Practice Profile: Adolescent Substance Use Treatment

The primary goal of substance use treatment is to reduce or treat substance use among adolescents. There are several different types of treatment modalities that can be used in substance use treatment for adolescents, such as cognitive–behavioral therapy, motivational enhancement therapy, and assertive continuing care programs. The practice is rated Effective for improving substance use outcomes of adolescents.

Practice Goals/Target Population

In 2020 an estimated 1.6 million youths ages 12 to 17 experienced a substance use disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) standards (SAMHSA 2021). This number includes various substances, such as alcohol, marijuana, and opioids. However, treatment of adolescent substance use is low. About 12 percent of youths who meet the criteria for substance use disorder actually participate in treatment (Haughwout et al. 2016). Treatment seeking and the use of treatment programs can be affected by many factors, such as the severity of the problem, family influence, and other mental health diagnoses.

The primary goal of substance use treatment is to reduce or treat substance use among adolescents, regardless of whether they meet the criteria for substance use disorder.

Practice Components

There are several different types of treatment modalities that can be used in substance use treatment for adolescents. Tanner–Smith and colleagues (2016) define these treatment modalities as the following:

1. Assertive continuing care programs provide integrated and coordinated case management services for youth after discharge from outpatient or inpatient treatment, including home visits, client advocacy for support services, and integrated social support services.
2. Behavioral or contingency management programs are based on operant behavioral principles that use incentives (e.g., gift certificates) to reward abstinence and/or treatment compliance.
3. Cognitive–behavioral therapy (CBT) programs are based on theories of classical conditioning and focus on teaching adolescents coping skills, problem-solving skills, and cognitive restructuring techniques for dealing with stimuli that trigger substance use or cravings.
4. Family therapy programs are based on ecological approaches that actively involve family members in treatment and address issues of family functioning, parenting skills, and family communication skills.
5. Motivational enhancement therapy (MET) programs use supportive and nonconfrontational therapeutic techniques to encourage motivation to change based on clients’ readiness to change and self-efficacy for behavior change.
6. MET/CBT programs use a combination of motivational enhancement and cognitive–behavioral therapy techniques.
7. Multiservice package programs use a combination of behavioral, CBT, family therapy, MET, pharmacological, psychoeducational therapy (PET), and/or group and mixed counseling in a comprehensive package. [Tanner–Smith et al. 2016, 3–4]

Tanner–Smith and colleagues (2016) conducted moderator analyses to determine the impact of individual types of treatment, compared with practice as usual (such as referrals to standard community services). The treatments examined were behavioral, cognitive–behavioral therapy, cognitive–behavioral therapy with family therapy, family therapy, motivational enhancement therapy and cognitive–behavioral therapy, multiservice, occupational skills training, assertive continuing care, and assertive continuing care with behavioral therapy. When compared with practice as usual, the authors found a statistically significant effect size favoring the treatments in all cases.

These sources were used in the development of the practice profile:

These sources were used in the development of the practice profile:

Haughwout, Sarah P., Thomas C. Harford, I–Jen P. Castle, and Bridget F. Grant. 2016. “Treatment Utilization Among Adolescent Substance Users: Findings From the 2002 to 2013 National Survey on Drug Use and Health.” Alcoholism: Clinical and Experimental Research 40(8):1717–27.

(SAMHSA) Substance Abuse and Mental Health Services Administration. 2021. “Key Substance Use and Mental Health Indicators in the United States: Results From the 2020 National Survey on Drug Use and Health.” Publication No. PEP21–07–01–003. Rockville, Md.: U.S. Department of Health and Human Services, SAMHSA.

Tanner–Smith, Emily E., Sandra Jo Wilson, and Mark W. Lipsey. 2013. “The Comparative Effectiveness of Outpatient Treatment for Adolescent Substance Abuse: A Meta-Analysis.” Journal of Substance Abuse Treatment 44:145–58.