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Young people with coexisting substance abuse and emotional problems need specialized residential treatment

Young people who are in residential treatment for serious emotional or behavioral problems are among the most needy children in the child welfare system. Those who also abuse drugs or alcohol are more likely than the others to escape from the residence, commit suicide, or be placed in an institution such as a hospital or detention center, according to a study that was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00078).

Young people entering residential treatment programs should be screened for type and severity of substance use problems, and services should be individualized to ensure close supervision and monitoring of their high-risk behaviors. This specialized approach could facilitate their discharge into foster homes or as adopted children rather than moving them to another institution, conclude the Northwestern University researchers who conducted the study. They retrospectively analyzed medical chart data on 564 children and adolescents in residential treatment and State custody in Florida and Illinois, who had serious emotional or behavioral disturbances. They evaluated differences in clinical characteristics and compared placement outcomes between young people with and without coexisting substance use disorders.

Overall, 26 percent of boys and 37 percent of girls had substance use problems in addition to serious emotional or behavioral disturbances. Youngsters with dual diagnoses were significantly more likely than those with only one diagnosis to be at risk for suicide (57 vs. 35 percent of girls, 45 vs. 32 percent of boys), elopement (77 vs. 41 percent of girls, 67 vs. 35 percent of boys), and crime or delinquency (63 vs. 31 percent of girls, 82 vs. 42 percent of boys). More girls with substance use problems were discharged to institutions than girls without these problems (56 vs. 15 percent), and fewer girls with substance use problems were placed in the community (44 vs. 85 percent). There were no significant differences in placement between boys with and without substance use problems.

For more details, see "Clinical characteristics of youths with substance use problems and implications for residential treatment," by Dana A. Weiner, Ph.D., Melissa E. Abraham, M.S., and John Lyons, Ph.D., in the June 2001 Psychiatric Services 52(6), pp. 793-799.

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