Adapting best practice guidelines for the prevention, screening and treatment of substance misuse in adolescents to a local Belgian context

Alcohol and drug misuse continues to be an important problem amongst adolescents worldwide. In order for Belgian policy makers to efficiently deal with such problems, the extent of alcohol and drug misuse among young people, including environmental factors impacting on this, should be clearly documented. It further requires an understanding on what constitutes ‘good practice’ in prevention, screening and treatment of adolescents. Aims of this project were threefold; (1) to generate a comprehensive overview of data on the prevalence of drug use among young people and the protective and risk factors associated with drug use, including a subgroup analysis on children living with misusing parents, (2) to provide a descriptive overview of Belgian organizations and initiatives working with adolescents in the area of substance misuse, and (3) to develop context-specific, best practice guidelines on the prevention, screening, assessment and treatment of alcohol and drug misuse in adolescents using the ADAPTE methodology. In what follows, we briefly highlight some of our core findings. An analysis of the available data on adolescent substance use and misuse in Belgium indicate that most of them have experience with alcohol and some also with cannabis, although the latter is more prevalent in older adolescents. From a European view, the substance use behavior of Belgian adolescents is relatively typical. Normative influences from the context or environment, i.e. having friends misusing substances were found to be a robust risk factor for drug misuse. Overall, the findings support the need to invest in programs that may prevent the early onset and continuation of substance use and misuse by adolescents in Belgium. Qualitative studies conducted in parallel with this research project suggest the need for specific medical care for those adolescents already in treatment for a substance related disorder. Our prevalence estimates on parental substance misuse indicate that 12% of Belgian children live with a parent that misuses alcohol whereas less than 1% of these children live with parents that use illicit drugs. Parental alcohol misuse tends to be adversely related to children’s health and health behavior, although strong significant correlations fail to appear. Some health outcomes at household level (i.e. being subject to passive smoking and postponing health care at household level) are significantly related with parental alcohol misuse, which may have a negative impact on children’s health. The literature review indicated that parental substance use is associated with various health and psychosocial risks for children. In order to provide appropriate prevention and support for children of substance misusing parents, parental substance use should become a topic of discussion and scientific research. Furthermore, a supportive and continuing approach towards these families is preferred above a directive and controlling approach. We further developed a descriptive map of stakeholders involved in prevention and treatment of adolescents misusing alcohol and drugs in Belgium and questioned them about their services and their attitude towards guidelines. Early intervention, harm reduction and re-socialisation for drug using adolescents are scarce in Belgium. The majority of the stakeholders in our sample had a positive attitude towards the use of guidelines, although they acknowledge that recommendations targeting adolescents are scarce. Three evidence-based practice guidelines for adolescent substance misuse were developed; one on the treatment of alcohol misuse, one on the treatment of drug misuse and one on the prevention of alcohol and drug misuse. The ADAPTE methodology was used to adapt existing, international guidelines to a local, Belgian context. To prepare for this process, we conducted a comprehensive search for relevant evidence-based guidelines. We identified 32 guidelines addressing substance misuse in adolescents, including nine of high quality. Of these, four guidelines provided recommendations specific for adolescents while the remaining guidelines focused on a broader population including adolescents. The quality of the guidelines was hampered by a lack of evidence specifically for adolescents. Also, it was often unclear which evidence underlies the recommendations. Experts from various disciplines and domains were recruited to assist us during the adaptation process. We also recruited family members of persons with an alcohol or drug problem. The experts evaluated 140 recommendations on treatment and 24 on prevention. Those that were judged to be relevant and applicable for the Belgian context were selected for our guideline. The guidelines were drafted and reviewed by the panel. Subsequently, we carried out an external review of the draft guidelines to assess the applicability of the recommendations among methodological experts, clinical experts, adolescents and parents of children who misuse drugs. The results were used to fine-tune the guidelines. Our ADAPTE-youth project was a challenging task, due to the broadness of the field including various domains, disciplines and topical areas. We experienced the adaptation process as promising but time-consuming. Some of the practical issues to be overcome include the tension between (a) the need to be efficient versus the demand to be rigorous, (b) the results from scientific studies versus the needs of professionals who work with these youngsters on a daily basis. The available international guidelines did not answer all of the questions formulated by the panel. This is a limitation of guideline adaptation. Also, clear instructions on how to valorize the input of the experts during the panel meetings and the stakeholders during the external review phase in the guidelines need to be developed as these are not provided by the ADAPTE working group.nrpages: 1-141status: publishe