Long-Term Outcomes of Adolescent Outpatient Treatment for Substance Use Problems: Exploring the Co-occurrence of Mental Health and Substance Use Problems

Descriptives	Total	SUP/no MHP	No SUP/MHP	SUP/MHP	no SUP/no MHP
Descriptives	N=451	n=69	n=90	n=58	n=234
%	%	%	%	%
Sex
Girls	29	7	40	38	30
Boys	71	93	60	62	70
Age (mean)	17	17	17	17	17
Living with parents	72	84	74	60	71
Low level of education for parents (primary school)	4	10	2	-	4
Reading and writing difficulties	19	28	18	29	14
Upper secondary school eligibility	68	52	74	67	71
Lack of employment	18	17	20	19	18
Serious conflicts with parents	36	29	36	35	39
Arrested for crime	61	78	48	60	62
Hazardous Alcohol Consumption (AUDIT)	48	36	50	50	50
Primary drug
Alcohol	14	6	18	14	15
Cannabis	77	86	71	81	75
Other drugs	9	9	11	5	10
Primairy drug use requency 2–3 days/week or more	49	55	38	57	49
Polydrug use	38	33	37	47	38
Anxiety or worry	49	38	63	57	46
Concentration problems	58	52	67	69	55
Suicide thoughts	8	7	8	9	8
Eating disorder	8	6	9	9	8
Self-harm behavior	7	1	4	12	8
Medication for Mental Health Problems	21	9	39	40	13

[i] Note. SUP=Substance use problems and MHP=Mental health problems

TABLE 2.

Descriptives of outcome indicators: Mental Health Problems (MHP) and Substance Use Problems (SUP) three years after initiated treatment.

	Total	Girls	Boys
	N=451	n=131	n=320
%	%	%	Chi-2	p-value
Indication of mental health problems (MHP)	33	44	28	10.47	0.00^**
Outpatient treatment, psychiatry	22	30	18	7.60	0.00^**
In-patient treatment, psychiatry	5	6	4	0.56	0.45
Medical treatment, mental illness	29	41	24	12.74	0.00^**
Indications of Substance use problems (SUP)	28	20	31	5.48	0.02^*
Outpatient substance use care	16	17	15	0.30	0.59
Inpatient substance use care	7	5	7	0.55	0.46
Medication for alcohol or drug use problems	1	1	1	0.02	0.88
Compulsory care	2	2	2	0.22	0.64
Substance use–related criminality	15	5	19	13.92	0.00^**

Note.

* p < 0.05,

** p < 0.01

TABLE 3.

Categories of psychiatric diagnoses according to ICD-10 during follow-up three years after initiated treatment for the outcome groups. Percentage distribution.

	Total	SUP/no MHP	no SUP/MHP	SUP/MHP no	SUP/no MHP
	N=451	n=69	n=90	n=58	n=234
%	%	%	%	%	Chi-2	p - value
Diagnostic category						463.514	<0.001
Assesment/observation	4	0	12	10	0
Anxiety/depression	14	0	43	40	0
Neurodevelopmental disorders	12	0	39	35	0
Psychosis/bipolar etc	2	0	6	16	0
No diagnosis	67	100	0	0	100

[i] Note. Percentages in italics are those with adjusted residuals that exceed +/− 2. SUP=Indication of Substance Use Problems. MHP=Indication of Mental Health Problems, SUP/MHP=Indication of coocurring Mental Health Problems and Substance Use Problems. NI=No Indication.

TABLE 4.

Bivariate association and logistic regression analysis of risk factors in relation to the outcome group Mental Health Problems (MHP) and Substance Use Problems (SUP) three years after initiated treatment. Odds ratio and confidence interval are reported (N=451).

Psychosocial risk factors	no SUP/MHP			SUP/MHP
	Bivariate association	Model 1	Model 2	Bivariate association	Model 3	Model 4
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
1. Lack of occupation	1.16 (0.65–2.08)	0.92 (0.50–1.69)	1.11 (0.58–2.16)	1.06 (.52–2.15)	.90 (.43–1.91)	.97 (.44–2.12)
2. Problems at school	2.75 (1.41–5.39)^**	2.51 (1.24–5.04)^*	2.53 (1.24–5.16)^*	1.15 (.60–2.22)	.94 (.47–1.91)	.91 (.45–1.85)
3. Placement in foster care/residential home	0.82 (0.45–1.50)	0.68 (0.36–1.26)	0.70 (0.37–1.32)	2.17 (1.19–3.98)^*	2.02 (1.07–3.80)^*	2.00 (1.06–3.76)^*
4. Problems in childhood environment	1.29 (0.80–2.08)	1.00 (0.58–1.71)	1.08 (0.62–1.88)	1.74 (.96–3.18)	1.48 (.76–2.86)	1.47 (.76–2.85)
5. Early drug debut	1.36 (0.80–2.32)	1.34 (0.76–2.35)	1.18 (0.66–2.10)	1.40 (.75–2.62)	1.17 (.61–2.26)	1.17 (.60–2.27)
6. Delinquent peers	1.09 (0.62–1.93)	0.98 (0.55–1.78)	1.24 (0.67–2.31)	.93 (.46–1.88)	.84 (.41–1.73)	.82 (.39–1.72)
7. Exposure to violence	1.43 (0.88–2,33)	1.11 (0.64–1.91)	1.09 (0.62–1.93)	1.48 (.82–2.67)	1.18 (.62–2.28)	1.16 (.59–2.25)
8. Depression	1.99 (1.24–3.19)^**	1.81 (1.07–3.07)^*	2.00 (1.14–3.50)^*	1.30 (.73–2.29)	1.05 (.55–1.99)	1.01 (.52–1.96)
9. Violent behavior	1.19 (0.69–2.05)	0.84 (0.47–1.51)	0.79 (0.43–1.44)	1.42 (.76–2.66)	1.40 (.71–2.76)	1.43 (.73–2.82)
10. Traumatic events	1.40 (0.87–2.25)	1.07 (0.63–1.82)	1.01 (0.58–1.74)	1.27 (.72–2.24)	.96 (.51–1.81)	.93 (.49–1.77)
Covariates
Sex	1.72 (1.03–2.90)^*			1.46 (0.80–2.69)
Age	1.00 (0.90–1.11)			0.97 (0.85–1.10)
Primary drug use frequency at intake	0.44 (0.26–0.75)^**			1.43 (0.78–2.62)

Note.

* p < 0.05;

** p < 0.01.

Note. Model 1 and Model 3 includes risk factors 1–10 and Model 2 and Model 4 includes risk factors 1–10 but also sex, age and primary drug use frequency at intake. Model 1: χ² [10] = 18.73, p = 0.04, Nagelkerke’s quasi R² = 0.06. Model 2: χ² [13] = 32.31, p = 0.00, Nagelkerke’s quasi R² = 0.11. Modell 3: χ² [10] = 10.12, p = 0.43, Nagelkerke’s quasi R² = 0.04. Modell 4: χ² [13] = 13.32, p = 0.42, Nagelkerke’s quasi R² = 0.05.

TABLE 5.

Odds ratios and confidence intervals for the association between adolescent cumulative risk in relation to the outcome group Mental Health Problems (MHP) and Substance Use Problems (SUP) three years after initiated treatment (N=451).

Cumulative risk	no SUP/MHP	SUP/MHP
Cumulative risk	OR (95 % CI)	OR (95 % CI)
	Model 5	Model 7
0–2 risk factors (31%) Ref	1	1
3–5 risk factors (49%)	1.85 (1.03–3.34)^*	1.69 (0.84–3.43)
6–10 risk factors (21%)	2.53 (1.29–4.97)^**	2.25 (1.01–5.00)^*
	Model 6	Model 8
0–2 risk factors (31%) Ref	1	1
3–5 risk factors (49%)	1.93 (1.05–3.55)^*	1.61 (0.78–3.30)
6–10 risk factors (21%)	2.74 (1.33–5.64)^**	2.09 (0.89–4.90)
Covariates
Sex	1.78 (1.08–2.93)^*	1.45 (0.81–2.60)
Age	1.02 (0.92–1.12)	0.95 (0.85–1.07)
Primary drug use frequency at intake	0.47 (0.28–0.78)^**	1.09 (0.92–1.29)

Note.

* p < 0.05,

** p < 0.01.

Model 5 and 7 includes the level of cummulative risk, Model 6 and Model 8 includes both the level of cumulative risk but also includes sex, age and primary drug use frequency at intake. Model 5: χ² [2] = 7.98, p = 0.02, Nagelkerke’s quasi R² = 0.03. Model 6: χ² [5] = 21.39, p = 0.00, Nagelkerke’s quasi R² = 0.07. Model 7: χ² [2] = 4.24, p = 0.12, Nagelkerke’s quasi R² = 0.02. Model 8:(χ² [5] = 7.09, p = 0.21, Nagelkerke’s quasi R² = 0.03.

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DOI: https://doi.org/10.2478/sjcapp-2024-0013 | Journal eISSN: 2245-8875

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Language: English

Published on: Dec 21, 2024

Published by: Center for Evidence-based Psychiatry

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Adolescents,

Substance use problems (SUP),

Mental health problems (MHP),

Co-occurring problems,

Longitudinal study

Related subjects:

Medicine,

Basic medical science,

Basic medical science, other

© 2024 Karin Boson, Mats Anderberg, Peter Wenneberg, Sabina Vlasman, Sabina Kapetanovic, Mikael Dahlberg, published by Center for Evidence-based Psychiatry
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 12 (2024): Issue 1 (January 2024)