Youth AOD service provision
A spectrum of interventions, ranging from prevention to treatment, can be implemented to tackle harmful and problematic substance use in populations of young people. Evidence suggests that this is best achieved through the ‘concerted application of a combination of regulatory, early-intervention, and harm-reduction approaches’ (Toumbourou et al., 2007, p.1). In relation to treatment and direct care (which incorporates harm reduction approaches and the capacity for early intervention) it is almost universally agreed that adolescents with AOD and other psychosocial difficulties require services and programs that are designed specifically to meet the unique developmental needs (Barry et al., 2002; Brannigan et al., 2004; Henderson et al., 2008).
Colby et al (2004) found strong evidence that tailoring services to meet individual needs or subgroup characteristics not only positively influences treatment outcomes but it also the likelihood of treatment involvement and retention (Colby et al, 2004). Even so, many early AOD services and programs targeting young people were based on adult models and did not adequately address the specific requirements of their target group (Muck et al 2001).
Over the past 15 years, however, a diverse range of youth-specific approaches to AOD service provision have emerged Research into the effectiveness of adolescent services is in its infancy with the few rigorous evaluations that have been conducted being inconclusive. Toumbourou et al (2007) note that the majority of studies have been conducted in the United States, where abstinence is often the only outcome measured, a research practice questioned by many researchers (see also Brown 2004). Toumbourou et al (2007, p.3) found that abstinence-only approaches ‘functionally deny services to those unwilling to completely eliminate use’. Desistance from AOD use, remains a goal that some young people who are clients of youth AOD services are supported to pursue but it is one among many options consistent the National Drug Strategy in Australia based on harm minimisation
The Australian context
The availability, scope and nature of youth-specific AOD services in Australia vary across states and territories. Australia’s size and relatively small population mean that young people in rural and remote areas are under-serviced. Culturally specific services are available for Indigenous young people, but their availability also varies according to region. Most capital cities and some provincial centres have at least one youth-specific AOD treatment program or service. Some focus solely on young people whereas others are adjuncts to adult services. Spooner, Mattick and Noffs (2005) argue that young people with serious AOD issues require a comprehensive range of interventions and sustained support. Funding limitations mean that this approach is not possible for many youth-specific services or for generalist service providers, such as GPs. By necessity, youth-specific health and welfare systems, together with statutory organisations (such as child-protection services), have developed responses for young AOD users. These agencies often take on case-management roles to ensure continuity of care but sometimes lack the specific expertise and resources to provide the AOD services their clients require.