adolescence and substance use by rick sampson, american institutes for research (03-15-07) an...

Adolescence and Substance Use

by Rick Sampson, American Institutes for Research (03-15-07)

An Overview


1. How does substance use impact adolescents?

2. What is the scope of the issue?3. Challenges to responding

effectively4. Yielding results: promising

practices


How does substance use impact adolescents?

Societal messages Family involvement Experimentation/use/abuse/

dependence The promise of recovery


Societal Messages

Beyond perception of risk to perception of self

Better living through chemistry

The double bind


Family Involvement

Parental use/abuse

Sibling use/abuse

Losing the childhood you never had


Experimentation/Use/Abuse/Dependence

Developmental denial

Motivational focus

Who am I?


The Promise of Recovery

Going away so we can go home


What is the Scope of the Issue? 1.5 m (6.1% youth aged 12 to 17) needed alcohol

treatment in the past year and only about 111,000 youth (7.2% of those needing alcohol treatment) received specialty treatment for alcohol in the past year.

1.4 m youth (5.4%) needed illicit drug use treatment in the past year and only about 124,000 (9.1% of those needing illicit drug treatment) received specialty treatment for an illicit drug.

Youth aged 12 to 17 who were in need of substance use treatment in the past year and did not receive treatment were not likely to perceive a need for substance use treatment.


What is the Scope of the Issue?

25

3% 31

0%

46

%

13

8%

-66

%

36

%

-56

%

44

%

19

%

11

1%

0

25,000

50,000

75,000

100,000

125,000

150,000A

lco

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ph

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mu

lan

ts

Inh

all

an

ts

Oth

er\

e -200%

-100%

0%

100%

200%

300%

400%

1993

2003

Change

Adolescent AOD Dependence/Abuse

Prevalence6.0 to 8.4%8.5 to 9.0%9.1 to 9.9%10.0 to 14.6%U.S.Avg.=8.9%

Source: Wright, D., & Sathe, N. (2005). State Estimates of Substance Use from the 2002–2003 National Surveys on Drug Use and Health (DHHS Publication No. SMA 05-3989, NSDUH Series H-26). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies (retrieved from http://oas.samhsa.gov/2k3State/2k3SAE.pdf ) and Kilpatrick et al, 2000.

Dependence/ Abuse up 27% from

7.0% in 1995 to 8.9% in

2003


Challenges to Responding Effectively

Retention and engagement Family involvement Availability Cost

Unmet Treatment Need Adolescent

(% of AOD Dependence/Abuse without any private/public treatment)

Prevalence82.4 to 90.1%90.2 to 92.3%92.4 to 94.2%94.3 to 98.0%U.S.Avg.=92.2%

Source: Wright, D., & Sathe, N. (2005). State Estimates of Substance Use from the 2002–2003 National Surveys on Drug Use and Health (DHHS Publication No. SMA 05-3989, NSDUH Series H-26). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies (retrieved from http://oas.samhsa.gov/2k3State/2k3SAE.pdf )

9 in 10 Untreated


Yielding results: promising practices

Data Review Review of two promising practices

CSAT is helping the field move towards evidence-based practice (EBP) by:

Introducing reliable and valid assessment that can be used At the individual level to immediately guide clinical judgments

about diagnosis/severity, placement, treatment planning, and the response to treatment

At the program level to drive program evaluation, needs assessment, and long term program planning

Introducing explicit intervention protocols that are Targeted at specific problems/subgroups and outcomes Having explicit quality assurance procedures to cause

adherence at the individual level and implementation at the program level

Having the ability to evaluate performance and outcomes For the same program over time Relative to other interventions

CSAT Adolescent Treatment (AT) Outcome Data Set

Recruitment: 1998-2006 (updated annually)

Sample: The 2006 CSAT adolescent treatment data set included data with 1 to 4 follow-ups on 12,690 adolescents from 96 local evaluations

Levels of Care: Early Intervention, Outpatient, Intensive Outpatient, Short, Moderate & Long term Residential, Corrections Based and Post Residential Outpatient Continuing Care

Instrument: Global Appraisal of Individual Needs (GAIN) (see www.chestnut.org/li/gain)

Follow-up: Over 80% follow-up 3, 6, 9 & 12 months post intake

Funding: CSAT contract 270-2003-00006 and 72 individual grants

Grant AAFTARTATMCYTDrug CourtDrug Court 2EarmarkEATRCFSCYTCEYORP

WA

AK

ALAR

AZ

CA CO DE

FL

GA

HI

IA

ID

IN

KS

LA

MD

ME

MI

MN

MO

MS

MT ND

NE

NH

NJ

NM

NV

NY

OH

OK

OR

PA

RISD

TN

TX

UTVAWV

WY

SAC

WI

IL

KY

VT

MA

CT

SAC expected

CSAT Adolescent Treatment Program Grantees Using the GAIN (1997-2007)

SC

NC

Current CSAT AT Outcome Data Set by Grant Program

SCY: Strengthening Communities-Youth (2002-2007; 2,292 from 11 grants)

TCE: Other Targeted Capacity Expansion (2002-2009; 523 from 8 grant)

ART: Adolescent Residential Treatment (2003-2006; 1,899 from 16 grants)

EAT: Effective Adolescent Treatment (2003-2007; 5,255 from 27 grants)

YORP: Young Offender Re-entry Project (2004-2008; 524 from 14 grants)

CYT: Cannabis Youth Treatment (1997-2001; 600 from 4 grants)

ATM: Adolescent Treatment Model (1998-2002; 1,429from 10 grants)

Source: CSAT 2006 AT Outcome Data Set (n=12,601)

DC: Drug Court (2005-2009; 524 from 6 grants)

Demographics

27%

19%

17%

4%

14%

19%

73%

8%

49%

31%

88%

31%

0% 10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Female

Hispanic

African American

Native American

Mixed

Age <15

Age 15-17

Age >17

Single Parent

Employed

In School

Ever Homeless or Runaway


Co-Occurring Psychiatric Problems

67%

52%

44%

36%

25%

15%

64%

46%

31%

24%

11%

0% 10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Any Co-occurring Psychiatric

Conduct Disorder

Attention Deficit/Hyperactivity Disorder

Major Depressive Disorder

Traumatic Stress Disorder

General Anxiety Disorder

Ever Physical, Sexual or Emotional Victimization

High severity victimization (GVS>3)

Ever Homeless or Runaway

Any homicidal/suicidal thoughts past year

Any Self Mutilation


Treatment Outcomes by Level of Care: Recovery*

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pre-Intake Mon 1-3 Mon 4-6 Mon 7-9 Mon 10-12

Per

cen

t in

Pas

t M

onth

Rec

over

y*

Outpatient (+97%, +2%)

Residential (+115%, +9%)

Cont. care (+165%, +27%)

* Recovery defined as no past month use, abuse, or dependence symptoms while living in the community. Percentages in parentheses are the treatment outcome (intake to 12 month change) and the stability of the outcomes (3months to 12 month change)


Regular Outpatient vs. Evidenced-Based Practices from CYT: Percent in Recovery*

* Recovery defined as no past month use, abuse, or dependence symptoms while living in the community. Percentages in parentheses are the treatment outcome (intake to 12 month change) and the stability of the outcomes (3months to 12 month change)

Source: CSAT 2007 AT Outcome Data Set (n=8,902 adolescents in outpatient)

0%10%20%30%40%50%60%70%80%90%

100%

Pre-Intake Mon 1-3 Mon 4-6 Mon 7-9 Mon 10-12

Per

cen

t in

Pas

t M

onth

Rec

over

y*

CYT (+213%, 5%)

EAT (+101%, 11%)

Other OP (+97%, -3%)


Yielding results: promising practices

Seven Challenges Integrated Co-occurring Treatment

(ICT)

adolescence and substance use by rick sampson, american institutes for research (03-15-07) an...

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