NDARC Monograph No. 40 (1999)
An evaluation of a comprehensive, intensive intervention for adolescents with a substance use disorder was conducted during its first 3 years of implementation (1996-98). The evaluation included action research, process evaluation, impact evaluation, and a cost comparison; the main focus was the outcome evaluation. The outcome evaluation included pretest, posttest and follow-up of an intervention group and a comparison group. The intervention group comprised adolescents who began treatment at the intervention (n=60); the comparison group was adolescents who successfully applied for the intervention but did not enter the program when a place became available (n=61). The 6 domains assessed were substance use, criminal activity, social functioning, psychological functioning, HIV risk-taking behaviour and physical health.
Data from the pretest assessments was used to describe the client profile. Study participants were aged 13-18 years and 64% were male. Most (88%) of the study participants had committed crime in the last month; 57% of the females and 25% of the males were identified as ‘cases’ requiring psychiatric assessment and treatment; and social functioning was poor, for example, most had been unemployed for the previous 3 months. The study participants were typically polysubstance users with high levels of substance dependence. The substances used most frequently on a daily basis were cannabis (61%), heroin (50%) and alcohol (12%). The data suggested that the client group were at the 'hard end' of adolescents seeking treatment for a substance use disorder, and that the prognosis for treatment was poor.
For both groups, there were significant improvements across all six domains between the pretest and the posttest and these improvements were maintained at follow-up. There were no significant differences between the intervention group and the comparison group in changes across time. Failure to detect group differences could have been the result of a combination of factors, particularly including problems with program implementation, and differential drop-out between the two groups over the course of the study.
Clients of the intervention did significantly improve on all domains: substance use, crime, social functioning, psychological distress, HIV risk-taking and physical health. Conservatively speaking, this improvement was at least as good as the improvement obtained by ‘usual care’. However, given the factors outlined above, it appears likely that the intervention was successful in that it has enabled the ‘harder end of the market’ to achieve positive results. These results were attained while the intervention was under-funded and the program was still being developed. Increased funding and the development of program materials and practices since the evaluation was conducted are likely to produce even better outcomes.