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Assertive Outreach Strategies for Narrowing the Adolescent Substance Abuse Treatment Gap: Implications for Research, Practice, and Policy

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Abstract

In any given year, only about 10% of the nearly two million adolescents exhibiting substance abuse or dependence in the United States receive substance abuse treatment. Given this state of affairs, it is unlikely that the massive effort and expenditure of resources over the past decade on developing, testing, and disseminating effective treatments for adolescent substance abuse will have an appreciable impact on the prevalence of substance use disorders among the adolescent population. In order to substantially diminish the pervasive gap between levels of need for and utilization of adolescent substance abuse treatment, specialized assertive outreach strategies may be needed. This paper outlines a framework for assertive outreach for adolescents with substance use disorders and proposes specific types of strategies for identifying and enrolling such adolescents into treatment. Implications for practice and policy pertaining to adolescent substance abuse treatment service delivery are considered.

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Notes

  1. A prime example of a systematic and cutting edge GPM-based approach to assertive outreach for individuals with substance abuse problems is the Screening, Brief Intervention, Referral, and Treatment (SBIRT) cooperative agreement initiated in 2003 by the Substance Abuse and Mental Health Services Administration (SAMHSA; see http://www.samhsa.gov/Matrix/programs_treatment_SBIRT.aspx). Briefly, the SBIRT cooperative agreement initiative is a 5-year $108 million program to support comprehensive substance use screening for individuals receiving health care services in a range of settings including hospitals, general medical clinics, emergency rooms, urgent care centers, and so forth.194 The screening is conducted by a specially trained medical professional. If a substance use problem is detected, the screener is equipped to provide a brief informational and motivational intervention on the spot, as well as to provide a referral for more comprehensive substance abuse treatment services as needed. Preliminary results regarding the impact of the SBIRT protocol on substance use among medical patients are somewhat positive, although uncertainties have been expressed pertaining to the dissemination and adoption of SBIRT among front-line service providers.207

  2. Although concrete guidelines for personnel and staffing of the outreach activities discussed in this paper remain to be developed, the authors’ position is that the majority of the effort and burden should be shouldered by specially trained outreach workers from the substance abuse treatment system. The authors are not in favor of imposing additional layers of burden and responsibility upon teachers or other staff members within the school system.

  3. It should be noted that these relatively short-term cost benefits would be realized if the assertive outreach procedures discussed in this paper were successful in directing a larger proportion of the relatively more chronic and comorbid segments of the adolescent substance abusing population into treatment. Undoubtedly, the majority of the short-term costs of untreated substance abuse (e.g., drug-related crimes, arrests, incarcerations, probation, etc) are attributable to this more severely impaired group of adolescents. In contrast, it is expected that substantial cost benefits from implementing assertive outreach among relatively less chronic and non-comorbid adolescents with substance use disorders may be realized over a much longer time period extending into the young adult years of such adolescents and beyond. Such long-term preventative cost benefits are discussed in the following paragraph.

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    Timothy J. Ozechowski PhD & Holly Barrett Waldron PhD

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Support for this manuscript was provided by grants from the National Institute on Drug Abuse to Holly B. Waldron, Ph.D. (1R01DA15762, 5R01DA017023).

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Ozechowski, T.J., Waldron, H.B. Assertive Outreach Strategies for Narrowing the Adolescent Substance Abuse Treatment Gap: Implications for Research, Practice, and Policy. J Behav Health Serv Res 37, 40–63 (2010). https://doi.org/10.1007/s11414-008-9136-0

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