Table 2.

Adolescent Substance Use: Evidence Based Practices

Practices	Description	Updates from Original Review16
1. Motivational Interviewing + Screening, Brief Intervention and Referral to Treatment (SBIRT)	Motivational interviewing (MI) uses a person-centered, nonconfrontational style in assisting youth in exploration of different facets of their use patterns. SBIRT is a packaged intervention which identifies substance use and encourages treatment for those who meet criteria. Brief intervention often consists of educational services that aim to help the adolescent recognize the negative consequences of substance use.	Inclusion of SBIRT.
2. Family-based Services	Family-based approaches seek to reduce an adolescent’s use of substances and promote healthy family functioning by addressing the mediating family risk factors, such as poor family communication.	Update on evidence for effectiveness and determinants of implementation (including reimbursement).
3. Behavior Therapies: Cognitive Behavior Therapy, Contingency Management	Cognitive-behavioral therapy encourages adolescents to develop self-regulation and coping skills by teaching youth to identify stimulus cues that precede substance use, to use various strategies to avoid situations that may trigger the desire to use, and to develop skills for communication and problem-solving. Contingency management is based on operant conditioning and utilizes rewards to reinforce desirable behaviors such as treatment attendance or use reduction.	Combined behavior and cognitive-behavior into a single practice; explicit inclusion of contingency management.
4. Pharmacotherapy	This treatment approach uses medication to address various aspects of addiction, including craving reduction, abstinence-promotion, relapse prevention, and withdrawal symptom management. Buprenorphine is the only FDA approved medication to treat a substance use disorder in adolescents. Harm reduction resources such as naloxone and fentanyl test strips can be used to reduce the risk of overdose.	Emphasis on MOUD, naloxone and other harm reduction practices.
5. Continuing Care and Recovery Monitoring, Support, and Re-intervention	Encourage the use of ongoing coordination of treatment and recovery needs. Support the use of mutual support groups, peer specialists, sponsorship, clubhouse communities, and recovery schools.	Addition as a new Practice that was not discussed in Winters et al. (2018)16
Updates across all practices	N/A	Integrated three practices (12-Step, Therapeutic Community, Electronic and web-based) throughout the other practices, rather than listing separately.

Note: Adapted from: Winters et al., 2018¹⁵ and NIDA, 2014¹⁶ , Electronic and web-based therapy was removed from Winters et al., 2018¹⁵ as these therapies can be integrated with any of the evidence-based practices described above. Note: FDA= Food and Drug Administration; MI= Motivational interviewing; SBIRT= Screening, brief intervention, referral to treatment.