Feasibility and acceptability of a mental health screening tool and training programme in the youth alcohol and other drug (AOD) sector

The high prevalence of co-occurring mental health and substance use disorders in young people is well established. Despite this, there are low rates of detection of co-occurring disorders across alcohol and other drug (AOD) services within Australia. This paper describes the development, implementation and evaluation of a mental health screening tool and training programme within the youth AOD sector. Thirty youth AOD workers received training in mental health screening, and the screening tool was subsequently piloted on 84 young people accessing two youth AOD services. Training was evaluated using measures of the trainee's mental health knowledge, attitudes, skills and confidence in mental health screening at baseline and 12-month follow-up. Feedback from young people supported the feasibility, acceptability and relevance of the screening tool. Evaluation of the associated training programme indicated improvements in AOD workers' mental health knowledge, skills and confidence in mental health screening. These findings provide preliminary evidence of the feasibility and acceptability of the mental health screening tool to young people and the effectiveness of the training package within the youth AOD sector. [Hides L, Lubman DI, Elkins K, Catania LS, Rogers N. Feasibility and acceptability of a mental health screening tool and training programme in the youth alcohol and other drug (AOD) sector. Drug Alcohol Rev 2007;26:509 - 515]     

Identifying High School Students “At Risk” for Substance Use and Other Behavioral Problems: Implications for Prevention

Attendance and grade point average (GPA) data are universally maintained in school records and can potentially aid in identifying students with concealed behavioral problems, such as substance use. Researchers evaluated attendance (truancy) and GPA as a means to identify high school students at risk for substance use, suicide behaviors, and delinquency in 10 high schools in San Antonio, Texas, and San Francisco, California, during the spring and fall of 2002. A screening protocol identified students as “high risk” if (1) in the top quartile for absences and below the median GPA or (2) teacher referred. Survey responses of 930 high-risk students were compared with those from a random sample of 393 “typical” students not meeting the protocol. Bivariate and multivariate analyses assessed associations between the screening protocol variables and demographics, risk and protective factors, and problem outcomes. The individual contribution of each of the variables was also assessed. Students identified as high risk were significantly more likely than typical students to use cigarettes, alcohol, and marijuana, evidence suicide risk factors, and engage in delinquent behavior. Norms varied between the two districts; nevertheless, high-risk students showed consistent differences in risk and protective factors, as well as problem behaviors, compared with typical students. Because of site differences in data collection and teacher participation, the comprehensive protocol is recommended, rather than individual indicators alone (e.g., truancy). Strengths of the screening protocol are the ready availability of school record data, the ease of use of the adapted protocol, and the option of including teacher referral. More research is recommended to test the generalizability of the protocol and to ensure that there are no unintended negative effects associated with identification of students as high risk.     

Substance Use Among High-School Students: Relationships with Temperament,Personality Traits,and Parental Care Perception

Alcohol use, “alcohol abuse,” and illicit drug use were investigated in a representative sample of 1076 urban, northern Italian high school students aged 14 to 19 years in 2001. In addition to questions on substance use, the participants were asked about school achievements and perceived substance use among friends. All the students were submitted to Zuckerman Sensation Seeking Scale (SSS) scale, Eysenck Personality Questionnaire (EPQ), Buss-Durkee Hostility Inventory (BDHI), and Parental Bonding Instrument (PBI). Lifetime alcohol use was found in 80.5%, “alcohol abuse” in 37.7%, cannabis use in 26.2%, ecstasy in 2.8%, heroin in 3.8%, and cocaine in 8.3% of the students: gender differences were significant for alcohol use, “alcohol abuse” and ecstasy use, with male subjects outnumbering females, but not for reported cannabis, heroin, and cocaine use. Early substance use onset among adolescents aged 14–16 years was detected. Higher sensation seeking on SSS, social coping impairment on EPQ, direct aggressiveness on BDHI, poor school achievements, and lower parental care on PBI were found associated with illicit drug use and “alcohol abuse” (multiple drugs users). Increased levels of aggressiveness and sensation seeking were evidenced both in minimal experimenters (ME) and habitual users (HU), without any significant difference, in comparison with abstinent students. Similarly, ME scored higher than abstinent subjects on EPQ for social coping impairment, but lower than HU. Parental care perception was lower in HU, but not in ME with, respect to abstinent subjects. Pearson inverse correlation was demonstrated between PBI scores and EPQ maladaptation and BDHI aggressiveness. Data from this preliminary pilot study suggest that temperamental traits and personality changes may be associated to early substance use “proneness” and reduced perception of parental care.     

The use of the Risky Sex Scale among adolescents receiving treatment services for substance use problems: Factor structure and predictive validity

This study evaluated the use of the Risky Sex Scale (RSS; T. O'Hare, 2001) among youth in outpatient treatment for substance use problems. An ethnically diverse sample of 394 adolescents (280 males; M(age) = 16.33 years, SD(age) = 1.15) was recruited from 2 treatment sites. The study was guided by two aims. First, a confirmatory factor analysis was conducted on RSS item responses. Findings replicated the factor structure identified in previous studies of undergraduate students cited for campus alcohol violations. Second, structural equation modeling was used to document associations between RSS subscales and self-reported substance use and sexual risk behaviors. The risky sex expectancies subscale was significantly associated with co-occurring alcohol use and sex, alcohol use at last intercourse, and alcohol use during the prior 30 days. The risky sexual behaviors subscale was significantly associated with co-occurring drug use and sex, condom use at last intercourse, and unprotected intercourse during the prior 30 days. The factor structure of the RSS was consistent across age group (12-16 and 16-18 years) and across gender, and the links between the RSS subscales and health risk behaviors varied somewhat by gender but not by age group. These findings suggest that the RSS is an appropriate brief screening tool for predicting health risk behaviors among adolescents in substance abuse treatment.     

武汉地区中学生使用药物/精神活性物质的流行病学调查

目的··:了解武汉地区中学生使用药物/精神活性物质情况。方法··:采用随机抽样方法 ,使用自拟《学生用药情况调查表》对该地区高二学生进行调查。调查内容包括8种药物/精神活性物质“一生”、“最近30d”的使用情况、用药频率 (经常、偶尔 )、最初使用年龄、使用原因与后果等。结果·· :在2923例有效问卷中 ,“一生中经常”使用最多的物质是挥发性溶剂 (2.89% ) ,其他物质依次是酒 (2.31 % )、烟草 (0.94 % )、非甾体抗炎止痛药 (0.76 % )。“一生中偶尔”使用最多的是酒 (71.08 % ) ,其他物质依次是非甾体抗炎止痛药 (28.34 % )、挥发性溶剂 (17.94 % )、烟草(16.31 %)。各种物质的初次使用年龄介于7a至12a之间。使用非甾体抗炎止痛药和镇静催眠药的主要原因是治病 (分别占99.20 %和83.33 % );使用挥发性溶剂、饮酒、吸烟的主要原因是“好奇”和“受周围人影响” (分别占83.65 %,81.64 %,93.53 % )。60.25 %的挥发性溶剂滥用者感到身体受到了损害 ;烟酒使用者中分别有56.55%和37.04 %感到身体受到损害。结论··:在部分中学生中已发现对挥发性溶剂、酒、香烟和某些精神药物使用成瘾现象 ,极个别学生有滥用违禁毒品的行为。建议加强对中学生的药物滥用预防教育。     

Cigarette Smoking in Youths With Mental Health and Substance Use Problems: Prevalence,Patterns, and Potential for Intervention

Mental health symptoms and substance use disorders are clear risk factors for cigarette smoking and nicotine dependence among young people, yet research on cigarette smoking among youths with concurrent mental health and substance use disorders (“dual diagnosis”) is considerably lacking. We examined smoking history and perspectives regarding smoking, cessation, and mental health and substance use in 97 adolescents and emerging adults (ages 14 to 24) referred to a program for youths with concurrent mental health and substance use disorders in Canada. Results show high rates of cigarette smoking, and modest interest in quitting but little interest in attending formalized programs to assist with cessation. Many participants reported smoking more when mental health was worse; most reported that they frequently smoke cigarettes and use drugs or alcohol concurrently. Current smokers perceived more benefits from cigarette smoking in regulating emotions and ameliorating their mental health symptoms than former smokers. In contrast, perceived detrimental effects of smoking were unrelated to current smoking status. Results suggest a need for integrated treatment that incorporates emotion regulation as part of cessation approaches. Integrating smoking cessation approaches into existing mental health and substance use treatments may be more palatable to adolescents and emerging adults than stand-alone smoking cessation programs.     

Arrest history as an indicator of adolescent/young adult substance use and HIV risk

Juvenile offenders are particularly at risk for HIV because of their substantially high rates of risk behaviors, high rates of substance use disorders and psychopathology. Most studies have focused on risk behaviors among incarcerated youth. This study sought to determine if an arrest history could serve as a marker for HIV risk and substance abuse among a community-based sample of high-risk adolescents and young adults. Adolescents (N=1400; mean age=18 years) who participated in a larger multi-site HIV prevention program in three states (GA, FL and RI) provided baseline data on sexual risk, substance use, attitudes and mental health history. Participants were grouped as arrestees (N=404) and non-arrestees (N=996) based on self-reported arrest history. Juvenile arrestees reported more alcohol and drug use, substance use during sex, unprotected sex acts, STI diagnoses, suicide attempts and psychiatric hospitalizations than non-arrestees. Having an arrest history may serve as a marker for adolescent HIV risk and substance abuse. Effectively screening adolescents for legal history and responding to the psychosocial and health needs of these high-risk adolescents could increase necessary engagement in substance use and mental health treatment, reduce HIV risk in the community, and reduce costs to the legal, medical and mental health systems.     

Use of non–face-to-face modalities for emergency department screening,brief intervention,and referral to treatment (ED-SBIRT) for high-risk alcohol use: A scoping review

Background: The purpose of this review was to examine and chart the “scope” of strategies reported in ED-SBIRT (emergency department-based screening, brief intervention and referral to treatment) studies that employ non–face-to-face (nFtF) modalities for high-risk alcohol use (i.e., risk for alcohol-related injury, medical condition, use disorder) and to identify research gaps in the scientific literature. Methods: The scoping review population included study participants with high-risk alcohol use patterns as well as study participants targeted for primary public health prevention (e.g., adolescent ED patients). Core concepts included SBIRT components among intervention studies that incorporated some form of nFtF modality (e.g., computer-assisted brief intervention). The context encompassed ED-based studies or trauma center studies, regardless of geographic location. After screening a total of 1526 unique references, reviewers independently assessed 58 full-text articles for eligibility. Results: A total of 30 full-text articles were included. Articles covered a period of 14?years (2003–2016) and 19 journal titles. Authors reported the use of a wide range of nFtF modalities across all 3 ED-SBIRT components: “screening” (e.g., computer tablet screening), “brief intervention” (e.g., text message–based brief interventions), and “referral to treatment” (e.g., computer-generated feedback with information about alcohol treatment services). The most frequently used nFtF modality was computerized screening and/or baseline assessment. The main results were mixed with respect to showing evidence of ED-SBIRT intervention effects. Conclusions: There is an opportunity for substance use disorder researchers to explore the specific needs of several populations (e.g., ED patients with co-occurring problems such as substance use disorder and violence victimization) and on several methodological issues (e.g., ED-SBIRT theory of change). Substance use disorder researchers should take the lead on establishing guidelines for the reporting of ED-SBIRT studies—including categorization schemes for various nFtF modalities. This would facilitate both secondary research (e.g., meta-analyses) and primary research design.     

High alcohol use and misuse among a national sample of school adolescents in Benin in 2016

Abstract

The study aimed to investigate the prevalence and correlates of alcohol use and misuse among adolescents in the 2016 Benin ‘Global School-Based Student Health Survey (GSHS)’. In all, 2536 adolescents with a median age of 17?years (interquartile range = 3) from Benin responded to the 2015 cross-sectional GSHS. A nationally representative sample of students between the ages of 13 and 17?years was selected based on a two-stage (schools and classes) cluster sample design. Students responded to questions on sociodemographic factors, substance use, psychological distress, other health risk behaviour and protective factors. Almost half (44.1%) of the adolescents reported past-month alcohol use, 25.3% ever been drunk, and 15.0% past-month heavy alcohol use (≥two more drinks/day). In adjusted Poisson regression analysis, among both boys and/or girls, current tobacco use, multiple sexual partners, ‘ever cannabis use’, ‘ever amphetamine use’, school truancy, bullying victimization, soft drink consumption and lack of parental support were associated with alcohol use and/or misuse. A high prevalence of alcohol use and misuse was found and strategies to prevent alcohol misuse, including a number of risk behaviours, are needed.     

Adolescent Drinking and Alcohol-Related Problems in a Nationwide General Population

A sample of 1,325 adolescents drawn from a nationwide multistage probability master sample of 4,290 persons were interviewed at their homes in 1984. The purpose of this study was to investigate the patterns and quantity of alcohol consumption and related problems. Moreover, mental health status of respondents and “risk” factors were explored. Alcohol use increased from the very young to the older ones and decreased between lifetime and past week frequencies. Of adolescents, 18% reported two or more alcohol-related problems including suffering from depressive symptoms. Discriminant analysis revealed 14 predictors with high discriminating power between problematic and nonproblematic drinking.     

Single vs. multiple drug prevention: is more always better?: a pilot study

OBJECTIVE: The purpose of this study was to compare the effects of a single drug, i.e., alcohol, against a multiple drug preventive intervention. METHODS: A controlled trial was conducted with 448 8th grade students (mean age = 13 years old) from an inner-city middle school (n = 216) and a rural junior high school (n = 232) in 2000-2001. Students were randomized within school, and 3-month post-intervention follow-up data were collected. RESULTS: Two risk/protective factors were found to differ significantly in favor of youth receiving the single drug alcohol intervention (p's = 0.03), while the frequency of alcohol use and two additional risk/protective factors approached significance (p's < 0.10). CONCLUSION: These findings support the potential efficacy of a brief, single drug preventive intervention over a brief, multi-drug intervention in producing short-term alcohol outcomes for adolescents, and indicate differential effects of interventions for subgroups of substance using youth.     

Recent Alcohol,Tobacco, and Substance Use Variations Between Rural and Urban Middle and High School Students

The use of addictive substances by adolescents is a major public health concern; however, rural versus urban variations are poorly understood. The purpose of the current study was to examine rural-urban differences in the prevalence of recent use of 11 substances in grades 6 through 12 in a statewide sample of students from the Georgia Student Health Survey II (N = 513,909). We found that rural-urban differences in substance use depend largely upon grade level, with rural middle school students demonstrating higher rates of alcohol, smoking tobacco, and chewing tobacco use, and urban high school students demonstrating higher rates of illicit drugs.     

Epidemiology of substance use in adolescence: prevalence, trends and policy implications.

This paper reviews the epidemiology of substance use among adolescents. There is a public health imperative in all countries to assess the population rates of tobacco, alcohol and illicit drug use among adolescents. In addition, monitoring trends over time may reflect the net effects of activities and programs carried out to prevent adolescent substance use. School based surveys provide prevalence estimates of substance use, but do not capture street and homeless youth and other high risk adolescents not found in the school environment. Overall, the results of this review suggest that tobacco, hazardous alcohol use, and most categories of illicit drug use have shown consistent increases in prevalence since about 1990 in most developed countries, for school-based adolescents, suggesting that the substance use problem among adolescents remains unsolved. These trends are remarkably similar across substance use behaviours, and among most developed countries, although limited data has emanated from adolescents in the developing world. Interventions to reduce or prevent substance use have shown mixed results, with those focusing on the adolescents' social environment showing the most promise. Broader public health approaches, including the linkage to community-wide prevention, and greater enforcement or regulatory and legislative approaches to tobacco and alcohol access are future directions for research and practice.     

Screening for Adolescent Alcohol Use in the Emergency Department: What Does It Tell Us About Cannabis,Tobacco, and Other Drug Use?

Background: The pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse. Objective: A multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs. Methods: Participants included 12–17-year olds (n?=?4834) treated in one of 16 participating PEDs. An assessment battery, including the NIAAA two-question screen and other measures of alcohol, tobacco and drug use, was self-administered on a tablet computer. Results: A diagnosis of CUD, lifetime tobacco use or lifetime drug use was predicted by any self-reported alcohol use in the past year, which indicates a classification of moderate risk for middle school ages and low risk for high school ages on the NIAAA two-question screen. Drinking was most strongly predictive of a CUD, somewhat weaker for lifetime tobacco use, and weakest for lifetime drug use. This same pattern held for high school and middle school students and was stronger for high school students over middle school students for all three categories. This association was also found across gender, ethnicity and race. The association was strongest for CUD for high school students, sensitivity 81.7% (95% CI, 77.0, 86.5) and specificity 70.4% (95% CI, 68.6, 72.1). Conclusions/Importance: A single question about past year alcohol use can provide valuable information about other substance use, particularly marijuana.     

The Role of Pregnancy Concerns in the Relationship between Substance Use and Unprotected Sex among Adolescents

Background: Substance use and unprotected sex are prevalent among adolescents. The link between substance use and unprotected sex is well-established. Research has also highlighted how adolescents’ attitudes and risk perceptions regarding unprotected sex, including concerns about pregnancy (“Getting pregnant would force me to grow up too fast”), are associated with unprotected sex and unplanned pregnancy. However, less research has examined the potential relationship between pregnancy concerns and substance use among adolescents. Objectives: The study prospectively examined (1) differences in pregnancy concerns across patterns of substance use and (2) whether pregnancy concerns mediate the relationship between substance use and later unprotected sex among a sample of middle and high school students. Method: 98 adolescents [M(SD) age = 14.28(1.68), 59.4% female, 59.4% black/African American] completed self-report measures of marijuana and alcohol use, pregnancy concerns, and unprotected sex across three time points over 6?months (T1–T3). Results: Substance users (alcohol/marijuana) reported fewer pregnancy concerns compared to non-substance users (t?=?2.99, p = .04). Pregnancy concerns at T2 mediated the relationship between T1 lifetime substance use and later unprotected sex (T3) (indirect effect: b?=?0.10, CI[.01–.41]; direct effect: b?=?0.15, p = .32), controlling for gender, age, and race. More frequent substance use (T1) was related to fewer pregnancy concerns at T2 (b = ?0.10, p = .04); fewer pregnancy concerns were related to increased likelihood of later unprotected sex (b = ?1.02, p = .02). Conclusions: Findings offer new insight into associations between substance use and unprotected sex and suggest that substance use and sexual health interventions should target pregnancy concerns.     

Assessing the association between the strength of state policies on school drug prevention and substance use disorders

Background: Adolescent substance use has been linked to numerous adverse health, social, and educational outcomes. While there have been intensive resources placed in school-based prevention programs, the association of these policies on prevention outcomes is still unclear. State variation in policies provides an opportunity to assess the influence of school-based prevention programs. Objectives: To examine the association between the strength of state high school-based prevention programing and the prevalence of substance use disorders among adolescents ages 14–17 in the United States. Methods: National Survey on Drug Use and Health (NSDUH) data with state-level identifiers were merged with National Association of State Boards of Education (NASBE) information on school-based prevention policy strength, categorized into “required,” “recommended,” and “no policy.” Unadjusted comparisons and multilevel random intercept linear regression models were estimated to assess the change in rates of substance abuse or dependence from pre- to post- policy implementation, accounting for the nesting of individuals within states. Results: Rates of alcohol and tobacco abuse/dependence were significantly lower in states that required an alcohol prevention curriculum. After covariate adjustment, rates of alcohol abuse/dependence remained significantly lower in those states. Conclusions: Reinforcing alcohol prevention messaging in school appears to have a modest association with decreased rates of adolescent alcohol use disorders, possibly in part due to a different approach to the curriculum. For other substances, policy requirements appear to be less effective in reducing the prevalence of adolescent substance use disorders, suggesting that more targeted messaging with higher-risk students may be required.     

Social influence,health variables and criminal behaviours associated with substance use among rural Norwegian adolescents

Aims: To investigate social influence, health, criminality and substance use in a sample of 1288 Norwegian rural adolescents. Relations between these factors and substance use were examined.

Methods: Data were obtained from the ‘UngData’ study. A cross-sectional questionnaire survey was conducted among adolescents (n?=?740) in nine secondary schools and among 548 adolescents in three high schools across two counties. The response rate was 63%.

Findings: Deviant behaviours had higher social status among males and adolescents in high school. The social status of deviant behaviours and participation in criminal activities were associated with alcohol and illicit substance use. Parent–adolescent trust was positively associated with alcohol use and parent involvement with friends was similarly related to illicit substance use. The social status of physical appearance and talent in sports were negatively associated with alcohol use.

Conclusions: Early intervention could promote the social status of healthy activities and reduce the status of deviant behaviours. The transition between secondary school and high school may constitute a risk period for establishing problem behaviours and interventions should target this period. Research should test whether substance availability relates to differences in substance use in rural and urban settlements.     

Substance Use and Parent Characteristics Among High School Students: Edirne Sample in Turkey

ABSTRACT

The current study on substance use and family characteristics of adolescents is a part of the extensive research on substance use characteristics among high school students in Edirne, Turkey. This cross-sectional study was conducted with 8,483 high school students within the 2010–2011 academic year. Self-administered questionnaires were completed anonymously by the participants. The lifetime prevalence of alcohol use was 24.6% and tobacco use was 21.4%. The most commonly used illicit substance was cannabis (1%), followed by inhalants (0.5%) and ecstasy (0.4%). The use of alcohol, tobacco, and nearly all the illegal substances was significantly higher among males compared to females. The rates of lifetime substance use varied by family-related factors such as family structure, perceived parental attitudes and intrafamilial relationships, parental socioeconomic status, and parental substance use. The limitations and implications of these findings are discussed.     

Mapping the Clinical Complexities of Adolescents with Substance Use Disorders: A Typological Study

SUMMARY

Because of the vast improvements in adolescent substance use assessment, it is widely recognized that adolescent substance use disorders (SUD) encompasses diverse drugs, patterns and etiologies and are characterized by extensive heterogeneity in other life domains. The next step in advancing adolescent SUD assessment is to classify adolescents with SUD into treatment-oriented typologies so that the question “What works with whom under what conditions?” can be empirically investigated. This paper: (1) identifies and describes seven subtypes of 205 adolescents with SUD in alcohol and other drug (AOD) treatment aged 12–18 years (via dimensions of delinquency, psychosocial problems, chemical dependency, and sexual risk behavior); and (2) examines whether certain patterns are distinctive among youth court-mandated to AOD treatment. Each profile type is described in terms of relative problem severity, prevalence for youth mandated to treatment through the courts, demographics, and performance on external measures of mental health and substance use disorders. Multiple logistic regression demonstrated that three profile types yielded 75.6% accuracy (sensitivity = 75.8%, specificity = 75.5%) for discrimination between court-mandated and non-court-mandated to treatment youth, even when controlled for the contributions of youth age, sex, and ethnicity. This paper discusses the need for triage to multiple treatments with varying levels of intensity for different subgroups of adolescents. If cost-effective services by setting by youth typology could be empirically identified and replicated, perhaps an empirically-guided cost-containment strategy would be developed and implemented by managed care and state government. In this way, the trend for a decline in the number and types of on-site services provided by AOD treatment programs might reverse, improving adolescent SUD outcomes.