Substance use and substance use disorders (SUDs) that emerge during adolescence are associated with increased morbidity and mortality, along with a number of short- and long-term negative health consequences. Many adolescents experiment with alcohol or other drugs, and a significant minority will develop problems with substance use. Recent national surveys indicate that 18% and 21% of US high school students report binge drinking and smoking marijuana, respectively, in the past 30 days.1
Of the 1.3 million adolescents who met criteria for an SUD in 2014, fewer than 10% received treatment.2 Early screening, diagnosis, and treatment of adolescents with SUDs have the potential to reduce morbidity and mortality. This is particularly important for child and adolescent mental health providers because approximately 40% of adolescents who present for mental health treatment may have a comorbid SUD.3
Core principles for the clinical management of adolescents
SUDs in adolescents have multifactorial etiologies and are treated using developmentally informed approaches that apply integrated and concurrent treatment for both substance use and any co-occurring psychiatric disorders. Table 1 presents 8 core principles for the clinical management of adolescents with SUDs.
Common risk factors for youths with an SUD fall into larger domain-level factors:
• Individual: genetic, early childhood temperament, psychiatric symptoms and disorders, history of trauma exposure
• Family and parent: family dysfunction, parent-teen relationship, parental substance use, parental psychiatric disorders, parental involvement, monitoring, permissibility relating to adolescent drug use, sibling drug use
• Environment/community: involvement with substance-using or antisocial peers, peer pressure, media promotion, access to alcohol and other drugs, poverty, exposure to community violence
A comprehensive diagnostic evaluation that includes the patient and his or her parents is used to characterize developmental history, risk and protective factors, current and lifetime psychiatric symptoms and disorders, and substance use and related disorders.
These sessions would provide psychoeducation on the negative consequences of marijuana use and the benefits of a drug-free household as well as parental skills training. Furthermore, screening the parent(s) for substance use and psychiatric disorders and referring them for treatment may improve family functioning.
In another example, a teen who presents with binge drinking 2 or 3 days per week and a history of recent sexual assault may benefit from a trauma-informed approach (eg, trauma-focused cognitive behavioral therapy [CBT]).
Dr. Hammond is Assistant Professor of Psychiatry, Division of Child & Adolescent Psychiatry, Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD. Dr. Sharma is a Child and Adolescent Psychiatry Fellow, Division of Child & Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine. The authors report no conflicts of interest concerning the subject matter of this article.
1. Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance: United States, 2015. MMWR Surveill Summ. 2016;65:1-174.
2. Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.
3. Aarons GA, Brown SA, Hough RL, et al. Prevalence of adolescent substance use disorders across five sectors of care. J Am Acad Child Adolesc Psychiatry. 2001;40:419-426.
4. Kaminer Y, Bukstein O, eds. Adolescent Substance Abuse: Dual Diagnosis and High Risk Behaviors. Binghamton, NY: Routledge, Francis & Taylor Group; 2008.
5. Hogue A, Henderson CE, Ozechowski TJ, Robbins MS. Evidence base on outpatient behavioral treatments for adolescent substance use: updates and recommendations 2007-2013. J Child Adolesc Psychol. 2014;43:695-720.
6. Waldron HB, Turner CW. Evidence-based psychosocial treatments for adolescent substance abuse. J Clin Child Adolesc Psychol. 2008;37:238-261.
7. Tripodi SJ, Bender K, Litschge C, Vaughn MG. Meta-analysis of controlled studies 1960-2010. Arch Pediatr Adolesc Med. 2010;164:85-91.
8. Hendricks V, Van der Schee E, Blanken P. Matching adolescents with a cannabis use disorder to multidimensional family therapy or cognitive behavioral therapy: treatment effect moderators in a randomized controlled trial. Drug Alcohol Depend. 2012;125:119-126.
9. Hammond CJ. The role of pharmacotherapy in the treatment of adolescent substance use disorders. Child Adolesc Psychiatr Clin N Am. 2016;25:685-711.
10. Hammond CJ, Gray KM. Pharmacotherapy for substance use disorders in youths. J Child Adolesc Subst Abuse. 2016;25:292-316.
11. Riggs PD, Mikulich-Gilbertson SK, Davies RD, et al. A randomized controlled trial of fluoxetine and cognitive behavioral therapy in adolescents with major depression, behavior problems, and substance use disorders. Arch Pediatr Adolesc Med. 2007;161:1026-1034.
12. Riggs PD, Winhusen T, Davies RD, et al. Randomized controlled trial of osmotic-release methylphenidate with cognitive-behavioral therapy in adolescents with attention-deficit/hyperactivity disorder and substance use disorders. J Am Acad Child Adolesc Psychiatry. 2011;50:903-914.
13. Deas D, Randall CL, Roberts JS, Anton RF. A double-blind placebo-controlled trial of sertraline in depressed adolescent alcoholics: a pilot study. Hum Psychopharmacol. 2000;15:462-469.
14. Solhkhah R, Wilens TE. Bupropion SR for the treatment of substance-abusing outpatient adolescents with attention-deficit/hyperactivity disorder and mood disorders. J Child Adolesc Psychopharmacol. 2015;15:777-786.
15. Geller B1, Cooper TB, Sun K, et al. Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependency. J Am Acad Child Adolesc Psychiatry. 1998;37:171-178.