The Impact of Co-Occurring Substance Use and Other Psychiatric Disorders on Risk Behaviors by Age
Objective: To examine the relationship between co-occurring substance use disorders (SUDs) and other psychiatric disorders (OPD) and a wide range of human immunodeficiency virus (HIV) risk behaviors. Method: The data are from 17,141 youth aged 12–25 entering 148 adolescent and young adult treatment programs in the United States who were interviewed at intake and at one or more quarterly follow-up visits for 12 months using the Global Appraisal of Individual Needs (GAIN). Of the participants, 90% were adolescents (ages 12–17), 10% transitional-aged youth (ages 18–25), 72% male, 39% White, 16% African American, 26% Hispanic, 3% another race and 16% multi-racial. Approximately 61% of self-reports met past-year criteria for both SUD and OPD, 18% for SUD only and 10% for OPD only. Transitional-aged youth were similar in demographic and clinical characteristics, though a higher percentage (25%) reported SUD only. Results: For both age groups, individuals with co-occurring SUD and OPD were consistently the most likely to report past-year needle use; needle sharing; unprotected sex; multiple sexual partners; sex trading; high-risk sex partners; a history of physical, emotional, and sexual victimization; self-mutilation; suicidal or homicidal thoughts; illegal activity; and violence towards others. Transitional-aged youth also had the highest rates of emergency room visits and cost to society. Co-occurring SUD and OPD also impacts post-treatment outcomes; while frequently starting and ending with greater severity, this group still had the largest reductions in several risk behaviors, substance use, emotional problems, illegal activity, and costs to society from intake to follow-up. Discussion: The implications of these findings are discussed, along with possible strategies to improve the effectiveness of treatment and recovery support services for these youth.