The Development of a Unique Designated Community Drug Service for Adolescents: policy, prevention and education implications

Abstract

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-professional team were to provide the first recognized designated methadone service for adolescent drug misusers, to identify and treat psychiatric comorbidity and to co-ordinate and liaise with other agencies and professionals. The objectives to attract, engage and retain adolescent drug misusers into treatment were achieved with 272 young people attending. The project has provided a service in an appropriate environment, staffed by personnel competent in responding effectively to the complex needs with which these young people present. Protocols have been developed which ensure a focused and timely response, and highlight the frustrations inherent in the absence of a designated service. Since there are few models of good practice nationally, and, as a result, even less outcome research, this paper outlines the characteristics of the first 48 (mean age = 17.1 years at initial consultation) patients with severe heroin dependence who accessed the designated community drug service and were prescribed methadone. The early age of initiation into substance use (mean = 13.3 years) and heroin use (mean = 15.8 years), the development of heroin dependence within a year, and injecting in 70%, highlight the importance of addressing these young patients' needs as early as possible. Only 30% were living with both parents, and in only 15% were both parents employed. Only 16% had taken examinations, and 25% had been excluded from school. Despite this, none were referred via the educational system. Only 13% were referred via the criminal justice system, though 56% had drug-related offences. General practitioners were prescribing analgesics or psychotropics in 40%, yet referred only 10%. Likewise, though 33% had a history of deliberate self-harm, psychiatrists had referred only 4%. Thus, the lost opportunities for targeting treatment and prevention are multiple. However, even against the background of severe disadvantage, 80% of young people prescribed methadone were retained in the service. Almost 40% complied or completed the agreed treatment plan, and demonstrated improved psychosocial functioning. Predictors of good outcome included supportive parents, educational achievement, and no psychiatric or forensic history. The implications of these findings are discussed in relation to service delivery, policy developments and research and educational activities.