University of Colorado, Anschutz Medical Campus, 13055 East 17th Avenue, Mail Stop F800, Aurora, CO 80045, USA.
Soc Sci Med. 2012 Jun;74(12):2037-45. doi: 10.1016/j.socscimed.2012.02.004. Epub 2012 Mar 13.
Using data from 89 American Indian adolescents and guided by the Network Episode Model, this paper analyses pathways to residential substance abuse treatment and their correlates. These adolescents were recruited at admission to a tribally-operated substance abuse treatment program in the southern United States from October 1998 to May 2001. Results from the qualitative analyses of these adolescent's pathways to care narratives indicated that 35% ultimately agreed with the decision for their entry into treatment; 41% were Compelled to enter treatment by others, usually by their parents, parole officers, and judges; and 24% did not describe a clear pathway to care. In the multinomial logistic regression model examining correlates of these pathways to care classifications, adolescents who described pathways indicative of agreement also reported greater readiness for treatment than the adolescents who described compelled or no clear pathways to care. Adolescents who described a Compelled pathway were less likely to meet diagnostic criteria for Conduct Disorder and described fewer social network ties. We were unable to find a relationship between pathways classifications and referral source, suggesting these narratives were subjective constructions of pathways to care rather than a factual representation of this process. In the final logistic regression model examining correlates of treatment completion, articulating a pathway to care, whether it was one of agreement or of being compelled into treatment, predicted a greater likelihood of completing treatment. Overall, these narratives and their correlates are highly consistent with the Network-Episode Model's emphasis on the interaction of self, situation, and social network in shaping the treatment seeking process, demonstrating the applicability of this model to understanding the treatment seeking process in this special population and suggests important considerations for understanding the dynamics of service utilization across diverse communities.
本文利用来自 89 名美国印第安青少年的数据，并以网络事件模型为指导，分析了导致他们接受住所内药物滥用治疗的途径及其相关因素。这些青少年是在 1998 年 10 月至 2001 年 5 月期间，在美国南部一个部落运营的药物滥用治疗项目入组时招募的。对这些青少年的治疗途径叙述的定性分析结果表明，35%的人最终同意他们接受治疗的决定；41%的人是被他人强迫进入治疗的，通常是他们的父母、假释官和法官；24%的人没有描述明确的治疗途径。在考察这些治疗途径分类相关因素的多项逻辑回归模型中，描述表明同意的途径的青少年比描述被迫或没有明确治疗途径的青少年报告出更高的治疗准备程度。描述被迫途径的青少年更不可能符合品行障碍的诊断标准，且他们描述的社会网络联系较少。我们未能发现途径分类与转介来源之间存在关系，这表明这些叙述是对治疗途径的主观构建，而不是对这一过程的真实描述。在最后一个考察治疗完成相关因素的逻辑回归模型中，表明治疗途径的叙述（无论是同意还是被迫接受治疗），都预示着完成治疗的可能性更大。总体而言，这些叙述及其相关因素与网络事件模型强调自我、情境和社会网络在塑造治疗寻求过程中的相互作用高度一致，证明了该模型在理解这一特殊人群的治疗寻求过程中的适用性，并表明了在理解不同社区的服务利用动态时需要考虑一些重要因素。
