The Wolfe Center adolescent substance abuse outpatient program was conceived in 1997 when a community planning process sponsored by Napa County’s Health and Human Services Agency (HHSA) identified substance abuse services for teenagers as one of the most pressing unmet social service needs in the county.  This assessment was validated by a survey of 1,000 Napa County students conducted by local public schools.  It found that 50% of all eleventh graders were drinkers, 20% were frequent binge drinkers, and 25% smoked marijuana.

Despite the beauty, mystique, perceived and actual wealth, Napa County faces social challenges similar to those impacting urban areas.  Substance abuse in Napa is evidenced by high rates of use, binge drinking, and criminal activity related to alcohol and drugs as indicated in the preceding tables.  These key findings from the 2006 California Healthy Kids Survey for Napa Valley on students reporting their drug and alcohol use indicate the need is greater than the services that are being provided.

Currently, the drugs of choice for Napa teens are methamphetamine, marijuana, alcohol and over the counter cough medicines. In California, methamphetamine is now the most commonly reported primary drug of abuse, surpassing alcohol and heroin. Methamphetamine use is growing among youth in the United States. Use can be devastating socially, physiologically, economically, and environmentally. Dependence and addiction occurs swiftly.

According to the report National Youth Treatment Need developed by SAMHSA,  1.5 million youth (6.1% youths aged 12 to 17) were classified as needing alcohol treatment in the past year and about 111,000 youth (7.2% of those needing alcohol treatment) received specialty treatment for alcohol in the past year. Specialty substance use treatment is defined as inpatient or outpatient treatment received at drug or alcohol rehabilitation facilities or mental health centers, or inpatient hospital treatment.  About 1.4 million youths (5.4%) were classified as needing illicit drug use treatment in the past year and 124,000 (9.1% of those needing illicit drug treatment) received specialty treatment for an illicit drug in the past year. 

The Alcohol and Drug Policy Institute also conducted a similar study to estimate the substance abuse needs of adolescents in California. In their document Adolescent Substance Abuse Needs and Services Planning Report, they estimate that of the 627, 144 youth who are considered to be high risk users of alcohol and drugs only 21, 469 received treatment from the public system representing 3% of the population who is in need of treatment services. The difference between national and state estimates of treatment utilization and need suggests that California youth are less likely to receive treatment than youth in other states. This difference between national and state estimates of need for treatment highlight the importance of conducting a local assessment of need due to the various factors that influence need and treatment availability. Assuming these estimates hold true for Napa County’s youth, approximately 953 youth ages 12-19 are in need of substance abuse treatment.  Currently the Wolfe Center treats approximately 107 youth per year in the intensive day treatment program and approximately 515 clients at the schools.  Through a current collaborative planning process with Napa County the Wolfe Center intends to develop better estimates of treatment need that combine national treatment need data with local and state data that address the nuances of the Napa County community.

Since most areas of public service are under-funded relative to need and demand, it is easy to lump adolescent AOD treatment in with the long list of these other under-funded systems, treating the funding levels of all of these systems in a similar manner; occasionally expanding them with a slight increase in allocations. But, AOD treatment for adolescents presents a set of problems that are in several ways more significant than issues in most other health care systems. There is no stable revenue stream; benefit structures are limited, even compared to other under-funded health care systems, and they are not adequate to support best practices in the field.

The under-funding of the AOD treatment system for adolescents has implications in virtually every other human services system in the public realm. The research is clear that substance abuse problems share a common etiology with virtually every other problem behavior, including delinquency, violence, school drop-out and failure and truancy, unsafe sex and teen pregnancy, drunk driving and related traffic accidents, and others. None of the efforts to prevent and treat these other problems can have any serious impact unless the related and concurrent AOD issues are addressed.

Alcohol and other Drug Addiction is the only chronic disease that has an onset in adolescence. The challenge therefore is to develop a full continuum or system of care for adolescent substance abusers with built in linkages to (and coordination with) other service systems providing services to adolescents such as mental health, the juvenile justice system, and the schools. Individual elements alone are not enough, and in fact are often inefficient and ineffective. An effective continuum of care operates across service systems and provides for several key elements. The continuum should allow for continuity of care and the placement of adolescents at the clinically appropriate level of treatment, with “stepped up” and “stepped down” referral as indicated in the American Society of Addiction Medicine’s Patient Placement Criteria.

Also, there is an increasing body of research indicating a clinically significant co-occurrence of substance abuse together with mental health disorders among adolescents. So clearly, the overall system of services required to adequately serve adolescents is improved by having an increased availability of AOD treatment.