Gender differences in psychosocial complexity for a cohort of adolescents attending youth-specific substance abuse services

Highlights

• Youth attending AOD treatment experience numerous co-occurring psychosocial problems.

• Young women experience more co-morbid psychosocial problems than young men.

• Young men experience higher rates of criminal justice involvement.

• Delays in accessing services may result in more psychosocial complexity for young women.

Abstract

This study examines gender differences in the characteristics of young people (N = 1000) attending alcohol and other drug (AOD) services in the state of Victoria, Australia. Females demonstrate levels of substance use that are at least as high, and perhaps more harmful than that of males. Our data add to a growing base of evidence that young women attending youth AOD services experience additional psychosocial problems at higher rates than their male counterparts. This evidence is now fairly consistent in regard to mental health problems, self-injury, suicide attempts, and homelessness. Findings from this study further suggest that the gender imbalance may extend to child protection involvement, family conflict and disconnection, access to social support, and exposure to neglect and abuse.

Introduction

It is well established that males are more highly represented than females in substance abuse treatment services. It has long been assumed that this reflects a higher prevalence and severity of substance use problems among male than female adolescents, but recent research is challenging this assumption and raising the question of whether selection factors other than need are shaping entry to higher levels of care for young males (Landsverk & Reid, 2013).

It is also well known that a large proportion of adolescents receiving treatment for substance abuse and dependence also experience additional behavioural health problems such as mental disorders and offending behaviour. Males are more highly represented in the service settings that provide treatment and remediation for these concerns. This may lead to the conclusion that these behavioural health problems are more prevalent and or more severe among males than females.

Much of the information that we have about the co-occurrence of substance use problems and other psychosocial difficulties comes from population-based surveys conducted in the general community or in schools. Fairly consistently these studies do find higher rates and higher severity of substance use, offending behaviour and other externalising mental health issues for males than females (Armstrong and Costello, 2002, Essau, 2011, Merikangas and McClair, 2012, Slade et al., 2009). A problem with these studies is that they capture small numbers of youth with multiple and complex needs, and do not study issues specific to this population in depth (Rounds-Bryant, Kristiansen, Fairbank, & Hubbard, 1998). To do this, research needs to be conducted with the populations attending services.

Only a small number of such studies have been conducted from the perspective of substance abuse treatment services. One of the earliest (also the largest) was conducted over 20 years ago from 1993 to 1995. Rounds-Bryant et al. (1998) found that young women and young men had very similar rates of substance use and dependence, but that young women had higher rates of mental health problems, as well as past and current physical and sexual abuse. Young men had higher rates of justice system involvement, but gender differences in rates of involvement in illegal activity were not as marked, particularly for more serious types of crime.

Following a long gap in research activity, several recent studies conducted in substance abuse services have confirmed differences between young males and females in the prevalence of co-occurring emotional and behavioural health problems (Dean et al., 2010, Edokpolo et al., 2010, Hodgins et al., 2014, James et al., 2012, Keane et al., 2015, Schroder et al., 2008, Slesnick and Prestopnik, 2005, Wu et al., 2004).

This literature is highly fragmented, with studies varying substantially in their jurisdiction, the variables examined, and the methods used to collect the data. Most studies also involve small samples. Despite this variability, some potentially important patterns are emerging involving higher prevalence of emotional and behavioural health problems among females. Unsurprisingly there are also inconsistencies in the data. There is a need to bring this literature together and develop methods of investigating gender differences with the potential to reduce fragmentation, and resolve or explain inconsistencies. Only then will it be possible to develop and test hypotheses about underlying causal processes and confidently identify potential practice implications.

We present a brief review of this recent literature, followed by a report of results from original research conducted in Victoria, Australia. Our work introduces a new method that enables investigation of a wider range of variables in a larger sample than has been achieved in previous studies. Our results and discussion demonstrate the potential of this approach to integrate and mobilise the existing research base by testing emerging trends, generating hypotheses about causal processes, and discerning implications for practice and further research.