Substance Abuse Among Homeless Youth Addressed By Nurse-Led Intervention
It is estimated that at least 1.2 million adolescents are homeless in the United States. These youths abuse substances with far greater frequency than do their non-homeless counterparts, and once under the influence, they are more likely to participate in delinquency and a host of assorted destructive behaviors.
One such behavior, often called "survival sex" because youths exchange sex for necessities like food or a place to stay, is accompanied by a lower rate of condom use, which can lead to unwanted pregnancies, HIV infection, hepatitis and other sexually transmitted diseases.
"Homeless youth often justify their use of drugs because of the need to stay awake at night to avoid getting mugged, because they are 'self-medicating' to quell the voices in their head, or because of the need to cope with the stress of life," said Adey Nyamathi, lead investigator on the study and associate dean for international research and scholarly activities at the UCLA School of Nursing. "But the sad truth is that once substance abuse use is entrenched, drugs begin to dominate all aspects of homeless youths' lives. We must put programs in place that break this vicious cycle."
The study involved 154 drug-using homeless youths in Santa Monica, Calif., many of whom had experienced a multitude of life crises, including a history of foster care, a low level of education and a support system of individuals who themselves use drugs and/or alcohol.
The study assessed the impact of two group interventions: an HIV/AIDS and hepatitis health program led by nurses and an "art messaging" program led by artists.
The nurse-led program featured three highly interactive group sessions that focused on educating youths about disease transmission and vaccinations and providing them with training in self-management and the development of healthy social networks. In these settings, participants shared their experiences and discussed how they could integrate health promotion strategies into their lives.
The art messaging program gave participants the opportunity to create messages about health and drug use to influence other drug-using youths. Faculty from the California Institute for the Arts engaged the youths in an exploration of their thoughts and feelings through art, photography and video and encouraged conversations about good health, risky behaviors and ways to stay safe.
"Both resulted in significant reductions in the use of alcohol and binge drinking, as well as dramatic decreases in the use of marijuana and, in the nurse-led program, noteworthy decreases in cocaine, methamphetamine and hallucinogens use," Nyamathi said.
Specifically, after six months, alcohol use decreased 24 percent in the nurse intervention program and 25 percent in the art messaging program, while marijuana use declined 17 percent in the nurse intervention program and 20 percent with art messaging. Youth in the nurse-led program reported additional reductions in drug use for cocaine (15 percent), methamphetamine (18 percent) and hallucinogens (20 percent).
"These results are very promising, as reducing alcohol and drug abuse in any population is very difficult," said Nyamathi.
In addition to Nyamathi, the study included UCLA School of Nursing clinical researchers Catherine Branson, Benissa Salem, Farinaz Khalilifard, Mary Marfisee, Daniel Getzoff and Barbara Leake, and Barbara Kennedy from California State University, Dominguez Hills.
Support for the research was provided by a grant from the National Institute of Drug Abuse. The authors report no conflict of interest.
University of California - Los Angeles
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