New Adolescent Substance Use Disorder Guidelines: Reducing Patient and Family Burden

CLINICAL CONVERSATIONS

The American Society of Addiction Medicine (ASAM) Criteria has announced a new updated edition, The Adolescents and Transition-Aged Youth volume. This set of guidelines establishes new dedicated treatment standards and admission criteria for youth with substance use disorder (SUD).^1-3 Following this news, Psychiatric Times connected with our Substance Use Section Editor—Roueen Rafeyan, MD, DFAPA, FASAM—to learn his thoughts on the criteria.

Psychiatric Times: The ASAM has announced a new set of guidelines that establish dedicated treatment standards and admission criteria for youth with SUD. What do you believe these guidelines will bring to the table for practicing mental health clinicians? How will it change current standards of care?

Roueen Rafeyan, MD: Thank you for covering this topic! I believe all clinicians need to be aware that ASAM has updated their criteria both for adults and adolescent treatments in their latest edition.

In the most recent March 2026 edition update, certain criteria have been defined for adolescent and transition age youth, and this is the first time that adolescent specific criteria have been separated from adult criteria.

SUD onset is often in adolescent years, so we can look at it as disease management. We know long term outcomes can improve if the duration of substance use is shorter in adolescent years, so it becomes imperative to target the disease when/if it starts in these age groups. By the time we treat adults, we are looking at managing a chronic disease which could have been prevented.

The more we focus on prevention, the better. Primary and secondary preventions have been effective in reducing the burden of many substances; however, the problem continues with significant toll on human lives, society, and families.

PT: Previously, standards for adolescent SUD care were lumped in with those for adults. Why is it so critical for us to differentiate the standards for youth? What do you think are the biggest differences between treating adults vs adolescents with SUD?

Rafeyan: In the updates to the recent edition, R2 actually specify the population “adolescence” as under 18 and “transition age” as ages 16 to 25.

One of the benefits of separating these age groups is brain development. We know our frontal lobes do not complete their development until age 25 and that is the main reason why a 16-year-old’s judgment is different than a 26-year-old’s judgment. If we take that into consideration, it just makes sense to target our interventions and treatments based on brain developmental stage.

Another new criterion is the new level of care, 1.0Y. Again, historically, a patient would have gone to a treatment center that is either residential or outpatient, such as an intensive outpatient program or a partial hospitalization program. If they were successful, it would be assumed that treatment is done. There were not significant standards implemented as to how the patient needs to be monitored; the new level of care introduces chronic care monitoring in stable remission. Main interventions will be regular checkups and medication management, along with recovery management.

PT: One of the things emphasized by these new guidelines is holistic care. Can you speak to the importance of engaging not just a young patient, but also their family or support system?

Rafeyan: Many of our patients also have co-occurring mental health issues. Common comorbid disorders include anxiety, depression, and attention-deficit/hyperactivity disorder. Appropriate diagnosis and treatment of co-occurring conditions will significantly enhance success in sobriety and recovery.

Another criterion that has been implemented is acknowledging the need for medical care, and the need for detox and safe monitoring of patients while they are going through detox. This has been implemented due to increased risk of fentanyl use in continuation of new designer drugs coming to markets.

And in my opinion, the most important criteria update is family centered approach. Substance use disorder does not just affect the person. It is a disorder that affects the whole family, and so families need to be involved and educated on how to provide support to the patient. Patients also need tools and skills to potentially deal with family dynamics that may be contributing to substance use. In many cases of adolescent SUD, families need as much help as the patient. They need ongoing support.

The holistic approach is needed both for adults and adolescence; however, adolescence especially require the additional help. There are integral differences between treating adults and adolescence. The issues that an adult faces are quite different from a teenager. One main difference is, in adolescence, you feel a sense of invincibility, yet you have a lack of knowledge of consequences. Add to that a hijacked brain with impaired reward response and poor impulse control. Young patients are just not able to see the devastating consequences of continued drug use.

Adult patients are more likely to respond, acknowledge, and realize the negative impact drug use has on them, and that differentiates treatment approaches.

PT: What do you see as the biggest treatment challenges in addressing SUDs in adolescents (defined as youth under 18 years of age) or transition-aged youth (defined as individuals between the ages of 16-25)?

Rafeyan: One of the biggest challenges in treatment for youth continues to be access.

There is also a lack of education in our schools, which adds to a culture accepting of drugs or the idea that cannabis is harmless.

Lack of family support and lack of knowledge on family care also remain a barrier.

Moving forward, I strongly believe our pediatrician colleagues need further education, support, and access to interventions. Family practice residency programs definitely need more exposure to addiction medicine. By increasing our collective knowledge, we can help prevent SUD from being a pediatric onset disease.

Dr Rafeyan is chief medical officer of the Gateway Foundation; an assistant professor of psychiatry at Northwestern University Feinberg School of Medicine in Chicago, Illinois; and the Psychiatric Times substance use section editor.

References

1. New standards for adolescent substance use disorder care announced. News release. March 25, 2026. Accessed March 26, 2026. https://www.hazeldenbettyford.org/press-release/asam-youth-criteria

2. The ASAM Criteria, Fourth Edition Adolescents and Transition-Aged Youth Volume. ASAM. Accessed March 26, 2026. https://www.asam.org/asam-criteria/adolescent-volume

3. Kuntz L. ASAM announces new standards for adolescent substance use disorder care. Psychiatric Times. March 26, 2026. https://www.psychiatrictimes.com/view/asam-announces-new-standards-for-adolescent-substance-use-disorder-care