The development of a unique designated community drug service for adolescents: Policy, prevention and education implications

This paper describes the initiation and development of the first designated service for adolescent drug misusers in the UK between 1995 and 1997. The priorities and objectives of the multi-agency partnership and multi-profess ional team were to provide the first recognized designated methadone servic e for adolescent drug misusers, to identify and treat psychiatric comorbidi ty and to co-ordinate and liaise with other agencies and professionals. The objectives to attract, engage and retain adolescent drug misusers into tre atment were achieved with 272 young people attending. The project has provi ded a service in an appropriate environment, staffed by personnel competent in responding effectively to the complex needs with which these young peop le present. Protocols have been developed which ensure a focused and timely response, and highlight the frustrations inherent in the absence of a desi gnated service. Since there are few models of good practice nationally, and , as a result, even less outcome research, this paper outlines the characte ristics of the first 48 (mean age=17.1 years at initial consultation) patie nts with severe heroin dependence who accessed the designated community dru g service and were prescribed methadone. The early age of initiation into s ubstance use (mean = 13.3 years) and heroin use (mean = 15.8 years), the de velopment of heroin dependence within a year, and injecting in 70%, highlig ht the importance of addressing these young patients' needs as early as pos sible. Only 30% were living with both parents, and in only 25% were both pa rents employed. Only 16% had taken examinations, and 25% had been excluded from school. Despite this, none were referred via the educational system. O nly 13% were referred via the criminal justice system, though 56% had drug- related offences. General practitioners were prescribing analgesics or psyc hotropics in 40%, yet referred only 10%. Likewise, though 33% had a history of deliberate self-harm, psychiatrists had referred only 4%. Thus, the los t opportunities for targeting treatment and prevention are multiple. Howeve r, even against the background of severe disadvantage, 80% of young people prescribed methadone were retained in the service. Almost 40% complied or c ompleted the agreed treatment plan, and demonstrated improved psychosocial functioning. Predictors of good outcome included supportive parents, educat ional achievement, and no psychiatric or forensic history. The implications of these findings are discussed ill relation to service delivery, policy d evelopments and research and educational activities.