(38) Adolescent Substance Use: A Mixed Methods Assessment

Background: Effective prevention and identification of adolescent substance use could help reduce consequences associated with later substance use disorder (SUD). Evidence suggests adolescent initiation of substance use is a risk factor for progression to more substantial substance use later in life. School-based prevention programs can reach many students, but their effectiveness remains unclear. The present study was conducted to assess the scope of adolescent substance use and the determine the impact of substance use-related educational content, programs, workshops, and trainings delivered to middle and high school students by the non-profit group Rise Together (RT).

Methods: Anonymous, cross-sectional, mixed methods data were collected using an online survey from middle and high school students across 53 counties in Wisconsin from 2014 to 2020. Survey questions focused on substance use, recovery, and mental health related topics. Quantitative data were analyzed using STATA and SPSS. Thematic qualitative analysis of free text data, provided in response to an open-ended question about the utility of the RT activities, was performed using an inductive thematic coding approach. Two researchers reviewed the themes; discrepancies were resolved by consensus.

Results: The survey was initiated by 10,438 students; 10,379 (43% male, 55% female, 2% other gender) answered questions about substance use. Among those who answered substance use-related questions, 2,852 (27%) endorsed ever using alcohol or another substance, with 2,802 providing information about the age they initiated substance use: 331 began substance use during elementary school (as early as <8 years old), 1,020 during middle school, and 1,185 in high school. Out of those who reported ever using alcohol or substances, 241 asked for help regarding their usage and 110 reported previously asking for and receiving help, and being in a long-term recovery. The most common substances used where alcohol, tobacco, and marijuana, with increasing prevalence along the increasing school grades. Thematic analysis of 2,884 qualitative responses identified three overarching categories: Impact of the RT program, substance use experiences, and feedback about the RT presentation delivered at schools. The major themes within the RT impact category included: increased insight and knowledge of scope and consequences of substance use; and improved ability to ask for help or confidence to help others with substance use. In the substance use experiences category, the major themes included: increased insight into their own or other’s struggles with substance use; and reports of deaths due to addiction or substance use. The major themes within the RT presentation feedback category included: positive comments on and thankfulness for the presentation, presenters, and the stories shared; respondents viewed the use of personal storytelling and the relatability of presenters to be key to delivering the substance use/addiction recovery-related messages in a non-stigmatizing way, inviting further dialogue.

Conclusion:
Adolescent substance use is prevalent among middle and high school students, with some children initiating substance use during elementary school. The Rise Together program was well-received by participants and could be an important strategy to reduce substance use and its harms in adolescents.

References:
Slade, E.P., et al., Impacts of age of onset of substance use disorders on risk of adult incarceration among disadvantaged urban youth: a propensity score matching approach. Drug Alcohol Depend, 2008. 95(1-2): p. 1-13.

Tillson, M., et al., An Examination of the Age of Substance Use Onset and Adult Severity of Use Among Offenders Entering Treatment. Journal of Drug Issues, 2019. 49(2): p. 238-252.

Choi, H.J., et al., Adolescent substance use: Latent class and transition analysis. Addict Behav, 2018. 77: p. 160-165.

Griffin, K.W. and G.J. Botvin, Evidence-based interventions for preventing substance use disorders in adolescents. Child Adolesc Psychiatr Clin N Am, 2010. 19(3): p. 505-26.

Strom, H.K., et al., Effectiveness of school-based preventive interventions on adolescent alcohol use: a meta-analysis of randomized controlled trials. Subst Abuse Treat Prev Policy, 2014. 9: p. 48.