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PhD Thesis - Spooner, C

The nature and treatment of psychoactive substance use disorders among adolescents
Spooner C (1999)

Abstract:
The problem investigated by this thesis was the treatment of psychoactive substance use disorders (PSUD) among adolescents. A number of research studies were conducted to investigate this problem. Initially, a review of the research literature on the nature and treatment of adolescent substance was conducted. Then four empirical studies were conducted. First, a service-based survey, including observational methods, individual interviews, group discussions and self-completion questionnaires was conducted. Second, consultations with adolescents with substance use problems were conducted by individual interview, group discussion and self-completion questionnaire. The information from this research was used to develop a comprehensive, intensive, medium-to-long-term PSUD-treatment intervention for adolescents.

Third, a survey study of the adolescents applying for the intervention was conducted. High levels of substance use and dependence, HIV risk-taking, social dysfunction, criminal behaviour, psychological distress, and physical health problems were reported. This suggested that changes in substance use might be difficult to achieve and that the comprehensive, intensive, medium-to-long-term intervention was appropriate.

Fourth, an outcome study using a quasi-experimental design with pretest, posttest and follow-up assessments of adolescents who attended the intervention (intervention group) and adolescents who received usual care (comparison group) was conducted. The outcome study was augmented with action research, process evaluation, impact evaluation, and a cost-comparison with detention. Outcome variables were substance use, crime, social dysfunction, psychological distress, HIV risk-taking and physical health. Participants improved on all of the outcome variables between pretest and posttest, and this improvement was maintained at follow-up. There was no significant group difference in these changes. It appeared that program implementation and methodological problems, particularly differential drop-out, hindered the ability to detect a group difference. From the research literature, it was concluded that comprehensive and long-term treatment is likely to be an important form of treatment for adolescents with a PSUD. A short period of residential treatment can be necessary at times, however, longer-term, community-based interventions that include support from family, non-substance abusing friends and involvement in meaningful activity such as education or employment were recommended.

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