Tracking the long-term functioning of adolescents with alcohol problems

While many adolescents reduce their alcohol use and have fewer related problems following treatment, a significant proportion continue to drink and/or use other drugs, have poor relations with family and friends, and experience academic problems. Scientists say that long-term studies of treated adolescents are essential for determining what impact treatment can have and what factors may change the severity of alcohol problems over time.

These findings, gathered from four studies of adolescents who were followed for one to eight years after treatment, were presented at a symposium during the joint June 2002 Research Society on Alcoholism/International Society for Biomedical Research on Alcoholism meeting in San Francisco. Symposium proceedings can be found in the February issue of Alcoholism: Clinical & Experimental Research.

"We know very little about the impact that adolescent problem drinking has on academic achievement, relations with family and friends, and employment through young adulthood," said Tammy Chung, assistant professor of psychiatry at the University of Pittsburgh Medical Center and co-organizer of the symposium. "Longer-term studies can help us to understand how certain developmental milestones, such as full-time employment and independent living, affect the course of alcohol problems that begin in adolescence. Longer-term studies can also tell us which adolescents are most likely to continue or return to problem drinking, and how treatment can be improved to more effectively meet their specific needs."

Findings presented at the symposium included:

• Treatment works for many teens. At least half of the adolescents studied showed reductions in alcohol use and problems following treatment, with concurrent improvements in psychosocial functioning.

• Treatment needs can change. The severity and frequency of alcohol problems among treated youth can fluctuate over the long term.

  "Researchers have identified multiple pathways of change in alcohol use and problems," said Chung. "About half of the treated adolescents maintained low levels of alcohol use and problems through young adulthood, while some treated adolescents experienced continuing alcohol problems."

• Use of other drugs following treatment is associated with greater alcohol use and related problems.

  "Adolescents who drank and used other drugs, such as marijuana, after treatment," said Chung, "generally had poorer outcomes in the areas of family relations and academic achievement. These poorer outcomes appeared to last through young adulthood."

• Researchers and clinicians need to consider the impact of developmental milestones on the course of adolescent-onset substance-use disorders.

  "We need to know more about the impact of certain developmental milestones - full-time employment, obtaining a driver's license, independent living - on the course of alcohol problems in treated youth," said Chung. "This will allow us to improve the timing, such as the addition of booster sessions, and content of interventions for youth."

• The value of pretreatment characteristics, such as a family history of alcoholism, may become more evident as youths transition into adult roles.

"The bottom line," said Chung, "is that alcohol problems that begin in youth do not necessarily have a chronic course. If we can identify the risk factors associated with alcohol problems that continue into young adulthood among treated youth, we can improve the effectiveness of their treatment.

Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors/presenters of the symposium proceedings published in ACER included: Christopher S. Martin of the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center; Christine E. Grella of the Drug Abuse Research Center, Neuropsychiatric Institute, University of California, Los Angeles; Ken C. Winters of the Center for Adolescent Substance Abuse Research at the University of Minnesota School of Medicine; Ana M. Abrantes of the Center for Alcohol and Addiction Studies at Brown University; and Sandra A. Brown of the VA San Diego Health Care System and the University of California, San Diego. The studies were funded by the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the Center for Substance Abuse Treatment.