Outcomes among youth attending inpatient treatment for co-occurring disorders

AIM

An emerging body of research is identifying effective outpatient integrated treatment approaches for youth with co-occurring psychiatric and substance use disorders, though few studies exist examining inpatient treatment. The current study aimed to address this gap by examining response to treatment during admission to, and in the year following discharge from, a specialized inpatient program for youth with co-occurring disorders.

METHODS

A single-cohort longitudinal design examined change in adaptive functioning, mental health symptoms, and substance use frequency among N = 142 youth (69.1% female) aged 14-21 (M = 16.9, SD = 1.5) attending the program. Participants completed self-report measures at admission, discharge, and 1-, 6- and 12-months post-discharge.

RESULTS

Analyses indicated significant improvements in adaptive functioning, internalizing and externalizing symptoms, and substance use frequency during admission. There was some loss of gains in adaptive functioning over the 12-months post-discharge. Improvements were maintained in internalizing symptoms and substance use frequency, and improvements in externalizing symptoms continued over the 12-months post-discharge. There was no significant interaction between change in functioning and internalizing symptoms at admission or type of substance use disorder diagnosis. There was a significant interaction with externalizing symptoms, such that those with clinically significant levels of externalizing symptoms at admission experienced greater improvement in functioning, though the groups ended treatment with comparable functioning scores.

CONCLUSIONS

The results provide preliminary support for integrated treatment for co-occurring disorders delivered in an inpatient setting. However, the results also reflect the significant needs of youth with co-occurring disorders and the importance of ongoing care post-discharge from intensive treatment settings.

Psychological maltreatment in relation to substance use problem severity among youth

OBJECTIVES

Research has demonstrated that experiences of childhood maltreatment are prevalent in the life histories of youth with substance use problems; however, most of this research has focused on sexual or physical abuse. The purpose of the current study was to extend the scope of previous investigations to include psychological maltreatment experiences, examining the extent to which emotional abuse and emotional neglect predict substance use problem severity among youth. The current study also sought to examine whether a cumulative model fit the data, in which the experience of multiple forms of maltreatment would be related most strongly to severity of substance use problems, or whether there was a distinct effect of psychological maltreatment.

METHODS

Data were collected through self-report questionnaires from 216 youth (144 males, 72 females) entering an outpatient treatment program for youth with substance use concerns.

RESULTS

Results indicated that, when considering all forms of abuse together, only emotional abuse and emotional neglect emerged as significant predictors of substance use problem severity. Furthermore, the association between psychological maltreatment and substance use problem severity was unaltered by the consideration of concurrent experiences of interpersonal violence.

CONCLUSIONS

The results of the current study are consistent with those of a body of research describing the detrimental effects of psychological maltreatment. The findings have potential implications for the development and provision of trauma-informed youth substance use treatment services. The findings suggest that attending to the sequelae of psychological maltreatment may be important in assisting these youth in achieving successful treatment outcomes.

Motivation and maltreatment history among youth entering substance abuse treatment

Research has established that maltreatment experiences are common in the life histories of youth with substance abuse problems, and efforts are now moving in the direction of enhancing our understanding of the unique clinical presentations and treatment needs of this population. The current study endeavored to contribute to this body of research by examining associations between experiences of maltreatment and levels of motivation among youth entering outpatient substance abuse treatment. Upon admission, 188 youth (131 males, 57 females) completed a package of self-report questionnaires including measures of motivation to change, motivation for treatment, and history of maltreatment experiences. Results indicated that youth with histories of all forms of maltreatment examined tended to be more aware of the problematic aspects of their substance use, more ready to engage in treatment, more motivated by feelings of shame, and more motivated by external influences. Emotional abuse was the form of maltreatment that predicted level of motivation most strongly. Emotional abuse was particularly strongly associated with the form of motivation reflecting shame regarding substance use, predicting this form of motivation over and above other factors previously reported to be associated with motivation, such as severity of substance abuse and age. While clinicians are increasingly attending to exposure to traumatic events among youth entering substance abuse treatment, these findings suggest that attending to experiences of emotional abuse is also important. Such experiences appear to be related to treatment motivation and may be important to treatment processes and outcomes for these vulnerable youth.