Pathways to Chemical Dependency Treatment for Adolescents in an HMO†

Abstract

This study examines pathways to chemical dependency (CD) treatment for adolescents in a prepaid health plan, including factors influencing treatment referral and access. Data were collected from 419 adolescent CD treatment intakes ages 13 to 18 in a large, private health plan. The study examines predictors of referral from different sources and of mental health treatment prior to CD treatment. Referral patterns, problem severity, and psychiatric comorbidity differed by gender. Being male (p < .05) and higher scores on the Youth Self-Report (YSR) externalizing scale (p < .01) predicted a justice system referral. Using more types of substances predicted referral by medical and mental health providers (p < .05) and self-referral (p < .01). Higher YSR internalizing scores predicted referral from mental health (p < .01) and self-referral (p < .01). Being White versus African American (p < .05) or Latino (p < .01), older (p < .05), and having higher YSR internalizing scores (p < .05), a conduct disorder (p < .01), or a family member with a substance use problem (p < .01) predicted a mental health visit prior to CD intake. The findings raise questions regarding the role of health plans, clinicians, families, schools, and community agencies in referring and treating adolescents with substance use problems. They suggest that improved coordination of care may promote more integrated treatment practices, which could decrease substance use, mental health, and medical problem severity. †This study was supported by the Robert Wood Johnson Foundation, the Center for Substance Abuse Treatment, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism. The authors would like to thank the counselors, therapists and program directors of the adolescent CD programs for their support of the project, and recruiters Georgina Berrios, Melanie Jackson-Morris, Carolynn Kohn, Cynthia Perry-Baker, and Sandra Wolters. In particular, we would like to thank Michael Leotaud, L.C.S.W. for suggesting the study. Thanks also to Andy Avins, M.D. for comments on a previous draft, and Agatha Hinman for editorial assistance.