DSM-IV alcohol and substance abuse and dependence in homeless youth

Abstract

Objective: The purpose of this study is to describe endorsement rates of substance use criteria among homeless adolescents and to evaluate the reliability of diagnostic formulations among a group of adolescents who use more frequently and more heavily than other samples of adolescents.

Method: Substance use rates and DSM-IV abuse and dependence criteria were assessed among 198 (109 male) homeless youths between the ages of 13 and 19, as part of a larger study. Endorsement rates and reliability analyses were completed for diagnostic criteria assessed for alcohol, marijuana, amphetamines and heroin.

Results: Consistent with other studies of homeless youth, data revealed high rates of substance use and high rates of substance dependence. Both dependence and abuse diagnoses were associated with greater rates of use. DSM-IV criteria showed acceptable internal reliability, although variability was observed when applied to different substances. Of the drugs assessed, problems with heroin use appeared to be best, and marijuana use least, represented by dependence criteria. Criteria pertaining to continued use despite interference with role obligations and the experience of craving were consistently related to other dependence criteria.

Conclusions: DSM-IV substance dependence criteria appear to have good internal reliability within a sample of adolescents who use at extremely high rates. Continued development of diagnostic systems for adolescent substance use should consider the social context of use, differential patterns of symptoms across different substances and the inclusion of additional criteria found reliable among adolescent samples.