Clinical characteristics of youths with substance use problems and implications for residential treatment

Objective: Despite high rates of dual diagnosis among children and adolesce nts and evidence that adults with coexisting substance use disorders requir e specialized services, many children are placed in residential settings an d are offered uniform service packages regardless of their individual clini cal profiles. The authors examined the rate of substance use problems in a sample of children and adolescents with severe emotional. or behavioral dis turbances who were in residential treatment. Differences in clinical charac teristics and placement outcomes between children with and without coexisti ng substance use disorders were evaluated. Methods: This retrospective stud y analyzed clinical data obtained by chart review using the Child Severity of Psychiatric Illness, a rating scale for symptom severity. The study subj ects were 564 children and adolescents in residential treatment and state c ustody in Florida and Illinois who had serious emotional or behavioral dist urbances. Results: Twenty-six percent of boys and 37 percent of girls had s ubstance use problems in addition to serious emotional or behavioral distur bances. Residents with co-occurring substance use disorders were significan tly more likely than those with serious emotional or behavioral disturbance s only to be at risk for suicide, elopement from residential placement, del inquent behavior, and institutional discharge placement. Conclusions: Child ren and adolescents with coexisting substance use problems require individu alized service packages to address their greater need for supervision and h igher rate of risk behaviors and to facilitate community discharge placemen ts.