Treatment motivation among caregivers and adolescents with substance use disorders

"His heart is hardening, but his BRAIN is softening": Life experiences of adolescents using psychoactive substances: A qualitative study

PURPOSE

The aim of the research was to portray the life experiences of adolescents using psychoactive substances with regard to their substance use.

DESIGN AND METHODS

This study was carried out in a descriptive phenomenological design, which is a qualitative research method. A purposeful sampling method, was used. The sample consisted of 15 adolescents who were treated for a history of substance use. The data were collected by the face-to-face individual interview method. A personal information form and a semi-structured interview form were used to collect data. The content analysis approach proposed by Graneheim and Lundman was used in the analysis of the data. Data were analyzed using the N-VIVO-10 Pro-package program.

RESULTS

Four main themes and thirteen sub-themes were determined: experiences before substance use (sub-themes: life before substance use, predisposing factors for substance use), experiences during substance use (sub-themes: symptoms of addiction, problems caused by substance use, family attitude to substance use, the meaning attached to substances) and experiences of the treatment process (sub-themes: motivation, difficulties experienced during treatment, the need for support, treatment results), prevention recommendations (sub-themes: for peers, for families, for society).

CONCLUSIONS

Many individual, family and social risk factors had an effect on the adolescents starting to use the substances. They were exposed to negative physical, mental, economic, social and life experiences.

PRACTICE IMPLICATIONS

Nurses working with adolescents who use substances can implement nursing interventions such as prevention activities, counselling, health education, coping and strengthening self-esteem in individual and school based interventions.

Resources for the Assessment and Treatment of Substance Use Disorder in Adolescents

Substance Use Disorder (SUD) is understood as the persistent use of substances to the detriment of the individual's livelihood and wellness. SUD can have serious mental, physical, and social ramifications if not properly addressed. Though SUD can develop at any age, it is especially important to address in adolescents, given rising prevalence of certain substances (e.g. cannabis) in that age group and poor prognosis associated with early-onset SUD.[1][2] Data from the National Survey on Drug Use and Health show the lifetime use of illicit drugs in people ages 12-17 is 20.9%.[3] The same survey found the rate of Substance Use Disorder in the past year for people ages 12-17 who used illicit drugs or alcohol to be 6.3% in 2020.[3] This paper is intended for clinicians and lay people to gain a deeper understanding of SUD in adolescents, particularly relating to alcohol, cannabis, nicotine, and opioids. Though alcohol, cannabis, and nicotine are the substances most commonly used by this age demographic nationally,[4] opioid use – and resulting deaths – have been on the rise. According to the Centers for Disease Control and Prevention (CDC), opioids were connected to about 75% of the nearly 92,000 drug deaths in 2020.[5] Beyond significant death rates in the general population, recent spikes in adolescent death rate tied to the synthetic opioid fentanyl – which held a relatively stable death rate from 2010 to 2019 until seeing a 94% increase from 2019 to 2020 and additional 20% increase to 2021 - warrants inquiry into opioids for this population.[6] Each of these substances can have adverse, long-lasting effects on health if not managed properly, resulting in seriously compromised lifelong wellbeing.[7] This article explores SUD prevalence and reviews diagnostic criteria in relation to adolescence, including a synopsis of changes in SUD classification between the DSM-IV and DSM-5 and discussion of ICD-11 and the Research Domain Criteria (RDoC) as a basis for research related to substance use. Effective assessment and consideration of co-occurring disorders are covered as well. Although the prognosis of SUD varies by an individual's environment and circumstances, a modal developmental course for SUD is discussed. Finally, a curated list of nationally recognized resources including hotlines, treatment locators, informational sites, and support groups is provided, along with tools to compile local resources. By addressing these aspects of adolescent SUD, the research team offers a broader view of its prevalence in the United States, key warning signs and comorbidities, and possible assessments and treatments for adolescents with SUD.

Disparities in substance use treatment retention: An exploration of reasons for discharge from publicly funded treatment

Although Delaware is the seventh smallest state in the country (including Washington, D.C.) in terms of population size, it has the second highest drug overdose death rate. The Delaware Division of Substance Abuse and Mental Health has increased attention in identifying disparities in treatment outcomes. We explored reasons for discharge from publicly-funded treatment in Delaware with special attention to populations at risk for health inequities, with a focus on covariates of treatment non-completion. Using secondary data collected from publicly-funded treatment providers, we analyzed data from individuals that were admitted to substance use treatment between 2015 and 2019 and had been discharged in 2019. We did this by using logistic and multinomial regression, focusing on non-completion treatment outcomes such as failure to meet requirements, loss of contact, and treatment refusal. Clients who were Black or African American, compared to white clients, were more likely to be lost contact with, administratively discharged, or marked as failing to meet treatment requirements than having a completed treatment discharge. Women were 30% less likely than men to have "failed to meet treatment requirements" compared to completing treatment. Further investigation is needed into these patterns. While treatment quality cannot be assessed using this data, the results point to a need for closer study of disparities in treatment related to race, ethnicity, gender, employment, criminal justice involvement, and type of drug used. Treatment providers should be made aware of culturally informed care, as well as client-created goals, in order to reduce disparities in exit from treatment.

Substance Abuse Amongst Adolescents: An Issue of Public Health Significance

Adolescence is a crucial time for biological, psychological, and social development. It is also a time when substance addiction and its adverse effects are more likely to occur. Adolescents are particularly susceptible to the negative long-term effects of substance use, including mental health illnesses, sub-par academic performance, substance use disorders, and higher chances of getting addicted to alcohol and marijuana. Over the past few decades, there have been substantial changes in the types of illegal narcotics people consume. The present article deals with the review of substance abuse as a public health problem, its determinants, and implications seen among adolescents. A systematic literature search using databases such as PubMed and Google Scholar was undertaken to search all relevant literature on teenage stimulant use. The findings have been organized into categories to cover essential aspects like epidemiology, neurobiology, prevention, and treatment. The review showed that substance addiction among adolescents between 12 to 19 years is widespread, though national initiatives exist to support young employment and their development. Research on psychological risk factors for teenage substance abuse is vast, wherein conduct disorders, including aggression, impulsivity, and attention deficit hyperactivity disorder, have been mentioned as risk factors for substance use. Parents' attitudes toward drugs, alcohol, academic and peer pressure, stress, and physical outlook are key determinants. Teenage drug usage has a significant negative impact on users, families, and society as a whole. It was found that a lot has been done to provide correct intervention to those in need with the constant development of programs and rehabilitative centers to safeguard the delicate minds of youths and prevent them from using intoxicants. Still, there is much need for stringent policy and program guidelines to curb this societal menace.

Influences of poly-victimization on adolescents' pre-treatment cognitive motivations and post-treatment outcomes

INTRODUCTION

Substance use treatment outcomes are challenging to predict: myriad potentially relevant factors influence outcomes, including age, sex, motivations, and history of victimization.

METHODS

The current study seeks to assess these factors in adolescents through an evaluation of the relationship between distinct victimization profiles, sex, and cognitive factors related to substance use treatment outcomes-specifically motivation, self-efficacy, and reasons for quitting-and the relationship between these factors and posttreatment outcomes. We report sex differences in the prevalence of specific types of victimization; females are more likely than males to report poly-victimization alongside higher levels of traumagenic characteristics such as fearing for your life, chronic abuse, abuse by a trusted individual, or negative reactions to disclosure.

RESULTS

Adolescents who endorsed high levels of poly-victimization and high traumagenic characteristics reported a) higher motivation for treatment, b) more reasons for quitting substance use, c) lower self-efficacy, and d) fewer adjusted days abstinent posttreatment relative to their peers. We report several sex differences: emergent poly-victimization profiles are different for males and females, class membership has a differential proportion, and, last, associations between class membership and pre-treatment cognitive motivations and posttreatment outcomes vary by sex.

CONCLUSION

Clinicians working with adolescents who report poly-victimization should aim to leverage their motivation and reasons for quitting, as these factors are traditionally associated with positive outcomes. Last, interventions aimed at fostering self-efficacy may also be particularly important to improve long-term outcomes, specifically among adolescents with a history of poly-victimization.

Characteristics and quality of life of substance users and their caregivers

The correlation between substance use and depression has been emphasized in the literature. Substance use disorders can also adversely affect the caregivers of drug-addicted persons. A cross-sectional study was conducted at the Special Hospital for Addiction Diseases in Belgrade in 2015 to analyze the characteristics, consequences, and health-related quality of life of drug users and their caregivers. The sample comprised 136 users of various substances, and 136 caregivers. A questionnaire on socio-demographic characteristics, the Short Form Health Survey 36 (SF-36), and Beck Depression Inventory were administered to all participants. According to multivariate logistic regression analysis, compared with caregivers, substance users were significantly more frequently male (P < .001), ≤ 39 years old (P < .001), and more frequently reported the use of sedatives (P = .009) and smoking (P < .001). Some level of depression was present in all participants, but severe forms were more frequent in substance users (P = .010). Among substance users, mean scores of SF-36 domains ranged from 56.62‒87.17, and among their caregivers, from 50.37‒75.07; however, the difference was significant only for the health change domain (P = .037), the score for which was lower in caregivers. Substance users suffered from more severe forms of depression compared to their caregivers, who had lower SF-36 scores in the domain of health change.

On what motivates us: a detailed review of intrinsic v. extrinsic motivation

Motivational processes underlie behaviors that enrich the human experience, and impairments in motivation are commonly observed in psychiatric illness. While motivated behavior is often examined with respect to extrinsic reinforcers, not all actions are driven by reactions to external stimuli; some are driven by 'intrinsic' motivation. Intrinsically motivated behaviors are computationally similar to extrinsically motivated behaviors, in that they strive to maximize reward value and minimize punishment. However, our understanding of the neurocognitive mechanisms that underlie intrinsically motivated behavior remains limited. Dysfunction in intrinsic motivation represents an important trans-diagnostic facet of psychiatric symptomology, but due to a lack of clear consensus, the contribution of intrinsic motivation to psychopathology remains poorly understood. This review aims to provide an overview of the conceptualization, measurement, and neurobiology of intrinsic motivation, providing a framework for understanding its potential contributions to psychopathology and its treatment. Distinctions between intrinsic and extrinsic motivation are discussed, including divergence in the types of associated rewards or outcomes that drive behavioral action and choice. A useful framework for understanding intrinsic motivation, and thus separating it from extrinsic motivation, is developed and suggestions for optimization of paradigms to measure intrinsic motivation are proposed.

Parenting to provide social recovery capital: A qualitative study

BACKGROUND

Although research demonstrates the necessity of social recovery capital (SRC) for youth in recovery, through having family that do not use substances and who support their recovery, the ways in which parents actually enact SRC have not been empirically examined. This qualitative study applied the Recovery Capital Model for Adolescents to group interview data from parent(s) of youth who resolved a substance use disorder (SUD) to explore the ways parents enacted SRC.

METHOD

The interviews were conducted in a prior ethnographic study in which parents of alternative peer group (APG) alumni volunteered to participate in a group interview; five mothers and five fathers of APG alumni participated in the interviews (n=10). Three investigators analyzed the interview transcripts using the constant comparative method to identify family SRC and the specific components parents supported their child's recovery.

RESULTS

The primary themes of parent support of SRC included locus of control, parent growth, and sober/supportive home. Locus of control included parent strategies to leverage youth's participation in treatment/recovery. Parent growth focused on the process of change parents described: from denial to developing insight and learning how to parent a child in addiction. Supportive and structured family included time spent with youth in recovery-related activities and improved communication and relationships.

CONCLUSIONS

Together, these themes suggest a process of parent change that supports an adolescent's recovery trajectory and increases parenting skills and coping. These themes also highlight how the APG structure enabled this process, generating potential hypotheses for future recovery-oriented research to address.

Association of Self-Leadership With Acute Stress Responses and Acute Stress Disorders in Chinese Medics During the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

The outbreak of the highly infectious coronavirus disease 2019 (COVID-19) renders a huge physical and psychological risk to the public, especially to the medics. Additionally, self-leadership has proven to improve self-efficacy and mediate tension, such as nervousness and depression. Therefore, a cross-sectional survey was conducted to explore the association of self-leadership with acute stress responses (ASRs) and acute stress disorders (ASDs) in medics during the COVID-19 epidemic.

METHODS

Self-reported online questionnaires were administered, and 627 participants were finally included. The data were analyzed using the univariate analysis and the logistical regression model to identify whether self-leadership and sociodemographic and epidemic characteristics were associated with mental health, including ASRs and ASDs.

RESULTS

Initially, 790 medics responded. Of these, 627 remained after excluding for invalid questionnaires and those with a substantial amount of missing data. Therefore, the participation validity rate was 79.37%. Frontline medical staff (β = 0.338; p < 0.001), possibility of infection among people around the medic being mild (β = 0.141; p < 0.001), subjective estimation of epidemic duration being 3-6 months (β = 0.074; p < 0.05), self-sets (β = -0.022; p < 0.001), self-punishment (β = 0.229; p < 0.001), belief hypothesis and evaluation (β = -0.147; p < 0.05), and successful foresight (β = 0.105; p < 0.05) were statistically significant with ASRs. Marital status [adjusted odds ratio (AOR) =1.813; 95% CI (1.141, 2.881); p = 0.012], being a frontline worker [AOR = 25.760; 95% CI (14.220, 46.667); p < 0.001], visiting Hubei in the previous 14 days [AOR = 3.656; 95% CI (1.500, 8.911); p = 0.004], self-punishment [AOR = 1.352; 95% CI (1.180, 1.548); p < 0.001], and self-dialogue [AOR = 1.256; 95% CI (11.063, 1.483); p = 0.007] were the risk factors for ASD. Conversely, having frontline medical staff in one's family [AOR = 0.523; 95% CI (0.297, 0.923); p = 0.025], self-sets [AOR = 0.814; 95% CI (0.715, 0.826); p = 0.002], and belief hypothesis and evaluation [AOR = 0.796; 95% CI (0.672, 0.943); p = 0.038] were the protective factors.

CONCLUSION

The special working environment of the COVID-19 epidemic resulted in ASR and ASD. Notably, findings revealed a positive association between ASR symptoms and frontline medical staff, the subjective estimation of epidemic duration, self-punishment, and successful foresight. Nevertheless, marital status, having visited Hubei in the previous 14 days, and self-dialogue were the risk factors accounting for ASD symptoms. Surprisingly, having frontline medical staff in one's family, self-sets, and belief hypothesis and evaluation had potential benefits for ASD symptoms.

Understanding the service needs of youth with opioid use: A descriptive study of demographics and co-occurring substance use and mental health concerns

INTRODUCTION

Opioid misuse among youth is a significant concern given its potential negative consequences; yet youth who use opioids continue to face challenges in seeking treatment. The goal of this study was to understand the demographics, mental health, and substance use and co-occurring concerns of service-seeking youth with opioid use to inform future services and research.

METHODS

This study characterized 1769 youth between 14 and 24 years old seeking services at an urban treatment facility in Toronto, Ontario (ON) between 2008 and 2019. Youth who could adequately read English, had no immediate psychiatric service needs, provided research consent, and responded to a question about opioid use history were eligible. Participants provided information on demographics, substance use, mental health, and treatment motivation.

RESULTS

Youth who use opioids were more likely to report challenges with social determinants of health, use more substances, initiate substance use earlier, and use some substances at a higher frequency than youth who do not use opioids. Youth with opioid use reported more co-occurring mental health and substance use concerns than youth with no opioid use. They also endorsed more trauma and a likely PTSD diagnosis. Not being in employment, education, or training and using a higher number of substances positively predicted youth opioid use. In terms of treatment motivation, youth who use opioids endorsed more internal forms of motivation than youth who do not use opioids.

CONCLUSIONS

Youth who use opioids have complex social and co-occurring mental health and substance use needs that may be addressed with integrated community-based services. Future research should focus on developing evidence-based opioid treatment programs in this context and other innovative platforms.

Primary Care Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Lebanon: A National Cross-sectional Study

INTRODUCTION

Substance use among adolescents is on the rise globally. Adolescents rarely seek help for problematic substance use and healthcare professionals can easily fail to identify adolescents with risky substance use. There is therefore a significant global need for substance use screening by healthcare professionals followed by appropriate intervention. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based practice that enables clinicians to determine adolescents' risk for substance use and intervene accordingly. However, little effort has been placed on empowering primary care clinicians to use it in Lebanon. We explored the attitudes, perceptions, and practices of primary care nurses and physicians regarding adolescent SBIRT use.

METHODS

The study used a cross-sectional multisite survey design targeting urban and rural areas in Lebanon. A national sample of 140 physicians and nurses was recruited using random sampling stratified by governorate. Participants completed mailed or online surveys addressing their practices, attitudes, role perceptions, and self-efficacy regarding SBIRT use.

RESULTS

This study revealed that 57.8% of healthcare professionals were not familiar with the SBIRT model and that 76.2% did not practice SBIRT in their setting. The majority addressed the problem of substance use through educating and counseling adolescents about the dangers of substance use (84.2%) and encouraged them to stop (82%) but only 2% reported using standardized instruments for substance use screening. Most participants (88.1%) reported their willingness to use SBIRT in their clinical practice and 92.4% expressed an interest in receiving SBIRT training. Overall, the results showed positive attitudes (M = 4.38, SD = 0.89) and role responsibility (M = 4.47, SD = 1.62) toward addressing substance use in adolescents, in addition to a high level of perceived self-efficacy in addressing substance use (M = 4.04, SD = 0.92). Our results showed minimal differences between nurses' and physicians' perceptions and self-efficacy regarding SBIRT use.

CONCLUSIONS

Our study confirms the lack of a standardized approach toward adolescent substance use screening and intervention by primary healthcare providers in Lebanon but revealed the readiness and willingness to receive training and proper support to adopt an evidence-based approach such as SBIRT.

Correlates of motivation for treatment among alcohol service users in Uganda

Purpose

Given the scarce literature on alcohol use disorders (AUD) and their treatment in developing countries, this paper aims to explore motivation levels and their correlates among alcohol service users in two residential treatment centres in Kampala, Uganda. This study how motivation levels of Ugandan alcohol service users compare with those from American studies; and the specific factors affecting internal and external motivation in the Ugandan context.

Design/methodology/approach

The motivation for treatment was measured among 100 individuals entering AUD treatment using the Texas Christian University (TCU) Treatment needs and Motivation scale. The WHOQoL–BREF, Addiction Severity Index–6 and Hopkins Symptoms Check List–37 were used to measure addiction severity, quality of life (QoL) and psychopathology, respectively. Correlates of motivation were identified using linear regression analyses.

Findings

Ugandan service users demonstrated low treatment motivation in the treatment needs a domain. While addiction severity (recent heavy alcohol use) and participating in private treatment were associated with higher internal and external motivation, deterioration in physical and environmental QoL, depressive symptoms and lower education were linked with higher internal motivation.

Research limitations/implications

Different elements affect domains of treatment motivation, requiring attention for clients’ unique needs as influenced by their background, addiction severity, QoL, psychological needs and contextual factors (e.g. treatment setting). Further studies are needed to explore additional correlates of motivation for treatment among alcohol service users in Uganda and to assess the longitudinal impact of motivation on treatment outcomes.

Originality/value

Although motivation has been extensively studied, clinicians are challenged in understanding and explaining motivational dynamics given the multiplicity of factors influencing change-related decisions and behaviours and the diversity in substance-using populations. This need is even bigger in non-Western societies as cultural differences may require differential therapeutic management. This is one of the first studies measuring motivation for AUD treatment in a low-income country and offers insight for understanding motivation dynamics in similar settings.

Redemption from plight: a qualitative study on reasons behind treatment decisions among Iranian male opioid users

BACKGROUND

Opioid use remains a significant cause of harm to individual health. Perceived motives are of the main factors that help lead a patient into seeking treatment voluntarily to obviate that harm. The current study expands on the literature by exploring when and how male users of opioids become motivated to voluntarily seek treatment services.

METHODS

In a qualitative study in Isfahan city from January 2018 to March 2019, 55 male participants who had already started a variety of treatment services to withdraw their dependence on opioids were recruited. Selection of participants was based on a maximum variation purposive sampling strategy. Each participant took part in a unstructured interview to identify his motives for seeking opioid use treatment. Interviews were undertaken in eight different treatment centers. An inductive thematic analysis method was used to analyze the interviews.

RESULTS

The findings highlight that Iranian male opioid users have different motivations to seek treatment. To be precise, the findings illuminate three global themes and six themes as treatment-seeking motives among the participants including; motives related to family (reason for family and reason of family), quality of life (adverse effects on personal lifestyle and health) and economic motives (financial failure and job failure).

CONCLUSIONS

The findings can improve our understanding of the motives for seeking treatment from the perspective of opioid patients who entered themselves into treatment. Particularly, these findings could help policymakers and treatment providers to better understand opioid-use patient's perceived concerns and fears as motives for treatment-seeking.

Self-Perceptions and Benefit Finding Among Adolescents With Substance Use Disorders and Their Caregivers: A Qualitative Analysis Guided by Social Identity Theory of Cessation Maintenance

Substance use disorders (SUDs) among young people have been linked with a range of adverse health consequences that can be successfully mitigated with early SUD treatment. According to the Social Identity Theory of Cessation Maintenance (SITCM), psychosocial processes including self-perceptions and benefit finding evolve with treatment, influencing recovery-based identities that can facilitate treatment success. However, this process has only been documented with adults; thus, the current study seeks to characterize these psychosocial processes among young people in SUD treatment and their caregivers. Nineteen young people receiving SUD treatment and 15 caregivers were interviewed about treatment experiences including negative self-perceptions, positive self-perceptions, and benefit finding. Results support the SITCM: Adolescents described escaping negative self-perceptions associated with the “substance use self” identity and strengthening a new “recovery self” identity characterized by positive self-perceptions and benefit finding. Caregivers described how extrinsic sources of support can help mitigate negative self-perceptions.

Predictors of five-year relapse rates of youths with substance abuse who underwent a family-oriented therapy program

BACKGROUND

Substance abuse among young people has become a serious public health problem for years. The risk of relapse among illicit drug use is essential for developing adequate substance reuse prevention policies. The purpose of the current study is to investigate the potential predictor in long-term relapse rates among young patients that underwent a family-based treatment program.

METHODS

To perform this study, 103 young patients with substance use (mean age: 16.2 years, 78.6% male) were referred to participate in a 10-week family-based treatment program. At the beginning and at the end of the treatment, the patients were required to fill out the Chinese Craving Beliefs Questionnaire (CCBQ), the Adolescents' Behavior-problem Scale (ABS), and the Family APGAR. Furthermore, the patients' caregivers had to fill out the Family APGAR, the 12-item version of the Chinese Health Questionnaire (CHQ), and the Parenting Stress Index (PSI). All patients were followed up for 5 years in order to observe their long-term outcomes regarding substance use relapse.

RESULTS

During the 10-week family-oriented programs, the CCBQ scores, the CHQ scores and the Child-domain of PSI significantly decreased. Better changes in patients' behavioral problems during the treatment program predicted a lesser likelihood of substance use relapse in the subsequent 5 years. Furthermore, methamphetamine or 3,4-methylenedioxy-methamphetamine use and living in single-parent families were two factors associated with higher relapse rates.

CONCLUSIONS

The changes in patients' behavioral problems during the treatment program may serve as a predictor of substance use relapse over the subsequent 5 years. This study's findings provide insight about substance use prevention and serve as a reference for policy-making.

Text Messaging to Enhance Behavioral Health Treatment Engagement Among Justice-Involved Youth: Qualitative and User Testing Study

BACKGROUND

Mental health and substance use disorders are highly prevalent in justice-involved youth, yet only 8% of court-involved, nonincarcerated (CINI) youth in need of treatment receive it. Dual diagnosis (co-occurring psychiatric and substance use disorders) in justice-involved youth is highly predictive of recidivism. Identifying novel approaches, such as the use of mobile health (mHealth) technologies, to close this gap between need and receipt of behavioral health treatment for the CINI population could potentially offset rates of reoffending into adulthood. Text-messaging (short message service, SMS) interventions have demonstrated efficacy in improving treatment adherence and other associated outcomes in other vulnerable youth populations, but development and testing of mHealth interventions to improve behavioral health treatment rates and outcomes for CINI youth are lacking.

OBJECTIVE

This study aimed to collect qualitative data from key stakeholders to inform the development of a theoretically grounded, family-based text-messaging (SMS) intervention targeting CINI youth's behavioral health treatment engagement; additionally, the aim was to conduct end-user testing over 6 months with CINI youth and caregivers to determine intervention feasibility and acceptability.

METHODS

CINI youth and caregivers were referred from a California-based Juvenile Probation Department and community-based provider organizations providing services for justice-involved youth. Eligibility criteria included the following: being a justice-involved youth or a caregiver of a justice-involved youth, English speaking, youth aged 13 to 17 years old and either referred to or currently attending mental health or substance use treatment, and youth and caregiver have access to a cell phone with text-messaging capability.

RESULTS

Overall, 28 individuals participated in focus groups and interviews-8 youth, 5 caregivers, and 15 juvenile justice (JJ) personnel. Three major themes emerged: (1) texting among JJ personnel and CINI youth and caregivers in their caseload is common but not systematic, (2) stigma and privacy are perceived as barriers to texting youth about behavioral health treatment appointments, and (3) messages should be short, simple, relatable, positive, and personalized. In total, 9 participants (7 youth and 2 caregivers) participated in end-user testing and rated the intervention as useful, helpful, and supportive.

CONCLUSIONS

Text messaging (SMS) is an acceptable and feasible means of reminding CINI youth to attend behavioral health treatment appointments. Future implementation challenges include making text messaging (SMS) personalized and tailored but not resource intensive (eg, requiring one-to-one, 24/7 human contact) and identifying which systems will deliver and sustain the intervention. Text messaging (SMS) among justice personnel, youth, and their caregivers is already widespread, but lack of clear guidelines about privacy, confidentiality, and information sharing poses ethical conundrums. Future hybrid-type research designs that explore the efficacy of the intervention while also studying ethical, system, and policy-level factors associated with using digital health interventions to improve CINI youth outcomes is a key next step.

Disclosure, Stigma, and Social Support among Young People Receiving Treatment for Substance Use Disorders and their Caregivers: A Qualitative Analysis

Relational processes (i.e., disclosure, stigma, social support) experienced by youth with substance use disorders (SUDs) and their caregivers may act as barriers to, or facilitators of, recovery but are understudied. Single-session qualitative semi-structured interviews were conducted with 19 patients and 15 caregivers recruited by clinicians from a SUD program. There was variability in disclosure experiences, including how many people knew about patients' SUD diagnosis and treatment, whether patients or caregivers primarily disclosed to others, and feelings about others knowing about one's or one's child's SUD treatment. After disclosing, patients and caregivers experienced stigmatizing (e.g., social rejection) and supportive (e.g., understanding, advice) reactions from others. Disclosures may have important implications for relationship and recovery-related outcomes. Moreover, some child-caregiver pairs have significant disagreements regarding disclosure of SUD treatment. Addressing relational processes within treatment by encouraging patients and caregivers to share the disclosure decision-making process may support the recovery of youth with SUDs.