Adolescents are undertreated for addiction

Only about 10 percent of adolescents needing help for substance abuse problems actually enter treatment, partly because of the lack of adolescent-only services in the nation's treatment system, according to a new study released today by a University of Kentucky researcher. The study also found that very few of the available addiction programs for teens received high marks for quality.

'We have known that out of 1.4 million teens needing help for substance abuse, one-tenth of those get treatment,' says author Hannah Knudsen, an assistant professor in the UK Department of Behavioural Science and a researcher in UK's Centre on Drug and Alcohol Research. 'Part of this treatment gap may be driven by the limited availability of adolescent-only treatment services. Less than one-third of addiction programs in the U.S. have a specialised program for adolescents.'

The study was funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation and appears in the March 2009 issue of the Journal of Substance Abuse Treatment.

'Despite the public health significance of adolescent substance abuse and the knowledge that treatment can be effective for this group, services for them are less available than for adults,' Knudsen says. 'It means we lose our chance at early intervention, and that families may be unable to find services for their children in their communities.'

Knudsen's study also found wide variations in quality among adolescent-only programs. She analysed nine 'domains' of quality offered by the programs, including things like whether families are encouraged to be involved in the treatment process or whether programs offer an array of comprehensive services. She found that only a small number of them scored high in each domain. The average treatment program in this national random sample of 154 treatment programs received a medium-ranking score in overall quality.

'The lack of comprehensive services in substance abuse programs for teens raises questions about whether teens will get what they need, since we know they are likely to have co-occurring psychiatric conditions and to engage in HIV risk behaviours,' says Knudsen.

When programs offered more intensive residential or inpatient treatment services, the treatment quality ranking tended to be higher. But such programs are in the minority. Seventy percent of adolescent substance abuse programs only treat addicted teens on an outpatient basis, according to her study.

'For parents who are looking for high-quality programs that offer the most comprehensive array of services, a good proxy indicator is whether that organisation has an inpatient or residential level of care,' says Knudsen.

Knudsen also explored whether certain programs 'would make it more or less likely that they accept adolescents into treatment programs that include only teens.' She found certain types of programs were more likely to exclude adolescents from admission, such as programs that relied heavily on governmental funding and those that were based in hospitals. She also found that larger treatment organisations and those accredited by external organisations such as the Joint Commission were less likely to bar adolescents from admission.

In addition, the data suggest that some treatment programs mix teens and adults. The practice runs contrary to the recommendations of the federal Centre for Substance Abuse Treatment (CSAT). Knudsen said such situations can create problems because adolescents are at a different stage of life than adults. They are typically living with their families, have shorter histories of substance abuse, and they need services to be tailored to their stage of cognitive development.