Screening for substance use problems in New Zealand adolescents: Applications in comorbidity and treatment

Abstract

Adolescent mental health workers are poor at identifying and treating co-­‐existing alcohol and other drug (AOD) disorder. Effective AOD screening can assist with identification, assessment and motivational enhancement, and lead on to treatment interventions for young people in a range of health services. I describe the reported prevalence of co-­‐existing AOD and mental health disorder in young people attending AOD services via systematic review. This is supported by a naturalistic study that directly compared self-­‐reported problems across ten domains of psychosocial functioning in a cross-­‐section of 131 adolescents attending two services. I found that addiction service adolescents reported a similar or higher complexity of morbidity to adolescents attending mental health services. Problems encountered using established AOD instruments motivated the development and evaluation of the Substances and Choices Scale (SACS), an adolescent AOD self-­‐report instrument designed in a similar format to the Strengths and Difficulties Questionnaire (SDQ). A literature review, extensive consultation, and discriminant analysis on a pilot sample (n = 61) of adolescents informed the development of the SACS. The psychometric properties of the SACS were tested in clinical and community samples of 651 adolescents. Reliability of the SACS was sound with coefficient alpha 0.91 and 3 week test-­‐retest correlation 0.88. Congruent validity coefficients of the SACS versus the CRAFFT and the POSIT were 0.79 and 0.91 respectively. A ROC curve demonstrated the SACS as having a predictive value of 92%. Repeat SACS scores in a treatment sample indicated the SACS had utility in measuring change. Feedback from participants indicated that the SACS was highly acceptable. A further project evaluates the utility and acceptability of a brief intervention training package utilizing the SACS delivered to child and adolescent mental health workers. 37 participants completed a 55-­‐item questionnaire and focus groups. We found the training led to improvements in attitudes, skills and knowledge although low response rates at follow-­‐up limited analysis of behaviour change. Finally the implications of the findings in this thesis are discussed with reference to current literature, including future directions for research and treatment of addiction in young people utilising the SACS and brief interventions.