Transcript Adolescence and Substance Use

Adolescence and Substance Use
by Rick Sampson,
American Institutes for Research
(03-15-07)
An Overview
Adolescence and Substance Use
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2.
3.
4.
How does substance use impact
adolescents?
What is the scope of the issue?
Challenges to responding
effectively
Yielding results: promising
practices
Adolescence and Substance Use
How does substance use
impact adolescents?
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Societal messages
Family involvement
Experimentation/use/abuse/
dependence
The promise of recovery
Adolescence and Substance Use
Societal Messages
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Beyond perception of risk to perception of self
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Better living through chemistry
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The double bind
Adolescence and Substance Use
Family Involvement
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Parental use/abuse
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Sibling use/abuse
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Losing the childhood you never had
Adolescence and Substance Use
Experimentation/Use/Abuse/
Dependence
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Developmental denial
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Motivational focus
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Who am I?
Adolescence and Substance Use
The Promise of Recovery
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Going away so we can go home
Adolescence and Substance Use
What is the Scope of the Issue?
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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.
Other\e
Inhallants
Stimulants
Other
Amphetamines
Methamphetamines
-66%
-56%
25,000
Hallucinogens
46%
36%
138%
310%
253%
125,000
Heroin/Opiates
44%
75,000
Cocaine/Crack
111%
150,000
Marijuana/Hash
19%
100,000
Alcohol
Adolescence and Substance Use
What is the Scope of the Issue?
400%
300%
50,000
0
200%
100%
0%
-100%
-200%
1993
2003
Change
Adolescent AOD Dependence/Abuse
Dependence/
Abuse up
27% from
7.0% in 1995
to 8.9% in
2003
Prevalence
6.0 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.
Adolescence and Substance Use
Challenges to Responding
Effectively
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Retention and engagement
Family involvement
Availability
Cost
Unmet Treatment Need Adolescent
(% of AOD Dependence/Abuse without any private/public
treatment)
9 in 10
Untreated
Prevalence
82.4 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 )
Adolescence and Substance Use
Yielding results: promising
practices
 Data Review
 Review of two promising practices
CSAT is helping the field move towards
evidence-based practice (EBP) by:
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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
CSAT Adolescent Treatment Program
Grantees Using the GAIN (1997-2007)
NH
WA
VT
MT
ND
ME
MN
OR
MA
WI
ID
WY
NV
UT
NY
RI
PA
IA
NE
CA
MI
SD
OH
IL
CO
KS
MO
IN
WV
VA
SC
AR
MS
TX
AK
HI
NC
OK
NM
DE
KY
TN
AZ
CT
NJ
AL
GA
LA
FL
MD
Grant
AAFT
ART
ATM
CYT
Drug Court
Drug Court 2
Earmark
EAT
RCF
SCY
TCE
YORP
SAC
SAC expected
Current CSAT AT Outcome Data Set
by Grant Program
DC: Drug Court (2005-2009;
524 from 6 grants)
YORP: Young Offender
Re-entry Project (20042008; 524 from 14
grants)
EAT: Effective
Adolescent Treatment
(2003-2007; 5,255
from 27 grants)
CYT: Cannabis Youth Treatment
(1997-2001; 600 from 4 grants)
ATM: Adolescent Treatment
Model (1998-2002; 1,429
from 10 grants)
SCY: Strengthening
Communities-Youth
(2002-2007; 2,292
from 11 grants)
TCE: Other Targeted
Capacity Expansion (20022009; 523 from 8 grant)
ART: Adolescent Residential
Treatment (2003-2006; 1,899
from 16 grants)
Source: CSAT 2006 AT Outcome Data Set (n=12,601)
19%
73%
8%
49%
Single Parent
31%
88%
In School
31%
Source: CSAT 2006 AT Outcome Data Set (n=12,601)
100%
90%
14%
Age 15-17
Ever Homeless or Runaway
80%
4%
Age <15
Employed
70%
17%
African American
Age >17
60%
50%
19%
Hispanic
Mixed
40%
27%
Female
Native American
30%
20%
10%
0%
Demographics
67%
Any Co-occurring Psychiatric
52%
Conduct Disorder
44%
Attention Deficit/Hyperactivity Disorder
36%
Major Depressive Disorder
25%
Traumatic Stress Disorder
General Anxiety Disorder
15%
64%
Ever Physical, Sexual or Emotional Victimization
46%
High severity victimization (GVS>3)
31%
Ever Homeless or Runaway
24%
Any homicidal/suicidal thoughts past year
Any Self Mutilation
Source: CSAT 2006 AT Outcome Data Set (n=12,601)
11%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Co-Occurring Psychiatric Problems
Percent in Past Month Recovery*
Treatment Outcomes by Level of Care:
Recovery*
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Outpatient (+97%, +2%)
Residential (+115%, +9%)
Cont. care (+165%, +27%)
Pre-Intake
Mon 1-3
Mon 4-6
Mon 7-9
Mon 10-12
* 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 2006 AT Outcome Data Set (n=12,601)
Percent in Past Month Recovery*
Regular Outpatient vs. Evidenced-Based
Practices from CYT: Percent in Recovery*
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
CYT (+213%, 5%)
EAT (+101%, 11%)
Other OP (+97%, -3%)
Pre-Intake
Mon 1-3
Mon 4-6
Mon 7-9
Mon 10-12
* 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)
Adolescence and Substance Use
Yielding results: promising
practices
 Seven Challenges
 Integrated Co-occurring Treatment
(ICT)