A study of the patterns and correlates of substance use among adolescents applying for drug treatment

Substance use and Psychosocial Functioning of Adolescents in Benue State, Nigeria: Assessing the role of age

AIM

To assess whether Substance Use (SU) is associated with Psychosocial Function (PF) among adolescent.

METHODS

Using a self-administered validated instrument, we obtained information on demographic, SU (defined as self-reported affirmative use of one or more of any form of alcoholic drinks, cigarettes, hemps etc) and PF [using the adolescent psychosocial functioning inventory comprising of three subscales; optimism and coping strategies (OCS), behaviour and relationship problems (BRP) and general psychosocial dysfunction designed (GPD)] among 2272 apparently healthy adolescents. PF was categorized as 'elevated' if the psychosocial functioning index (PFI) score were >75th percentile, otherwise, 'not elevated' and multivariable-adjusted logistic regression was used to compute odds ratio (OR) and 95% confidence interval (CI) of SU for elevated PF risk. In addition, we applied Johnson Neyman (JN) technique to identifying the JN significance regions at which age moderated the SU-PF relationship at a statistical significance of two-sided P<0.05.

RESULTS

Prevalence of SU and elevated PF was 50.7% and 79.8% respectively. Prevalence of elevated PF differed insignificantly by sex, but the proportion of adolescent with elevated PFI on SU (82.6%) was significantly higher (P<0.001) compared to those with elevated PFI but not on SU (76.9%). Multivariable-adjusted odds of decreased OCS risk given SU exposure was; OR (95%CI): 1.3791 (1.1458-1.6698), P=0.0007. Similarly, multivariable-adjusted odds of elevated PF risk in the light of SU exposure was; OR (95%CI): 1.4286 (1.1617-1.7567), P=0.0007. Furthermore, the JN significance regions for moderated regression analyses of odds of decreased OCS risk was between 10.4years [OR (95%CI): 0.5820 (0.1411-1.0228), P=0.0097] and 16.7years [OR (95%CI): 0.3025 (0.0001-0.6050), P=0.0500].

CONCLUSION

Adolescents on SU are about one and half times at risk of psychosocial dysfunction and age significantly attenuated the SU-decreased OCS risk link particularly in early adolescence.

Gender differences in adolescents attending a drug and alcohol withdrawal service

INTRODUCTION AND AIMS

Gender differences have been reported in adult substance users, but little research has examined gender differences in adolescents presenting to treatment services. This study aimed to explore gender differences in adolescents presenting to a withdrawal service.

DESIGN AND METHODS

All presentations to a withdrawal service between March 2000 and September 2004 were identified. For each presentation, the following information was extracted from clinical databases: sociodemographics, drug use, risk-taking behaviour, mental health symptoms, reasons and context of drug use. Significant gender differences identified at bivariate analysis were then incorporated into multivariate models exploring predictors of heroin use, cannabis use and sharing injecting equipment.

RESULTS

A total of 262 young people were admitted during the study period (53% male, mean age 16.8 years; SD 1.13). Bivariate analysis indicated that girls were more likely to report: being homeless, using a greater number of substances, using heroin and amphetamines, higher rates of injecting, sharing injecting equipment and using with a partner. Multivariate analysis identified that being female was an independent predictor of heroin use and that being male was an independent predictor of cannabis use. Significant predictors of sharing injecting equipment were using with a partner and current use of heroin; the effect of gender was not significant after controlling for other factors.

DISCUSSION AND CONCLUSIONS

Our findings indicate that male and female adolescents presenting to a withdrawal treatment service exhibit differences in substance use characteristics. Future research should examine the role of gender in determining optimal treatment approaches in substance-using adolescents.

Opiate-dependent adolescents in Ireland: a descriptive study at treatment entry

OBJECTIVES

To describe the drug history and co-existing psycho-social problems among under-19 year olds accessing treatment for opiate dependency, including methadone maintenance, and examine for any gender differences.

METHOD

A descriptive study of under-19 years assessed at the largest drug treatment clinic in Dublin, Ireland, between October 2000 and September 2006. Data was obtained through review of case notes, assessment questionnaires and urine drug screens.

RESULTS

Eighty-six young people were included. Their mean age was 16.8 years. Forty-six (54%) were female. Only 26 (30%) reported an intact family of origin. Twenty-three (27%) had been in care. Mean age for first use of any illicit drug was 12.4 years, and for heroin was 14.8 years. The mean age of leaving school was 14.4 years; 42 (49%) first tried heroin after leaving school. Forty-one (48%) had a history of homelessness. Forty-four (51%) had previously injected; 26 (30%) were currently injecting. Fifty-six (65%) had not been screened for blood-borne diseases; twenty-one (24%) subsequently tested positive for hepatitis C. Thirty-eight (48%) had previous convictions; 33 (38%) were facing charges. Forty-five (52%) had previously seen a psychiatrist; nine (11%) had received inpatient psychiatric treatment. Boys were more likely to leave school early, have a substance-abusing sibling, and to have a past conviction. Girls were more likely to have a partner, and have taken a deliberate overdose.

CONCLUSIONS

This study highlights the multiple and complex needs of teenagers abusing opiates. Services seeking to meet their needs will require a broad range of interventions and excellent interagency co-operation.

Income inequality and alcohol use: a multilevel analysis of drinking and drunkenness in adolescents in 34 countries

BACKGROUND

Economic inequality has been hypothesized to be a health determinant, independent of poverty and household income. The goal of this study was to explore the contextual influences of income inequality on alcohol use and frequency of drunkenness in adolescents.

METHODS

The Health Behaviour in School-aged Children study surveyed 162 305 adolescents (ages 11, 13 and 15 years) in 34 countries, providing self-report data on family affluence, alcohol consumption and episodes of drunkenness. Country-level data on income inequality and overall wealth were retrieved from the United Nations Development Program.

RESULTS

Multilevel logistic regression revealed that 11- and 13-year-olds in countries of high income inequality consumed more alcohol than their counterparts in countries of low income inequality (after adjustment for sex, family affluence and country wealth). No such effect on alcohol consumption was found in 15-year-olds. Eleven-year-olds in countries of high income inequality reported more episodes of drunkenness than their counterparts in countries of low income inequality. No such effect of income inequality on drunkenness was found in 13- or 15-year-olds.

CONCLUSIONS

Income inequality may have a contextual influence on the use of alcohol among younger adolescents. Findings suggest that economic policies that affect the distribution of wealth within societies may indirectly influence the use of alcohol during early and mid-adolescence.

Patterns and correlates of substance use amongst juvenile detainees in New South Wales 1989-99

In the decade 1989 - 99 there have been significant changes in the patterns of substance use in the Australian community. Juvenile offenders have been a sentinel population of these emerging trends. The social and personal costs associated with adolescent substance use, especially where it leads to increased criminal offending requires urgent attention. This study was a replication of the 1989 and 1994 surveys of young people in detention in New South Wales, Australia. The 300 voluntary participants from nine detention centres had a similar demographic profile to participants of the previous surveys. They were predominantly male (90%) with a mean age of 16.5 years and an over-representation of Aboriginal and Torres Straits Islander peoples. The patterns of lifetime alcohol and tobacco use were stable over the decade, with particular increases in amphetamine, opioid and cocaine use since 1994. The more concerning pattern of at least weekly substance use revealed significant increases in cannabis, opioid and cocaine use since 1994, but a significant decrease in the frequent use of alcohol. This study also reports on high levels of negative health and psychosocial consequences of substance use, including overdose, among this group. High levels of self-reported depression and suicidal behaviours, family and gender issues are also discussed. Encouragingly, there was a relatively high level of self-recognized treatment need for substance use and mental health problems among the sample. This highlights further the growing need for the development and dissemination of novel interventions that harness this willingness and actively engage, motivate and maintain these young people in accessible, appropriate and effective interventions.