Continuing Care for Adolescents in Treatment for Substance Use Disorders

As a chronic disease with consistent relapse rates, substance use disorders (SUD) require a continuity-of-care approach. Unfortunately, many patients do not have access to continuing care. This systematic review analysed the current scientific knowledge to better understand if app-based smartphone interventions can be an effective alternative. The databases Cochrane Library, PubMed, Web of Science, and PsycINFO were used to find experimental and quasi-experimental studies investigating the effectiveness of a smartphone intervention in individuals who had completed treatment for SUD. After removing duplicates, a total of 1488 studies were screened, with 48 being selected for a full-text review. Four studies met all the criteria, with one other being added by identification through other resources, making a total of 5 studies included in the present review. Out of the four studies using a control group, only one found no significant differences in favour of the experimental group. That study used an active control group and compared the smartphone intervention to its therapeutic group equivalent. There were no significant differences between the two experimental groups. Overall, the results indicate that app-based smartphone interventions can be an effective alternative to traditional forms of continuing care. However, literature is still scarce, and more research needs to be made on this subject.

This systematic review is registered at PROSPERO with the identifier [CRD42021272070].

The overall prevalence of alcohol use disorders and drug use disorders in adolescents has been declining in recent years, yet little is known about treatment use for these disorders among adolescents. This study aimed to examine the patterns and demographics of treatment of alcohol use disorders, drug use disorders, and both conditions among U.S. adolescents.

This study used publicly available data for adolescents aged 12–17 years from the annual cross-sectional surveys of the National Survey on Drug Use and Health, 2011–2019. Data were analyzed between July 2021 and November 2022.

From 2011 to 2019, fewer than 11%, 15%, and 17% of adolescents with 12-month alcohol use disorders, drug use disorders, and both conditions received treatment, respectively, with significant decreases in treatment use for drug use disorders (OR=0.93; CI=0.89, 0.97; p=0.002). Overall, treatment use in outpatient rehabilitation facilities and self-help groups was most common but decreased over the course of the study period. Extensive disparities in treatment use were further identified on the basis of adolescents’ gender, age, race, family structure, and mental health.

To improve adolescent treatment use for alcohol and drug use disorders, assessments and engagement interventions that are gender specific, developmentally appropriate, culturally sensitive, and contextually informed are especially needed.

Despite the utility of parent involvement in continuing care following adolescent residential treatment, parent engagement in traditional office-based treatment is low. In our prior work, we found that parents who had access to a continuing care forum directed questions to a clinical expert and to other parents around five topics: parenting skills; parent support; managing the post-discharge transition; adolescent substance use; family functioning. The current qualitative study elicited questions from parents without access to a continuing care support forum to explore overlapping and new themes

This study was embedded within the pilot trial of a technology-assisted intervention for parents of adolescents in residential treatment for substance use. Thirty-one parents randomized to residential treatment as usual were asked two prompts at follow-up assessments: what questions they would like to ask a clinical expert and what questions they would like to ask other parents of adolescents discharged from residential care. Thematic analysis identified major themes and subthemes

Twenty-nine parents generated 208 questions. Analyses revealed three themes identified in prior work: parenting skills; parent support; adolescent substance use. Three new themes emerged: adolescent mental health; treatment needs; socialization

The current study identified several distinct needs among parents who did not receive access to a continuing care support forum. Needs identified in this study can inform resources to support parents of adolescents during the post-discharge period. Parents may benefit from convenient access to an experienced clinician for advice on skills and adolescent symptoms, paired with access to parental peer support.

Alcohol-related morbidity and mortality have increased substantially in the U.S. Understanding the population health implications of these concerning trends, including by identifying clinical subgroups of alcohol users at increased risk for potentially preventable acute causes of mortality, is of critical importance.

This retrospective cohort study used statewide, all-payer, longitudinally-linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED at least once in 2009–2011 with a diagnosis of alcohol use disorder (AUD). Participants were followed for one year after index ED visit to assess acute injury (unintentional poisoning, suicide, homicide, motor vehicle crash, and fall- or fire-related injury) and all-cause mortality rates per 100,000 person-years. Age-, sex-, race/ethnicity-adjusted standardized mortality rates (SMRs) for acute injury causes of death were determined using statewide mortality data.

Among 437,855 patients with index non-fatal ED visits for AUD, the 12-month acute injury mortality rate was 608.6 per 100,000 (SMR=8.0; 95% CI=7.7, 8.3), and all-cause mortality was 5700.7 per 100,000 (SMR=6.5; 95% CI=6.4, 6.6). Unintentional poisoning accounted for 46.5%, and suicide for 19.7%, of acute-injury deaths. Acute injury deaths comprised 71.7% of all-cause mortality among patients aged 10–24 years, but much lower proportions among older patients. Female AUD patients had lower rates for all mortality outcomes.

Emergency department patients with a recognized AUD comprise a population at persistently elevated risk for mortality. Age-related AUD patient differences in common causes of death, including drug overdose and suicide, can inform the structure of future clinical interventions.

This study examines the association between treatment in a therapeutic community for adolescents with drug and alcohol problems on hospitalisation outcomes up to 15 years later for all clients, and separately for those with and without a history of criminal conviction.

A quasi-experimental design was used to examine the linked administrative health and criminal justice records for all adolescents admitted to the Program for Adolescent Life Management (PALM) from January 2001 to December 2016 (n = 3059) in Sydney, Australia. ICD-10AM codes were used to designate hospitalisation outcomes as either physical injury, mental health problems, substance use disorders, or organic illness. The treatment and comparison groups were matched on factors associated with program retention, resulting in a final sample of 1266 clients. We examined the rate of hospitalisation up to 15 years posttreatment for all clients and stratified by prior conviction status using Cox regression analyses.

The treatment group had significantly lower rates of hospitalisation for a physical injury (HR = 0.77 [95% CI = 0.61–0.98]), mental health problem (HR = 0.62 [95% CI = 0.47–0.81]), substance use disorder (HR = 0.59 [95% CI = 0.47–0.75]), and organic illness (HR = 0.71 [95% CI = 0.55–0.92]). There was a significant interaction between treatment and prior criminal conviction status on rate of hospitalisation for physical injury, suggesting that the effect of treatment on physical injury was significantly greater for clients with a prior criminal conviction.

Adolescents who engage in a therapeutic community treatment program may have a long-lasting reduction in the risk of subsequent hospitalisation. This also appears to apply to those with a history of criminal conviction.

Adolescents in residential level of care for substance-related problems have high risk of relapse following discharge. Parent engagement lowers relapse risk, but there are myriad barriers to engaging parents in residential treatment and continuing care. Parent SMART (Substance Misuse in Adolescents in Residential Treatment) is a technology-assisted parenting intervention that was designed to circumvent barriers associated with traditional, office-based continuing care interventions to better engage parents. This pilot randomized trial assessed the acceptability, feasibility, and preliminary effectiveness of Parent SMART as an adjunctive intervention to adolescent residential treatment-as-usual (TAU). Sixty-one parent-adolescent dyads were randomized to Parent SMART+TAU or TAU-only. Thirty-seven dyads were recruited from a short-term facility and 24 dyads were recruited from a long-term facility. Those randomized to Parent SMART received a multi-component technology-assisted intervention combining an off-the-shelf online parenting program, coaching sessions, and a parent networking forum. Parent and adolescent assessments were conducted at baseline, 6, 12, and 24-weeks post-discharge. Feasibility (e.g., parental effectiveness) and acceptability (e.g., parental satisfaction, willingness to recommend the intervention) benchmarks were specified a priori as the primary hypotheses. Secondary effectiveness indicators were the proportion of days adolescent used alcohol, cannabis, and any substance. All acceptability and feasibility benchmarks were met or exceeded among dyads in both short- and long-term residential. Generalized linear mixed models showed no significant effects pooled across sites. Analyses by facility revealed two significant time by condition interactions. Adolescents in short-term residential whose parents received Parent SMART showed fewer drinking days and fewer school problems over time, relative to adolescents whose parents received TAU. Results indicate that Parent SMART was both acceptable and feasible, with preliminary indication of effectiveness among those in short-term residential. A fully-powered trial is warranted to reliably test the effectiveness of Parent SMART and understand possible mechanisms of improvement.