The Characteristics of Adolescent Tailored Substance Use Treatment Facilities & Services: Implications for Organizations & Management

Background and Purpose:
Adolescent substance use remains a significant public health issue in the United States, with recent data revealing concerning trends and areas of stability. According to the Monitoring the Future Survey (2023), self-reported use of alcohol, cannabis, and illicit drugs among adolescents remained unchanged between 2021 and 2022, following a decline in 2021. However, narcotics use, particularly opioids like Vicodin and OxyContin, saw a slight increase among 12th graders. Moreover, overdose deaths among adolescents aged 10 to 19 rose significantly (109%) from 2019 to 2021, including deaths linked to fentanyl. These trends highlight an urgent need for targeted intervention and effective treatment strategies for adolescent substance use. Despite the recognized need, treatment access remains limited, with barriers such as stigma, perceived need for treatment, and readiness to change hindering service utilization. In 2017, approximately one million adolescents needed substance use disorder (SUD) treatment, yet only 184,000 adolescents received any form of treatment. This gap in service utilization underscores the importance of examining the availability and quality of adolescent-focused substance use treatment services, especially in light of disparities in access across regions and insurance types.

Methods:
This study, guided by the Andersen Behavioral Model of Health Services Use, examines facility characteristics of adolescent substance use treatment services. Using data from the 2017 and 2019 National Surveys of Substance Abuse Treatment Services (N-SSATS), we identified facilities providing adolescent-specific treatment services for ages 12 to 17. Statistical analyses, including chi-square and Fisher's exact tests, were employed to compare facility characteristics between 2017 and 2019. SPSS version 29 was used to analyze the data with an alpha level of 0.05.

Results:
In 2017, 3,537 facilities offered adolescent-focused substance use treatment services, compared to 3,211 in 2019. The South led the nation in service provision in both years, but the West saw a notable increase in service availability between 2017 and 2019. Significant reductions in intensive outpatient programming (p<0.05), outpatient services (p<0.05), and non-hospital residential services (p<0.05) were observed. Conversely, the availability of ancillary social services (p<0.05) and substance abuse education (p<0.05) increased. Payment source analysis revealed a decline in the number of facilities accepting Medicaid (p=0.001), private pay, and state-financed payments between 2017 and 2019. Additionally, there was a decrease in facilities with state health department licensure (p<0.05) and state substance abuse agency licensure (p<0.001), while accreditation by the Joint Commission increased (p<0.05).

Conclusions and Implications:
This study underscores the shifting landscape of adolescent substance use treatment services over a short period. The findings emphasize the need for more affordable, accessible, and tailored treatment options to meet the growing demand for adolescent substance use services. Disparities in treatment availability based on region, payment source, and licensure highlight critical areas for policy intervention. These results also stress the vital role of organizations and management in ensuring adequate resources and infrastructure to address the adolescent substance use crisis effectively. Ensuring that treatment services align with adolescents' unique needs and barriers to care is essential in addressing the public health challenge of adolescent substance use.