Substance use among adolescents applying for drug treatment
hensive, intensive and long-term intervention to assist with
this sample. Schools, police, community services, health work-
ers and the juvenile justice system are in a position to identify
and intervene with the adolescents and their families long before
they present to a residential treatment program.
the number and severity of signs and symptoms of distress.
While there has been some debate about the issue of treatment
matching, it is commonly accepted that the intensity and dura-
tion of treatment needs to increase as problem severity in-
creases.3-5 While residential treatment is more expensive per cli-
Acknowledgements
6
ent per day than non-residential treatment, intensive residen-
The authors would like to thank the Commonwealth Depart-
ment of Health and Aged Care for funding this study, and Dr
Maree Teesson for advice regarding data analysis.
This was a joint study of the National Drug and Alcohol
Research Centre, University of New South Wales and the Ted
Noffs Foundation.
tial treatment has been advocated when intrapersonal, interper-
sonal and environmental factors are particularly dysfunctional.4
The significance of substance-using peers in the lives of the
sample, identified by the Social Functioning Scale, suggested
that time-out from such influences and development of new non-
substance-using peer networks, could be an important part of
treatment. A short period of residential treatment (up to three
months) could provide the time-out from environmental factors
that contribute to the drug problems and an opportunity for
stabilisation, prior to a longer period of non-residential treat-
ment in the community.
References
1. American Psychiatric Association. Diagnostic and Statistical Manual of
Mental Disorders. Washington (DC): APA; 1994.
2
.
Simpson DD. Effectiveness of drug-abuse treatment: A review of research
from field settings. In: Egertson JA, Fox DM, Leshner AI, editors. Treating
Drug Abusers Effectively. Malden (MA): Blackwell; 1997.
Whether treatment is residential or non-residential, it is rec-
ommended that treatment include a comprehensive range of in-
terventions to address the multiple problems associated with
PSUDs. For example, a comprehensive treatment program could
include: relapse-prevention-skills training to assist with man-
aging drug use, health education to encourage safer sex and safer
injecting, vocational assistance and recreational programs to
encourage societal reintegration, medical assessment and treat-
ment to address physical health problems, psychiatric screen-
ing and referral to address psychological distress, and social
skills training and family interventions to improve social func-
tioning.
3
.
Babor T, Del Boca F, McLaney M, Jacobi B, Higgins-Biddle J, Hass W. Just
say Y.E.S. Alcohol Health Res World 1991;15(1):77-86.
4. Schonberg S. Guidelines for the treatment of alcohol and other drug abusing
adolescents. Rockville (MD): Center for Substance Abuse Treatment; 1993.
Treatment Improvement Protocol (TIP) Series No.: 4.
5. Friedman AS, Granick S, Kreisher C, Terras A. Matching adolescents who
abuse drugs to treatment. Am J Addict 1993;2(3):232-7.
6
.
Anderson DW, Bowland BJ, Cartwright WS, Bassin G. Service-level costing
of drug abuse treatment. J Subst Abuse Treat 1998;15(3):201-11.
Jainchill N, Bhattacharya G, Yagelka J. Therapeutic communities for adoles-
cents. In: Rahdert E, Czechowicz D, editors. Adolescent Drug Abuse: Clini-
cal Assessment and Therapeutic Interventions. Rockville (MD): National In-
stitute on Drug Abuse; 1995. NIDA Research Monograph No.: 156.
Spooner C, Mattick R, Howard J. The nature and treatment of adolescent
substance abuse. Sydney: University of New South Wales, National Drug
and Alcohol Research Centre; 1996. NDARC Monograph No.: 26.
Weinberg NZ, Rahdert E, Colliver JD, Glantz MD.Adolescent substance abuse:
A review of the past 10 years. J Am Acad Child Adolesc Psychiatry
1998;37(3):252-61.
7
.
8
9
1
.
.
Finally, these adolescents require sustained treatment and sup-
port while in the community. Even several months in a residential
facility is not sufficient for positive outcomes in the long-term.
Adolescents need to be nurtured and supported to deal with their
own problems, as well as with an increasingly difficult and hos-
tile society.50,51
0. Anglin M, Hser Y. Treatment of drug abuse. In: Tonry M, Wilson J, editors.
Drugs and Crime. Chicago: University of Chicago Press; 1990.
11. Crowley T, Mikulich S, MacDonald M, Young S, Zerbe G. Substance-
dependent, conduct-disordered adolescent males: Severity of diagnosis pre-
dicts 2-year outcome. Drug Alcohol Depend 1998;49:225-37.
12. Dobkin PL, Chabot L, Maliantovitch K, Craig W. Predictors of outcome in
drug treatment of adolescent inpatients. Psychol Rep 1998;83(1):175-86.
1
3. Karadeniz N, Hawkings R. Dunsmore House sixth annual report. Rooty Hill:
Dunsmore House, Western Sydney Area Health Service; 1995.
Conclusions
1
4. Lynskey M, Hall W. Age of initiation to heroin use: Cohort trends and conse-
quences of early initiation for subsequent adjustment. Sydney: University of
New SouthWales, National Drug andAlcohol Research Centre; 1998. NDARC
Technical Report No.: 61.
5. McKetin R, Darke S, Humeniuk R, et al. Drug trends 1999. An overview of
drug trends in Australia: Findings from the Illicit Drug Reporting System
(IDRS). Sydney: University of New South Wales, National Drug and Alcohol
Research Centre; 2000. NDARC Monograph No.: 43.
The adolescents in this study tended to be poly-substance us-
ers, with cannabis, heroin and alcohol the main substances used.
Heavy use in terms of frequency and amounts of use were re-
ported. The profile of the group was highly problematic in the
areas of substance dependence, social functioning, criminal be-
haviour, psychological distress, physical health and HIV risk.This
profile suggested that improvements would be likely to be diffi-
cult to achieve and maintain.
1
1
1
6. Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia:
I. Prevalence and correlates of non-fatal overdose. Addiction 1996;91(3):405-
1
1.
7. Hall W. Proceedings of an International Opioid Overdose Symposium, Syd-
ney, Australia, 14-15 August. Sydney: University of New South Wales, Na-
tional Drug and Alcohol Research Centre; 1998. NDARC Monograph No.:
Recommendations
3
5.
It is recommended that a comprehensive, intensive, longer-term
PSUD-treatment intervention is needed to address the variety and
severity of problem areas evident in the sample. It is further rec-
ommended that greater attention be given to earlier community-
based interventions to prevent drug abuse and related problems
among at-risk adolescents from escalating to the levels seen in
18. Hall W, Lynskey M, Degenhardt L. Heroin use in Australia: Its impact on
public health and public order. Sydney: University of New South Wales,
National Drug and Alcohol Research Centre; 1999.
19. Brown K, Crofts N. Health care costs of a continuing epidemic of hepatitis C
virus infection among injecting drug users.Aust N Z J Public Health 1998;22(3
Suppl):384-8.
20. MacDonald M, Crofts N, Kaldor J. Transmission of hepatitis C virus: rates,
routes, and cofactors. Epidemiol Rev 1996;18(2):137-48.
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