Long-term Outcomes of a Residential Treatment Program for Adolescents with Problematic Drug and Alcohol Use: Evidence from a Longitudinal Modelling Approach Using Linked Data
- Publication Type:
- Thesis
- Issue Date:
- 2023
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Among various alcohol and other drug (AOD) use treatment programs for adolescents, residential Therapeutic Community (TC) approach has received very little research attention, despite evidence showing that adolescents in residential program have severe AOD-use, psychiatric comorbidities, criminal involvement, and other related problems. Most extant research show improved AOD-use, health and related outcomes of residential program for adolescents in the short-term. There is very little rigorous research evaluating longer-term outcomes, with existing studies showing inconsistent findings. Therefore, important knowledge gaps exist. This study aims to address gaps by investigating post-program long-term patterns of mortality, AOD-use, and mental health outcomes and associated pre-treatment factors of adolescents referred to a residential TC program.
The sample included 3529 adolescents (13-18 years; median referral age=16.8 years; 73% male; 43% Aboriginal Australians; 51% justice-involved; 26% with severe/clinical psychological distress) referred to an Australian residential TC program called Program for Adolescents Life Management (PALM) using data-linkage following up to 16 years. I examined crude and standardised mortality rates, causes of deaths, post-PALM crude AOD- and MH-hospitalisation rates, and conducted growth mixture modelling (GMM) to identify distinct long-term AOD- and MH-hospitalisation trajectories, and multinomial logistic regressions to determine pre-treatment predictors of those trajectories.
Findings showed substantially higher mortality rate for the cohort, five times higher than the general population of same age-group. Two-thirds of deaths involved AOD, caused primarily by overdose (mainly opioids), suicide, and transport accidents. Both AOD- and MH-hospitalisation crude rates were substantially elevated for the cohort, one hospitalisation in five person-years. Mortality and hospitalisation rates were higher for females, Aboriginal Australians, older participants, those with greater psychological distress, and treatment-attending groups (vs non-attend group). Trajectory analyses showing one-third of participants having higher AOD- and MH-hospitalisation trajectories indicate no evidence of treatment effects for these subgroups including Aboriginal Australians, females, older participants, those with greater psychological distress, unstable living, cannabis and opioids as drug of concern (DoC). Two-thirds, mainly younger, non-Aboriginal, those with lower psychological distress, stable living, and justice-involved participants, demonstrated improved outcomes.
Finding of justice-involved participants showing improved outcomes prompt further research examining full extent of this relationship. Findings of poor outcomes for Aboriginal Australians, females, those with severe pre-treatment psychological problems, cannabis and opioids as DoC highlight the importance of early-screening and tailored, culturally-safe, evidence-based integrated interventions, and longer and effective continuing care. Further research is needed to evaluate whether one AOD-program can address comorbidity and range of needs among diverse adolescents referred.
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