Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide
From the Director

Since its first edition in 1999, NIDA’s Principles of Drug Addiction Treatment has been a widely used resource for health care providers, families, and others needing information on addiction and treatment for people of all ages. But recent research has greatly advanced our understanding of the particular treatment needs of adolescents, which are often different from those of adults. I thus am very pleased to present this new guide, Principles of Adolescent Substance Use Disorder Treatment, focused exclusively on the unique realities of adolescent substance use—which includes abuse of illicit and prescription drugs, alcohol, and tobacco—and the special treatment needs for people aged 12 to 17.

The adolescent years are a key window for both substance use and the development of substance use disorders. Brain systems governing emotion and reward-seeking are fully developed by this time, but circuits governing judgment and self-inhibition are still maturing, causing teenagers to act on impulse, seek new sensations, and be easily swayed by their peers—all of which may draw them to take risks such as trying drugs of abuse. What is more, because critical neural circuits are still actively forming, teens’ brains are particularly susceptible to being modified by those substances in a lasting way—making the development of a substance use disorder much more likely.

Addiction is not the only danger. Abusing drugs during adolescence can interfere with meeting crucial social and developmental milestones and also compromise cognitive development. For example, heavy marijuana use in the teen years may cause a loss of several IQ points that are not regained even if users later quit in adulthood. Unfortunately, that drug’s popularity among teens is growing—possibly due in part to legalization advocates touting marijuana as a “safe” drug. Nor do most young people appreciate the grave safety risks posed by abuse of other substances like prescription opioids and stimulants or newly popular synthetic cannabinoids (“Spice”)—and even scientists still do not know much about how abusing these drugs may affect the developing brain.

These unknowns only add to the urgency of identifying and intervening in substance use as early as possible. Unfortunately, this urgency is matched by the difficulty of reaching adolescents who need help. Only 10 percent of adolescents who need treatment for a substance use disorder actually get treatment. Most teens with drug problems don’t want or think they need help, and parents are frequently blind to indications their teenage kids may be using drugs—or they may dismiss drug use as just a normal part of growing up. Historically the focus with adolescents has tended to be on steering young people clear of drugs before problems arise. But the reality is that different interventions are needed for adolescents at different places along the substance use spectrum, and some require treatment, not just prevention. Fortunately, scientific research has now established the efficacy of a number of treatment approaches that can address substance use during the teen years. This guide describes those approaches, as well as presents a set of guiding principles and frequently asked questions about substance abuse and treatment in this age group. I hope this guide will be of great use to parents, health care providers, and treatment specialists as they strive to help adolescents with substance use problems get the help they need.

Nora D. Volkow, M.D.
National Institute on Drug Abuse