Table 1.

Principles of adolescent substance use treatment

Principle	Description
1. Identify and address substance use as soon as possible	Identifying and addressing adolescent substance use as soon as possible is important due to the negative effects early use can have on the brain. Additionally, adults with substance use disorders often report using drugs as adolescents or young adults.
2. Adolescents do not have to be addicted to benefit from a substance use intervention	Interventions can successfully treat a range of substance use disorders from problematic use to severe addiction. Youth in particular can benefit from intervention at early stages. Even use that does not seem problematic can lead to heavier use and other risky behaviors.
3. Medical visits are an opportunity to ask about drug use	Medical doctors (eg, pediatricians, emergency room doctors, dentists) can use standardized screenings to determine if an adolescent is using substances and if an intervention is warranted. In some instances, it is possible to provide a brief intervention in the physician’s office and in other cases referral to treatment is more appropriate.12,67
4. Legal or family pressure may be an important influence on adolescent’s involvement in treatment	Most adolescents with a substance use disorder do not think they need treatment and rarely look for treatment. Treatment can be successful even if the adolescent is legally mandated to treatment or goes due to family pressures.68
5. Treatment should be tailored to the adolescent’s needs	Many factors need to be considered when developing a treatment plan for an adolescent including sex, family and peer relationships, and community environment. Therefore, it is necessary to begin with a comprehensive assessment.
6. Treatment should not focus on just substance use	Treatment is most successful when it focuses on the whole person. Treatment should address housing, medical, social, and legal needs.
7. Behavioral therapies can effectively treat substance use disorders	Behavioral therapies have been shown to be an effective treatment. These therapies help build motivation to change by providing incentives for abstinence, teaching skills to deal with cravings, and finding positive and rewarding activities.
8. Family and community support are important features of treatment	There are several evidence-based interventions for adolescent substance use that involve family members and individuals in the community. These interventions try to improve family communication and provide the adolescent with support.
9. Mental health conditions need to be addressed in order to effectively treat substance use	Adolescents with a substance use disorder often have co-occurring mental health conditions. It is important that adolescents are screened and treated for these other conditions in order for substance abuse treatment to be successful.
10. Sensitive issues should be addressed and confidentiality maintained when possible	It is common for adolescents with substance use disorders to have a history of abuse or other trauma.69 Whereas maintaining confidentiality with respect to sensitive issues is important in the therapeutic setting, appropriate authorities need to be informed if abuse is suspected.
11. Drug use should be monitored during treatment	It is important to monitor an adolescent’s drug use while in treatment and identify a relapse early on. The relapse could indicate that treatment should be intensified or needs to be altered to better meet the adolescent’s needs.
12. Completing treatment and having a continuing care plan are important	The length of treatment will vary based on the severity of the adolescent’s substance use disorder; however, studies have shown outcomes are best when an individual is in treatment 3 months or longer.70 The adolescent can also benefit from continuing care.
13. Adolescents should be tested and treated for sexually transmitted diseases and hepatitis	Drug using adolescents are at an increased risk for sexually transmitted and blood borne diseases (eg, human immunodeficiency virus, hepatitis B and C) due to the increase in high-risk behaviors that result from drug use. Addressing this in treatment can help decrease high-risk behaviors thereby reducing the likelihood of infection.

Notes: Data from the National Institute on Drug Abuse. Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. Bethesda: National Institute on Drug Abuse; 2014. Available from: http://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/principles-adolescent-substance-use-disorder-treatment. Accessed August 5, 2014.63