8 Core Principles When Treating Addiction in Adolescents

July 7, 2017

Christopher J. Hammond, MD, PhD, Pravesh Sharma, MD

The main goal in treating addiction is to help the patient achieve and improve functioning. When that patient is also an adolescent, there are special considerations. Here's a quick primer.

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The principal goal of treatment of substance abuse disorders (SUDs) in adolescents is achieving and maintaining abstinence and improving functioning. This slideshow presents 8 core principles for the clinical management of adolescents with SUDs.

SUDs in adolescents have multifactorial etiologies and treatment requires integrated and concurrent approaches for both substance use and any co-occurring psychiatric disorders. Be aware of stages of development and use developmentally-informed approaches (ie, meeting adolescents “where they are”).

Know the level of care you as a provider are comfortable managing and the referral sources in your community for higher levels of care (ie, residential/inpatient, intensive outpatient services).

One behavioral intervention is to involve parents and family in the treatment process. This will help to improve family functioning and parent-teen relationships. Changing parental monitoring, limit setting, and substance use beliefs can improve outcomes. 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.

Use evidence-based behavioral interventions as your treatment backbone. There is strong evidence for the efficacy of psychosocial or behavioral interventions in the treatment of adolescent SUDs. This will help to fine-tune and solidify approaches to treatment.

Evaluate patients for co-occurring psychiatric disorders (eg, ADHD, conduct disorder, depression, PTSD) and provide integrated and concurrent treatment if necessary. Evidence-based psychosocial and pharmacotherapy approaches are used concurrently to treat psychiatric disorders when present.

Adjunctive pharmacotherapy may be used for the treatment of withdrawal symptoms and craving in youth that have failed behavioral interventions.

Incorporate urine drug screening, in a systematic way, as part of the initial screening and maintenance phases of treatment. Using a contingency management approach that provides awards for negative UDSs can improve outcomes.

Twelve step programs, such as Alcoholics or Narcotics Anonymous (AA/NA), especially those with a teen focus, may be helpful when added to (but not in place of) the above described integrated treatment approaches.

For more on this topic, see Treatment Strategies for Substance Use Disorders in Adolescents, by Christopher J. Hammond, MD, PhD and Pravesh Sharma, MD, on which this slideshow is based.