Academic journal article Journal of Drug Issues

Introduction to the Special Section: Qualitative Explorations of Adolescents in Treatment

Academic journal article Journal of Drug Issues

Introduction to the Special Section: Qualitative Explorations of Adolescents in Treatment

Article excerpt

The papers in this special section are among the products of a multi-site effort, funded by the Center for Substance Abuse Treatment (CSAT), to apply qualitative analysis to the study of adolescents in substance abuse treatment. The project was part of a larger CSAT study, the Adolescent Treatment Models (ATM) project, which sought to identify potentially promising treatment models for adolescents that might usefully be disseminated and replicated (Substance Abuse and Mental Health Services Administration [SAMHSA], 2001). The ATM project made use of a largescale quantitative, longitudinal analysis across 10 sites around the country, based on the Global Appraisal of Individual Needs (GAIN) survey instrument, to develop indicators of treatment outcomes and cost-effectiveness. It also produced manuals through which these promising treatment programs could be rigorously described and widely disseminated. The ATM study is one of the largest and most ambitious attempts ever to gather quantitative evidence on the performance of adolescent treatment programs and by now has produced a substantial body of findings (see Stevens & Morral, 2002, for a detailed discussion of this project).

Early on, however, it was decided to include a smaller-scale, qualitative component to the project. In particular, we felt that more intensive interviewing of smaller groups of clients would provide a fine-grained analysis and description of adolescent experiences, which, in turn, would complement the quantitative measures. We were keenly aware that, in a field where relatively little research of any kind had been done, there was an even greater paucity of this kind of qualitative analysis. We wanted to make some contribution to filling that gap.

The relative absence of qualitative studies of adolescent treatment meant that the unforced perceptions of adolescents themselves were mainly missing from studies of what happened to them in treatment. As a result, we were probably missing a great deal that was important in understanding the impact of the treatment we now have and in learning how to do it better; we were also leaving the voices of the consumers of treatment themselves out of the discussion. Moreover, even the best of the existing quantitative studies tended to paint with a rather broad brush. They provided information about treatment outcomes, for example, but told us little about what the experience had meant to the teenagers who went through it. Similarly, the existing research suggested that the treatment experience, like the problem of substance abuse itself, differed by gender: but we knew little about what girls or boys in treatment thought about their experience. Talking directly and in less structured ways with adolescents in treatment could, we thought, get beneath what one of these papers calls the "abstractions and generalizations" that characterized much of the discussion of treatment for young people. It would also, we hoped, provide insights that went well beyond treatment itself to broader questions about teens and drugs: how and why they got started in drug use; how they moved into and out of drug using lifestyles; how they perceived the impact of substance use on their health and their futures; what supports, if any, were available for them in their communities as they attempted to move away from drugs, and much more.

Seven programs around the United States provided the sites for this ethnographic research, four of which are represented here. The sites differ widely in many ways. They range from residential therapeutic communities to outpatient programs; the usual length of stay ranges from a few weeks to three years. The demographic mix of their clients varies widely across the sites, as do the severity of substance abuse and the kinds of drugs most commonly encountered. In some heroin is a key problem; in others, methamphetamine, marijuana, or alcohol. The specific methods used in these studies vary, too, as do the sample sizes and the length of follow-up by the researchers. …

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