Addictive Behaviours in Adolescent Boys: Developing A Low-Cost Care Model in India.

Background: Adolescent boys with addictive behaviours often have comorbidities. India has scarce free short-term rehabilitation facilities for them. The Ministry of Social Justice funds one centre per state. In our centre in Kerala state, a low budget allowed full-time treatment staff of two counsellors and two nurses only. A yoga therapist, a clinical psychologist, and a psychiatrist visit part-time. This study aimed to develop a comprehensive care model within such staff constraints.

Methods: We collected screening and assessment tools from child psychiatry clinics and through a literature search. We chose activities and worksheets from adolescent-specific workbooks on therapeutic (e.g., motivational enhancement, mindfulness) and positive psychology (e.g., managing emotions or relations) techniques. The psychiatrist trained the counsellors in their application.

Results: We utilised pre-available Malayalam (the local vernacular) versions of the Alcohol, Smoking, and Substance Involvement Screening Test and Strengths and Difficulties Questionnaire. We translated and content-validated DBD Rating Scale, Teen Addiction Severity Index, and Adolescent Smoking Consequences Questionnaire. From 11 workbooks, we chose 123 activities, considering patient needs and cultural relevance, and translated 17 worksheets. Counsellors found the CBT Toolbox for Children and Adolescents the most useful workbook. Of the 49 inpatients from the past year, 41 had dual diagnoses, the commonest being conduct-dissocial disorder. Chart review revealed that 46 patients found the activities comprehensible and acceptable. Frequent staff change was a challenge.

Conclusions: We developed an adaptive, low-cost, feasible, and acceptable care model for addictive behaviours and common comorbidities. Its acceptability and effectiveness need to be evaluated in larger, more diverse samples.