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Substance Use and Dependence in Youth: Treatment Considerations

While the downward shift in substance use among youth in 8th, 10th and 12th grades over the past two years is a hopeful sign (U.S. Department of Health and Human Services, 2003), prevention efforts and early intervention with those at high risk must continue unabated. Fashion trends, alcohol advertising, peer pressure, and other factors all may contribute to erode the gains made by the efforts of the public and private sectors in reducing youth substance use. For example, in the area of advertising, reports in the popular media point to the danger in the promotion of alcohol products that are concocted and packaged to resemble soft drinks. These products are readily available in convenience or liquor packaging stores. Recent lawsuits against the alcohol industry indicate that there are citizens who believe that the availability and promotion of these sweetened blends such as flavored malt products, commonly known as “alcopops,” are aimed at attracting underage youth. (Lawton, 2004, p. B7). A reduction in the numbers of youth who use psychoactive substances will help to prevent the emergence of substance use disorders in this population, however a significant number of young people are in need of treatment for existing substance use disorders. In 2001, an estimated 16.6 million Americans aged 12 or older were classified with dependence on or abuse of either alcohol or illicit drugs (U.S. Department of Health and Human Services, 2002a). Among adolescents aged 12 to 17 in 2001, the rate of alcohol or other drug dependence or abuse among females (8.0 percent) was similar to the rate among males (7.6 percent)[U.S. Department of Health and Human Services, 2001]. The significant level of substance use dependence in the adolescent population requires treatment services that are tailored to this population’s unique needs. Unfortunately, the availability of and financing for substance use disorder treatment has not kept pace with the needs of young people (U.S. Department of Health and Human Services, 2002c). Only about ten percent of adolescents, who need substance abuse treatment, currently receive it, and of those who do receive treatment, only about one-quarter receive the length of treatment time necessary to support success (U.S. Department of Health and Human Services, 2001). Underlying this nationwide deficit is a lack of understanding concerning the nature of drug abuse and the special needs of adolescent drug abusers. Other contributing factors include a paucity of treatment models and insufficient access to treatment. Further, those services that are available are generally not sufficiently comprehensive enough to meet the complex needs of adolescents with multiple psychological and socialenvironmental problems. In addition to insufficient treatment services available for this population, there is inadequate data on which to match treatment modalities with client needs. (U.S. Department of Health and Human Services, 2002b). Treatment for behavioral, psychosocial and psychiatric problems must be integrated with substance dependence treatment, (Riggs, 2003). Prior to the current decade, most adolescents who received treatment did so in programs with adult models and results were unsatisfactory (White, 1998). There is some indication that when adolescents are treated in programs geared to their special needs there is a significant reduction in alcohol and other drug use posttreatment ( Hser et al., 2001). This is promising and it is suggested that research continue in this area and in the examination of treatment processes and client factors that predict treatment and aftercare outcomes (Kaminer, 2001; Latimer, Newcomb, Winters, & Stinchfield, 2000a). Overall, the meager success of adolescent treatment speaks to the importance of understanding factors that contribute to poor treatment retention (Latimer & Stinchfield, 2000). There is some evidence indicating that length of stay represents a barometer for several factors related to treatment effectiveness, including