Dr Yvonne Bonomo¹, Dr Nicholas Allen², Nich Rogers¹, Dr Dan Lubman² and Dr Enrico Cementon³
¹ Youth Substance Abuse Service (YSAS)
² ORYGEN Youth Health
³ Drug and Alcohol Services Western (DASWest)
beyondblue Victorian Centre of Excellence
Project completion year
High rates of co-morbid affective and substance-use problems have been identified in substance-using adults seeking treatment; however less research has been conducted in younger populations. This study’s major aim was to diagnostically assess rates of depression and anxiety conditions in a sample of treatment-seeking, adolescent drug users. A follow-up analysis was completed to assess changes in symptoms over time.
The Structured Clinical Interview assessed depressive, anxiety and substance use disorders. A range of other instruments were used to assess quality of life, strength of the therapeutic alliance, severity of substance-use dependence and psychological distress.
Participants (n=100) were 53 per cent male and 47 per cent female; most (77 per cent) identified as Australian; and had completed a minimum of secondary school to Year 9 level (67 per cent). Seventy-one participants subsequently agreed to a follow-up interview. Attrition analysis found no key demographic or drug-use differences between the baseline (n=100) and follow-up (n=71) samples.
Similarly, a comparison of the research sample with a broader population sample of participants within the services found no demographic or drug-use differences, suggesting these findings could be generalised to the general youth drug treatment-seeking population.
Unsurprisingly, high levels of substance abuse/dependence were identified in our sample (75 per cent current, 99 per cent lifetime).
High rates of mental health distress were also identified, with 50 per cent of participants reaching a current diagnosis for any depressive or anxiety condition (69 per cent lifetime). Most commonly reported current mental health conditions included:
- major depression (26 per cent)
- post traumatic stress disorder (24 per cent)
- panic disorder (both with and without agoraphobia) (7 per cent).
62 per cent of participants reached critical symptom threshold for a combined and current mental health and substance use condition. Most common conditions combined with a diagnosis of substance abuse/dependence included: major depression (26 per cent) and post traumatic stress disorder (22 per cent).
Results also demonstrated that young people with a stronger therapeutic alliance with their case manager at baseline, were more likely to report a reduction in their depressive symptoms, but not their substance-use symptoms at follow-up interview.
However, it was also noted that clients with a high level of psychological distress at baseline found it harder to develop sound therapeutic alliances with the outreach case managers over time.
Implications for policy and practice
This study demonstrated the high levels of psychological distress in young drug-using populations, highlighting that co-morbidity is common in the treatment population, and underlining the need for further workforce development to identify better and manage mental health needs in young drug users.
The study suggests staff across both youth alcohol and other drug and mental health service systems must develop a broad array of skills to not only effectively treat young people with complex needs, but also to engage them better, effectively identify their needs, and retain them within the service system. It also suggests that multiple needs must be effectively managed together, if optimal substance-use and mental health outcomes are to be achieved.
Based on these findings, this partnership has subsequently received funding to develop ‘co-morbidity clinics’ embedded within each service. These clinics provide a broad array of direct care and capacity-building opportunities including, but not limited to:
- psychological assessments and provision of brief cognitive behavioural interventions by a psychologist
- training in and provision of a brief mental health screening tool for AOD staff
- secondary consultations and training for staff in brief cognitive behavioural interventions and other basic psychological assessment and support.
About the researchers
The research team is drawn from across the three partnership organisations: Youth Substance Abuse Service (YSAS), ORYGEN Youth Health and Drug and Alcohol Services Western (DASWest). The team aimed to enhance each others’ understanding of service system differences and constraints in order to provide more effective and acceptable youth alcohol and drug, and mental health services to our client group. This project is part of a broader service development activity aimed at enhancing the capacity to identify and treat co-occurring problems.