Positive outcomes for young adults with substance use and mental health disorders
Young adulthood is a time of both increased freedom as well as responsibility. When parental and other authoritative and protective influences recede, many young adults awaken to new possibilities in both personal and social freedom (Arnett, 2000). Many young adults struggle with the new roles and responsibilities this new freedom affords, and some develop unhealthy methods for coping.
Young adults are particularly vulnerable to substance use and mental health issues. According to the Substance Abuse and Mental Health Services Administration (2012), young adults aged 18-25 have the highest rates of substance dependence and abuse of all age groups. Twenty years old is the most common age of onset for substance abuse disorders (Kessler, 2005). It’s during that time between18-25 that many young adults develop a problem. (Kessler, 2007).
Substance use and mental health disorders often co-occur. Research suggests that the presence of mental health issues, including ADHD, depression and anxiety, often pre-dates the development of substance use disorders (NIDA, 2018). Seventy-five percent (75%) of mental health diagnoses are made by age 24 (Park, 2006) and suicide is one of the major leading causes of death in young adults (SPRC, 2019).
During the transition to young adulthood (age 18 to 25 years), people with co-occurring disorders need coordinated support to help them navigate potentially stressful changes in education, work and relationships (Sheidow, McCart, Zajac, Davis, 2012). Young adults face unique challenges as well, including a lack of experience and life skills, inability to regulate emotions, becoming easily overwhelmed, social immaturity and possible negative influences. Often the young adult inadvertently pushes away those who can support them best: their families.
Research into the outcomes of young adults has been conducted by Foundations Recovery Network. Patients who enter treatment at Foundations Recovery Network facilities were 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 proven research instruments. Responses from the research instruments are designed to assess several aspects of a patient’s mental and physical functioning and all other aspects affecting a patient’s life, including alcohol use, drug use, psychiatric symptoms, legal issues, family/social relationships, medical issues and employment issues.
In doing this research, Foundations is able to implement interventions that address the unique issues facing young adults, thus providing greater likelihood of positive long-term outcomes following treatment and offering outcomes that matter to the patient and their families.
Historically, younger patients have difficulty remaining in treatment. Remaining in treatment is important because there is a strong relationship between completing treatment and improved outcomes including:
- Decrease in days in past month using alcohol
- Decreased frequency using opioids and sedatives
- Decrease in suicidal thoughts
- Decrease in suicide and attempts
- Improved depression and anxiety symptoms
- Fewer family problems
At intake and again at follow up, patients were questioned about their substance use. Over 60% of former patients were reached to determine their long term outcomes. Specifically, former patients 18-25 were asked how many days of the prior 30 they consumed alcohol, consumed alcohol to intoxication, used illegal drugs and used more than one substance. Among young adults, significant reduction in substance use outcomes were noted at 6-months post treatment and sustained for the year following treatment.
The same patients were asked about their psychological symptoms during the same time frame. Again, significant reductions in psychiatric symptoms were reported at six months and appeared to be sustained across the entire year after treatment.
Young adults need additional support to continue the healing process after treatment. At six months after treatment, nearly 50% of young adult patients reported living in sober housing and staying on average 90 days. Nearly 60% of young adult patients reported attending outpatient treatment following residential treatment at Foundations Recovery Network.
Family is an important part of the support that young adults need. Seventy-five percent (75%) of young adult patients reported serious family conflict within the 30 days prior to intake, with an average of about 10 days per month of conflict with their family. However, at six months post treatment, only 8% of young adult patients reported serious family conflict within the prior 30 days and the average number of days of conflict was reduced to less than three days per month. Having the support of family can positively influence a patients’ long term outcomes.
Young adults have special needs, different from other members of the treatment community. Foundations Recovery Network has done research into what those needs are, and how to best support positive long term outcomes. Patients attending treatment at Foundations Recovery Network report significant improvements in substance use behaviors, psychiatric symptoms and family relationships in the six months and one year following treatment.
Siobhan A. Morse, MHSA, Universal Health Services
Samuel MacMaster, PhD, Baylor College of Family Medicine
Susie Adams, PhD, Vanderbilt University
Sam Choi, PhD, Alabama A&M University
Cayce Watson, MSW, Lipscomb University
Brian Bride, PhD, Georgia State University
Arnett, J.J. (2000). Emerging Adulthood: a theory of development from the late teens through the twenties. American Psychologist 55(5), 469-480.
Kessler, R.C., Berglund, P., Demler,O., Jin, R., Merikangas, K.R., Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry, 62(6), 593-602.
Kessler, R.C. etal. (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(3), 168-176.
Park, M.J., Mulye, T.P., Adams, S.H. , Brindis, C.D., and Irwin, C.E. (2006). The health status of young adults in the united states. Journal of Adolescent Health 39, 205-317.
SPRC. (2019). https://www.sprc.org/populations/young-adults
SAMHSA. (2012). http://www.samhsa.gov/newroom/advisories/1202071917.aspx
SheidowJ, McCart M, Zajac K, Davis M. Prevalence and impact of substance use among emerging adults with serious mental health conditions. Psychiatr Rehabil J. 2012;35(3):235-243. doi:10.2975/35.3.2012.235.243
Foundations Recovery Network Original Research Publications on this Topic:
“Characteristics and Outcomes of College-Age Adults Enrolled in Private Residential Treatment: Implications for Practice” in Journal of Social Work Practice in the Addictions, 14:6-26, 2014. DOI: 10.1080/1533256X.2014.871998
“Characteristics and Outcomes of Young Adult Opiate Users Receiving Residential Substance Abuse Treatment” in Journal of Evidence-Informed Social Work. 2015 April 16:1-11. DOI: 10.1080/15433714.2013.872071
“A Comparison of Older and Younger Adults in Residential Treatment for Co-Occurring Disorders” in Journal of Dual Diagnosis, 2015; 11(1): 75-82. DOI: 10.1080/15504263.2014.993263
“Substance Use and Mental Health Treatment Retention Among Young Adults” in Global Journal of Addiction and Rehabilitation Medicine, 1(3), March 2017. GJARM.MS.ID.555564 (2017).