Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Despite considerable concern about adolescents who use/abuse alcohol and other drugs (AOD), little is known about how such adolescents are functioning as young adults. To what degree do AOD problems in adolescence interfere with the development of adult life skills, and can these skills be learned later? Do adolescent substance abusers need to “work their recovery” throughout their lives or can some “age out” of problems with AOD without significant longer-term implications? What types of treatment and recovery strategies lead to better circumstances in later life? This grounded theory study analyzes the current functioning and life experiences of a group of young adults who had significant AOD problems in adolescence. From these data, we extract key questions for future research and implications for practice.

Methods:

Ten women and twelve men between the ages of 21 and 30 were interviewed from 6 to 13 years after entry into an intensive residential treatment program for adolescents. Interviewees entered treatment between the ages of 14 and 17. We also extracted data from treatment files about circumstances prior to and during treatment. Interview topics included treatment experiences, key positive and difficult events before and since treatment, goals and current circumstances, and perceptions of what has helped and hindered reaching their goals. After organizing all data into common formats, four researchers independently categorized interviewees' current functioning by coding their current status in 10 life areas. We constructed thematic calendars of key life events, identified facilitators, barriers, and recovery strategies, and compared and contrasted these within and between categories.

Results:

Interviewees were categorized as: a) overall positive functioning (5); b) some problematic AOD use but functioning well in other life areas (4); c) “troubled recovery” [no AOD use but trouble in some life areas (5)]; d) “precariously functioning” with significant difficulties in several life areas (5); and e) major difficulties in many life areas including AOD (3). We present several types of timelines for the different clusters, and identify key strengths and challenges at time of treatment, status immediately post-treatment, and different trajectories post-treatment. Circumstances at times of relapse provide opportunities for growth for some, but major negative turning points for others. We identify the impact of the age when major problems began and some differences by gender in the types of issues and problems experienced.

Discussion/Implications:

In this sample, what was known at time of treatment does not help us to understand functioning in young adulthood, although several participants report drawing on things they learned in treatment to inform decisions and problem-solving at later stages. Recovery strategies vary widely, with positive peer and social support and meaningful activities appearing to be especially important for those who are doing better at the time of interview. Unaddressed co-occurring psychological disorders appear to be one factor for some who are struggling. Very few in any category are regularly attending self-help groups. We discuss some implications for future research (e.g., focusing on relapse and key decision-points within life-calendars), issues in understanding adolescent substance abuse, and for service options.