Home > Psychological health of heroin-dependent teenagers in treatment.

Cannon, Aoife (2016) Psychological health of heroin-dependent teenagers in treatment. Drugnet Ireland, Issue 58, Summer 2016, pp. 23-24.

PDF (Drugnet 58)

A recent Irish study examined the effect of psychologically supported opiate substitution treatment (OST) on the psychological well-being of an adolescent population attending an outpatient clinic in Dublin for their heroin dependence.1 It is an important study because of the dearth of data reported in the literature on the psychological well-being of adolescents undergoing OST.


Background and methodology

Following previously published findings that substance abuse and mental health issues often occur simultaneously, especially in adolescents,2 Smyth and colleagues sought to examine the prevalence of mental health issues among heroin-dependent adolescents and to determine the effect of psychologically supported treatment on their mental health. In a previous Irish study, it had been noted that heroin-dependent adolescents experienced more psychological distress and a greater number of problems than their peers with other substance use disorders.3 Despite knowing this, the psychological well-being of drug users, especially adolescents, remained under-studied.


The authors of the current paper hypothesised that psychological support during OST would result in improvements in the psychological health of adolescent patients study was carried out prospectively on individuals aged 18 years or younger who were seeking treatment for opiate addiction between May 2006 and December 2013 in Dublin. In addition to OST with either methadone or buprenorphine, participants in the study were also in receipt of individual counselling and group work which focused on life skills. Psychological well-being was measured at the beginning of the study (baseline) and again after four months of treatment (follow-up), using the 2nd edition Beck Youth Inventory (BYI-II).4


The BYI-II is a self-reporting tool with 100 questions based on a Likert scale (never, sometimes, often, always), designed for use with people aged 18 years or younger. It was created to assess the participants’ experience of the following five subscales:

  • self-concept,
  • depression,
  • anxiety,
  • anger, and
  • disruptive behaviour. 

For each parameter, scores are converted into a standardised score, known as a T-score, which enables score comparison between individuals. T-scores were compared to age- and gender-matched scores from a general population sample.


While these scores are not diagnostic of psychiatric disorders, Smyth and colleagues established ‘normal’ and ‘abnormal’ cut-off points. For the subscale of self-concept, scores of <44 were considered ‘abnormal’, and for the other four subscales a score of >55 was considered ‘abnormal’. At baseline, structured clinical sessions were carried out to assess drug use, and the socio-demographic and clinical characteristics of the participants.


Of the 55 participants that were eligible at the beginning of the study, 32 completed treatment and had baseline and follow-up (BYI) questionnaires, while 23 participants did not complete the follow-up BYI. 



The most novel finding was that all five subscale scores improved during the OST period, and the improvements in the mean scores for depression, anxiety and anger were statistically significant. Interestingly, approximately a third of participants with ‘abnormal’ scores for anxiety and depression had follow-up scores that were categorised as ‘normal’. In an attempt to further elucidate the relationship between improved scores for depression and heroin use, the authors conducted linear regression analysis, which revealed greater improvements in depression scores among those who were heroin abstinent.


Interestingly, there were stark differences between those who did not complete the follow-up BYI and those who did. The participants who did not complete the follow-up (n=23) were statistically significantly more likely to experience homelessness or imprisonment compared to those who did complete the follow-up (p=0.02 and p=0.03 respectively). Furthermore, the group who did not complete the follow-up BYI were more likely to be misusing methadone, heroin and cocaine (p<0.001, p=0.001 and p=0.02, respectively).



The results reported in this study highlight the importance of psychosocial support for adolescents undergoing OST. They mirror the results found in studies of adults receiving OST, where psychological support during treatment was found to have a positive impact on psychological well-being.6 Additionally, this study gives insight into the psychological health of teenagers seeking treatment for opiate addiction in Dublin and some of the problems experienced by this group, which remains poorly characterised. The socio-demographics of the adolescent cohort in this study is reflective of similar adolescent groups internationally, especially with regards to poor educational status, family difficulties and mental health problems.7,8


  1. Smyth BP, Ducray K and Cullen W (2016) Changes in psychological well-being among heroin-dependent adolescents during psychologically supported opiate substitution treatment. Early Intervention in Psychiatry doi:10.1111/epi12318 https://www.drugsandalcohol.ie/25117/
  2. Kaminer Y and Bukstein OG (2007) Adolescent substance abuse; psychiatric comorbidity and high risk behaviors. New York: Haworth Press
  3. Keane L, Ducray K and Smyth BP (2014) Psychological characteristics of heroin-dependent and non-opiate substance dependent adolescents in community drug treatment services in Dublin, Ireland. Journal of Child & Adolescent Substance Abuse (23): 205–9
  4. Moore SK, Marsch LA, Badger GJ, Solhkhah R and Hofstein Y (2011) Improvement in psychopathology among opioid-dependent adolescents during behavioural-pharmacological treatment. Journal of Addict Medicine (5): 264–71
  5. Beck, J.S., Beck, A.T., Jolly, J.B., & Steer, R.A. (2005). Beck Youth Inventories Second Edition for Children and Adolescents manual.
  6. Gossop M, Marsden J, Stewart D and Treacy S (2001) Outcomes after methadone maintenance and methadone reduction treatments; two-year follow-up results from the National Treatment Outcome Research Study. Drug Alcohol Dependence (62): 255–64
  7. Bell J and Mutch C (2006) Treatment retention in adolescent patients treated with methadone or buprenorphine for opioid dependence; a file review.’ Drug and Alcohol Review. (25): 167–71
  8. Subramaniam GA and Stitzer MA (2009) Clinical characteristics of treatment-seeking prescription opioid vs. heroin-using adolescents with opioid use disorder. Drug and Alcohol Dependence (101): 13–19

Repository Staff Only: item control page