Table 2.

Adolescent Reponse with Major Themes, Defintions and Examples

Theme	Definition	Sub-themes	Examples
Identification of the Problem	The identification or labeling of a concern, state of difficulty or unresolved situation associated with or contributing to adolescent substance use.
		Pleasurable Aspects of Using	“Maybe they’re enjoying what they were doing.” “See right now, weed and alcohol or whatever it is, that’s the excitement we get around here right now. That’s the excitement we get.” “You’re having too much fun. “I’m not going to stop smoking. I want to smoke weed.”
		Minimization of Substance Use and Consequences	“If that man chooses to do drugs, that’s him; I’m sure all of us feel like that. If that man chooses to do drugs, that’s him.” “I manage my habit.” “Who says you can’t be successful on drugs, though?”
		Coping Mechanism	“Once you do it, I mean, I had friends, whenever they were stressed, they had to pick up a cigarette. They’d be like, ‘Man, I don’t know what to do about this.’ Their hand would reach into their pocket you know, trying to light one up. I mean, when they don’t have one, they don’t know what to do. They don’t have any other way to cope with what they’re coping with. They smoke and drink.” “Also a reason to use drugs…if you call it an excuse …the emotional stuff… pregnancy, sexual abuse, things like that…for women, it’s emotional. It’s an emotional thing.” “Some people use drugs and they get smart.”
		Economic Benefits	“Hey, if I can’t help the young man…somebody’s going to sell it to him, it would be better if I sell it to him. I’d rather get to him and sell him a bag of smokes.” “As the money gets high, he gets high.” 13 year old on crack…12 year old on heroin…they getting’ rich off them, taking allowance off them.”
		Peer Sanction	“You hang around your friends and you don’t want to leave…and that’s when the peer pressure starts.” “And then some people who aren’t their friends, they give into peer pressure.” “I mean, they have influences, their peers influence them. I mean, it’s a lot of things that could stop them from wanting help.”
		Generational Transmission	“But all these other kids, from like 15 and up… more than likely, they’ve got somebody in their family that do it, and that’s the influence, and I mean, their mama is either on it or their daddy is on it.” “If I can’t help her (my sister), I’ll sell it to her.” “At least if you’re goin’ to do it, don’t do it around your kids.”
Decision to Seek Services	Factors influencing support selection that were considered or would be considered in seeking help for addiction and substance use problems.
		Internal Motivation to Change	“Yeah, if you want a good job, they’re going to be doing test, so you’re going to know you’re going to have to stop.” “If they can’t ever find it in their heart to come in on their own, it just ain’t going to help.” “You know, like say for instance, you come close to death and live, you know, then at the time you know you get to thinking about your life then.”
		Family Considerations	“Like if you’re lost, your parents tell you there’s different ways of coping.” “I know this might sound crazy on my behalf, but I have a lot of friends, and I have an eight month old son, and if I really, really, really needed help, I wouldn’t go. I love my baby just that much. I would not go. I would just, I would try my best to quit at home, because I wouldn’t, I would not leave my baby with no stranger for nothing…” “[If] parents know their child is substance abusing, [they think], ‘Oh, we’re not good parents,’ so they wouldn’t say too much about it, because they’re feeling bad about themselves.”
		Stigma/Shame/Fear	“A lot of people don’t like to admit they need help and if they do, don’t want to admit they’re crazy or needy and what wants to fee like that?” “What if other people find out?” “Being a teen, you feel like you have your own problems. You don’t want to go to anybody. You get an attitude; you don’t want to go to no one.” “If one of us goes [to treatment], we’re the joke.”
		Lack of Service Accessibility/Availability	“If we were into hard drugs, it ain’t nowhere to go to get help” “I mean, we don’t have nothing in [town]. It’s small. We don’t have that down here.” “[Name of a treatment facility], and they’ll guide her to another place, but the other place ain’t going to be here. She’s going to be out of town somewhere.” “It costs an arm and a leg, and I ain’t got it.”
		Informal Supports	“…not enough encouragement from people around you or people trying to help you.” “We ain’t got no sponsors out there in the streets or in the schools or anywhere.” “Like, for instance, if the role model is doing substance abuse and they get treatment, then they [the substance abuser] may want to get help too.” “Somebody’s got a friend somewhere. I mean, even if your friend has kids…somebody’s got to help me, because I’ve got to get help, and I don’t want my kids to be in foster care, or you know, split out everywhere.”
Service Selection	The tangible or intangible resources or services identified, selected and/or used by the individual that had the highest probability of success or effectiveness or that best fits the desired goals, desires, lifestyle or values of the community or individual.
		Treatment Components	“I’d have it [treatment program] open from the time school is out until about 9:30–10:00 pm.” “If this program tells their parents they’re smoking, nobody will go in the group. If family members were in there, they wouldn’t open up.” “I’d have some like, you know, some people don’t actually know, I’d have a picture up there of a guy fighting inside his body…I’d have a diagram of the body, showing the inside, showing what drugs will do to you. That would scare some people. They’ll actually wake up and realize…” “Where would we put it? You see all these big fields out here? I’d take some of these folks’ fields.” “I mean, they go swimming every day, they will when it gets warm. Swimming, they have activities, volleyball, softball, they got a basketball court. When you feel like you’ve got a urge, go play basketball, tennis.” “And for the outpatient’s that’s going in and out, they have to take a drug test. When they come back in, they have to have a test, I’d say every 3–4 weeks.” “…I’d make it an incentive thing, to where if you move from one level to the next level, then you get such and such. Then move on up, you get such and such more, then something like that. Something that’ll make them want to change.” “I would have stuff about God, and ‘Look the opposite way,’ and other stuff like that; little slogans that you see on key chains and stuff. “They could have drug classes…alcohol classes…all different kinds of things.” “Some people have never finished school. They could probably have a class where they could get their GED.”
		Desired Treatment Relationship	“I need that trust thing; if I talk to you, I just wanted to trust you. You’re here for me, not just for your pay.” “If I really need some help, I would have a place here in town. It would have the nicest greeting. I would have somebody out there with the nicest greeting. When they pull up, they would want to come in there. [They would want to come in] because of the greeting.” “If they stayed in the program long enough and I know they’re …that they’ve done changed over…you could get it on a gift card. Don’t give them no money, because…give them gift cards.” Everybody’s accepted, because if I wanted to get help, I’d want to be accepted.”
Community Influences	Drug use and/or distribution that arises through the relationships and interactions among the adolescent and his/her environment.
		Pervasiveness of Substances	“…and then they know it’s out on the street. They’re in [town], or they know it’s on the street, so they’re going to get out and go get it if they want it.” “Anybody, a 10 year old, can go buy some drugs if he got his money or she got her money right.” “Yeah, and if they got the party they want, and they got their money, them people out there actually don’t care about themselves or the next person; so they will give it to them.”
		Lack of Human and Social Capital	“People that’s got good jobs don’t smoke or drink. But people that ain’t got no job, smoking and drinking.” “See now, it ain’t no activities. That’s why, that’s why 90% of [town] is on drugs, because you know, it ain’t nothing, it ain’t no type of excitement.” “[There] are more negative things to do than positive things. Negative things seem to be taking over…”
		Drug-Related Violence	“Everybody down there, everybody’s got pistols too, just like yesterday it was fixing to be a shootout like the wild, wild west. Last week they had a wild, wild west shooting.” “I’m talking about they’re going to hide in your bushes, or they’re going to wait, they’re going to be right outside your window, knocking on your window with a pistol.”
		Community Response	“They’ll tell you, ‘You ain’t going to make nothing out of your life.’” “ Old people, like the parents, aren’t encouraging them to do things, aren’t supporting them.” “If you’re out here doing drugs, it ain’t nobody around here [who will] just come and pull you off the street, like, ‘Hey man, you need to stop doing this.’ You know, it ain’t none of that…They just let you do this until you just die out.”