Substance Use Patterns Among Adolescents Involved with Child Protective Services: The Relation of Child, Family, and Contextual Risks to Changes in Use over Time

Introduction: Adolescent substance use is a prominent and costly public health concern in the U.S.  Problematic substance use during adolescence is associated with negative outcomes such as risky sexual behavior, delinquency, and poor educational attainment. Given the costs to both individuals and society, it is important to investigate specific youth populations who might be high risk for problem use of alcohol, tobacco, and other drugs, as well as specific risk and protective factors that contribute to their substance use trajectories over time. Youth involved with Child Protective Services (CPS) may be at particular risk for problematic substance use as a result of their experiences of abuse and neglect, other traumatic experiences, and exposure to family- and community-level risk factors. The current study investigated: (1) substance use classes (groups) in a child welfare population; (2) change in substance use patterns over time; and, (3) which social-ecological risk and protective factors predict class membership.

Methods: Data were analyzed from the National Survey of Child and Adolescent Well-Being (NSCAW-II), which is a national probability sample of youth involved in a CPS investigation. Using a subsample (n = 546) of youth (aged 11-17) and their caregivers, we used latent transition analysis (LTA) to identify distinct classes of substance use, examine changes in class membership over an 18-month period, and predictors of class membership at the baseline assessment.

Results: Analyses identified three groups: a larger non-use class; a moderate-use class; and, a smaller problem use class marked by high rates of active alcohol use and binge drinking, moderate to high rates of tobacco and marijuana use, moderate rates of hard drug use, and elevated substance use problem scores. Predictors of problem use group membership compared to the non-use group were older youth (OR 1.62, 95% CI 1.29, 2.03), greater deviant peer affiliations (OR 1.21, 95% CI 1.07, 1.34), and less school engagement (OR 0.86, 95% CI 0.74, 0.99), whereas predictors of moderate use group membership were older youth (OR 1.62, 95% CI 1.21, 2.17) and greater parent alcohol dependence (OR 1.11, 95% CI 1.59, 5.75). Patterns of use remained relatively stable over time, with the non-use group demonstrating greatest stability.

Conclusion: Study findings highlight CPS system-level implications for prevention and treatment of substance use problems. Early screening, identification, and intervention of risk factors in particular school, peer, and family domains may prevent or reduce problem and moderate substance use trajectories within a CPS population.