Erica Harvitt, OTS, Ginger Maddox, OTS, Slavica Bjazevic, OTS, Lauren Favorito, OTS & Lynn Jaffe, ScD, OTR/L, FAOTA Florida Gulf Coast University, Fort Myers, FL

PROCEDURE

PURPOSE RESULTS / DISCUSSION

METHODS

RECOMMENDATIONS

REFERENCES

Research results continuously express the importance of environmental factors on modifying habits, especially habits related to substance use. The family dynamics, including parent-child relationship (Branstetter & Furman, 2011;Johnson et al., 2014), can have a significant correlation to substance use. Exposure to substances through family members or peers has also been found to be correlated with increased rates of substance use, even when exposed through social groups in competitive sports (Rüütel et al., 2014; Kothari et al., 2014; Huang et al., 2014; Lisha & Sussman, 2010).  Perhaps the most concerning research result is that the key transition age when contextual factors start to have an effect on substance use is believed to be between ages 14-16 years old (Mennis & Mason, 2012).

Therefore, we decided to use the Lifestyle History Questionnaire Youth version (LHQ-Y) newly developed by Martin et al., (2015) with the adolescent population in an inpatient rehab unit. The adult version of the LHQ is already used in practice, with the reliability and validity already established. Specifically, the LHQ-Y measures the habits and occupational dysfunctions that occur as a result of substance use in adolescence. The items of the LHQ-Y asses how aforementioned environmental factors influence or are influenced by the occupational dysfunctions that occur while using substances, further indicating an individual’s level of immersion in the culture of addiction as defined by White (1996).

The goals of the current study are to compare the factor structure of the LHQ-Y with the factor structure of the LHQ adult version, to identify the habits, patterns, and roles of adolescents while using addictive substances, to establish the reliability and validity of the LHQ-Y, and to identify the individual level of immersion in the culture of addiction as defined by White (1996).

Subjects: 23 participants (15 males, 8 females) ages ranged from 14-18 were administered the LHQ-Y in the treatment center.

Instrument: The LHQ-Y, developed by Martin et al., (2015), is a 50 item Likert-scale self-report assessment designed to measure occupational dysfunction related to substance abuse. It is used to acquire information about patterns in life to guide interventions for those affected by substance abuse. The items ask participants to report how environmental and contextual factors related to their substance use and lifestyle within 1-2 months before entering treatment. For example, items may ask about factors such as family or social dynamics. The theoretical basis for the LHQ-Y and LHQ-adult is William White’s work on the culture of addiction, and specifically the subcultures within the culture of addiction.

The researchers obtained approval from Florida Gulf Coast University's Institutional Review Board before participant recruitment. The researchers obtained parent consent during a weekly parent meeting at the treatment center, during which the researchers would present the research study and its purpose to the parents, as well as provide a copy of the LHQ-Y for them to review. Adolescent assent was obtained before administering the LHQ-Y to them at the treatment center. Administration and completion of the 50 item LHQ-Y questionnaire took approximately 10-15 minutes.   Participation in the study was anonymous and voluntary, having no impact on the treatment the participants received.

One of the limitations of this study was that our sample was only drawn from one treatment center. Few centers provide treatment solely to the adolescent population in the Southwest Florida region, and those that do have strict regulations in place to protect those under 18 years of age. The research team attempted to recruit participants from another treatment center in the area, yet due to the strict requirements of test administration set by the university IRB and the policies of this center, we were unable to collect data from this source.

Another limitation was the low client turnover rate within the facility. Researchers began administration in March of 2015 and concluded by August of the same year. The facility remained at capacity (n=20) with an approximately 3-6 month stay per client for the duration of that time.

Both of these factors contributed to the small sample size in our study. This challenge created an inability to compare the factor structure of the LHQ-Y to the original LHQ. It is advised that future researchers take their geographic accessibility of this specific population into account when planning further research with the LHQ-Y.

Branstetter, S. A., Low, S., & Furman, W. (2011). The influence of parents and friends on adolescent substance use: A multidimensional approach. Journal of Substance Use, 16(2), 150-160. doi: 10.3109/14659891.2010.519421

Denham, B., E. (2014). High school sports participation and substance use: Differences by sport, race, and gender. Journal of Child & Adolescent Substance Abuse, 23(3), 145-154. doi: 10.1080/1067828X.2012.750974     

Huang, G., Unger, J., Soto, D., Fujimoto, K., Pentz, M., Jordan-Marsh, M., & Valente, T. (2014). Peer Influences: The impact of online and offline friendship networks on adolescent smoking and alcohol use. Journal of Adolescent Health, 54, 508- 514. Retrieved from: http://dx.doi.org/10.1016/j.jadohealth.2013.07.001

Johnson, B., McBride, D., Hopkins, G., & Pepper, S. (2014). An examination of Parent–Child relationships and teen substance use: A brief report. Journal of Child & Adolescent Substance Abuse, 23(4), 210-216 doi:10.1080/1067828X.2013.786926  

Kothari, B. H., Sorenson, P., Bank, L., & Snyder, J. (2014). Alcohol and substance use in adolescence and young adulthood: the role of siblings. Journal of family social work, 17(4), 324-343.

Lisha, N., Sussman, S. (2010). Relationship of high school and college sports participation with alcohol, tobacco, and illicit drug use: A review. Addictive Behaviors, 35, 399-407. doi:10.1016/j.addbeh.2009.12.032

Martin, L. M., Triscari, R., Boisvert, R., Kipp, K., Gersten, J., West, R. C., ... & Escobar, P. (2015). Development and evaluation of the lifestyle history questionnaire (LHQ) for people entering treatment for substance addictions. American Journal of Occupational Therapy, 69(3).

Mennis, J., & Mason, M. J. (2012). Social and geographic contexts of adolescent substance use: The moderating effects of age and gender. Social Networks, 34(1), 150-157. doi: http://dx.doi.org/10.1016/j.socnet.2010.10.003      

Neal, D. T., Wood, W., & Quinn, J. M. (2006). Habits—A repeat performance. Current Directions in Psychological Science, 15,198–202. http://dx.doi.org/10.1111/j.1467-8721.2006.00435.x

Rüütel, E., Sisask, M., Värnik, A., Värnik, P., Carli, V., Wasserman, C., ... & Wasserman, D. (2014). Alcohol consumption patterns among adolescents are related to family structure and exposure to drunkenness within the family: results from the SEYLE Project. International Journal of Environmental Research And Public Health, 11(12), 12700-12715.

White, W. L. (1996). Pathways from the culture of addiction to the culture of recovery: A travel guide for addiction professionals (2nd ed.). Center City, MN: Hazelden.

Lifestyle History Questionnaire-Youth Version: A Pilot Study

Due to the limited number of participants (n=22) reliability and validity were unable to be established, nor were the researchers able to establish domains that could indicate factors of higher incidence rate. The data analysis of the original LHQ, with adult participants (n=268) produced 7 such domains.  During the re-writing of the LHQ into the LHQ-Y, the 50 response items were transformed to be applicable to adolescents instead of adults. Due to the limited number of participants, the factor structure of the LHQ-Y data was unable to be compared with the factor structure of its predecessor, the LHQ, which was measured on an adult demographic.

Despite its limitations, the study was able to produce useful statistics from the sample. In addition to the demographics of the youth in this inpatient treatment facility, several frequency statistics were determined. 74% of participants reported that they frequently or very often used immediately after waking up, while 83% reported frequently or very often using immediately before they went to sleep. 78% reported frequently or very often obtaining drugs or alcohol from their homes or their friends homes. 22% rarely felt pressure from their family to quit using. 48% reported rarely to never thinking of finding new activities during or after school. 87% reported frequently or very often using at the same time each day and 70% reported frequently or very often having difficulty managing daily activities because of their use.

It is also important to highlight areas that were found to be non-affected within this demographic. Hygiene, for example, seems to be in good standing as 96% report frequently or very often being careful of personal hygiene. It also appears that keeping their addiction a secret had no trend as the responses were almost evenly distributed across all 5 response levels from never to very often.