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Best Practices -- Early Intervention, Outreach and Community Linkages for Youth with Substance Use Problems
4. Focus Groups
4.1 Introduction
The purpose of the focus groups was to elicit the perspectives of youth who had previous experiences with problem substance use. Data gathering was completed across northern, western, central and eastern Canada. In each region, one focus group was conducted with females and another with males. Initial contact with potential participants was done in collaboration with local and regionally based treatment service providers to explain the sessions and to ask for their input.
Each focus group used a semi-structured format for discussion. Participants were also given an opportunity to review their responses at the close of each session and to highlight specific themes they viewed as most crucial. Four key areas of inquiry were addressed:
- What key challenges face youth with substance use problems?
- What services or supports might make a difference for youth early on in the development of substance use problems?
- How might services in your community more effectively reach out and connect with youth who have or who are at risk for problem substance use?
- What community services would be most needed or helpful for youth with problem substance use?
Descriptive session notes provided the basis from which to write a summary for each focus group exercise. At the end of the eight sessions, individual summaries were merged to provide a unified data set. Content analysis was applied to identify major themes and trends arising from the data. Clustering of key themes subsequently provided the basis to develop categories for the various areas of inquiry. Theme categories were included based on endorsement of at least two focus groups. Unless otherwise indicated, the themes that are summarized reflect contributions from groups of both male and female youth. The major findings for each area of inquiry are presented in the following sections.
4.2 Participant Demographics
A total of 46 youth participated in the focus groups, with an average attendance of six. Youth ranged in age from 16 to 28 years, with an average age of 18 for both males and females. Demographic data gathered from participants are presented in Table 7.
4.3 Challenges Faced by Youth with Substance Use Problems
"It happens so fast."
"... to leave drugs you must abandon friends."
"... no job...no hope for a job because there is no education...no place to live."
"Selling, whatever you have, all you have, for drugs."
"Stealing from them...it hurts families and ruins trust."
"It hurts on the inside."
Participants were initially asked to describe the challenges faced by youth with substance use problems, and which issues were of greatest concern. The following indicates the challenges and the number of focus groups that endorsed the given theme:
- feelings of desperation and loss of control (8);
- peer influences (8);
- history of abuse, trauma and complex family issues (6);
- disengagement from school or work activities (5);
- exposure to substance use by family members or older individuals (4);
- decreased hope and self-esteem (4);
- gender-based stigma (2).
4.3.1 Feelings of Desperation and Loss of Control
Focus group participants indicated that problems with substance use patterns were characterized by "chasing that first high" and focusing on the next chance to use. Motivations linked with problem substance use often reflected attempts to escape from negative emotions, dissatisfaction with self, or other stressors related to complex family problems, basic need issues or other social factors. "Having money" was often regarded as a reason to sustain substance use patterns, whereas "not having money" was associated with a sense of desperation and a willingness to "doing anything" to obtain substances. Stealing from friends, family and others, selling drugs and prostitution were cited as typical means used by youth to obtain money to support use. The consequences of such behaviours often culminated in loss of personal support from others, and rejection and estrangement from friends and family members.
4.3.2 Peer Influences
Influence from peers was regarded as a major challenge facing youth trying to reduce substance use. Participants stressed that substance use is a lifestyle shared by friends and that adopting patterns of decreased use or no use requires disassociation from current peers. The decision to decline use was often associated with peer rejection or even threats from others to their personal safety. Forming connections with non-using peers was regarded as a major challenge, but recognized as an important step in adopting other lifestyles and choices.
4.3.3 History of Abuse, Trauma and Complex Family Issues
Participants disclosed that many youth who have substance use problems have experienced physical, emotional or sexual abuse. Trauma, significant loss and grief were cited as factors contributing to initiation of substance use and development of problems with using. In many instances, traumatic experiences were related to or exacerbated by a range of complex, stressful family relationships.
4.3.4 Disengagement from School or Work Activities
Participants noted that intoxication and substance use often impeded the ability to be successful in academic and work-related activities. Prolonged substance use can interfere with attendance in structured daily routines and subsequently result in withdrawal from school or work or being asked to leave by educational authorities or employers. Re-engaging in school following problems with substance use was viewed as particularly challenging.
4.3.5 Exposure to Substance Use by Family Members or Older Individuals
Participants reported that youth are often influenced by older individuals, including siblings, parents and other youth. Times of transition from middle/junior high school to high school often are accompanied by increased exposure to older youth who use substances as well as decreased supervision by school personnel and parents.
4.3.6 Decreased Hope and Self-Esteem
As a result of the complexity of issues facing those with substance use problems, participants stressed that many youth lack hope that positive changes are possible in their current life situations. This sense of hopelessness is often accompanied by both depressive feelings and a sense of diminished self-worth and self-respect.
4.3.7 Gender-Based Stigma
Some participating young women reported that there was greater stigma attached to substance use for females than for males. They cited experiences when they had encountered disrespect from legal and health care professionals toward female youth. They stressed that judgments and presumptions made about them or their peers were often not justified or made without cause.
4.4 Early Intervention
"There is nothing for kids to do during the day, after school or evenings. It's so boring that they pick up drugs, and the young ones follow the older ones."
"Introduce new activities, try new stuff. Expand youths' experiences beyond the (drug using) community."
"We need flexible rules and space to move."
"The people I trusted, that I hung out with, said that I was doing too much."
"Delay onset of use. Get them early on".
"Find out what they are good at. Even though they use, they have a talent. Just find it. Point out what they are doing right. Notice what is good."
"Strength is an anti-drug...using strengths as a natural high."
Participants were asked to identify key services, supports or actions that might assist in intervening earlier with youth and averting the development of long-standing problem substance use. The following summarizes the key themes and the number of focus groups that endorsed each theme:
- provide opportunities for open and supportive interactions about substance use (6);
- engage youth in high-interest recreation and leisure activities (6);
- ensure access to positive sources of social support (5);
- intervene with younger adolescents (5);
- focus on youths' strengths (4).
4.4.1 Provide Opportunities for Open and Supportive Interactions About Substance Use
Participants emphasized the value of honest information exchanges with educators and family members about the consequences of substance use. Use of "scare tactics" and "punitive measures" were regarded as ineffective for engaging youth in dialogue and were often viewed as contributing to increased tension and alienation in youth and adult relationships. Participants also stressed that such interactions should include opportunities for youth perspectives to be heard and respected, despite their current choices or behaviours.
4.4.2 Engage Youth in High-Interest Recreation and Leisure Activities
Boredom and lack of interesting recreational or leisure activities were cited as factors contributing to both the initiation and continuance of substance use among youth. Participants highlighted activities in which youth could engage, including camping, wilderness adventures, organized outdoor sports, indoor activities such as pool and ping pong, artistic and music activities, as well as community excursions or volunteer opportunities. Youth participation in structured social activities with other youth was identified as beneficial for providing positive social support and promoting pro-social behaviours.
4.4.3 Ensure Access to Positive Sources of Social Support
In preventing or reducing the development of problem substance use, participants highlighted the importance of having access to positive social support. For female youth, emphasis was placed on having positive points of connection in the immediate or extended family. In addition, having caring adults in the school or community setting was seen as beneficial for supporting positive changes in behaviour or lifestyle. Such relationships were also identified as trusted sources of feedback and advice.
4.4.4 Intervene with Younger Adolescents
Participants stressed the importance of intervening earlier among youth, especially among adolescents who had started experimenting with substance use at the middle or junior high school level. Exclusionary policies and consequences were regarded as ineffective for motivating positive changes in youth substance use behaviours. Participants underscored the value of taking time to listen, communicate and establish rapport with youth.
4.4.5 Focus on Youths' Strengths
Early intervention with youth should focus on identifying and using areas of competency. This may entail exploring youths' preferences, interests, strengths and aspirations. Participants stressed that focusing on strengths facilitates the development of positive interactions with youth and serves to enhance their confidence and self-esteem.
4.5 Outreach Approaches
"Staff need to be real to help us. The staff here are real people: they owned our shoes... they get on the same level to talk."
"The legal approach is all wrong. Don't go by the book. Police should talk to us instead of charging us."
"It takes a lot of time to build trust in someone and get used to them."
"Talk to me, be interested in what I have to say."
"They don't put pressure on you...when you are ready then they will be there."
Participants were asked to describe effective ways of reaching out or connecting with youth with substance use problems. The following summarizes the key responses and indicates the number of focus groups in which each theme was discussed:
- convey a genuine interest (7);
- sustain supportive and problem-solving interactions (6);
- take time to build a relationship (5);
- provide timely assistance to youth (5);
- avoid use of sanctions alone (3);
- go where youth are (2).
4.5.1 Convey a Genuine Interest
Participants emphasized that youth are generally receptive to approaches in which they perceive outreach workers to be sincere. In particular, genuineness was viewed as a central ingredient in initially developing trust with youth. They also indicated that outreach personnel who have lived in similar circumstances are regarded as more credible, and are more readily accepted by youth.
4.5.2 Sustain Supportive and Problem- Solving Interactions
Participants underscored the importance of youth having access to sources of social support and understanding during times when they re-initiate or increase substance use. Having individuals with whom they could interact during difficult times was seen as beneficial for problem-solving.
4.5.3 Take Time to Build a Relationship
Participants stressed that building relationships with youth takes time. Developing trust may require frequent encounters with youth over extended time periods. The nature of such interactions should be based on mutual respect and caring.
4.5.4 Provide Timely Assistance to Youth
Participants indicated that community service providers should be responsive to youth needs, especially when youth ask for assistance or communicate a readiness to pursue change. Providers should act upon the "window of opportunity" to support youth in making positive changes.
4.5.5 Avoid Use of Sanctions Alone
The use of sanctions alone to address substance use problems was regarded as ineffective for engaging youth in making changes. Participants stressed that school personnel, police and community service providers should adopt approaches that foster the development of personal and positive interactions with youth.
4.5.6 Go Where Youth Are
The importance of getting to know youth in their "own spaces" and meeting places in the community was highlighted.
4.6 Community Services and Linkages
"Community frowns upon drugs--you feel like the black sheep. Makes you feel guilty."
"Look at me like you want to know me, like you care. Hear what I am saying. I am not a monster, I'm just like you."
"We all make mistakes and all need help--we all need people around us."
"Go to youth for their ideas."
"It needs to be a safe place....Somewhere to spend time."
Participants were asked to identify specific community services and supports that should be available to youth with substance use problems. They highlighted a range of key actions that could strengthen youth linkages in their communities:
- provide safe and positive meeting places for youth (7);
- ensure practical and meaningful educational experiences (5);
- build positive peer support networks (5);
- ensure youth focused-transition support and treatment options (4);
- increase community members' understanding and appreciation of youth (4).
4.6.1 Provide Safe and Positive Meeting Places for Youth
Concern was expressed about the lack of access to local recreational or youth centres, especially for those living in rural areas. Participants indicated that facilities in urban centres often have policies and rules that do not permit youth to hang out or congregate. To be responsive to youth needs, they stressed the importance of eliciting youths' perspectives and leadership in organizing and delivering community-based recreational activity programs. These program sites should offer activities during the day and evening, and be characterized as safe places for all youth.
4.6.2 Ensure Practical and Meaningful Educational Experiences
Participants stressed the importance of providing youth with educational experiences that encourage them to stay in school. Academic programs should include individual academic assistance, hands-on learning activities, basic life skill instruction and opportunities to participate in apprenticeship programs (e.g. trades) or co-op learning experiences. Ideally, they should be tailored to meet the individual needs of youth, and be geared to building upon areas of interest and strength.
4.6.3 Build Positive Peer Support Networks
In sustaining positive changes in behaviour, participants recognized the importance of youth having meaningful relationships with non-using peers. The sense of "not being alone" and having friends with common interests were important considerations.
4.6.4 Ensure Youth-Focused Transition Support and Treatment Options
Participants cited examples of youth with problem substance use who had attended community or residential rehabilitation programs designed for adults. They stressed the importance of developing youth-specific programming for problem substance use and related concerns, such as detoxification programs, residential treatment services, shelters and transitional housing options.
4.6.5 Increase Community Members' Understanding and Appreciation of Youth
Some participants stressed that youth with substance use problems often feel judged and misunderstood by members of the wider community. They asserted the need for community members to value youth and to foster their potential to be successful and to make positive contributions to others.
