Treatment of Adolescent Substance Use Disorders

Abstract

Opinion statement Significant progress has been made in development and dissemination of evidence-based behavioral interventions for adolescents with substance use disorders (SUD). Medications have also shown promise in reducing substance use when used in conjunction with psychosocial treatment for adolescents with SUD, even in the context of co-occurring psychopathology. Although the efficacy or “probable efficacy” of the behavioral interventions discussed in this review have been established based on at least two randomized controlled trials, they produce relatively low abstinence rates and modest reductions in substance use that attenuate over time. Research has shown that abstinence rates may increase with the addition of abstinence-based incentives, however, post-treatment relapse rates remain high with few treated adolescents sustaining abstinence one year post-treatment. This may be due to the paucity of continuing care or post-treatment recovery support services and the lack of integrated or concurrent treatment for co-occurring psychiatric conditions that contribute to poorer treatment outcomes. Thus, despite significant progress, there is clearly room for improvement of existing treatment for adolescents with SUD. There is also critical need to increase the availability and access to substance and behavioral health treatment services for adolescents. Although 10–15% of U.S. high school students would currently meet diagnostic criteria for at least one SUD, only 10% of those who could benefit from substance treatment receive it. Five-year trends showing significant increases in the use of marijuana and nonmedical prescription drugs among U. S. high school students are evidence of the shortcomings of existing school-based interventions and poor access to community-based substance treatment for non-juvenile-justice involved youth. There is clearly a need to adapt or develop more effective prevention, early interventions, and treatment for youth who are “at risk” as well as the increasing number of adolescents who have progressed to more serious substance involvement.

Technology-based Interventions for Preventing and Treating Substance Use Among Youth

“…11–14 Clinician-delivered treatment is expensive with variable adherence to intervention fidelity. Unfortunately, less than one-third of substance abuse treatment facilities offer adolescent-specific programs 15 and only 10–15% of youth who could benefit from treatment actually receive it.…”

“…Unfortunately, less than one-third of substance abuse treatment facilities offer adolescent-specific programs 15 and only 10–15% of youth who could benefit from treatment actually receive it. 14 Interventions that leverage computer, mobile, and web technologies are appealing to youth, 16 require minimal cost, 13,17 deliver therapeutic content in a consistent and standardized manner, 17 minimize burden on staff, 18 and can be tailored to different individuals and treatment settings. 17,19 Technology is well suited as a means of providing universal prevention, 20 selective prevention, 21 and treatment 22 interventions that can: fully or partially replace face-to-face interactions with prevention or therapeutic staff (thereby reducing costs and freeing staff to attend to more patients); or augment standard services under a “clinician extender” model that increases access and availability of evidenced based practices outside clinical settings.…”

Emerging Pharmacologic Treatments for Adolescent Substance Use: Challenges and New Directions

“…On the whole, research shows psychosocial techniques to be modestly effective first-line treatments for adolescent substance misuse, but effects are often small and diminish over time (22-24). Thus, despite clinical demands, substance abuse treatment initiatives for youth remain inadequate.…”

“…Medications are commonly successful for treating a broad array of psychiatric diagnoses in adolescents, yet they are infrequently used for treating adolescent SUDs (18, 22, 25-27). The relevance of pharmacotherapies to the development of more effective, comprehensive care for adolescents is unclear, in part, because the quality of evidence on which to make recommendations is limited.…”

“…Prior reviews of the literature on pharmacotherapy for adolescents with substance use disorders illustrate the scant nature of research in this area (22, 26, 31, 34-36). Our primary objective for this review is not to duplicate recent surveys of the literature, but rather to review some of the limitations of existing medication development research with adolescents and outline novel methods to address these limitations.…”