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Treatment Strategies for Substance Use Disorders in Adolescents: A Clinical Review

Treatment Strategies for Substance Use Disorders in Adolescents: A Clinical Review

Core treatment principles for adolescents with substance use disordersTABLE 1. Core treatment principles for adolescents with substance use ...
© Complot/shutterstock.com© Complot/shutterstock.com
Evidence-based behavioral interventions for adolescent substance use disordersTABLE 2. Evidence-based behavioral interventions for adolescent substa...
SIGNIFICANCE FOR THE PRACTICING PSYCHIATRISTSIGNIFICANCE FOR THE PRACTICING PSYCHIATRIST

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.

Related content: 8 Core Principles When Treating Addiction in Adolescents
8 Core Principles When Treating Addiction in Adolescents

8 Core Principles When Treating Addiction in Adolescents

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]).

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