Treatment Attendance among Homeless Youth: The Impact of Childhood Abuse and Prior Suicide Attempts

Abstract

Treatment engagement and retention is a significant challenge for those who serve adolescent substance abusers. Homeless youth are considered especially challenging to engage and maintain in intervention efforts given their lack of residence and range of associated problems. This study examined predictors of treatment attendance and its impact on substance use outcome among a sample of substance abusing homeless youth (n = 133). Stepwise regression results indicated that a history of sexual abuse and suicide attempts were the two strongest predictors of the treatment attendance rate, higher attendance among those with these histories. Youths who attended greater than 6 treatment sessions showed a significant reduction in alcohol use at post-treatment, but attendance rates did not impact other substance use. Identifying predictors of treatment attendance among this subgroup of adolescents is vital given that much research suggests that treatment attendance alone is associated with better short and long term outcomes.

Keywords

Homeless youth alcohol and drug use treatment attendance

References

Kleinman

P H

, Miller

A B

, Millman

R B

Woody

G E

. 1990. Psychopathology among cocaine abusers entering treatment. J Nerv Ment Dis, 178: 442–447.

Lawendowski

L A

. 1998. A motivational intervention for adolescent smokers. Prev Med, 27: A39

Liddle

H A

and Dakof

G A

. 1995. Family-based treatment for adolescent drug use: State of the science. NIDA Res Monogr, 156: 218–254.

Joanning

, Quinn

, Thomas

and Mullen

. 1992. Treating adolescent drug abuse: A comparison of family systems therapy, group therapy, and family drug education. J Marital Fam Ther, 18: 345–356.

Ogborne

A C

. 1995. Characteristics of youth and young adults seeking residential treatment for substance use problems: An exploratory study. Addict Behav, 20: 675–678.

Pompi

K F

. 1994. Adolescents in therapeutic communities: Retention and postention and post treatment outcome. NIDA Res Monogr, 144: 128–161.

Carroll

K M

and Rounsaville

B J

. 1993. History and significance and childhood attention deficit disorder in treatment-seeking cocaine abusers. Comp Psychiatry, 34: 75–82.

Levin

F R

, Evans

S M

, Vosburg

S K

, Horton

, Brooks

and Nag

. 2004. Impact of attention-deficit hyperactiv-ity disorder and other psychopathology on treatment retention among cocaine abusers in a therapeutic community. Addict Beh, 29: 1875–1882.

Wise

B K

, Cuffe

S P

and Fischer

. 2001. Dual diagnosis and successful participation of adolescents in substance abuse treatment. J Subst Abuse Treat, 21: 161–165.

10.

Ensign

and Bell

. 2004. Illness experiences of homeless youth. Qual Health Res, 14: 1239–1254.

11.

Nock

M K

and Kazdin

A E

. 2005. Randomized controlled trial of a brief intervention for increasing participation in parent management training. J Consult Clin Psychol, 73: 872–879.

12.

Neighbors

C J

, Zywiak

W H

, Stout

R L

and Hoffman

N G

. 2005. Psychobehavioral risk factors, substance treatment engagement and clinical outcomes as predictors of emergency department use and medical hospitalization. J Stud Alcohol, 66: 295–304.

13.

Robertson

M J

and Toro

P A

. 1999. “Homeless youth: Research, intervention, and policy”. In Practical Lessons: The 1998 National Symposium on Homelessness Research, Edited by: Fosburg

L B

and Dennis

D L

. 3–1. 3–32. Washington, DC: U.S. Department of Housing and Urban Development and U.S. Department of Health and Human Services.

14.

Trautman

P D

, Stewart

and Morishima

. 1993. Are adolescent suicide attempters noncompliant with outpatient care?. J Am Acad Child Adolesc Psychiatry, 32: 89–94.

15.

Piacentini

, Rotheram-Borus

M J

, Gillis

J R

, Graae

, Trautman

, Cantwell

, Garcia-Leeds

and Shaffer

. 1995. Demographic predictors of treatment attendance among adolescent suicide attempters. J Consult Clin Psychol, 63: 469–473.

16.

Shaffer

and Piacentini

. 1994. “Suicide and suicide attempts”. In Child and Adolescent Psychiatry, 3rd ed., Edited by: Rutter

, Hersov

and Taylor

. 407–424. London: Blackwell Scientific Publications.

17.

Kinard

E M

. 2001. Recruiting participants for child abuse research: What does it take?. J Fam Violence, 16: 219–236.

18.

Wolfe

D A

and McGee

. 1994. Dimensions of child maltreatment and their relationship to adolescent adjustment. Dev Psychol, 6: 165–181.

19.

Shaffer

. 1992. The Diagnostic Interview Schedule for Children, 2.3 Version, New York: Columbia University.

20.

Runaway and Homeless Youth Program. 1999. Title 45. 4v C.F.R. pt. 1351

21.

Godley

S H

, Meyers

R J

, Smith

J E

, Karvinen

, Titus

J C

, Godley

M D

, Dent

, Passetti

and Kelberg

. 2001. The Adolescent Community Reinforcement Approach for Adolescent Cannabis Users DHHS Publication No. (SMA) 01–3489

22.

Meyers

R J

and Smith

J E

. 1995. Clinical guide to alcohol treatment: The Community Reinforcement Approach, New York: Guilford Press.

23.

Miller

W R

and DelBoca

F K

. 1994. Measurement of drinking behavior using the Form-90 family of instruments. J Stud Alcohol, 12: 112–118.

24.

Sobell

L C

and Sobell

M B

. 1992. “Timeline follow-back”. In Measuring Alcohol Consumption, Edited by: Litten

and Allen

. 41–72. Totowa, NJ: Humana Press.

25.

Miller

W R

and Marlatt

G A

. 1984. Manual for the Comprehensive Drinker Profile, Odessa, FL: Psychological Assessment Resources.

26.

Tonigan

J S

, Miller

W R

and Brown

J M

. 1997. The reliability of Form 90: An instrument for assessing alcohol treatment outcome. J Stud Alcohol, 58: 358–364.

27.

Westerberg

V S

, Tonigan

J S

and Miller

W R

. 1998. Reliability of Form 90D: An instrument for quantifying drug use. Subst Abuse, 19: 179–189.

28.

Slesnick

and Tonigan

J S

. 2004. Form 90 Assessment of Runaway Youth's Substance Use: Reliability and Validity. Alcohol Treat Q, 22: 21–34.

29.

Wolfe

S M

, Toro

P A

and McCaskill

P A

. 1999. A comparison of homeless and matched houses adolescents on family environment variables. J Res Adolesc, 9: 53–66.

30.

Myers

. 1990. Classical and modern regression with applications, 2nd ed, Boston, MA: Duxbury.

31.

Field

. 2005. Discovering statistics using SPSS, 2nd ed, Thousand Oaks: CA; SAGE Publications.

32.

Jacobson

N S

, Follette

W C

and Revenstorf

. 1984. Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behav Ther, 15: 336–352.

33.

Jacobson

N S

and Truax

. 1991. Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. J Consult and Clin Psych, 59: 12–19.

34.

May

. 1980. Psychology and the Human Dilemma, New York: W.W. Norton & Co.

35.

Agosti

, Nunes

, Stewart

J W

and Quitkin

F M

. 1991. Patient factors related to early attrition from an outpatient cocaine research clinic: A preliminary report. Int J Addict, 26: 327–224.

36.

Coatsworth

J D

, Santisteban

D A

, McBride

C K

and Szapocznik

. 2001. Brief strategic family therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Fam Process, 40: 313–332.

37.

Santisteban

D A

, Szapocznik

, Perez-Vidal

, Kurtines

W M

, Murray

E J

and LaPerriere

. 1996. Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness. J Fam Psychol, 10: 35–44.

38.

Donohue

, Azrin

N H

, Lawson

, Friedlander

, Teichner

and Rindsberg

. 1998. Improving initial session attendance of substance abusing and conduct disordered adolescents: A controlled study. J Child Adolesc Subst Abuse, 8: 1–13.

39.

Miller

W R

and Rollnick

. 2002. Motivational interviewing: Preparing people for change, 2nd ed, New York: Guilford Press.

40.

Aubrey

L L

. 1998. Motivational interviewing with adolescents presenting for outpatient substance abuse treatment. Dissertation Abstracts International: Section B. The Sciences & Engineering., 59: 1357

41.

Dennis

, Godley

S H

, Diamond

, Tims

F M

, Babor

, Donaldson

, Liddle

, Titus

J C

, Kaminer

, Webb

, Hamilton

and Funk

. 2004. The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials. J Subst Abuse Treat, 27: 197–213.

42.

Azrin

N H

, Donohue

, Teichner

G A

, Crum

, Howell

and DeCato

L A

. 2001. A controlled evaluation and description of individual-cognitive problem solving and family-behavior therapies in dually-diagnosed conduct-disordered and substance-dependent youth. J Child Adolesc Subst Abuse, 11: 1–43.

43.

Santisteban

D A

, Perez-Vidal

, Coatsworth

J D

and Kurtines

W M

. 2003. Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use. J Fam Psychol, 17: 121–133.

44.

Slesnick

, Bartle-Haring

, Glebova

and Glade

. 2006. Primary alcohol versus primary drug use among adolescents: An examination of differences. Addict Behav, 31: 280–293.

45.

Deters

P B

, Novins

D K

, Fickenscher

and Beals

. 2006. Trauma and posttraumatic stress disorder symptomol-ogy: Patterns among American Indian adolescents in substance abuse treatment. Am J Orthopsychiatry, 76: 335–345.