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Substance Abuse & Dependence

The initiation of drug and alcohol use is most likely to occur during adolescence, and some experimentation with substances by older adolescents is common. For example, results from Monitoring the Future (2008), a nationwide study on rates of substance use, show that 47% of 12th graders report having used an illicit drug at some point in their lives. Thankfully, the large majority of adolescents will phase out of drug use before it becomes problematic. Thus, although rates of overall use are high, the percentage of adolescents who meet criteria for substance abuse is significantly lower (close to 5%).

Substance abuse and dependence are each forms of problematic substance use. Signs that an individual's substance use has reached the level of abuse are that his or her substance use interferes with school or a job and/or disrupts family relationships and friendships. Someone struggling with substance abuse may show sudden drops in academic performance and be unable to stop despite frequent conflict with family or friends.

Substance dependence is more severe. Some signs that an individual's substance use has reached the level of dependence are that he or she repeatedly uses drugs in a physically dangerous situation (i.e., driving under the influence), focuses on substance use to the neglect of other interests, often uses more than intended or for longer periods of time, and cannot cut down or quit if desired. Someone struggling with substance dependence may show academic failure, spend most of his or her time using alcohol or drugs, hang out exclusively with substance-using friends, and have experienced injury, illness, or legal repercussions related to substance use.

As can be seen in the table, Cognitive-behavioral therapy (CBT), family based ecological treatment, combined Motivational Enhancement Treatment (MET) and CBT, and combined MET and CBT and family-based behavioral treatment currently have the most research evidence for the treatment of children and adolescents with substance use disorders.

Adolescent Substance Abuse

Works Well
What does this mean?
  • Group CBT
  • Individual CBT
  • Family Based Treatment - Ecological
  • Combined Motivational Enhancement Treatment (MET)/CBT
  • Combined MET/CBT/Family-Based treatment - Behavioral
Works
What does this mean?
  • Family-Based treatment-Behavioral
  • Motivational Interviewing/MET
  • Combined Family-based Treatment-Ecological and Contingency Management
  • Combined MET/CBT/Family-Based treatment-Behavioral/Contingency Management
Might Work
What does this mean?
  • Drug Counseling/12-Step
Unknown/Untested
What does this mean?
None
Not Effective
What does this mean?
None

Source: Aaron Hogue , Craig E. Henderson , Timothy J. Ozechowski & Michael S. Robbins (2014): Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013, Journal of Clinical Child & Adolescent Psychology, DOI: 10.1080/15374416.2014.915550
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