Alcohol and drug abuse could also mean a host of other problems, New Zealand researchers have found.
Youth who undergo alcohol and other drug (AOD) treatment have also to grapple with mental health issues, criminal conviction, family conflict and disengagement from school. That obviously means the staff too have to be appropriately trained.
Predictably a majority of young people are referred for treatment by schools, health services, family or the justice system, and only a very small minority turn up on their own.
The study has been carried out by the University of Otago Christchurch's National Addiction Centre and has been published in the Australian and New Zealand Journal of Psychiatry.
The researchers investigated the profile of young people attending AOD services by gathering data from clinical files of 184 randomly selected people between the ages of 13-19 years who attended one of eight treatment services.
"These results show the kinds of young people who use these services and the complex issues that they, and the treatment services, must deal with," says lead investigator Dr Ria Schroder. "It's very important to understand the findings in this study are not related to any one service in particular, but tell a story about what is happening across youth AOD treatment services as a whole in New Zealand.
"One of the issues that these findings highlight, and which probably needs further attention, is the extent to which staff have the skills to respond to the very complex needs and difficult problems of these young people," says Dr Schroder.
"This is not to undermine the important work that staff are currently doing, but highlights that we need to make sure that staff are well supported in their often difficult work."
A particular area of concern that emerged from the study was the apparent under reporting of mental health and substance use diagnoses in treatment files. This suggests that the rates of substance misuse and mental health issues among youth attending AOD treatment may be higher than recorded in this study. Issues of incomplete diagnosis have previously been found to negatively impact on treatment outcomes for youth. This is an issue that the authors recommend needs to be urgently addressed.
A further concern highlighted by the study is the small numbers of females attending residential treatment facilities despite reported increases in substance use and misuse among females, and equal numbers of males and females attending outpatient AOD services. This is likely to be related to the limited number of beds available for female youth and may be compounded by the fact that there are no specific female AOD youth residential programmes anywhere in the country.
Treatment retention is also a problem. It may be related to programme funding, and staff training and skill development. If young people don't stay for the full treatment period then treatment is likely to be less effective, and may not work at all.
25 per cent of young people attending AOD treatment dropped out earlier than advised to obtain optimal benefits, and nearly 50 per cent of young people attending AOD treatment were discharged by these services for reasons that were deemed not conducive to treatment.
This study shows a high number of discharges are because of disciplinary issues, raising questions about how to better engage and retain youth with a number of complex problems.
The researchers suggest that youth treatment services, regardless of whether they are for addiction or other issues, need to involve young people more by allowing them to engage in the running of the service, and to be active in the development and management of their individual treatment plans.