Both Democratic and Republican Presidents have long pledged to close the treatment gap, but today the gap is as wide as it was a decade ago. The core problem is lack of funding as well as ever-shrinking managed care benefits that provide only limited coverage for treatment. Campaign promises have not translated into adequate appropriations for treatment, particularly when law enforcement and interdiction, which have traditionally received two-thirds of the federal anti-drug budget, are competing for increased funding. The current Drug Czar, John Walters, declared that treatment would be his top priority during his Senate confirmation hearings in 2001, but to date, the funding picture remains unchanged.
Why is treatment even scarcer for adolescents than for adults? Election politics aside, the fundamental reality is that teens with substance abuse problems generally have been overlooked. Few programs are designed specifically for adolescents. Most teens that do get treatment participate in adult programs that may or may not have been modified in some way for adolescents.

In addition, treatment can be expensive, particularly if not covered by insurance. Health plans do not generally offer full coverage for substance abuse treatment, although six states now require parity so that substance abuse treatment is covered at the same level as any other illness. Medicaid coverage for substance abuse treatment varies by state. Some states, like Massachusetts, provide Medicaid coverage for a wide range of treatment options, while others, like Mississippi, cover only inpatient detoxification. In recent years, the juvenile justice system has become the single largest funder of adolescent treatment: almost half of all adolescents currently in treatment have been mandated to programs by the juvenile justice system, or in the case of older teens, by the adult criminal courts.

Research on adolescent treatment is still in its infancy. Funding for research, like funding for treatment, has concentrated almost entirely on adult addiction and treatment effectiveness. Moreover, the small number of adolescent treatment studies done in the past three decades often have had methodological problems that make definitive conclusions difficult. For example, only 21 of the 53 adolescent treatment studies identified by the Addiction Center Adolescent Research Group in a recent comprehensive review were considered methodologically sound enough to justify analyzing their results. Overall, these studies found that treatment does reduce adolescent substance use and related problems. Current large scale research also reports that treatment can effectively reduce adolescent drug use during treatment and a one year follow-up. In addition, treatment can reduce family, school, and behavioral problems.

The Cannabis Youth Treatment Program (CYT) (1997-2001) and Adolescent Treatment Models (ATM) (1998-present) which are both supported by the federal Center for Substance Abuse Treatment (CSAT) continue to provide data on adolescent treatment effectiveness.

Despite its present limitations, adolescent treatment research points to certain factors that appear to be related to successful outcomes. They include family involvement in therapy; retaining adolescents in treatment until completion; comprehensive services that address educational, vocational, psychological and legal concerns; experienced, empathetic staff; aftercare as part of the continuum of care; and encouraging parent and peer support for the adolescent's efforts to stay drug-free. In addition, completing the course of treatment, including the continuum of care after the formal program ends, is closely related to positive outcomes.

Drug Strategies, with support from the Robert Wood Johnson Foundation, has recently produced a comprehensive review of adolescent drug treatment designed to help parents, teachers, judges, counselors, doctors and other concerned adults find more effective treatment for teens. Treating Teens: A Guide to Adolescent Drug Prog-rams (Drug Strategies, 2003) provides a bridge between research and practice as well as practical tools for finding help for teen substance abusers. Working with a distinguished panel of nationally recognized experts, Drug Strategies identified nine key elements that contribute to adolescent treatment effectiveness. These elements, which are discussed in detail, form the conceptual basis of the guide.

To observe how the key elements are implemented in practice, Drug Strategies conducted written surveys and extensive telephone interviews with 144 adolescent drug programs across the country. These programs were selected based on recommendations of the expert advisory panel, 20 national organizations, such as the American Medical Association, and state alcohol and drug abuse agency directors in all fifty states and the District of Columbia. Current, reliable information about 144 programs, which was gathered from this process, is presented in summary form in the guide. In addition, the guide takes an in-depth look at seven promising programs that reflect a variety of treatment approaches. Treating Teens provides a framework for making better informed choices about teen treatment. It is also intended to encourage treatment providers to build the nine key elements of effectiveness into their programs.

Unfortunately, many adolescent programs do not address various aspects of treatment, like intensive family involvement in the treatment process, which recent research suggests is a critically important element in treatment success. In part, this failure reflects widespread lack of knowledge of what we have learned in the past decade about key elements of effectiveness in adolescent treatment. Programs are often hard-pressed to provide comprehensive treatment with inadequate resources, and program staff may not have easy access to current developments in clinical research and best practices. Lack of funding support from federal and state agencies as well as shrinking insurance reimbursements only compound the problem.

Adolescents should be our first priority. Timely, effective intervention can change the trajectory of a young person's life, turning from destructive behaviors, such as substance abuse, toward productive participation in adult society. It is time to put into practice what we have learned about effective adolescent drug treatment and to find the funds to provide treatment to all those who need help.

Mathea Falco, JD, is President of Drug Strategies, a non-profit research institute in Washington, D.C. For more information about the work of Drug Strategies, visit their web site at www.drugstrategies.org