Clinical characteristics of youths with substance use problems and implications for residential treatment

Objective: Despite high rates of dual diagnosis among children and adolescents and evidence that adults with coexisting substance use disorders require specialized services, many children are placed in residential settings and are offered uniform service packages regardless of their individual clinical profiles. The authors examined the rate of substance use problems in a sample of children and adolescents with severe emotional or behavioral disturbances who were in residential treatment. Differences in clinical characteristics and placement outcomes between children with and without coexisting substance use disorders were evaluated. Methods: This retrospective study analyzed clinical data obtained by chart review using the Child Severity of Psychiatric Illness, a rating scale for symptom severity. The study subjects were 564 children and adolescents in residential treatment and state custody in Florida and Illinois who had serious emotional or behavioral disturbances. Results: Twenty-six percent of boys and 37 percent of girls had substance use problems in addition to serious emotional or behavioral disturbances. Residents with co-occurring substance use disorders were significantly more likely than those with serious emotional or behavioral disturbances only to be at risk for suicide, elopement from residential placement, delinquent behavior, and institutional discharge placement. Conclusions: Children and adolescents with coexisting substance use problems require individualized service packages to address their greater need for supervision and higher rate of risk behaviors and to facilitate community discharge placements.