Addiction Nursing and the Quality of Adolescent Substance Abuse Treatment

Adolescent substance abuse is a significant public health problem in the United States. Nearly half of US twelfth graders have tried at least one illicit drug, and nonmedical use of prescription drugs is on the rise (Johnston, O’Malley, Bachman, & Schulenberg, 2007). Almost 30% of high school students report past-month binge drinking (Miller, Naimi, Brewer, & Jones, 2007). A recent study of adolescents screened in primary care practices found that nearly 15% screened positive for substance abuse (Knight et al., 2007). Substance abuse during adolescence poses short-term risks to physical and mental health (Delaney, Broome, Flynn, & Fletcher, 2001; Dennis, DawudNoursi, Muck, & McDermeit, 2003; Diamond et al., 2002) and sets the stage for continuing addiction during adulthood (Volkow & Li, 2005). The scientific literature has documented the effectiveness of adolescent substance abuse treatment in improving health outcomes (Brown, D’Amico, McCarthy, & Tapert, 2001; Hser et al., 2001; Muck et al., 2001; Winters, Stinchfield, Opland, Weller, & Latimer, 2000). Yet, while there is a sense that “treatment works,” it has been less clear how to define quality in service delivery at the level of treatment programs. Discussions of quality have been accelerating within the broader addiction treatment field (Garnick, Lee, Horgan, Acevedo, & Washington Circle Public Sector Workgroup, 2009; Institute of Medicine, 2006; McCarty, Gustafson, Capoccia, & Cotter, 2009; McLellan, Chalk, & Bartlett, 2007), but the quality of adolescent treatment has rarely been studied (Mark et al., 2006). Pioneering research by Brannigan and colleagues (2004) established a new paradigm for studying adolescent treatment quality. By reviewing the literature and eliciting input from an expert panel, they identified nine domains of quality in adolescent treatment services. Brannigan and colleagues suggested that high quality was indicated by services in the following nine domains: 1) assessment and treatment matching; 2) a comprehensive treatment approach that addresses key areas of the adolescent’s life; 3) involvement of families in the treatment process; 4) delivery of programming that is developmentally appropriate; 5) employing strategies to engage and retain adolescents in treatment; 6) the hiring of qualified staff; 7) the tailoring of treatment services to address gender and cultural differences; 8) inclusion of continuing care services; and 9) evaluation of the program’s treatment outcomes. By summing the presence of key services and practices within each domain, an overall measure of treatment quality can be calculated. This framework for measuring quality was implemented in a recent study of adolescent-only treatment programs across the U.S. (Knudsen, 2009), which found that the average adolescent-only program was of moderate quality. Based on this framework for treatment quality developed by Brannigan et al. (2004), it is possible to consider the importance of nurses in improving the quality of addiction treatment programs. Nurses play key roles in at least two of the nine domains of quality, namely the hiring of qualified staff and the comprehensiveness of the treatment approach. By definition, the presence of nurses with expertise in treating addiction is an indicator that a program employs qualified staff. Treatment comprehensiveness refers to addressing the multiple needs that adolescents may have when they enter substance abuse treatment. Many of these needs are directly related to health, and as such, may be better addressed in programs that employ nurses. For example, adolescents with substance use disorders (SUDs) are highly likely to have co-occurring mental health problems, such as depression, anxiety, attention deficit/hyperactivity disorder (ADHD), and conduct disorders (Chan, Dennis, & Funk, 2008; Rowe, Liddle, Greenbaum, &