Associations between childhood risk factors and alcohol treatment outcomes in adolescence

TL;DR

This study finds that adolescents with higher alcohol use, mental health issues, or adverse childhood experiences are more likely to have poor outcomes in alcohol treatment.

Contribution

The study identifies specific risk factors that predict poor alcohol treatment outcomes in adolescents, an area previously overlooked.

Findings

NEET adolescents had double the incomplete treatment rate compared to the general cohort.

Adolescents with higher alcohol or illicit substance use at treatment start had worse outcomes.

Being placed on a child protection plan increased the risk of treatment dropout.

Abstract

Early onset alcohol use, mental health problems, familial alcohol use, and adverse childhood experiences (ACEs) increase the likelihood of persistent alcohol-use disorders later in life. This study aimed to determine the relative influence of such risk factors when predicting adolescent alcohol treatment outcomes, an area overlooked in prior research.

Retrospective cross-sectional analysis using the National Drug Treatment Monitoring System, incorporating data from all publicly funded community alcohol services in England. The study included adolescents (aged 11–17) whose alcohol treatment took place between 1 April 2018 and 31 March 2023 (n = 2621). Logistic regression models tested for associations between predictors and key outcomes, including treatment non-completion and being non-abstinent at treatment completion. Predictors included demographics, treatment information, alcohol use, ACEs, care status, psychological, and socioeconomic factors.

Significant predictors of not completing treatment: increased age; increased monthly drinking days; year of exit 2020–2021; Not in Education, Employment or Training (NEET) status and being placed on a child protection plan. NEET adolescents had double the incomplete treatment rate compared to the general cohort. Significant predictors of non-abstinent completion: increased age, monthly drinking days, units per drinking day, mental health treatment need, early onset use, affected by others’ substance use, and illicit substance use.

Adolescents with higher alcohol or illicit substance use at treatment start, NEET status and/or child protection plan (care status indicating prior ACE exposure) have worse alcohol treatment outcomes. These groups are highlighted for tailored interventions which consider psychological and environmental challenges adolescents may be experiencing.

Adolescents with higher alcohol use at treatment start tend to have poorer alcohol treatment outcomes in England. NEET status and being placed on a child protection plan also increased the risk of treatment dropout. This highlights the need for trauma-informed and socially responsive interventions and for policy commitments that address the structural determinants of poor treatment engagement.

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