Adolescents' perceptions of friends during substance abuse treatment: a qualitative study.

Peer relationships have long been recognized as a significant influence on the behavior of adolescents. A substantial body of research supports the view that substance-using peers are a significant predictor of adolescent substance use initiation and on-going use and that these peers impact negatively on an adolescent's ability to remain abstinent from alcohol and drugs (Brown, Vik & Creamer, 1989; Dishion & Owen, 2002; Garnier & Stein, 2002; Kosterman, Hawkins, Guo, Catalano & Abbott, 2000; Preston & Goodfellow, 2006; Rai, Stanton, Wu, Li, Galbraith, Cottrell, et al., 2003). Peers may also dissuade adolescents from seeking and valuing treatment even when problems are acknowledged, suggesting that concern over peer acceptance may contribute to substance abuse treatment resistance (Raniseski & Sigelman, 1992). Moreover, other research provides support that an adolescent's affiliation with non-using peers is associated with reduced substance use (Swadi & Zeitlin, 1988) and that positive peer support is associated with long-term recovery (Margolis, Kilpatrick & Mooney, 2000).

In light of research suggesting that peers are related to adolescents' recovery process, substance abuse treatment professionals are sensitive to this issue during the course of substance abuse treatment. Clinicians often attempt to convince adolescents in treatment to develop relationships with non-substance-using peers and to sever relationships with those who are substance users. Since an emphasis on changing peer groups is a common feature of many substance abuse treatment approaches (for example: Godley, Meyers, Smith, Godly, Titus, Karvinen, et al., 2001; Godley, Risberg, Adams & Sodetz, 2003; Sampl & Kadden, 2001), it is important to understand how adolescents perceive their peers and respond to this practice. Few studies were identified that examined if adolescents perceive that peers support substance abuse treatment, and no published studies were found that investigated if adolescents perceive that peers support abstinence or if and why clinical recommendations regarding peers are followed. Such information may provide input into the development of theory and treatment approaches to address this issue and, thus, provide a basis for further research and treatment development with the goal of helping reduce the risk of relapse for adolescents who participate in treatment.

Qualitative methods are particularly useful in describing and interpreting individuals' personal and social experiences. These methods rely on in-depth interviewing in order to understand a small number of individuals' perceptions rather than to test a hypothesis on a large sample (Smith, 2003). The aim of this article is to explore the following issues using qualitative data from interviews with adolescents admitted to outpatient substance abuse treatment (for the purposes of this research, "peer" is defined as "friend"): 1) Did adolescents perceive that their friends supported substance abuse treatment?; 2) Did adolescents perceive that their friends supported abstinence?; and 3) Did adolescents change friends between intake and discharge?

Method

Participants

Qualitative interviews (n=12) were conducted with a subset of participants in a larger outcome study (n=151) of an adolescent outpatient substance abuse treatment program. To be considered for qualitative interviews, adolescents and a legal guardian must have met eligibility criteria for and signed an informed consent to participate in the outcome study. These eligibility criteria were: (a) admission to the outpatient program; (b) the presence of a guardian who could understand English; (c) sufficient ability to understand the consent form, instruments, and study procedures; (d) no initial recommendation for and transfer to residential treatment within two months of admission; (e) lack of participation in another research study at the same agency; and (f) a legal guardian other than the state.

Based on the funding timeline of the outcome study, 12 adolescents completed qualitative interviews. Adolescents were approached about participation in these interviews in order of their admission to outpatient treatment. Adolescents and a legal guardian for those under the age of 18 were provided with an explanation of the nature and conditions of the qualitative study as part of a separate informed consent process under the supervision of an Institutional Review Board. Twelve out of fifteen adolescents approached agreed to participate. Ten of the twelve were Caucasian, with one African-American, and one Hispanic. Eight were male, nine were 15 or 16 years old, and five were living with a single parent.