Download - Adolescence and Substance Use by Rick Sampson, American Institutes for Research (03-15-07)
Adolescence and Substance Use
by Rick Sampson, American Institutes for Research (03-15-07)
An Overview
Adolescence and Substance Use
1. How does substance use impact adolescents?
2. What is the scope of the issue?3. Challenges to responding
effectively4. Yielding results: promising
practices
Adolescence and Substance Use
How does substance use impact adolescents?
Societal messages Family involvement Experimentation/use/abuse/
dependence The promise of recovery
Adolescence and Substance Use
Societal Messages
Beyond perception of risk to perception of self
Better living through chemistry
The double bind
Adolescence and Substance Use
Family Involvement
Parental use/abuse
Sibling use/abuse
Losing the childhood you never had
Adolescence and Substance Use
Experimentation/Use/Abuse/Dependence
Developmental denial
Motivational focus
Who am I?
Adolescence and Substance Use
The Promise of Recovery
Going away so we can go home
Adolescence and Substance Use
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.
Adolescence and Substance Use
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
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ts
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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
Adolescence and Substance Use
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
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:
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
Source: CSAT 2006 AT Outcome Data Set (n=12,601)
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
Source: CSAT 2006 AT Outcome Data Set (n=12,601)
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)
Source: CSAT 2006 AT Outcome Data Set (n=12,601)
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%)
Adolescence and Substance Use
Yielding results: promising practices
Seven Challenges Integrated Co-occurring Treatment
(ICT)