Ib. Crome et al., The development of a unique designated community drug service for adolescents: Policy, prevention and education implications, DRUG-EDUC P, 7(1), 2000, pp. 87-108
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.