September 3, 2009

School System Referrals to Substance Abuse Treatment

In 2007, 1.9 million school-aged children and adolescents met the criteria for past year abuse of or dependence on alcohol or illicit drugs according to the 4^th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Of these, an estimated 1 million abused or were dependent on illicit drugs, 1.4 million abused or were dependent on alcohol, and 518,000 abused or were dependent on both.¹ Nevertheless, of the 1.8 million admissions to substance abuse treatment in 2007, just under 134,000 admissions of individuals were 17 years of age or younger, accounting for approximately 7 percent of the entire treatment population.

Elementary, middle, and high schools have become important arenas for educational programs in the field of substance abuse prevention, but these institutions also can serve a significant role in the early identification of students in need of professional substance abuse treatment. Substance abuse treatment admissions referred by the educational system can be examined by the Treatment Episode Data Set (TEDS). Using TEDS, this report examines the demographic characteristics, substances of abuse, and treatment characteristics of child and adolescent admissions referred to treatment by the educational system in 2007. Because the criminal justice system can also have a major impact on the lives of young people, child and adolescent admissions referred by the educational system are compared to those referred by the criminal justice system. Therefore, this issue examines the approximately 132,000 treatment admissions aged 17 or younger (i.e., school-aged admissions) with a known source of referral. Of these, 12 percent were referred by schools, 48 percent by the criminal justice system, and 40 percent by other sources.

Substance abuse treatment admissions for school-aged children and adolescents are more likely overall to be male than female (70 v. 30 percent). However, school-aged admissions referred through schools show both gender and age differences. For example, males aged 11 or younger were more likely than females of the same age to be referred by the school system (19 vs. 14 percent) (Figure 1). But, among admissions between the ages of 12 and 14, females were about as likely as males to be referred by schools (21 vs. 18 percent). However, for all age groups except the very youngest, referrals to treatment were more likely to come through the criminal justice system than the educational system regardless of gender.

Among child and adolescent school referrals, the majority were non-Hispanic White (44 percent) or Hispanic (28 percent) (Figure 2). Schools were more likely than the criminal justice system to refer Hispanic and Asian youth to treatment, but less likely to refer non-Hispanic Whites and non-Hispanic Blacks.

Marijuana was the illicit drug most often identified as the primary drug of abuse for school-aged admissions (65 percent). Primary substance of abuse, however, varied among school-referred youth admissions by gender (Figure 3). Among school-referred youth admissions, males were more likely than females to report marijuana as the primary substance of abuse (74 vs. 52 percent), but less likely to identify alcohol (22 vs. 37 percent) or substances other than marijuana or alcohol (4 vs. 11 percent) as the primary substance of abuse. The same pattern of gender differences was present among youth admissions referred by the criminal justice system. Regardless of gender, school referrals were more likely than criminal justice system referrals to report primary alcohol abuse and less likely to report primary marijuana abuse.

Schools were more likely than the criminal justice system to refer children and adolescents to treatment for the first time (i.e., no prior treatment admissions) (88 vs. 68 percent). Because the majority of substance abuse treatment available in the United States is outpatient, children and adolescents are therefore more likely to be referred to this type of service than any other type, regardless of their primary substance of abuse and referral source (Table 1). However, children and adolescents referred to treatment through schools were more likely than those from the criminal justice system to be referred to outpatient treatment.

Treatment completion is frequently used as an indicator of longer term recovery from addiction. Treatment completion and transfer to further care are considered successful treatment outcomes. Over one half (52 percent) of children and adolescents referred to substance abuse treatment through the educational system completed treatment. However, school referrals of children and adolescents were less likely than those from the criminal justice system to have completed treatment or transferred to further care (52 vs. 58 percent).

State and local policies often dictate the level of emphasis that local schools will place on the identification of physical and behavioral health problems. Similarly, local policies often dictate the disposition of children and adolescents through the juvenile justice system. As a result, the proportions of school-aged admissions referred to substance abuse treatment by the educational system and the criminal justice system varied substantially by State (school referrals ranged from 0 to 34 percent; criminal justice system referrals ranged from 10 to 87 percent). The States with the highest proportion of admissions aged 17 or younger referred by the educational system included Hawaii (34 percent), South Carolina and Virginia (28 percent each), Vermont (22 percent), and California (19 percent). None of the school-aged admissions in Delaware, Nebraska, and New Jersey, and 1 percent or less of the school-aged admissions in Arizona, Arkansas, Nevada, and North Dakota were referred by schools. In comparison, the highest proportion of school-aged referrals from the criminal justice system were in Arkansas (87 percent), Nevada (81 percent), Texas (73 percent), Nebraska (71 percent), and North Dakota and Idaho (68 percent each). New Mexico (12 percent) and Arizona and Hawaii (10 percent each) had the lowest proportion of school-aged criminal justice referrals.

In addition to their responsibilities for providing an academic education, schools have increasingly been asked to take on additional areas of instruction and concern. One of these areas is substance abuse. Classroom instruction, zero tolerance policies, and “no drug” pledges are among the tools that they bring to this task. School employees are also well positioned to identify students with substance abuse problems early and to intervene by referring them to appropriate care. The data from TEDS clearly show how well schools can identify early substance use behavior and make appropriate referrals to treatment with positive results.

¹Office of Applied Studies. (2008). Results from the 2007 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 08-4343, NSDUH Series H-34). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (September 3, 2009). The TEDS Report: School System Referrals to Substance Abuse Treatment. Rockville, MD.

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