Predictors of alcohol and other drug treatment completion among young people accessing residential and community-based treatment: A retrospective analysis of routinely collected service data

BACKGROUND AND AIMS

Young people accessing alcohol and other drug (AOD) treatment experience high rates of treatment disengagement, contributing to poorer outcomes. To improve outcomes, it is important to identify factors associated with treatment retention. This study measured the relationships between client characteristics, treatment characteristics, clinical severity measures and completion of treatment among young people.

DESIGN, SETTING AND PARTICIPANTS

This study was a retrospective analysis of routinely collected data set in residential- and community-based AOD services in New South Wales, Australia. Routinely collected data from the Network of Alcohol and Other Drug Agencies' (NADA) database were used. Included individuals were aged 10-24 years and accessed treatment between 2012 and 2023 (n = 17 474).

MEASUREMENTS

Variables included client-related characteristics, service characteristics and baseline measures of clinical severity [Kessler-10 (K10), EUROHIS-QoL, severity of dependence scale (SDS)]. Multivariable binary logistic regression models assessed the relationships between these characteristics and treatment completion.

FINDINGS

Rates of treatment completion were highest among adolescents in community-based treatment (57%) and lowest among young adults in residential treatment (35%). Polysubstance use was negatively associated with treatment completion among adolescents [adjusted odds ratio (adjOR) = 0.71, P < 0.001] and adults (adjOR = 0.70, P < 0.001) in community-based treatment, and adolescents in residential treatment (adjOR = 0.62, P = 0.006), as was housing insecurity (adolescents in community treatment, adjOR = 0.61, P = 0.001; adults in community treatment, adjOR = 0.77, P = 0.002; adolescents in residential treatment, adjOR = 0.42, P = 0.005). Attending youth-specific services was associated with higher treatment completion rates among adults in community-based (adjOR = 1.81, P < 0.001) and residential treatment (adjOR = 1.72, P < 0.001). Varying correlates of treatment completion were identified throughout treatment groups, reflecting the differences in population and/or needs across contexts.

CONCLUSIONS

In New South Wales, Australia, fewer than half of young people accessing alcohol and other drug treatment between 2012 and 2023 completed treatment, and completion rates were lower among those facing barriers such as polysubstance use and housing insecurity.

Predictors of Housing Trajectories Among Young Adults Experiencing Homelessness in Los Angeles

Experiencing homelessness during young adulthood is associated with negative health outcomes and understanding housing trajectories of young adults experiencing homelessness may aid in the development of evidence-based public health programs designed to serve this at-risk age group. In the present study, the authors examined baseline predictors of 24-month trajectories of housing stability and unsheltered housing among a sample of 271 young adults aged 18 to 25 recruited from drop-in centers in Los Angeles. In multivariate models, the authors found that identifying as multi-racial/other and better friendship quality at baseline were associated with less steep increases in the likelihood of stable housing over time. Being employed at baseline was associated with a less steep decrease in the probability of being unsheltered over time, while illicit drug use days associated with a steeper decrease in the probability of being unsheltered over time. Continued research is needed to establish important factors determining young adults' long-term housing trajectories in the effort to promote greater access and engagement with housing services.

Secondary Outcomes of a Brief Group Alcohol and Risky Sex Intervention for Emerging Adults Experiencing Homelessness

AWARE is a four-session group-based motivational enhancement intervention designed to reduce substance use and sexual risk behavior among emerging adults experiencing homelessness. Expanding on promising intervention effects on substance use and risky sex outcomes, this study explored intervention effects on changes in secondary outcomes from baseline to 12-month post-intervention: depression, physical health (general health ratings, physical symptoms), social functioning (satisfaction, quality of friendships), and housing stability. Among the 240 participants with baseline and 12-month follow-up data, we found small effect sizes generally favoring the intervention over usual care for all outcomes. Findings show promise that addressing substance use and risky sexual behavior through interventions in drop-in centers could benefit emerging adults experiencing homelessness in additional areas of their lives. More work is needed to understand how interventions could be tailored to more directly address these outcomes and sustain changes in the long-term.

Suicide risk profile and the social convoy: Population-level patterns of the young generation's help-seeking behavior and implications for suicide prevention

BACKGROUND

Social support network offers a large potential in augmenting suicide prevention efforts tailored for the young generation (YG), but has so far been largely overlooked in population health studies. Key issues that remain scarcely understood include the composition of the YG's activated support network when they faced psychological distress, along with the prevalence and suicide risk profile associated with these patterns.

METHODS

Using data from three consecutive population-representative surveys (2018-2020) on help-seeking behaviors of the YG living in Hong Kong, we first conducted latent class analysis to derive the YG's help-seeking patterns. Next, we conducted multinomial logistic regression to identify unique factors associated with each pattern and multiple logistic regressions for suicide risk indicators to examine risk levels associated with each pattern.

RESULTS

Analyses revealed 4 underlying patterns of help-seeking behaviors among the study population. Each pattern was consistently associated with a distinct suicide risk profile based on constituents' level of distress and history of suicide risk behaviors. Severity of suicide risk increased as individuals increased the activation radius of their social convoy, and this increase was more pronounced when individuals extended the radius beyond their inner circle. Individuals whose activated inner circle consisted of family members in addition to just friends & partner had lower suicide risks.

CONCLUSIONS

Social support networks hold much potential in augmenting suicide prevention efforts tailored for the general young population. Such efforts may be directed at empowering the inner circle of their convoy, given its predominance for the YG to seek help from.

Dynamics of Parental Opioid Use and Children's Health and Well-Being: An Integrative Systems Mapping Approach

The seemingly intractable opioid epidemic compels researchers, the media, and families to better understand the causes and effects of this complex and evolving public health crisis. The effects of this crisis on people using opioids, maternal prenatal opioid exposure, and neonatal abstinence syndrome are well-documented, but less is known about the impact of caregivers' opioid use on children's health and well-being. One challenge to understanding the effects of parental opioid use disorder (OUD) on child and adolescent outcomes is the numerous interrelated pathways in which a child's health and well-being can be impacted. To better understand these dynamic relationships, we applied a systems mapping approach to visualize complex patterns and interactions between pathways and potential leverage points for interventions. Specifically, we developed a causal loop diagram system map to elucidate the complex and interconnected relationships between parental OUD, social determinants of health at the family and socio-environmental levels, family strengths, social supports, and possible adverse impacts on children's physical and mental health and risks for future substance misuse. The goals of this research are to (1) identify factors and dynamics that contribute to the relationship between parental OUD and children's health and well-being and (2) illustrate how systems mapping as a tool can aid in understanding the complex factors and dynamics of the system(s) that influence the well-being of children and their parents or primary caregivers.

The Developmental Process of Peer Support Networks: The Role of Friendship

This study investigated the characteristics and development of peer support networks in an effort to unravel the role of friendship in this developmental process. The relationships between friendship networks and peer support networks were explored, and the influence of dyadic and triadic friendships on the development of peer support relationships was examined. Two waves of data were collected among a sample of adolescents in six Chinese junior high schools (n = 913 students from 28 classrooms; mean age = 14.13 years; 50.49% boys), and classroom friendship networks and peer support networks were analyzed. The results showed that peer support networks were sparse, hierarchical, and sex-segregated. Furthermore, peer support networks and friendship networks partially overlapped. Friends tended to have similar support-seeking and support-providing ties. Longitudinal multiplex social network analysis revealed that peer support networks changed moderately over time, and friendships played various roles in the development of peer support networks. Dyadic friendships improved the formation of peer support ties. A mutual friend improved the formation of support relationships between two students when the mutual friend chose the two students as friends, but a mutual friend also hindered or had no effects on the formation of support relationships in other cases. The implications for educators to improve peer support networks are presented, and directions for future research are discussed.

Sick Enough? Mental Illness and Service Eligibility for Homeless Individuals at the Border

This paper measures mental illness among individuals experiencing homelessness in a border city and compares it to the general housed population. We use original data from a homeless survey conducted in El Paso, Texas. Respondents self-reported any possible mental illness or related symptoms. We find that mental illness is not disproportionally common among the homeless, yet this is something that is often claimed by laypersons, some social service workers, and some researchers that limit sampling to institutionalized settings where formal mental illness is often among the prerequisites for admission. We find that “severe mental illness” among homeless persons is 6.2% (only around 2–3% higher than the general population), and “any mental illness” is 20.8% (only 1–3% higher than in the general population). Our results are consistent with other research focusing on street samples.

Problem Drinking, Alcohol-Related Violence, and Homelessness among Youth Living in the Slums of Kampala, Uganda

This paper examines problem drinking, alcohol-related violence, and homelessness among youth living in the slums of Kampala—an understudied population at high-risk for both alcohol use and violence. This study is based on a cross-sectional survey conducted in 2014 with youth living in the slums and streets of Kampala, Uganda (n = 1134), who were attending Uganda Youth Development Link drop-in centers. The analyses for this paper were restricted to youth who reported current alcohol consumption (n = 346). Problem drinking patterns were assessed among youth involved in alcohol-related violence. Mediation analyses were conducted to examine the impact of homelessness on alcohol-related violence through different measures of problem drinking. Nearly 46% of youth who consumed alcohol were involved in alcohol-related violence. Problem drinkers were more likely to report getting in an accident (χ² = 6.8, df = 1, p = 0.009), having serious problems with parents (χ² = 21.1, df = 1, p < 0.0001) and friends (χ² = 18.2, df = 1, p < 0.0001), being a victim of robbery (χ² = 8.8, df = 1, p = 0.003), and going to a hospital (χ² = 15.6, df = 1, p < 0.0001). For the mediation analyses, statistically significant models were observed for frequent drinking, heavy drinking, and drunkenness. Interventions should focus on delaying and reducing alcohol use in this high-risk population.