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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. How does substance use impact adolescents? What is the scope of the issue? Challenges to responding effectively Yielding results: promising practices.

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Adolescence and Substance Use by Rick Sampson, American Institutes for Research (03-15-07)

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  1. Adolescence and Substance Useby Rick Sampson, American Institutes for Research (03-15-07) An Overview

  2. Adolescence and Substance Use • How does substance use impact adolescents? • What is the scope of the issue? • Challenges to responding effectively • Yielding results: promising practices

  3. Adolescence and Substance Use How does substance use impact adolescents? • Societal messages • Family involvement • Experimentation/use/abuse/ dependence • The promise of recovery

  4. Adolescence and Substance Use Societal Messages • Beyond perception of risk to perception of self • Better living through chemistry • The double bind

  5. Adolescence and Substance Use Family Involvement • Parental use/abuse • Sibling use/abuse • Losing the childhood you never had

  6. Adolescence and Substance Use Experimentation/Use/Abuse/ Dependence • Developmental denial • Motivational focus • Who am I?

  7. Adolescence and Substance Use The Promise of Recovery • Going away so we can go home

  8. 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.

  9. Adolescence and Substance Use What is the Scope of the Issue?

  10. 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.

  11. Adolescence and Substance Use Challenges to Responding Effectively • Retention and engagement • Family involvement • Availability • Cost

  12. 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 )

  13. Adolescence and Substance Use Yielding results: promising practices • Data Review • Review of two promising practices

  14. 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

  15. 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

  16. CSAT Adolescent Treatment Program Grantees Using the GAIN (1997-2007) NH WA VT ME MT ND MN OR MA WI MI NY ID SD WY RI PA IA CT NE OH NJ NV IN UT IL CA CO WV DE VA KS MO KY MD TN NC Grant OK AZ NM SC AAFT ART AR GA AL ATM MS CYT TX Drug Court LA AK Drug Court 2 Earmark EAT RCF FL HI SCY TCE YORP SAC SAC expected

  17. Current CSAT AT Outcome Data Set by Grant Program DC: Drug Court (2005-2009; 524 from 6 grants) CYT: Cannabis Youth Treatment (1997-2001; 600 from 4 grants) YORP: Young Offender Re-entry Project (2004-2008; 524 from 14 grants) ATM: Adolescent Treatment Model (1998-2002; 1,429 from 10 grants) SCY: Strengthening Communities-Youth (2002-2007; 2,292 from 11 grants) EAT: Effective Adolescent Treatment (2003-2007; 5,255 from 27 grants) TCE: Other Targeted Capacity Expansion (2002-2009; 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)

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

  19. Co-Occurring Psychiatric Problems Source: CSAT 2006 AT Outcome Data Set (n=12,601)

  20. Treatment Outcomes by Level of Care: 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 2006 AT Outcome Data Set (n=12,601)

  21. 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)

  22. Adolescence and Substance Use Yielding results: promising practices • Seven Challenges • Integrated Co-occurring Treatment (ICT)

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