings. This study aimed to systematically compare engagement in virtual research recruitment between AYA in SUD treatment and AYA in behavioral health (BH) treatment.

METHODS

Study staff contacted patients ages 16-30 at three outpatient clinics to recruit them for a naturalistic longitudinal online study. Staff documented whether patients answered the phone, expressed interest in the study, answered questions regarding eligibility, and enrolled in the study.

RESULTS

Overall, 18% (n = 117) of those contacted by phone enrolled in the study. The rate of AYA reached did not significantly differ between those in SUD treatment (51%) and those in BH treatment (55%). Among those who were reached, those in SUD and BH treatment did not significantly differ (all p > 0.05) in rates of being interested in the study (SUD: 58%; BH: 49%), completing the phone screen (SUD: 46%; BH: 41%) or enrolling in the study (SUD: 33%; BH: 35%).

CONCLUSIONS

Overall, we found that engaging AYA in SUD treatment in virtual naturalistic longitudinal research was no more difficult than engaging AYA seen in general behavioral health settings. Future research should examine generalizability of engagement in naturalistic research to other study designs and explore the continuity of this effect into study retention and completion.

Cannabis use disorder treatment use and perceived treatment need in the United States: Time trends and age differences between 2002 and 2019

BACKGROUND

As trends in CUD treatment are understudied, we examined time trends in CUD treatment and perceived treatment need among people with CUD overall and by age group.

METHODS

Data from the 2002-2019 National Survey on Drug Use and Health included 43,307 individuals who met past-year DSM-5-proxy CUD criteria. Last/current treatment for cannabis use (i.e., any or specialty CUD treatment) and perceived treatment need were regressed on survey year and age (12-17, 18-25, ≥26) using generalized linear spline models. Time-varying effect modification assessed the magnitude of age-treatment associations over time.

RESULTS

Between 2002 and 2019, 6.1% of people with CUD used any CUD treatment, 2.8% used specialty treatment, and 2.2% perceived a treatment need. CUD treatment use decreased by 54.23% between 2002 and 2019 (9.11%-4.17%). Compared with adolescents, adults ages 18-25 were less likely to use specialty CUD treatment [aRR: 0.70: 95% CI: 0.52, 0.93] and ages ≥26 were more likely to perceive treatment need [aRR: 1.84: 95% CI: 1.19, 2.83]. Age-specific differences in the time-varying magnitude of associations were observed (e.g., in 2010 perceived treatment need was higher in ages ≥26 versus ages 12-17 [aOR: 2.34, 95% CI: 1.47, 3.71]).

CONCLUSIONS

CUD treatment is decreasing and young adults have lower treatment use compared with adolescents. Attitudes towards cannabis use harms are shifting, potentially contributing to decreasing CUD treatment utilization and perceived treatment need. Future research should identify treatment barriers, especially among young adults with the lowest CUD treatment use.

Trends in the Use of Naltrexone for Addiction Treatment among Alcohol Use Disorder Admissions in U.S. Substance Use Treatment Facilities

Background: Naltrexone, a medication for addiction treatment (MAT), is an FDA-approved medication recommended for the treatment of alcohol use disorder (AUD). Despite the high prevalence of AUD and efficacy of naltrexone, only a small percentage of individuals with AUD receive treatment. Objectives: To identify trends for the prescription of naltrexone in AUD admissions in substance use treatment centers across the U.S. Methods: Data from the 2000–2018 U.S. Treatment Episode Data Set: Admissions (TEDS-A) were used in temporal trend analysis of naltrexone prescription in admissions that only used alcohol. Data from the 2019 National Survey of Substance Abuse Treatment Services (N-SSATS) were also used to characterize medication use among AUD clients across different treatment service settings. Results: Treatment of AUD with naltrexone was 0.49% in 2000 and tripled from 0.53% in 2015 to 1.64% in 2018 in AUD admissions (p < 0.0001 for the Cochran–Armitage trend test). Women, middle-aged adults, and admissions for clients living in the Northeast U.S. were more likely to be prescribed naltrexone than their respective counterparts, as were admissions with prior treatment episodes and referrals through alcohol/drug use care providers, who paid for treatment primarily through private insurance, used alcohol daily in the month prior to admission, and waited 1–7 days to enter treatment. Naltrexone was more commonly prescribed by AUD admissions compared to acamprosate and disulfiram and was more frequently prescribed in residential and outpatient services as opposed to hospital inpatient services. Conclusions: Naltrexone remains underutilized for AUD, and factors that influence prescription of medication are multifaceted. This study may contribute to the creation of effective interventions aimed at reducing naltrexone disparities for AUD.

Sex differences in US emergency department non-fatal visits for benzodiazepine poisonings in adolescents and young adults

BACKGROUND

Benzodiazepine (BZD)-related overdose deaths have risen in the past decade and BZD misuse contributes to thousands of emergency department (ED) visits annually, with the highest rates in adolescents and young adults. Because there are gaps in understanding BZD poisoning in youth and whether differences occur by sex, we aimed to characterize BZD poisoning ED visits in young people by sex.

METHODS

BZD poisoning visits were identified in the Nationwide Emergency Department Sample, among adolescents (12-17 years) and young adults (18-29 years). Stratified by sex and age, we described ED visits for BZD poisonings in 2016, including poisoning intent, concurrent substances involved, and co-occurring mental health disorder diagnoses. With logistic regression we examined the association between intent and concurrent substance.

RESULTS

There were approximately 38,000 BZD poisoning ED visits by young people nationwide with annual population rates per 10,000 of 2.9=adolescents and 5.8=young adults. Depression was diagnosed in 40 % of female and 23 % of male BZD visits (p < 0.01). Over half of BZD poisonings in females and a third in males were intentional (p < 0.01). Male BZD visits were more likely to involve opioids or cannabis and less likely to involve antidepressants than females (p-values<0.01). In males and females, BZD poisonings concurrent with antidepressants and other psychotropic medications were more likely to be intentional than unintentional (OR range:2.1-6.3).

CONCLUSIONS

The high proportion of BZD poisonings that are intentional and include mental health disorder diagnoses, especially among young females, underscore the importance of ED mental health and suicide risk assessment with appropriate follow-up referral.

Barriers, facilitators, and disparities in retention for adolescents in treatment for substance use disorders: a qualitative study with treatment providers

BACKGROUND

Retention in substance use treatment is one of the strongest predictors of improved outcomes among adolescents, making retention an important goal of treatment. We examined treatment providers' perspectives on barriers and facilitators to treatment retention among adolescents, and their views on contributors to racial/ethnic disparities in retention including ways to address disparities.

METHODS

Semi-structured interviews were conducted with 19 providers at state-licensed detoxification, residential, and outpatient facilities serving adolescents for substance use disorders in Massachusetts. Interviews were coded by at least two independent coders.

RESULTS

Providers identified barriers and facilitators at the policy/systems, facility, family, and client levels. Some of the barriers included insurance limits on sessions/length of stay and low reimbursement (policy/systems), staff turnover (facility), low family engagement (family), and low internal motivation (client). Some facilitators mentioned were support from state's substance use agency (policy/systems), flexibility with meeting location (facility), family participation (family), and high internal motivation and presence of external motivators (client). Barriers that contributed to racial/ethnic disparities included lower socio-economic status, language barriers, and mistrust. Having bilingual/bicultural staff and multi-lingual materials, and facilitating transportation were identified as strategies for reducing disparities in treatment retention.

CONCLUSIONS

It is critical that adolescents who access substance use services remain and complete treatment and that there is equity in treatment retention. Provider perspectives in factors associated with retention can inform the development of comprehensive interventions and policies to help improve retention and reduce disparities.

Why Are Suicide Rates Increasing in the United States? Towards a Multilevel Reimagination of Suicide Prevention

Suicide, a major public health concern, takes around 800,000 lives globally every year and is the second leading cause of death among adolescents and young adults. Despite substantial prevention efforts, between 1999 and 2017, suicide and nonfatal self-injury rates have experienced unprecedented increases across the United States - as well as in many other countries in the world. This chapter reviews the existing evidence on the causes behind increased suicide rates and critically evaluates the impact of a range of innovative approaches to suicide prevention. First, we briefly describe current trends in suicide and suicidal behaviors and relate them to recent time trends in relevant suicide risk markers. Then, we review the existing evidence in suicide prevention at the individual and the population levels, including new approaches that are currently under development. Finally, we advocate for a new generation of suicide research that examines causal factors beyond the proximal and clinical and fosters a socially conscious reimagining of suicidal prevention. To this end, we emphasize the need for the conceptualization of suicide and suicidal behaviors as complex phenomena with causes at several levels of organization. Future interdisciplinary research and interventions should be developed within a multilevel causal framework that can better capture the social, economic, and political settings where suicide, as a process, unfolds across the life course.

Delays in making initial treatment contact after the first onset of mental health disorders in the Argentinean Study of Mental Health Epidemiology

AIMS

While there are effective treatments for psychiatric disorders, many individuals with such disorders do not receive treatment and those that do often take years to get into treatment. Information regarding treatment contact failure and delay in Argentina is needed to guide public health policy and planning. Therefore, this study aimed to provide data on prompt treatment contact, lifetime treatment contact, median duration of treatment delays and socio-demographic predictors of treatment contact after the first onset of a mental disorder.

METHODS

The Argentinean Study of Mental Health Epidemiology (EAESM) is a multistage probability sample representative of adults (aged 18+) living in large urban areas of Argentina. A total of 2116 participants were evaluated with the World Mental Health Composite International Diagnostic Interview to assess psychiatric diagnosis, treatment contact and delay.

RESULTS

Projections of cases that will make treatment contact by 50 years taken from a survival curve suggest that the majority of individuals with a mood (100%) or anxiety disorder (72.5%) in Argentina whose disorder persist for a sufficient period of time eventually make treatment contact while fewer with a substance disorder do so (41.6%). Timely treatment in the year of onset is rare (2.6% for a substance disorder, 14.6% for an anxiety disorder and 31.3% of those with a mood disorder) with mean delays between 8 years for mood disorders and 21 years for anxiety disorders. Younger cohorts are more likely to make treatment contact than older cohorts, whereas those with earlier ages of disorder onset are least likely to make treatment contact. Those with anxiety disorders and major depressive disorder are more likely to make treatment contact when they have comorbid disorders, whereas those with substance use disorders are less likely.

CONCLUSIONS

Argentina needs to implement strategies to get individuals with substance use disorders into treatment, and to reduce treatment delays for all, but particularly to target early detection and treatment among children and adolescents.

Key Considerations in Planning for Substance Use Treatment: Estimating Treatment Need and Demand

OBJECTIVE

Estimates of the extent of treatment need (defined by the presence of a diagnosis for which there is an effective treatment available) and treatment demand (defined as treatment seeking) are essential parts of effective treatment planning, service provision, and treatment funding. This article reviews the existing literature on approaches to estimating need and demand and the use of models to inform such estimation, and then considers the implications for health planners.

METHOD

A thematic review of the literature was undertaken, with a focus on covering the key concepts and research methods that have been used to date.

RESULTS

Both need and demand are important estimates in planning for services but contain many difficulties in moving from the theory of measurement to the practicalities of establishing these figures. Furthermore, the simple quantum of need or demand is limited in its usefulness unless it is matched with consideration of different treatment types and their relative intensity, and/or explored as a function of geography and subpopulation. Modeling can assist with establishing more fine-tuned planning estimates, and is able to take into account both client severity and the various treatment types that might be available.

CONCLUSIONS

Moving from relatively simplistic estimates of need and demand for treatment, this review has shown that although such estimation can inform national or subnational treatment planning, more sophisticated models are required for alcohol and other drug treatment planning. These can help health planners to determine the appropriate amount and mix of treatments for substance use disorders.

U.S. adolescent alcohol use by race/ethnicity: Consumption and perceived need to reduce/stop use

Understanding racial/ethnic drinking patterns and service provision preferences is critical for deciding how best to use limited alcohol prevention, intervention, and treatment resources. We used nationally representative data from 150,727 U.S. high school seniors from 2005 to 2016 to examine differences in a range of alcohol use behaviors and the felt need to reduce or stop alcohol use based on detailed racial/ethnic categories, both before and after controlling for key risk/protective factors. Native students reported particularly high use but corresponding high felt need to reduce/stop use. White and dual-endorsement students reported high use but low felt need to stop/reduce alcohol use.

Appalachian Women's Use of Substance Abuse Treatment: Examining the Behavioral Model for Vulnerable Populations

The Gelberg-Andersen Behavioral Model for Vulnerable Populations was applied to understand vulnerable Appalachian women's (N = 400) utilization of addiction treatment. A secondary data analyses included multiple multivariate analyses. Strongest correlates of treatment utilization included ever injecting drugs (OR = 2.77), limited availability of substance abuse treatment facilities (OR = 2.03), and invalidated violence abuse claims (OR = 2.12). This study contributes theory-driven research to the greater social work addiction literature by confirming that vulnerable domains related to substance abuse treatment utilization warrant unique considerations compared to non-vulnerable domains. Findings also highlight the importance of understanding the unique role that cultural factors play in treatment utilization among Appalachian women. Inferences relevant to clinicians and policymakers are discussed.

Sex and gender differences in substance use disorders

The gender gap in substance use disorders (SUDs), characterized by greater prevalence in men, is narrowing, highlighting the importance of understanding sex and gender differences in SUD etiology and maintenance. In this critical review, we provide an overview of sex/gender differences in the biology, epidemiology and treatment of SUDs. Biological sex differences are evident across an array of systems, including brain structure and function, endocrine function, and metabolic function. Gender (i.e., environmentally and socioculturally defined roles for men and women) also contributes to the initiation and course of substance use and SUDs. Adverse medical, psychiatric, and functional consequences associated with SUDs are often more severe in women. However, men and women do not substantively differ with respect to SUD treatment outcomes. Although several trends are beginning to emerge in the literature, findings on sex and gender differences in SUDs are complicated by the interacting contributions of biological and environmental factors. Future research is needed to further elucidate sex and gender differences, especially focusing on hormonal factors in SUD course and treatment outcomes; research translating findings between animal and human models; and gender differences in understudied populations, such as those with co-occurring psychiatric disorders and gender-specific populations, such as pregnant women.

Gender differences in substance use patterns and disorders among an Iranian patient sample receiving methadone maintenance treatment

BACKGROUND

The current prevalence rate of substance abuse and dependence, represents an increasing trend of substance abuse and dependence among women, and the results of epidemiology studies indicate that substance use patterns are different between men and women. This study aimed to determine gender differences in substance use patterns and disorders among the patients undergoing methadone maintenance treatment.

METHODS

This cross-sectional study was conducted throughout a specified time bracket ranging from September 2012 through March 2013 in Methadone Maintenance Treatment (MMT) clinics of Mashhad, Iran. In this study, 140 men and 120 women were selected from among the patients referring to MMT clinics in Mashhad through purposeful sampling method. The sample units were assessed using a demographic information questionnaire and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID). The data were then analyzed by Chi Square test, Mann-Whitney U test, and Independent-samples t-test. SPSS software 16 was used to conduct statistical analyses with P values less than 0.05 regarded as significant.

RESULTS

The results showed that men and women are significantly different from each other in terms of marital status (p=0.001), education (p=0.001), income (p=0.001), history of injection (p=0.002), imprisonment (p=0.001), and substance use abstention (p=0.023). It was also revealed that methamphetamine dependence (p=0.017) and simultaneous use of multiple substances (p=0.001) in the past 12 months were diagnosed, to a larger extent, in male participants than those in female participants. In addition, the diagnoses of nicotine dependence (p=0.001), cannabis abuse (p=0.001), heroin dependence (p=0.001), and substance abuse and alcohol dependence (p=0.001) during a lifetime were more frequently existing in males than those in females.

CONCLUSION

There are gender differences in substance use patterns and disorders that appear to be caused by the degree of access to substances and the impacts of cultural and social aspects on men and women in Iran.