FRN Research Report January 2014: Treatment Outcomes for Young Adults with Substance Use Disorders

Introduction

Young adulthood is a time in life characterized by higher levels of risk-taking behaviors and independence seeking. This can make treatment for young adults particularly challenging. As a result, there are misconceptions about the outcomes for treating young adults for substance use disorders. This population is traditionally associated with higher levels of behavior problems and greater resistance to positive interventions. But how accurate are these beliefs about young adults and their ability to find recovery?

Research from residential populations at Foundations Recovery Network shows positive outcomes for addiction1 and mental health treatment across all age groups, including young adults. While significant differences in attitude and desire exist between young adults and older adults, there are effective ways to engage young adults and encourage greater participation in the recovery process. The results of this study may have implications for the types of programming offered at facilities by further highlighting the benefits of individualized treatment.

Foundations Recovery Network’s Internal Research

Foundations Recovery Network operates nine integrated treatment centers across three states: California, Georgia and Tennessee. From its Nashville, Tenn., headquarters, the FRN research department evaluates patient data, satisfaction surveys and outcome results, actively incorporating this information in the management and decision-making processes.

This paper discusses patient outcomes for young adults (18-25 years of age) and offers data collected at FRN’s residential facilities: The Canyon at Peace Park, Michael’s House and La Paloma. The information in this report is significant because historically, most research in substance abuse has been conducted in public treatment facilities, while FRN’s research is conducted in private, for-profit residential treatment centers. The research therefore offers information about a potentially different population.

Young Adults and Drug Use

Substance abuse disorders experience the most rapid increase in prevalence in the adolescent and young adult years (Kessler, 2007). Among Americans age 12 and older, young adults (18-25 years of age) use illicit drugs and alcohol more than any other age group. Around 21% of young adults used illicit drugs in 2012, compared to 9.5% of youths (12-17 years of age) and 7% of adults (26 years of age and older). In 2011, 22% of full-time college students were estimated to be current users, similar to the rate of illicit drug use for all 18-22-year-olds nationally (23.4%). The rate was highest among males in this age group at 25.8% (SAMSHA, 2012). The graph below illustrates the increase in illicit drug use among 18-25-year-olds since 2007.

Illicit Drug Use among Persons 18-25

Overall, nearly 1 in 5 (19.6%) young adults 18-25 report having a mental illness in the prior year. Most individuals (75%) who will experience a mental health disorder during their lifetime will be diagnosed by age 24 (Park, 2006) and nearly half of college-age adults are estimated to have had a psychiatric disorder in the prior year (Blanco, 2008). Nearly 7% of college students report having thoughts of suicide in the prior year and the percent is even higher in their peers not attending college (9%) (SAMHSA, 2012).

Treatment for Young Adult Populations

As research continues to demonstrate the relationship between mental illness and substance abuse, special attention should be paid to the needs of young adults. Research has indicated that young adults have different characteristics and needs than other populations, suggesting that treatment for young adults may need to be contextually different.

Young adults with substance use disorders and co-occurring mental health disorders are particularly vulnerable because there are significant gaps in America’s current mental health system. This population, particularly young adults with co-occurring disorders, needs treatment programs that promote mental health and social role functioning (Sheidow, McCart, Zajac, & Davis, 2012). These findings underscore the importance of individualized treatment.

Information that can clarify the ways males and females in the 18-25 age group rely on a substance are helpful in screening people for risk and directing them toward important services (Cotto, Davis, Dowling, Elcano, Staton, & Weiss, 2010).

As a whole, young adults are less likely than older adults to seek treatment. In addition, young women more commonly present with mental health issues than substance use disorders, while young men are more likely to present with substance use disorders. Improving the mental health status of all young adults is recommended to ease the transition into successful older adulthood (Adams, Knopf, & Park, 2013).

In contrast, some studies show that young adults may be more open to change than other populations. Research that evaluated a group of young adults’ readiness to change found that females and young adults with more severe drug problems may be more receptive to change. Furthermore, individuals with more severe drug use problems are affected more by the drug use than emotional problems (Alley, Ryan, & von Sternberg, 2014).

FRN Research Model

Patients who enter treatment at FRN’s residential centers are offered the opportunity to participate in an ongoing study. Participants must sign Institutional Review Board approved consent prior to participation, and the follow-up study includes interviews at intake and again at 30 days, six months and one year post-discharge.

Data is collected using validated instruments, including the Addiction Severity Index, Treatment Service Review and University of Rhode Island Change Assessment (URICA – Readiness for Change Instrument). Responses from the research instruments are designed to assess several aspects of a person’s mental and physical functioning and all other aspects affecting a person’s life, including alcohol use, drug use, psychiatric symptoms, legal issues, family/social relationships, medical issues and employment issues.

FRN is committed to scientifically-sound research. All results reported herein are independently verified by a third party. Both research enrollment and response rates exceed federal minimum standards, further adding to the validity of findings.

Our Findings: Young Adults Receiving Treatment at FRN

Young adults represent approximately one-quarter of the population receiving treatment at FRN residential facilities. The average age for young adults in treatment at FRN is 21.4 years, and nearly 38% are female. Less than half of the young adults reported employment in the 30 days prior to treatment and nearly one-quarter of them reported earning money from illegal activities in the same time period. Young adults reported using alcohol an average of 7.6 days and drugs an average of 18.7 days in the 30 days prior to treatment. The average reported amount of money spent on substance use in the 30 days prior to admission exceeded $1300.

Although young adult patients entered treatment at FRN with lower than average levels of motivation evidenced by readiness to change scores, they actually had a longer than average length of stay. Similarly, young adults showed higher than average benefits of treatment. Reduction in the use of marijuana, heroin and other opiates was greater for young adults than the overall population. Young adults also showed significant improvement in major life areas, including legal issues, drug use and alcohol use as measured by the Addiction Severity Index.

Young Adults' Substance Use at Baseline and 6 months post-Treatment

Despite historical accounts of the resistance of young adults to treatment and the low levels of motivation noted at intake, FRN young adult patients appear to have benefitted greatly from treatment. At six months, former FRN young adult patients were questioned regarding their use habits in the prior 30 days, and significant differences between pre-treatment and post-treatment drug use were noted. This may be a result of FRN’s commitment to both individualized and evidence-based treatment.

Since young adults experience lower levels of treatment motivation and completion rates, it is important that they receive stage-wise programming that includes motivation-enhancing interventions. FRN’s past research shows positive results with Motivational Interviewing, a technique that keeps patients engaged in recovery by reducing their resistance to change and lowering feelings of ambivalence about the process. Such cognitive therapeutic interventions are part of FRN’s integrated treatment program that treats a person’s addiction while also treating any emotional or psychiatric illnesses.

Conclusion

Even though young adults have greater levels of impairment and more social challenges than average, they showed significant positive outcomes. This points to a high degree of resiliency in young adults (Shumway, Bradshaw, Harris, & Baker, 2013) as well as the importance of using both individualized treatment and evidenced-based practices.

Furthermore, this finding suggests that FRN’s abstinence-based residential treatment models that include treatment for co-occurring addiction and mental health problems, stage-wise monitoring and clinical interventions can be effective in treating young adults.

Overall, FRN sees positive outcomes for its patients and is noted for its evidence-based therapeutic practices. The company is committed to scientific research and is an active participant in the mental health and substance use treatment community. In order to take its research to the next level, FRN has submitted its data to outside validity tests and reliability confirmation. The company’s goal is to conduct further research in order to improve addiction and mental health treatment for all adults.

Foundations Recovery Network is committed to research that improves treatment for all addicted individuals. If you would like to speak with an admissions coordinator today or if you would like to learn more about our research methods and programs, please call us directly at 615-490-9376.

References

Adams, S. H., Knopf, D. K., & Park, M. J. (2013, December 2). Prevalence and treatment of mental health and substance use problems in the early emerging adult years in the united states: Findings from the 2010 NSDUH. Emerging Adulthood. Retrieved January 31, 2014 from SAGE Journals: http://eax.sagepub.com/content/early/2013/11/27/2167696813513563.abstract

Alley, E. S., Ryan, T., & von Sternberg, K. (2014). Predictors of readiness to change young adult drug use in community health settings. Substance Use & Misuse, 49 (3), 253-261.

Blanco, C., Okuda, M., Wright, C., Hasin, D. S., Grant, B. F., Liu, S. M., & Olfson, M. (2008). Mental health of college students and their non-college-attending peers: Results from the National Epidemiologic Study on Alcohol and Related Conditions. Archives of General Psychiatry, 65, 1429–1437.

Cotto, J. H., Davis, E., Dowling, G. J., Elcano, J. C., Staton, A. B., & Weiss, S. R. (2010). Gender effects on drug use, abuse, and dependence: A special analysis of results from the national survey on drug use and health. Gender Medicine, 7 (5), 402-413.

Ford, K. L., Bryant, A. N., & Giyeon, K. (2012). Age differences in satisfaction with and perceived benefit from mental health services: Results from the collaborative psychiatric epidemiology surveys. International Journal of Geriatric Psychiatry, 28 , 831–840.

Kessler, R. C., Angermeyer, M., Anthony, J. C., De Graaf, R., Demyttenaere, K., 660 Gasquet, I., . . . Üstün, T. B. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry, 6, 168–176.

Morse, S. A., & MacMaster, S. (2014). Characteristics and outcomes of college-age adults enrolled in private, residential treatment: Implications for practice. Journal of Social Work Practice in the Addictions, 14, 1-21.

Morse, S. A., & MacMaster, S. A. (2013). Characteristics and outcomes of young adult opiate users receiving residential substance abuse treatment. Manuscript submitted for publication.

Park, M. J., Mulye, T. P., Adams, S. H., Brindis, C. D., & Irwin, C. E. (2006). The health status of young adults in the United States. Journal of Adolescent Health, 39, 205–317.

Sheidow, A. J., McCart, M., Zajac, K., & Davis, M. (2012). Prevalence and impact of substance use among emerging adults with serious mental health conditions. Psychiatric Rehabilitation Journal, 35 (3), 235-243.

Shumway, S. T., Bradshaw, S. D., Harris, K. S., & Baker, A. K. (2013). Important factors of early addiction recovery and inpatient treatment. Alcoholism Treatment Quarterly, 31, 3–24. doi:http://dx.doi.org/10.1080/07347324.2013.747313

Substance Abuse and Mental Health Services Administration. (2013, September 4). National survey shows continued reduced levels of prescription drug use among young adults. Retrieved January 31, 2014, from Substance Abuse and Mental Health Services Administration: http://www.samhsa.gov/newsroom/advisories/1309033910.aspx

Substance Abuse and Mental Health Services Administration. (2013). NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Retrieved January 31, 2014, from Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings: http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm

Substance Abuse and Mental Health Services Administration. (2012b). NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Retrieved from http://www.samhsa.gov/data/NSDUH/2k11Results/NSDUHresults2011.pdf

This white paper is based on the findings reported in Morse, S.A. and MacMaster, S. (in press). Characteristics and Outcomes of College-Age Adults Enrolled in Private Residential Treatment: Implications for Practice. Journal of Social Work Practice in the Addictions volume 14, issue 1.