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Study: Nurse-led intervention deters substance abuse among homeless youth

Friday April 19, 2013
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A study led by researchers from the UCLA School of Nursing has found that nursing intervention can significantly decrease substance abuse among homeless youth. Published in the November/December issue of the American Journal on Addictions, the research also revealed that structured art sessions can have a positive effect on drug and alcohol abuse and other risky behaviors among this population.

It is estimated that at least 1.2 million adolescents are homeless in the U.S. 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 behavior, often called "survival sex" because youths exchange sex for necessities such as 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, or because they are 'self-medicating’ to quell the voices in their head, or because of the need to cope with the stress of life," Adeline Nyamathi, ANP, PhD, FAAN, lead investigator on the study and associate dean for international research and scholarly activities at the UCLA School of Nursing, said in a news release. "But the sad truth is that once substance abuse 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 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 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 exploring 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 in the release.

After six months, alcohol use decreased 24% in the nurse intervention program and 25% in the art messaging program, while marijuana use declined 17% in the nurse intervention and 20% with art messaging, according to the study. Youth in the nurse-led program reported additional reductions in drug use for cocaine (15%), methamphetamine (18%) and hallucinogens (20%).

Other researchers involved in the study were UCLA School of Nursing clinical researchers Catherine Branson, MPH, PhD(c); Benissa Salem, RN, MSN, PHN, CNL; Farinaz Khalilifard, MA, LMFT; Mary Marfisee, MD, MPH; Daniel Getzoff; Barbara Leake, PhD; and Barbara Kennedy, ND, APRN, FNP-BC, ACRN, CNE, from California State University, Dominguez Hills.

Support for the research was provided by a grant from the National Institute of Drug Abuse.

Register to read the study at http://onlinelibrary.wiley.com/doi/10.1111/j.1521-0391.2012.00288.x/abstract.