A substantial portion of adolescents who are admitted substance users may be willing to change their behavior regarding their alcohol or illicit drug use, according to research from Nationwide Children’s Hospital.
“Substance use is among the most prevalent and serious public health issues for adolescents in the United States,” said Jack Stevens, PhD, principal investigator in the Center for Behavioral Health at The Research Institute at Nationwide Children’s and study author. “Prior studies have suggested that patients often fit into one of three categories regarding readiness to change: Precontemplation, not even considering decreasing substance use; Contemplation, considering decreasing substance use; and Action, taking steps to decrease substance use.”
The literature on readiness to change has primarily focused on adults. The available studies on adolescents have largely included hospitalized and/or incarcerated youths with severe substance-related difficulties. “Little research has been completed regarding readiness to change focused on a primary care system’s teenage population, which consists of youths typically engaging in less serious forms of substance use,” said Dr. Stevens.
To examine readiness to change in this patient population, Dr. Stevens and colleagues from Nationwide Children’s designed a study in which 1,528 adolescents from nine of Nationwide Children’s primary care clinics completed behavioral screening in waiting rooms to evaluate for drug use. One hundred sixty-eight patients screened positive for alcohol and/or illicit drug use during the past month. Of this group, adolescents were ask to complete a “Readiness to Change Questionnaire” and were also screened for depressive symptoms.
The study’s findings showed that a substantial portion of primary care youths who screened positive for alcohol and/or illicit drug use within the past month reported some willingness to reduce their substance use. Nearly 60 percent of these positive screens were in the Action stage, with another 16 percent in the Contemplation stage.
Depressive symptoms emerged as a significant predictor of later stages of change. Also, adolescent suicidal ideation was related to later stages of change. “These findings suggest that emotional distress might lead certain adolescents to at least consider reducing their experimental or mild levels of substance use,” said Dr. Stevens. “Therefore, pediatricians encountering particular youths who are both using substances and experiencing emotional distress may especially want to concentrate their prevention and treatment efforts on this subgroup.”
Although Dr. Stevens cautions in generalizing these findings to all adolescent primary care patients, he says primary care sites may be excellent targets for prevention and early intervention efforts. “Pediatricians should not assume that their adolescent patients are typically resistant to considering or taking steps to reduce substance use.”
Future studies are needed to determine if and how depressive symptoms predict actual reductions in adolescent substance use, not just motivation to change.
Stevens J, McGeehan J, Kelleher KJ. Readiness to change in adolescents screening positive for substance use in urban primary care clinics. J Child Adolesc Subst Abuse. 2010 Apr 1;19(2):99-107.