Any substance use by young people is problematic, even if it appears on the surface to be “age-appropriate” experimentation. It exposes young people to the dangers posed to by the substance itself, risky behaviors associated with substance use, and increases their chances of developing a SUD later in life.
Tailored Treatment Is Essential for Adolescents
A comprehensive evaluation is used to assess an adolescent’s level of psychological development, relationships with family and peers, academic success, pro-social behavior, cultural and ethnic identity, and any special physical or behavioral issues. These factors should be used in developing a personalized treatment plan for each patient.
Treatment Should Address the Whole Person
Treatment that focuses only on an adolescent’s substance use is less likely to be successful. Instead, broader life needs, such as those related to medical, psychological and social well-being, as well as housing, school, transportation and legal services, should simultaneously be addressed.
Behavioral therapies can motivate adolescents to refrain from substance use. These treatments should focus on building skills to deal with triggers, help them resist drug use, replace drug use with constructive and rewarding activities, improve problem-solving skills, and facilitate stronger interpersonal relationships.
Families and Communities Are Important
Several evidence-based interventions for adolescent SUDs seek to strengthen family relationships by improving communication and improving family members’ ability to support abstinence from drugs. In addition, members of the community (such as school counselors, parents, peers and mentors) can encourage young people who need help to start treatment—and support their recovery along the way.
There are many different treatment options for youth with a SUD, and the level of care and setting should be chosen following an assessment of each adolescent’s individual needs. The American Society of Addiction Medicine (ASAM) has guidelines to assess adolescent patients and help them and their doctors decide the type and length of treatment that is best for them. assessments in six areas:
Intoxication level and withdrawal potential
Presence of other medical conditions
Presence of other emotional, behavioral or cognitive conditions
Readiness or motivation to change
Risk of relapse or continued drug use
Recovery environment, including family, peers, school and legal system
Medications for Treating Adolescent SUDs
Currently, few of the medications found to be effective in treating addiction to opioids, alcohol or nicotine in adults have been studied enough to be approved by the Food and Drug Administration (FDA) for adolescent treatment. The evidence for their effectiveness and safety for individuals under 18 is preliminary, and thus most can only be used “off-label” when treating adolescents.
Buprenorphine is an exception. The FDA approved the use of buprenorphine for patients 16 and older in 2002. Provider experience to date using buprenorphine to treat adolescent and young adult opioid dependence shows it is feasible in a community treatment settings. Parental involvement enhances adolescent compliance with medication adherence, which in turn, leads to higher treatment retention rates and fewer relapses. Additionally, youth who comply are more likely to engage in substance use counseling, which is recommended as part of a comprehensive treatment approach.
Compared to non‐opioid using youths, those using opioids have higher rates of relapse and outpatient treatment dropout and worse post‐residential treatment outcomes. The use of medication as part of a comprehensive treatment plan has the potential to improve outcomes and is increasingly accepted by patients and their families.
Policies, attitudes and messages that prevent adolescents from accessing medications that can effectively treat their substance use disorder put their health at risk. Youth have lower overall rates of treatment retention when compared with adults, making the delivery of developmentally appropriate treatment imperative to support their recovery.
Supporting Adolescents in Recovery
Adolescents can benefit from recovery support services that are culturally relevant and tailored to meet their individual needs, including:
Assertive Continuing Care (ACC) - Clinicians provide home-based, assertive continuing care to help adolescents and their caregivers learn problem-solving and communication skills that promote their social engagement. It is intended for adolescents who have completed Adolescent Community Reinforcement Approach (A-CRA) therapy and combines A-CRA with assertive case management services, including multidisciplinary teams, round-the-clock coverage and assertive outreach.
Mutual Aid Groups - Mutual Aid groups include the 12-step programs Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), SMART Recovery 4-Point Program®, among others. Some 12-step fellowships have meetings and conventions specific to young people, for example YPAA or Young People in AA. These groups bring people in recovery together through weekly meetings in a community setting to share experiences and offer support. A set of principles guide 12-step groups, such as acknowledging: recovery cannot be sustained by willpower alone; the value in one person in recovery helping another; and the spiritual, emotional, and physical parts of recovery. Adolescents who have recently completed or are in substance use disorder treatment can benefit from being part of a peer group supportive of recovery efforts and attitudes.
Peer Recovery Support Services - Peer recovery support services connect adolescents in recovery with peer specialists who have experienced addiction, achieved recovery and are trained to support others in their recovery process. These services can be provided in individual or group settings. Peer specialists serve as mentors and can help recovering adolescents build new friendships and facilitate social networks through drug- and alcohol-free community-building activities.
Recovery High Schools and Collegiate Recovery Programs - Recovery high schools are designed to meet the needs of students recovering from substance use disorders. Though they are often part of another school, students in recovery take classes apart from other students through scheduling or the use of separate spaces. These high schools also offer academic and recovery support services. A growing number of colleges and universities offer collegiate recovery programming on campuses across the country. These programs aim to support students wishing to maintain recovery and can help teens who are considering applying to school.
These programs offer a community setting where recovering youth can share experiences, provide mutual support and reinforce their substance-free lifestyle. They are not a substitute for treatment.