Street youth in substance abuse treatment: characteristics and treatment compliance

Adolescence, Fall, 1994 by Reginald G. Smart, Alan C. Ogborne

INTRODUCTION

Researchers in countries such as Australia (Wales, 1991); Canada (Radford, King, & Warren, 1989; Smart & Adlaf, 1991) and the United States (Robertson, Koegel, & Ferguson, 1989) recently studied street youth and found that they have substantial alcohol and drug problems as well as psychiatric and social problems. Indeed, a new wave of street youth is appearing in many parts of the world. Unlike many of the counterculture or hippie youth of the 1960s and 1970s who left home to establish new lifestyles and values, few young people are abandoning home for these reasons. Most seem to leave because of conflicts with parents and school, sexual or physical abuse, or alcohol and drug abuse by parents (Smart, Adlaf, Walsh, & Zdanowicz, 1992; Radford et al., 1989; Young, Godfrey, Matthews, & Adams, 1983).

Given their large number of emotional and drug abuse problems it is reasonable to expect that many street youth will require drug abuse treatment. This is a report on the first study of street youth in treatment for alcohol or drug abuse.

The current wave of street youth includes many with serious psychiatric as well as substance abuse problems. Fischer (1989) recently reviewed studies on the prevalence of mental health problems among the homeless. Although estimates vary from one study to another, the rate seems to be about 40% for both alcohol and drug problems and mental illness. More recently, Robertson et al. studied 93 homeless youth in Hollywood, California and found that almost half were alcohol or drug abusers according to DSM III criteria. Radford et al.'s (1989) study of street youth in ten Canadian cities found that daily drug use was prevalent. About 24% were using marihuana daily, 4% cocaine, 2% solvents, and 9% alcohol, but no problem measure was used. Also, Smart and Adlaf (1991) studied 145 street youth in Toronto. They found that 9% drank alcohol daily. In addition, daily use of cannabis, cocaine, and crack were also high (16%, 6%, and 6%, respectively). Almost half reported current alcohol problems at a clinically significant level, and 24% reported a high level of drug problems. However, only 15% had ever received treatment for alcohol problems and 24% for drug problems. Little is known about street youth in treatment and we have been unable to find any study which deals with the problem. Because street youth have so many social and psychiatric problems, they should be difficult to treat. This report describes a study of 847 youth seen at a variety of treatment centers in Ontario. Comparisons were made between street youth and conventional youth on social and demographic characteristics, alcohol and drug abuse histories, and treatment outcomes.

METHODS AND MATERIALS

The data for this paper were derived from 11 Ontario substance abuse treatment programs participating in an ongoing monitoring study involving 20 such programs. Programs contributing data for the present analysis had, at the time of writing, each completed assessment on at least 30 cases aged 24 or under. Included were three specialized addiction assessment/referral services (Ogborne & Rush, 1990), a 28-day residential program serving people 16 or older, an early-intervention program geared to school referrals, and five youth-oriented outpatient counselling services. These programs are clearly varied, and some are also unique within the province. They were included in the study for a variety of reasons and are not necessarily representative of other Ontario programs.

The analysis focused on 847 cases between the ages of 12 and 24 for whom reasonably complete intake profiles were currently available. These cases represent 69% of all youth seen at least once in the program concerned. Most of the other cases dropped out before assessments were completed. However, in a few cases, assessments were ongoing at the time the programs last submitted data for analysis. These also are excluded from most analyses. (Programs computerize their own data and periodically submit data disks for review and analysis by the project team.)

The assessment instrument was designed especially for the study and featured a detailed substance use section and questions concerning a range of psychosocial issues. The assessment profile is completed by program staff, and the forms were designed to serve both clinical and program monitoring purposes. Thus the items were all clinically relevant and the data collection form has spaces for clinical notes. One objective of the overall study was to enhance the assessment function within the participating programs, and the completeness of the assessment profile was one of the criteria used to determine if this objective was achieved.

Identifying Street Youth

For the present report, cases were considered to be street youth if, at the time of assessment, they had no fixed address or reported that they had been without one at some time in the previous six months. Cases were also considered to be street youth if they had two or more of the following characteristics: (1) they had dropped out of school before grade 12; (2) they reported having slept on the streets at some time during the past six months; (3) they reported eating at mission shelters in the previous six months; (4) they reported using a food bank in the previous six months; (5) they reported that scarce resources caused them to go without food for a whole day at some time in the previous six months. If data were not sufficient to classify cases as street youths or non-street youths, they were excluded from the analysis.