Category: Addictive Behaviors

PS1- #A22 - Patterns of Substance Use Diagnosing in a Community Mental Health System

Friday, Nov 17
8:30 AM – 9:30 AM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: Substance Abuse | Diagnosis | Adolescents

An estimated 1.3 million United States adolescents met diagnostic criteria for a substance use (SU) disorder. However, DSM criteria, which apply the same symptoms to adults and youth, might not adequately capture SU challenges in adolescents. Studies using DSM-IV and/or DSM-IV-TR diagnostic criteria have identified a group of “diagnostic orphans” who endorse one or two symptoms of a SU disorder but do not meet the full criteria for diagnosis, despite problematic use. As such, diagnostic prevalence estimates likely underestimate youth need for services. In community mental health, youth often carry multiple comorbid diagnoses, and research suggests that SU problems might not be prioritized in treatment planning if SU is not the principal diagnosis. Furthermore, additional research suggests substance use problems can slow treatment progress and act as a barrier to treatment response if not addressed adequately. This study reports on rates of SU diagnoses and rated of targeting substance use as part of treatment in a multiethnic population of adolescents receiving community mental health care.


Participants in the current study included 5,820 youth between the ages of 13 and 17 (M = 16 years, SD = 1.78) who received mental health services in one or more levels of care. Of these, 2451 (42.11%) carried a substance use diagnosis, but only 379 (6.51%) had a primary diagnosis of SU. Therapists indicated having targeted substance use problems in one or more months of treatment for 2,179 (37.44%), a rate somewhat below the overall diagnostic rate.

Results suggest substance use problems are quite common in adolescent community mental health, though not frequently seen as the primary problem area. Given there are limited empirically supported treatments for adolescent substance use problems and the fact that SU has been shown to predict poorer outcomes, the high rates of SU problems but low rates of primary diagnoses suggest a need for future research on ways to identify what works with such youth and hope to incorporate such treatment into other aspects of community mental health.  Discussion will consider possible implications for discrepancies between substance use as a principal versus any diagnosis and further directions for research, including treatment differences for youth with principal vs. non-principal substance use diagnoses.

Emilee Turner

Graduate Student
University of Hawai at Manoa
Kailua, Hawaii

Daniel Wilkie

Graduate Student
University of Hawaii at Manoa
Honolulu, Hawaii

Brad Kingsbury

Undergraduate Research Assistant
University of Hawai'i at Mānoa, Hawaii

Charles W. Mueller

University of Hawaii at Manoa