0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
CLINICAL SYNTHESIS   |    
Understanding and Treating Adolescent Substance Abuse: A Preliminary Review
Katia Delrahim Howlett, M.P.P., M.B.A., Ph.D.; Thalia Williams, M.P.H.; Geetha Subramaniam, M.D., F.A.P.A.
FOCUS 2012;10:293-299. doi:10.1176/appi.focus.10.3.293
View Author and Article Information

Author Information and CME Disclosure

Katia Delrahim Howlett, M.P.P., M.B.A., Ph.D., Synergy Enterprises, Inc.

Thalia Williams, M.P.H., ICF International

Geetha Subramaniam, M.D., F.A.P.A., National Institute on Drug Abuse

All authors report no competing interests.

Address correspondence to Katia Delrahim Howlett, Synergy Enterprises, Inc., 8757 Georgia Ave. #1440; Silver Spring, MD 20910; e-mail: khowlett@seiservices.com

Adolescent substance use and its consequent sequelae is a significant public health issue that has immediate and long-term consequences. Implementation of office-based strategies such as screening for substance use and early intervention can potentially lower the rates of misuse in youth and arrest the development of abuse/ dependence. Beginning with a standardized biopsychosocial assessment, providers can obtain necessary information, such as risk and protective factors as well as substance use, to aid the development of tailored treatment plans that consist of evidenced-based psychosocial (and when applicable, pharmacological) treatment approaches to assist youth in achieving abstinence and improved global functioning. This article presents an overview of adolescent substance use and abuse including, recent trends in drug use, associated risk and protective factors, and a brief review of current treatment interventions and practices.

Abstract Teaser
Figures in this Article

Adolescence, a developmental period of physical and psychological changes, marks the commencement of greater independence, increased experimentation, and risk-taking among youth between the ages of 12 to 18 years (1). Experimentation with illicit substances (i.e., marijuana, nonmedical use of prescription medications, hallucinogens, etc.) and licit substances (i.e., alcohol, tobacco, prescription drugs, etc.) has onset during the adolescent years with noticeable peaks at young adult ages (2). Substance use has shown to cause a number of adverse physical (i.e., death from injury and increased participation in risky behaviors), mental (i.e., depression, personality disorders, and developmental lags), and social (i.e., poor academic performances, withdrawal, delinquency, and disengagement from family and peers) health effects among adolescents (36). Furthermore, research has revealed that adolescent substance use problems increase the risk of developing a substance use disorder (SUD) later in life (7).

In order to effectively implement interventions and evidence-based practices that provide the best patient outcomes for adolescents with substance use and abuse, it is critical that treatment providers are aware of recent trends in adolescent substance use, associated risk and protective factors, as well as current clinical practices.

+

Prevalence and recent trends

Despite continual prevention efforts by health practitioners, recent estimates from national surveys such as Monitoring the Future (MTF) and the National Survey on Drug Use and Health (NSDUH) suggest that adolescent substance use and abuse continues to be a persistent and commonly widespread public health issue (810). Conducted annually to monitor and analyze drug use among 8th, 10th, and 12th graders, recent MTF results suggest that experimentation with drugs among adolescents has remained relatively steady over the past few years and use continues to increase with age (11). Specifically, current MTF data indicate that 50% of 12th graders reported trying an illicit drug in their lifetime, 40% used one or more illicit drugs in the past year, and 25% used one or more illicit drugs in the past month. However, among 10th graders, the results are lower but still disturbing, with 38% of 10th graders reporting having tried an illicit drug in their lifetime, 31% using an illicit drug within the past year, and 19% using at least one illicit drug within the past month. The results for 8th graders are similar; with 20% reporting trying an illicit drug in their lifetime, 15% using an illicit drug in the past year, and 9% using at least one illicit drug within the past month (11). Furthermore, while MTF data suggests slight decreases in alcohol and cigarette use among this population in recent years, approximately 40% of 12th graders continue to report either alcohol use in the past month or having tried cigarettes by the 12th grade, which represents a significant public health concern (11). When looking at specific categories of licit and illicit drugs, MTF data are more alarming for rates of marijuana and nonmedical prescription medication use. According to MTF, nonmedical prescription medication use among adolescents has held a steady and high prevalence rate since 2005; with an approximate range between 14.5% and 17.5% among 12th graders reporting use in the past year. Moreover, daily marijuana use has continued to increase among the three cohorts from 2007to 2011 (+0.5%, +0.8%, and +1.5%, respectively) (11).

The 2010 NSDUH report showed that 7% and 4.5% of youth aged 12 to 17 meet past year substance dependence/abuse and alcohol dependence/abuse criteria, respectively (9). In addition, NSDUH data also provide insight into potential risk for future substance use through the identification of perception of risk for the use of specific licit and illicit drugs. A recent NSDUH report showed that the percentage of adolescents between the ages of 12 and 17 perceiving great risk from using selected illicit substances once or twice a week has declined since 2002. Specifically, in 2010, 65.5% of youth perceived great risk with smoking one or more packs of cigarettes per day, a decline of 4.2% since 2008. The decline in the percentage of youth that perceived great risk with smoking marijuana once or twice a week is even more alarming with a 7.2% decrease (from 54.7% in 2007 to 47.5% in 2010) (9). Such declines in perceived risk are similar for cocaine, heroin, and LSD. Typically, a reduction in perceived risk for the use of a specific substance has been shown to be directly proportional to future and immediate increases in use of that substance. In addition, there has been a recent increase in the misuse of prescription medications (i.e., opioids, stimulants, and sedatives). According to the Treatment Episode Data Set (TEDS), adolescents entering publicly funded treatment programs reported marijuana (71.9%) or alcohol (17.7%) as their primary substance of abuse and over half (56.3%) reported first using their primary substance between the ages of 12 and 14 (12).

The recent prevalence rates and drug use trends not only confirm that adolescent substance use continues to be a major health concern, but also, as demonstrated by the MTF and NSDUH data findings, while rates of use of some licit drugs have remained steady, there have been considerable increases in illicit drug use among this population. In addition, new drugs and rediscovery of older drugs have facilitated the cyclic patterns of substance use and abuse among American youth in recent years (9, 11). Furthermore, the extant literature suggests that age of onset of substance use is highly correlated with future use and abuse in adulthood as well as the development of substance use disorders and dependence later in life (7, 13, 14). Therefore, it is imperative that pediatric and adolescent treatment providers become competent in the identification of misuse and abuse among youth and employ strategies to intervene effectively.

+

Risk and protective factors

According to the National Institute on Drug Abuse (NIDA), crucial to informing effective substance abuse prevention and intervention programs has been the identification of risk and protective factors impacting youth substance use (15). Although adolescence alone represents a developmental risk period for experimentation with alcohol and other substances, a variety of contextual or individual risk and protective factors have been found to be significant. Contextual factors, that include ecological factors such as availability of and access to substances, are often directly related to community policies and social norms. Individual factors include biological vulnerability; early exposure to substance use (either proximal such as prenatal exposure or distal through a family member or peer); preexisting psychiatric and or psychological issues such as depression, anxiety, attention deficit hyperactivity disorder, conduct disorder, trauma and impulsivity; and neurobiological developmental factors including immature frontal lobe development (normative) and lowered serotonergic function (nonnormative) (6, 1620).

Risk and protective factors exist at each interaction level in a person’s life—individual level, organizational/local network level, community level, and population/societal level (15). Some individual risk factors can be identified as early as infancy or early childhood, such as aggressive behavior, lack of self-control, or difficult temperament. As the child gets older, contextual risk factors such as interactions with family, with peers and within school, and within the community can affect that child’s risk for later drug abuse and dependence. Research has shown that the key risk periods for drug abuse are during major transitions in children’s lives (2124). The first significant transition for children is when they leave the security of the family and enter school. Later, when they advance from elementary school to middle school, they often experience new academic and social situations, such as learning to get along with a wider group of peers. It is at this stage—early adolescence—that children are likely to encounter drugs for the first time (6, 25). When they enter high school, adolescents face additional social, emotional, and educational challenges. At the same time, they may be exposed to greater availability of drugs, drug abusers, and social activities involving drugs. These challenges can increase the risk that they will abuse alcohol, tobacco, and other substances (26). When young adults leave home for college or to enter the workforce and are on their own for the first time, their risk for drug and alcohol abuse increases significantly (27, 28).

Substance use in adolescent years is often a result of proximal and distal precursors originating in early childhood and possibly even during the prenatal period (29, 30). The level of exposure to these precursors is often directly correlated with the success of subsequent treatment interventions. Therefore, it is imperative that treatment providers are aware of risk and protective factors at multiple levels of a patient’s environment so that they may target these factors in their treatment planning and implementation.

The foundation for many effective behavioral substance use disorder treatments is the identification of potential risk factors for that population and the enhancement of protective factors to prevent or reduce current use within the target population. Hence, it is important to begin the intervention with a standardized assessment that collects history on biological, psychological and social domains in addition to substance use/abuse, to better inform how best to tailor evidence-based interventions.

+

Psychosocial treatments

Research looking at outcomes of various psychosocial treatment modalities in the adolescent population has suggested positive effects for all treatment models as compared with comparison groups (31). However, the best outcomes have come from cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), and family-based treatments; all described in more detail below. In addition, it is important to consider the format of psychosocial treatment modalities, such as individual and group formats, which allow a patient or a group of patients to participate in a psychosocial therapeutic session with a therapist or counselor. Although both individual and group formats are used in adolescent substance abuse treatment, research has shown that group therapy is most common in practice (32, 33).

+

Cognitive Behavioral Therapy (CBT).

CBT is a manual-guided approach in which the therapist assists the youth with acquiring cognitive skills (e.g., identifying and addressing distorted thought patterns in order to change behaviors) which are combined with behavioral strategies (e.g., coping with cravings for substances; anger management) to address the substance use problem. CBT is typically offered in outpatient settings, via either individual or via group sessions of 12-16 week duration (3436).

+

Contingency Management (CM).

CM is based on the principle of operant conditioning, in which consequences (i.e. reinforcement or punishment) are used to reduce substance use with the ultimate goal of weakening the influence of the reinforcement derived from substance abuse. Positive reinforcement, (i.e. prizes or cash vouchers) such as immediate and tangible rewards, may be delivered via either fixed or intermittent intervals (37). Although, typically a therapist delivers CM in person, there is emerging evidence for training parents to deliver CM and the use of web-based delivery with adolescents as well (38, 39).

+

Motivational Enhancement Therapy (MET).

MET is an adaptation of motivational interviewing (MI) that includes one or more patient feedback sessions in which normative feedback is presented and discussed in an explicitly nonconfrontational manner (36). MET is typically not meant as a stand-alone treatment, but used to engage the patient into treatment. MET shows promise for application within the time constraints of busy general medical practices, especially to target less severe forms of substance abuse.

+

Family-Based Treatments.

These manual-based approaches, in which the adolescent and at least one parent/legal guardian are involved in the treatment sessions, have been found to be highly efficacious and in some comparisons, superior to other treatments available for substance abusing adolescents (31). Family treatments have been derived from various theories of family functioning and ecological models and highlight the need to engage and involve families in treatment. The following approaches have been shown to be efficacious in reducing substance use among youth

  • Multidimensional Family Therapy (MDFT) includes both an adolescent and a parent/ family and extra familial domains that target parent monitoring, conflict resolution, communication, fostering family competency and collaborative work with involved systems (e.g. school, juvenile justice) during a 4-month duration. MDFT has been shown to be effective in dealing with higher severity substance use and feasible in community reintegration of substance abusing juvenile detainees (40).

  • Multi-Systemic Therapy (MST) is a comprehensive and intensive family-and community-based treatment (i.e. home, school-based, etc.) of 4-6 month duration. This modality views the substance abusing youth/juvenile offender as a complex of interconnected systems that encompass individual, family, and extrafamilial (peer, school, neighborhood) factors (41). MST also appears to be effective in higher severity youth with delinquent and/or violent substance-abusing adolescents (42).

  • Brief Strategic Family Therapy (BSFT) is based on an integrative theoretical model that combines structural and strategic family therapy theory and intervention techniques. It operates on the principle that problem behaviors stem from maladaptive family interactions and, therefore, it seeks to transform how the family functions to help improve the presenting problem (43).

  • Functional Family Therapy (FFT) is based on an integrative ecological model that typically involves two intervention phases: a) engaging families in the treatment process and enhancing motivation for change, and b) effecting behavioral changes in the family using contingency management, communication and problem solving, behavioral contracting, and other behavioral interventions (34).

  • Adolescent Community Reinforcement Approach (a-CRA) is a comprehensive substance use treatment intervention that involves both the adolescent and their families in the sessions. It seeks to increase the family, social, and educational/vocational reinforcers of an adolescent to support recovery and to encourage prosocial activities (44). Assertive Continuing Care (ACC), a home-based intervention, combines a-CRA and case management for a duration of 12–14 weeks, to work with adolescents discharged from residential or outpatient treatment to help maintain the progress achieved during active treatment.

In addition to the above mentioned manual-driven treatments there are other forms of less well-evaluated yet popular treatment modalities. Twelve-step programs encompass self-help approaches with a focus on reciprocal support from other individuals facing the same substance use problems, e.g., Alcoholics Anonymous (AA), Narcotics Anonymous, and Cocaine Anonymous (45). The therapeutic community approach uses holistic treatment practices to address adolescent substance use problems. In this approach, the community is viewed as the primary agent of change with emphasis placed on shared self-help and values for a healthy lifestyle, and behavioral consequences (46).

+

Pharmacotherapy

Several FDA-approved medications have been found efficacious in increasing abstinence in the treatment of nicotine, alcohol, or opioid dependence. The mechanism of action for these medications ranges from substitution (e.g. nicotine products for nicotine dependence), reduction of cravings (e.g., naltrexone for alcohol dependence), and receptor blockades (e.g., naltrexone for opioid dependence) to management of withdrawal symptoms and cravings (e.g., buprenorphine). However, these medications have not yet been FDA-approved for use among youth with addictive disorders (except for buprenorphine in youth 16 years or older) due to the lack of sufficient evidence demonstrating efficacy.

As mentioned above, while some medications have been approved for the treatment of specific drug dependence in adults (i.e. alcohol, nicotine, opioid dependence); to date, no medication has received FDA approval for the treatment of cocaine, methamphetamine or cannabis dependence (12). The following is a brief description/listing of all available FDA approved addiction medications.

+

I. Medications as Aids to Smoking Cessation/Nicotine Dependence (47–51).

1) Nicotine replacement therapies (NRT) are nicotine receptor agonists and are available in patch, gum, lozenge, and nasal spray and inhaler preparations. 2) Bupropion is a dopamine and norepinephrine reuptake inhibitor. 3) Varenicline is a partial nicotine agonist. It is important to recognize that current practice guidelines for youth smoking cessation treatments only recommend counseling approaches (52).

+

II. Medications for the Treatment of Opioid Dependence.

1) Buprenorphine is a partial agonist of the mu opioid receptor. Buprenorphine is available combined with naloxone (an opioid antagonist) and as a standalone preparation. Naloxone, which is not absorbed sublingually, is added to buprenorphine, in order to reduce diversion by injection drug use (if injected naloxone will precipitate opioid withdrawal). FDA reports that buprenorphine has been found to be safe for use in opioid dependent patients ages 16 and older, which is particularly noteworthy, especially since the vast majority of opioid dependent youth who might benefit from this treatment are older (53). Two randomized controlled outpatient trials (including a large NIDA Clinical Trials Network multisite trial) showed that sublingual buprenorphine is safe and superior to clonidine in a 4-week trial (N=38; ages 14-18) (54) and that 12 weeks of buprenorphine is both safe and superior to detoxification with up to 2 weeks on an outpatient basis (N=152, ages 15-21 years) (55). In both trials buprenorphine was offered along with a psychosocial treatment and was found to work well for dependence to either prescription opioids or heroin, and for both males and females. 2) Naltrexone is an antagonist of the mu opioid receptor and is efficacious in relapse prevention (i.e. in maintaining opioid abstinence in those who achieve any abstinence from opioids) (56). 3) Methadone, a full-agonist of the mu opioid receptor is only available for dispensing at specially licensed Opioid Treatment Programs (OTP). Methadone is not a feasible option for most youth <18 years due to strict regulations which stipulate that individuals ages 16-18 years need a) consent from their legal guardian(s) for the use of methadone; and b) have documented failure for at least two prior treatment attempts.

+

III. Medications for Treatment of Alcohol Dependence (57, 58).

1) Naltrexone has been shown to decrease alcohol-induced euphoria, time to relapse, and the quantity and frequency of drinking among alcohol dependent adults who relapse. 2) Acamprosate is proposed to normalize the deregulation of N-methyl-d-aspartate (NMDA)-mediated glutamatergic (excitatory) neurotransmission and stimulate inhibitory GABA transmission that occurs during chronic alcohol consumption and withdrawal. 3) Disulfiram is an aversive agent that inhibits alcohol dehydrogenase (involved in the metabolism of alcohol), resulting in an accumulation of acetaldehyde which provides an aversive reaction if alcohol is consumed after taking the medication. The histamine-induced aversive experience can consist of flushing of the skin, hypotension, reflex tachycardia, tachypnea, a sensation of warmth, palpitations, anxiety, headache, nausea and, in some instances, vomiting.

Even in the adult population, for whom efficacy has been established, medications for the treatment of SUDs are not meant to be delivered as stand-alone treatments, but in combination with counseling/therapy. Also, in the context of recent FDA “black box” warnings of hostility, agitation, depressed mood, suicidal thoughts or actions and/or psychotic behaviors with several of the psychotropic medications (e.g. selective serotonin reuptake inhibitors, bupropion, psychostimulants, varenicline, etc.), treatment providers remain skeptical about the use of psychotropic medications for adolescents. However, based on the limited research evidence, it appears that, when available, the use of medications in combination with therapy appears to be well-tolerated and superior to use of placebo or therapy alone.

Further research is needed to not only establish the safety and efficacy of medications, but also their impact on the developing brain.

In order to effectively address the consistent and growing public health problem of substance use and abuse among adolescents, healthcare practitioners and clinicians need to modify patient (and family) behaviors and attitudes by screening and better identifying either risk for or current problem substance use as well as integrating more evidence-based strategies. Research has shown that identification and early intervention by a healthcare practitioner and/or clinician for adolescent substance use and abuse can greatly impact the incidence of use and abuse and consequently decrease the prevalence of addiction (59). The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry highlight the need to address practice gaps and have urged membership to increase their knowledge and practice of integrating substance abuse treatments into their respective practices (60, 61).

In practice, particularly due to third party reimbursement requirements, most providers utilize the expert consensus-driven Patient Placement Criteria published by American Society of Addiction Medicine to determine levels of treatment care. The levels are as follows: (1) early intervention services, (2) outpatient treatment, (3) intensive outpatient, (4) residential/inpatient treatment, and (5) medically managed intensive inpatient (62). Once a level has been determined, practitioners can then integrate appropriate evidenced-based practices to treat their adolescent patients within the levels of care.

While evidence is limited for pharmacotherapeutic approaches and efficacious behavioral and family treatments for SUDs are labor-intensive and require high levels of fidelity for success, the extant literature demonstrates for adolescent substance abuse that a number of effective programs, both inpatient and outpatient, are creating comprehensive treatment frameworks by integrating multiple therapeutic practices (33). With recent legislation mandating the meaningful use of electronic health records as a provision of the Health Information Technology for Economic and Clinical Health (HITECH) Act – a component of the American Recovery and Reinvestment Act of 2009 (63), practitioners are not only encouraged to become familiar and competent in the use of existing, albeit limited, tools for screening and assessment, brief interventions, and evidence-based treatments for SUDs, but to also capitalize on the currently available financial incentives for such use (64). These new legislative actions provide unprecedented opportunities to integrate prevention and treatment of SUDs in multiple medical settings and expand benefits to cover treatment for vulnerable populations including youth (65, 66). Outside of the healthcare and medical fields, it is vital that all stakeholders, i.e. clinicians, parents, policymakers, and researchers advocate for youth substance use issues on a global level to change social norms, policies and to diminish the often devastating consequences of substance misuse.

Burrow-Sanchez  JJ:  Understanding Adolescent Substance Abuse: Prevalence, Risk Factors, and Clinical Implications.  J Couns Dev 2006; 84:283–290
[CrossRef]
 
Greydanus  DE;  Patel  DR:  The adolescent and substance abuse: current concepts.  Curr Probl Pediatr Adolesc Health Care 2005; 35:78–98
[PubMed]
[CrossRef]
 
Gropper BA.Probing the Links Between Drugs and Crime. Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice. 1985 (February).
 
Hawkins  JD;  Lishner  DM;  Jenson  JM;  Catalano  RF:  Delinquents and drugs: What the evidence suggests about prevention and treatment programming, in  Youth at High Risk for Substance Abuse . Edited by Brown  BS;  Mills  AR.  Rockville, MD,  National Institute on Drug Abuse, 1987
 
Newcomb  MD;  Bentler  PM:  Substance use and abuse among children and teenagers.  Am Psychol 1989; 44:242–248
[PubMed]
[CrossRef]
 
Hawkins  JD;  Catalano  RF;  Miller  JY:  Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention.  Psychol Bull 1992; 112:64–105
[PubMed]
[CrossRef]
 
Chen  C-Y;  Storr  CL;  Anthony  JC:  Early-onset drug use and risk for drug dependence problems.  Addict Behav 2009; 34:319–322
[PubMed]
[CrossRef]
 
Sussman  S;  Skara  S;  Ames  SL:  Substance abuse among adolescents.  Subst Use Misuse 2008; 43:1802–1828
[PubMed]
[CrossRef]
 
Substance Abuse and Mental Health Services Administration: Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. U.S. Department of Health and Human Services, 2011. www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm.
 
Johnston  LD;  O'Malley  PM;  Bachman  JG;  Schulenberg  JE. Monitoring the Future national survey results on drug use, 1975-2011., vol. I:  Secondary school students .  Ann Arbor,  Institute for Social Research, The University of Michigan, 2012, pp 751
 
Johnston  LD;  O'Malley  PM;  Bachman  JG;  Schulenberg  JE:  Monitoring the Future national results on adolescent drug use: Overview of key findings, 2011 .  Ann Arbor,  Institute for Social Research, The University of Michigan, 2012, pp 78
 
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The TEDS Report: Substance Abuse Treatment Admissions Aged 15 to 17. Rockville, MD. 2012(February).
 
Grant  BF;  Dawson  DA:  Age of onset of drug use and its association with DSM-IV drug abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey.  J Subst Abuse 1998; 10:163–173
[PubMed]
[CrossRef]
 
Dennis ML: Treatment Research on Adolescents Drug and Alcohol Abuse: Despite Progress, Many Challenges Remain. Connection. Washington, DC: Academy for Health Services Research and Health Policy. 2002; www.academyhealth.org/publications/connection/index.htm
 
National Institute on Drug Abuse: Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders, Second Edition. United States Department of Health and Human Services. 2003; www.nida.nih.gov/pdf/prevention/RedBook.pdf
 
Yates  WR;  Cadoret  RJ;  Troughton  EP;  Stewart  M;  Giunta  TS:  Effect of fetal alcohol exposure on adult symptoms of nicotine, alcohol, and drug dependence.  Alcohol Clin Exp Res 1998; 22:914–920
[PubMed]
[CrossRef]
 
Swadi  H:  Individual risk factors for adolescent substance use.  Drug Alcohol Depend 1999; 55:209–224
[PubMed]
[CrossRef]
 
Zeitlin  H:  Psychiatric comorbidity with substance misuse in children and teenagers.  Drug Alcohol Depend 1999; 55:225–234
[PubMed]
[CrossRef]
 
Hanna  EZ;  Yi  HY;  Dufour  MC;  Whitmore  CC:  The relationship of early-onset regular smoking to alcohol use, depression, illicit drug use, and other risky behaviors during early adolescence: results from the youth supplement to the third national health and nutrition examination survey.  J Subst Abuse 2001; 13:265–282
[PubMed]
[CrossRef]
 
Schepis  TS;  Adinoff  B;  Rao  U:  Neurobiological processes in adolescent addictive disorders.  Am J Addict 2008; 17:6–23
[PubMed]
[CrossRef]
 
Johnston  L;  O'Malley  P;  Eveland  L:  Drugs and delinquency: A search for causal connections, in  Longitudinal Research on Drug Use: Empirical Findings and Methodological Issues . Edited by Kandel  DB.  Washington, DC,  Hemisphere-Wiley, 1978, pp 132–156
 
O’Malley  PM;  Bachman  JG;  Johnston  LD:  Period, age, and cohort effects on substance use among American youth, 1976-82.  Am J Public Health 1984; 74:682–688
[PubMed]
[CrossRef]
 
Brown  SA;  D’Amico  EJ;  McCarthy  DM;  Tapert  SF:  Four-year outcomes from adolescent alcohol and drug treatment.  J Stud Alcohol 2001; 62:381–388
[PubMed]
 
Tucker  JS;  Ellickson  PL;  Orlando  M;  Martino  SC;  Klein  DJ:  Substance use trajectories from early adolescence to emerging adulthood: A comparison of smoking, binge drinking, and marijuana use.  J Drug Issues 2005; 35:307–332
[CrossRef]
 
Warren  CW;  Kann  L;  Small  ML;  Santelli  JS;  Collins  JL;  Kolbe  LJ:  Age of initiating selected health-risk behaviors among high school students in the United States.  J Adolesc Health 1997; 21:225–231
[PubMed]
[CrossRef]
 
Kandel  DB;  Logan  JA:  Patterns of drug use from adolescence to young adulthood: I. Periods of risk for initiation, continued use, and discontinuation.  Am J Public Health 1984; 74:660–666
[PubMed]
[CrossRef]
 
Raveis  VH;  Kandel  DB:  Changes in drug behavior from the middle to the late twenties: initiation, persistence, and cessation of use.  Am J Public Health 1987; 77:607–611
[PubMed]
[CrossRef]
 
Chen  K;  Kandel  DB:  The natural history of drug use from adolescence to the mid-thirties in a general population sample.  Am J Public Health 1995; 85:41–47
[PubMed]
[CrossRef]
 
Brook  JS;  Whiteman  M;  Cohen  P;  Tanaka  JS:  Childhood precursors of adolescent drug use: a longitudinal analysis.  Genet Soc Gen Psychol Monogr 1992; 118:195–213
[PubMed]
 
Andrews  JA;  Hops  H;  Ary  D;  Tildesley  E;  Harris  J:  Parental influence on early adolescent substance use: Specific and nonspecific effects.  J Early Adolesc 1993; 13:285–310
[CrossRef]
 
Lipsey  MW;  Tanner-Smith  EE;  Wilson  SJ:  Comparative Effectiveness of Adolescent Substance Abuse Treatment: Three Meta-analyses With Implications for Practice .  Nashville, TN,  Peabody Research Institute, Vanderbilt University, 2010
 
Weiss  RD;  Jaffee  WB;  de Menil  VP;  Cogley  CB:  Group therapy for substance use disorders: what do we know? Harv Rev Psychiatry 2004; 12:339–350
[PubMed]
[CrossRef]
 
Winters  KC;  Botzet  AM;  Fahnhorst  T:  Advances in adolescent substance abuse treatment.  Curr Psychiatry Rep 2011; 13:416–421
[PubMed]
[CrossRef]
 
Waldron  HB;  Slesnick  N;  Brody  JL;  Turner  CW;  Peterson  TR:  Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments.  J Consult Clin Psychol 2001; 69:802–813
[PubMed]
[CrossRef]
 
Kaminer  Y;  Burleson  JA;  Goldberger  R:  Cognitive-behavioral coping skills and psychoeducation therapies for adolescent substance abuse.  J Nerv Ment Dis 2002; 190:737–745
[PubMed]
[CrossRef]
 
Dennis  M;  Godley  SH;  Diamond  G;  Tims  FM;  Babor  T;  Donaldson  J;  Liddle  H;  Titus  JC;  Kaminer  Y;  Webb  C;  Hamilton  N;  Funk  R:  The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials.  J Subst Abuse Treat 2004; 27:197–213
[PubMed]
[CrossRef]
 
Stanger  C;  Budney  AJ:  Contingency management approaches for adolescent substance use disorders.  Child Adolesc Psychiatr Clin N Am 2010; 19:547–562
[PubMed]
[CrossRef]
 
Cohen  DA;  Linton  KL:  Parent participation in an adolescent drug abuse prevention program.  J Drug Educ 1995; 25:159–169
[PubMed]
[CrossRef]
 
Dishion  TJ;  Nelson  SE;  Kavanagh  K:  The family check-up with high-risk young adolescents: Preventing early-onset substance use by parent monitoring.  Behav Ther 2003; 34:553–571
[CrossRef]
 
Liddle  HA;  Rowe  CL;  Dakof  GA;  Henderson  CE;  Greenbaum  PE:  Multidimensional family therapy for young adolescent substance abuse: twelve-month outcomes of a randomized controlled trial.  J Consult Clin Psychol 2009; 77:12–25
[PubMed]
[CrossRef]
 
Henggeler  SW;  Clingempeel  WG;  Brondino  MJ;  Pickrel  SG:  Four-year follow-up of multisystemic therapy with substance-abusing and substance-dependent juvenile offenders.  J Am Acad Child Adolesc Psychiatry 2002; 41:868–874
[PubMed]
[CrossRef]
 
Henggeler  SW;  Halliday-Boykins  CA;  Cunningham  PB;  Randall  J;  Shapiro  SB;  Chapman  JE:  Juvenile drug court: enhancing outcomes by integrating evidence-based treatments.  J Consult Clin Psychol 2006; 74:42–54
[PubMed]
[CrossRef]
 
Robbins  MS;  Feaster  DJ;  Horigian  VE;  Rohrbaugh  M;  Shoham  V;  Bachrach  K;  Miller  M;  Burlew  KA;  Hodgkins  C;  Carrion  I;  Vandermark  N;  Schindler  E;  Werstlein  R;  Szapocznik  J:  Brief strategic family therapy versus treatment as usual: results of a multisite randomized trial for substance using adolescents.  J Consult Clin Psychol 2011; 79:713–727
[PubMed]
[CrossRef]
 
Godley  SH;  Garner  BR;  Passetti  LL;  Funk  RR;  Dennis  ML;  Godley  MD:  Adolescent outpatient treatment and continuing care: main findings from a randomized clinical trial.  Drug Alcohol Depend 2010; 110:44–54
[PubMed]
[CrossRef]
 
Borkman  T:  The twelve-step recovery model of AA: a voluntary mutual help association.  Recent Dev Alcohol 2008; 18:9–35
[PubMed]
 
Jainchill  N:  Therapeutic communities for adolescents: the same and not the same, in  Community as method: therapeutic communities for special populations and special settings . Edited by DeLeon  G.  Westport,  Praeger, 1997, pp 161–178
 
Moolchan  ET;  Robinson  ML;  Ernst  M;  Cadet  JL;  Pickworth  WB;  Heishman  SJ;  Schroeder  JR:  Safety and efficacy of the nicotine patch and gum for the treatment of adolescent tobacco addiction.  Pediatrics 2005; 115:e407–e414
[PubMed]
[CrossRef]
 
Killen  JD;  Robinson  TN;  Ammerman  S;  Hayward  C;  Rogers  J;  Stone  C;  Samuels  D;  Levin  SK;  Green  S;  Schatzberg  AF:  Randomized clinical trial of the efficacy of bupropion combined with nicotine patch in the treatment of adolescent smokers.  J Consult Clin Psychol 2004; 72:729–735
[PubMed]
[CrossRef]
 
Muramoto  ML;  Leischow  SJ;  Sherrill  D;  Matthews  E;  Strayer  LJ:  Randomized, double-blind, placebo-controlled trial of 2 dosages of sustained-release bupropion for adolescent smoking cessation.  Arch Pediatr Adolesc Med 2007; 161:1068–1074
[PubMed]
[CrossRef]
 
Gray  KM;  Carpenter  MJ;  Baker  NL;  Hartwell  KJ;  Lewis  AL;  Hiott  DW;  Deas  D;  Upadhyaya  HP:  Bupropion SR and contingency management for adolescent smoking cessation.  J Subst Abuse Treat 2011; 40:77–86
[PubMed]
[CrossRef]
 
Gray  KM;  Carpenter  MJ;  Lewis  AL;  Klintworth  EM;  Upadhyaya  HP:  Varenicline versus bupropion XL for smoking cessation in older adolescents: a randomized, double-blind pilot trial.  Nicotine Tob Res 2012; 14:234–239
[PubMed]
[CrossRef]
 
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update.Clinical Practice Guideline. Rockville, MD: U.S. Departmentof Health and Human Services. Public Health Service. May 2008.
 
Hopfer  CJ;  Khuri  E;  Crowley  TJ;  Hooks  S:  Adolescent heroin use: a review of the descriptive and treatment literature.  J Subst Abuse Treat 2002; 23:231–237
[PubMed]
[CrossRef]
 
Marsch  LA;  Bickel  WK;  Badger  GJ;  Stothart  ME;  Quesnel  KJ;  Stanger  C;  Brooklyn  J:  Comparison of pharmacological treatments for opioid-dependent adolescents: a randomized controlled trial.  Arch Gen Psychiatry 2005; 62:1157–1164
[PubMed]
[CrossRef]
 
Woody  GE;  Poole  SA;  Subramaniam  G;  Dugosh  K;  Bogenschutz  M;  Abbott  P;  Patkar  A;  Publicker  M;  McCain  K;  Potter  JS;  Forman  R;  Vetter  V;  McNicholas  L;  Blaine  J;  Lynch  KG;  Fudala  P:  Extended vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth: a randomized trial.  JAMA 2008; 300:2003–2011
[PubMed]
[CrossRef]
 
Fishman  MJ;  Winstanley  EL;  Curran  E;  Garrett  S;  Subramaniam  G:  Treatment of opioid dependence in adolescents and young adults with extended release naltrexone: preliminary case-series and feasibility.  Addiction 2010; 105:1669–1676
[PubMed]
[CrossRef]
 
Niederhofer  H;  Staffen  W:  Acamprosate and its efficacy in treating alcohol dependent adolescents.  Eur Child Adolesc Psychiatry 2003; 12:144–148
[PubMed]
[CrossRef]
 
Niederhofer  H;  Staffen  W:  Comparison of disulfiram and placebo in treatment of alcohol dependence of adolescents.  Drug Alcohol Rev 2003; 22:295–297
[PubMed]
[CrossRef]
 
Feinstein  EC;  Richter  L;  Foster  SE:  Addressing the critical health problem of adolescent substance use through health care, research, and public policy.  J Adolesc Health 2012; 50:431–436
[PubMed]
[CrossRef]
 
Bukstein  OG;  Bernet  W;  Arnold  V;  Beitchman  J;  Shaw  J;  Benson  RS;  Kinlan  J;  McClellan  J;  Stock  S;  Ptakowski  KK;  Work Group on Quality Issues:  Practice parameter for the assessment and treatment of children and adolescents with substance use disorders.  J Am Acad Child Adolesc Psychiatry 2005; 44:609–621
[PubMed]
[CrossRef]
 
Levy  SJ;  Kokotailo  PK;  Committee on Substance Abuse:  Substance use screening, brief intervention, and referral to treatment for pediatricians.  Pediatrics 2011; 128:e1330–e1340
[PubMed]
[CrossRef]
 
American Society on Addiction Medicine: ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders (Second Edition—Revised): (ASAM PPC-2R) 2001; www.asam.org/PatientPlacementCriteria.html
 
American Recovery and Reinvestment Act of: 2009; www.gpo.gov/fdsys/pkg/PLAW-111publ5/html/PLAW-111publ5.htm
 
Ghitza  UE;  Gore-Langton  RE;  Lindblad  R;  Shide  D;  Subramaniam  G;  Tai  B:  Common data elements for substance use disorders in electronic health records: the NIDA Clinical Trials Network experience.  Addiction 2012; May 8. doi: 10.1111/j.1360-0443.2012.03876.x. [Epub ahead of print]
 
Substance Abuse and Mental Health Services Administration. What you need to know about health reform. Substance Abuse and Mental Health Services Administration News. 2010:18(5).
 
Buck  JA:  The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act.  Health Aff (Millwood) 2011; 30:1402–1410
[PubMed]
[CrossRef]
 
References Container
+

References

Burrow-Sanchez  JJ:  Understanding Adolescent Substance Abuse: Prevalence, Risk Factors, and Clinical Implications.  J Couns Dev 2006; 84:283–290
[CrossRef]
 
Greydanus  DE;  Patel  DR:  The adolescent and substance abuse: current concepts.  Curr Probl Pediatr Adolesc Health Care 2005; 35:78–98
[PubMed]
[CrossRef]
 
Gropper BA.Probing the Links Between Drugs and Crime. Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice. 1985 (February).
 
Hawkins  JD;  Lishner  DM;  Jenson  JM;  Catalano  RF:  Delinquents and drugs: What the evidence suggests about prevention and treatment programming, in  Youth at High Risk for Substance Abuse . Edited by Brown  BS;  Mills  AR.  Rockville, MD,  National Institute on Drug Abuse, 1987
 
Newcomb  MD;  Bentler  PM:  Substance use and abuse among children and teenagers.  Am Psychol 1989; 44:242–248
[PubMed]
[CrossRef]
 
Hawkins  JD;  Catalano  RF;  Miller  JY:  Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention.  Psychol Bull 1992; 112:64–105
[PubMed]
[CrossRef]
 
Chen  C-Y;  Storr  CL;  Anthony  JC:  Early-onset drug use and risk for drug dependence problems.  Addict Behav 2009; 34:319–322
[PubMed]
[CrossRef]
 
Sussman  S;  Skara  S;  Ames  SL:  Substance abuse among adolescents.  Subst Use Misuse 2008; 43:1802–1828
[PubMed]
[CrossRef]
 
Substance Abuse and Mental Health Services Administration: Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. U.S. Department of Health and Human Services, 2011. www.samhsa.gov/data/NSDUH/2k10NSDUH/2k10Results.htm.
 
Johnston  LD;  O'Malley  PM;  Bachman  JG;  Schulenberg  JE. Monitoring the Future national survey results on drug use, 1975-2011., vol. I:  Secondary school students .  Ann Arbor,  Institute for Social Research, The University of Michigan, 2012, pp 751
 
Johnston  LD;  O'Malley  PM;  Bachman  JG;  Schulenberg  JE:  Monitoring the Future national results on adolescent drug use: Overview of key findings, 2011 .  Ann Arbor,  Institute for Social Research, The University of Michigan, 2012, pp 78
 
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The TEDS Report: Substance Abuse Treatment Admissions Aged 15 to 17. Rockville, MD. 2012(February).
 
Grant  BF;  Dawson  DA:  Age of onset of drug use and its association with DSM-IV drug abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey.  J Subst Abuse 1998; 10:163–173
[PubMed]
[CrossRef]
 
Dennis ML: Treatment Research on Adolescents Drug and Alcohol Abuse: Despite Progress, Many Challenges Remain. Connection. Washington, DC: Academy for Health Services Research and Health Policy. 2002; www.academyhealth.org/publications/connection/index.htm
 
National Institute on Drug Abuse: Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders, Second Edition. United States Department of Health and Human Services. 2003; www.nida.nih.gov/pdf/prevention/RedBook.pdf
 
Yates  WR;  Cadoret  RJ;  Troughton  EP;  Stewart  M;  Giunta  TS:  Effect of fetal alcohol exposure on adult symptoms of nicotine, alcohol, and drug dependence.  Alcohol Clin Exp Res 1998; 22:914–920
[PubMed]
[CrossRef]
 
Swadi  H:  Individual risk factors for adolescent substance use.  Drug Alcohol Depend 1999; 55:209–224
[PubMed]
[CrossRef]
 
Zeitlin  H:  Psychiatric comorbidity with substance misuse in children and teenagers.  Drug Alcohol Depend 1999; 55:225–234
[PubMed]
[CrossRef]
 
Hanna  EZ;  Yi  HY;  Dufour  MC;  Whitmore  CC:  The relationship of early-onset regular smoking to alcohol use, depression, illicit drug use, and other risky behaviors during early adolescence: results from the youth supplement to the third national health and nutrition examination survey.  J Subst Abuse 2001; 13:265–282
[PubMed]
[CrossRef]
 
Schepis  TS;  Adinoff  B;  Rao  U:  Neurobiological processes in adolescent addictive disorders.  Am J Addict 2008; 17:6–23
[PubMed]
[CrossRef]
 
Johnston  L;  O'Malley  P;  Eveland  L:  Drugs and delinquency: A search for causal connections, in  Longitudinal Research on Drug Use: Empirical Findings and Methodological Issues . Edited by Kandel  DB.  Washington, DC,  Hemisphere-Wiley, 1978, pp 132–156
 
O’Malley  PM;  Bachman  JG;  Johnston  LD:  Period, age, and cohort effects on substance use among American youth, 1976-82.  Am J Public Health 1984; 74:682–688
[PubMed]
[CrossRef]
 
Brown  SA;  D’Amico  EJ;  McCarthy  DM;  Tapert  SF:  Four-year outcomes from adolescent alcohol and drug treatment.  J Stud Alcohol 2001; 62:381–388
[PubMed]
 
Tucker  JS;  Ellickson  PL;  Orlando  M;  Martino  SC;  Klein  DJ:  Substance use trajectories from early adolescence to emerging adulthood: A comparison of smoking, binge drinking, and marijuana use.  J Drug Issues 2005; 35:307–332
[CrossRef]
 
Warren  CW;  Kann  L;  Small  ML;  Santelli  JS;  Collins  JL;  Kolbe  LJ:  Age of initiating selected health-risk behaviors among high school students in the United States.  J Adolesc Health 1997; 21:225–231
[PubMed]
[CrossRef]
 
Kandel  DB;  Logan  JA:  Patterns of drug use from adolescence to young adulthood: I. Periods of risk for initiation, continued use, and discontinuation.  Am J Public Health 1984; 74:660–666
[PubMed]
[CrossRef]
 
Raveis  VH;  Kandel  DB:  Changes in drug behavior from the middle to the late twenties: initiation, persistence, and cessation of use.  Am J Public Health 1987; 77:607–611
[PubMed]
[CrossRef]
 
Chen  K;  Kandel  DB:  The natural history of drug use from adolescence to the mid-thirties in a general population sample.  Am J Public Health 1995; 85:41–47
[PubMed]
[CrossRef]
 
Brook  JS;  Whiteman  M;  Cohen  P;  Tanaka  JS:  Childhood precursors of adolescent drug use: a longitudinal analysis.  Genet Soc Gen Psychol Monogr 1992; 118:195–213
[PubMed]
 
Andrews  JA;  Hops  H;  Ary  D;  Tildesley  E;  Harris  J:  Parental influence on early adolescent substance use: Specific and nonspecific effects.  J Early Adolesc 1993; 13:285–310
[CrossRef]
 
Lipsey  MW;  Tanner-Smith  EE;  Wilson  SJ:  Comparative Effectiveness of Adolescent Substance Abuse Treatment: Three Meta-analyses With Implications for Practice .  Nashville, TN,  Peabody Research Institute, Vanderbilt University, 2010
 
Weiss  RD;  Jaffee  WB;  de Menil  VP;  Cogley  CB:  Group therapy for substance use disorders: what do we know? Harv Rev Psychiatry 2004; 12:339–350
[PubMed]
[CrossRef]
 
Winters  KC;  Botzet  AM;  Fahnhorst  T:  Advances in adolescent substance abuse treatment.  Curr Psychiatry Rep 2011; 13:416–421
[PubMed]
[CrossRef]
 
Waldron  HB;  Slesnick  N;  Brody  JL;  Turner  CW;  Peterson  TR:  Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments.  J Consult Clin Psychol 2001; 69:802–813
[PubMed]
[CrossRef]
 
Kaminer  Y;  Burleson  JA;  Goldberger  R:  Cognitive-behavioral coping skills and psychoeducation therapies for adolescent substance abuse.  J Nerv Ment Dis 2002; 190:737–745
[PubMed]
[CrossRef]
 
Dennis  M;  Godley  SH;  Diamond  G;  Tims  FM;  Babor  T;  Donaldson  J;  Liddle  H;  Titus  JC;  Kaminer  Y;  Webb  C;  Hamilton  N;  Funk  R:  The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials.  J Subst Abuse Treat 2004; 27:197–213
[PubMed]
[CrossRef]
 
Stanger  C;  Budney  AJ:  Contingency management approaches for adolescent substance use disorders.  Child Adolesc Psychiatr Clin N Am 2010; 19:547–562
[PubMed]
[CrossRef]
 
Cohen  DA;  Linton  KL:  Parent participation in an adolescent drug abuse prevention program.  J Drug Educ 1995; 25:159–169
[PubMed]
[CrossRef]
 
Dishion  TJ;  Nelson  SE;  Kavanagh  K:  The family check-up with high-risk young adolescents: Preventing early-onset substance use by parent monitoring.  Behav Ther 2003; 34:553–571
[CrossRef]
 
Liddle  HA;  Rowe  CL;  Dakof  GA;  Henderson  CE;  Greenbaum  PE:  Multidimensional family therapy for young adolescent substance abuse: twelve-month outcomes of a randomized controlled trial.  J Consult Clin Psychol 2009; 77:12–25
[PubMed]
[CrossRef]
 
Henggeler  SW;  Clingempeel  WG;  Brondino  MJ;  Pickrel  SG:  Four-year follow-up of multisystemic therapy with substance-abusing and substance-dependent juvenile offenders.  J Am Acad Child Adolesc Psychiatry 2002; 41:868–874
[PubMed]
[CrossRef]
 
Henggeler  SW;  Halliday-Boykins  CA;  Cunningham  PB;  Randall  J;  Shapiro  SB;  Chapman  JE:  Juvenile drug court: enhancing outcomes by integrating evidence-based treatments.  J Consult Clin Psychol 2006; 74:42–54
[PubMed]
[CrossRef]
 
Robbins  MS;  Feaster  DJ;  Horigian  VE;  Rohrbaugh  M;  Shoham  V;  Bachrach  K;  Miller  M;  Burlew  KA;  Hodgkins  C;  Carrion  I;  Vandermark  N;  Schindler  E;  Werstlein  R;  Szapocznik  J:  Brief strategic family therapy versus treatment as usual: results of a multisite randomized trial for substance using adolescents.  J Consult Clin Psychol 2011; 79:713–727
[PubMed]
[CrossRef]
 
Godley  SH;  Garner  BR;  Passetti  LL;  Funk  RR;  Dennis  ML;  Godley  MD:  Adolescent outpatient treatment and continuing care: main findings from a randomized clinical trial.  Drug Alcohol Depend 2010; 110:44–54
[PubMed]
[CrossRef]
 
Borkman  T:  The twelve-step recovery model of AA: a voluntary mutual help association.  Recent Dev Alcohol 2008; 18:9–35
[PubMed]
 
Jainchill  N:  Therapeutic communities for adolescents: the same and not the same, in  Community as method: therapeutic communities for special populations and special settings . Edited by DeLeon  G.  Westport,  Praeger, 1997, pp 161–178
 
Moolchan  ET;  Robinson  ML;  Ernst  M;  Cadet  JL;  Pickworth  WB;  Heishman  SJ;  Schroeder  JR:  Safety and efficacy of the nicotine patch and gum for the treatment of adolescent tobacco addiction.  Pediatrics 2005; 115:e407–e414
[PubMed]
[CrossRef]
 
Killen  JD;  Robinson  TN;  Ammerman  S;  Hayward  C;  Rogers  J;  Stone  C;  Samuels  D;  Levin  SK;  Green  S;  Schatzberg  AF:  Randomized clinical trial of the efficacy of bupropion combined with nicotine patch in the treatment of adolescent smokers.  J Consult Clin Psychol 2004; 72:729–735
[PubMed]
[CrossRef]
 
Muramoto  ML;  Leischow  SJ;  Sherrill  D;  Matthews  E;  Strayer  LJ:  Randomized, double-blind, placebo-controlled trial of 2 dosages of sustained-release bupropion for adolescent smoking cessation.  Arch Pediatr Adolesc Med 2007; 161:1068–1074
[PubMed]
[CrossRef]
 
Gray  KM;  Carpenter  MJ;  Baker  NL;  Hartwell  KJ;  Lewis  AL;  Hiott  DW;  Deas  D;  Upadhyaya  HP:  Bupropion SR and contingency management for adolescent smoking cessation.  J Subst Abuse Treat 2011; 40:77–86
[PubMed]
[CrossRef]
 
Gray  KM;  Carpenter  MJ;  Lewis  AL;  Klintworth  EM;  Upadhyaya  HP:  Varenicline versus bupropion XL for smoking cessation in older adolescents: a randomized, double-blind pilot trial.  Nicotine Tob Res 2012; 14:234–239
[PubMed]
[CrossRef]
 
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update.Clinical Practice Guideline. Rockville, MD: U.S. Departmentof Health and Human Services. Public Health Service. May 2008.
 
Hopfer  CJ;  Khuri  E;  Crowley  TJ;  Hooks  S:  Adolescent heroin use: a review of the descriptive and treatment literature.  J Subst Abuse Treat 2002; 23:231–237
[PubMed]
[CrossRef]
 
Marsch  LA;  Bickel  WK;  Badger  GJ;  Stothart  ME;  Quesnel  KJ;  Stanger  C;  Brooklyn  J:  Comparison of pharmacological treatments for opioid-dependent adolescents: a randomized controlled trial.  Arch Gen Psychiatry 2005; 62:1157–1164
[PubMed]
[CrossRef]
 
Woody  GE;  Poole  SA;  Subramaniam  G;  Dugosh  K;  Bogenschutz  M;  Abbott  P;  Patkar  A;  Publicker  M;  McCain  K;  Potter  JS;  Forman  R;  Vetter  V;  McNicholas  L;  Blaine  J;  Lynch  KG;  Fudala  P:  Extended vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth: a randomized trial.  JAMA 2008; 300:2003–2011
[PubMed]
[CrossRef]
 
Fishman  MJ;  Winstanley  EL;  Curran  E;  Garrett  S;  Subramaniam  G:  Treatment of opioid dependence in adolescents and young adults with extended release naltrexone: preliminary case-series and feasibility.  Addiction 2010; 105:1669–1676
[PubMed]
[CrossRef]
 
Niederhofer  H;  Staffen  W:  Acamprosate and its efficacy in treating alcohol dependent adolescents.  Eur Child Adolesc Psychiatry 2003; 12:144–148
[PubMed]
[CrossRef]
 
Niederhofer  H;  Staffen  W:  Comparison of disulfiram and placebo in treatment of alcohol dependence of adolescents.  Drug Alcohol Rev 2003; 22:295–297
[PubMed]
[CrossRef]
 
Feinstein  EC;  Richter  L;  Foster  SE:  Addressing the critical health problem of adolescent substance use through health care, research, and public policy.  J Adolesc Health 2012; 50:431–436
[PubMed]
[CrossRef]
 
Bukstein  OG;  Bernet  W;  Arnold  V;  Beitchman  J;  Shaw  J;  Benson  RS;  Kinlan  J;  McClellan  J;  Stock  S;  Ptakowski  KK;  Work Group on Quality Issues:  Practice parameter for the assessment and treatment of children and adolescents with substance use disorders.  J Am Acad Child Adolesc Psychiatry 2005; 44:609–621
[PubMed]
[CrossRef]
 
Levy  SJ;  Kokotailo  PK;  Committee on Substance Abuse:  Substance use screening, brief intervention, and referral to treatment for pediatricians.  Pediatrics 2011; 128:e1330–e1340
[PubMed]
[CrossRef]
 
American Society on Addiction Medicine: ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders (Second Edition—Revised): (ASAM PPC-2R) 2001; www.asam.org/PatientPlacementCriteria.html
 
American Recovery and Reinvestment Act of: 2009; www.gpo.gov/fdsys/pkg/PLAW-111publ5/html/PLAW-111publ5.htm
 
Ghitza  UE;  Gore-Langton  RE;  Lindblad  R;  Shide  D;  Subramaniam  G;  Tai  B:  Common data elements for substance use disorders in electronic health records: the NIDA Clinical Trials Network experience.  Addiction 2012; May 8. doi: 10.1111/j.1360-0443.2012.03876.x. [Epub ahead of print]
 
Substance Abuse and Mental Health Services Administration. What you need to know about health reform. Substance Abuse and Mental Health Services Administration News. 2010:18(5).
 
Buck  JA:  The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act.  Health Aff (Millwood) 2011; 30:1402–1410
[PubMed]
[CrossRef]
 
References Container
+
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
Over the past few decades, a major factor increasing the burden on families of chronically ill children has been:

See Smith and Kaye, Introduction, p 255
2.
An often unrecognized psychological dynamic with the parents of chronically ill children is guilt over:

See Smith and Kaye: The Psychological Experience of Parents and Caregivers, p 256
3.
Diagnostic overshadowing is a frequent problem for mental health professionals assessing individuals with severe IDD. Which of the following best describes this problem?

See Barnhill and McNelis: Epidemiology and Natural History, p 300
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 3.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 5.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 16.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 17.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 39.  >
Topic Collections
Psychiatric News
PubMed Articles