Substance use among adolescents in special education and residential youth care : Prevalence, onset and risk factors

Adolescents attending special education for learning disabilities (SEL), special education for behavioural problems (SEB) and adolescents living in a residential youth care (RYC) institution present a complex risk profile including severe behavioural and emotional problems, deviant peer networks, and problematic family backgrounds. In addition to these problems, youth in these groups appear to be at higher risk for substance use compared to adolescents in the general population. Recent, representative studies on substance use levels and related risk indicators are however limited. The objectives of the present thesis are a) to examine prevalence and onset of daily use of cigarettes, alcohol consumption, and lifetime use of cannabis and hard drugs among adolescents in SEL/SEB/RYC compared to adolescents attending mainstream education, and b) to identify the extent to which the elevated risk of substance use among youth in SEL/SEB/RYC is explained by high levels of individual, family, and peer risk indicators that are known to characterize these adolescents. The cross-sectional part of the thesis includes information from 1,905 adolescents attending SEL, 603 adolescents attending SEB and 531 adolescents living in a RYC institution between 12 to 16 years of age. Self-report questionnaires are compared to those of a reference group consisting of 6,946 adolescents in the same age category attending mainstream education. The longitudinal part of the thesis includes youth in SEL (N = 536) and in RYC (N = 241). Results illustrate that in particular youth in RYC are a high risk group for substance use (onset). Also youth in SEB report very high levels of tobacco, alcohol, and drug use. Differences are especially large in the youngest age category (12-13 year olds), with more than twenty times as daily use tobacco users in RYC compared to their counterparts in mainstream education. Although adolescents attending SEL show higher levels of tobacco and hard drug use, having a learning disability does not seem to put adolescents at risk for substance use. In fact, adolescents with learning disabilities do not differ from their counterparts in mainstream education with respect to the onset of tobacco use and even have a smaller risk of alcohol and cannabis onset. Individual, family, and particularly peer risk indicators explain a substantial part of the elevated risk of substance use among adolescents in SEB and RYC. This implies that the high substance use levels within these settings partially need to be understood as a result of the selection of youth with a high-risk profile. SEB schools and RYC institutions therefore need to take into account that substance use belongs to the risk profile of these adolescents. However, the elevated risk of substance use can not be completely explained by the risk indicators. In particular the risk of starting to use hard drugs after one year residential care remains substantial when individual and family risk indicators are considered. This might suggest that processes and factors within SEB or RYC may provide an additional explanation for the high risk of substance in these settings.