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Continued Decline in Youth Substance Abuse

Current illicit drug use among teens is continuing to decline, according to a new report by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) released today. The study also shows positive signs that teens are seeing the dangers of abusing prescription drugs and methamphetamine and are pushing back. Among youth ages 12-17, the 2007 National Survey on Drug Use and Health (NSDUH), the Nation's largest substance use survey, shows that the significant decline in overall past month illicit drug use that began in 2002 continued through 2007, from 11.6 percent to 9.5 percent.

The survey, released at the start of the 19th Annual National Alcohol and Drug Addiction Recovery Month, shows that the reductions in youth drug use occurred for nearly every type of illicit drug including marijuana, cocaine, hallucinogens, LSD, and Ecstasy. The survey also shows dramatic declines in meth use, down by 67 percent (from 0.3% to 0.1%) and prescription drug abuse among teens, which declined overall by 18 percent, from 4 percent to 3.3 percent between 2002-2007.

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Treating Adolescents

Columns - Policy

Friday, 30 November 2001

An increasing number of adolescents need substance abuse treatment, but there is a scarcity of programs designed specifically to serve youth. Historically, treatment for adolescents evolved from models developed to treat adults, which begs a critical question: Do programs that treat adults work for adolescents? As the field has progressed, the differences between the needs of adults and youth in treatment have become increasingly clear. Most experts agree that adolescent programs should be tailored to meet their distinct development needs. In addition to factors normally considered when placing an adult in treatment, such as addiction severity, cultural background, and presence of coexisting disorders, treatment programs for adolescents must also examine other variables such as age, level of maturity, and family and peer environment.

A major difference between adults and adolescents is severity of use when entering treatment. Adult substance abuse is often more entrenched, involving more serious addiction issues. With adolescents, frequent use or binging may be transitional rather than chronic, allowing some adolescents to "grow out" of the abusing behavior. Often with adolescents, the presenting issue for treatment is abuse rather than dependence.

Although adolescents may have different, less consistent use patterns than adults, they usually have more complex, serious problems when they enter treatment, and they are likely to need a broader range of services. The adolescent substance abuser may need a combination of therapies, including treatment for a variety of co-occurring disorders including depression, anxiety, ADHD, eating and/or conduct disorders. Learning disabilities can also be addressed in treatment as well as issues of sexual and physical abuse. Youth tend to present a constellation of behavioral and emotional problems while adults may present more tangible needs, such as vocational training or housing assistance. Due to the high incidence of co-existing disorders providers should be familiar with adolescent mental disorders.

Additionally, treatment for adolescent substance abuse should be grounded in an understanding of adolescent development, and staff should be trained to work with adolescents. Treatment programs need to be sensitive to multiple developmental issues that make treatment challenging.

Family dynamics are especially important with adolescents, since almost all adolescents are emotionally and financially dependent on their families. Clinicians have found that treatment of the adolescent almost always involves the family. The effectiveness of family therapy has been documented extensively, particularly among substance-using adolescents who are the most difficult to treat. Adolescent programs often include a family assessment within the larger treatment assessment, and families participate in group therapy and individual counseling when needed. The role of the family, while pivotal in adolescent treatment, is often not as significant when treating adults.

In addition to parents and families, adolescent treatment should address other contexts that influence youth, particularly school and peer groups. Schools provide social support for youth while they are in treatment and can be key factors in re-socialization after treatment. Many adolescent programs work closely with patients' schools to ensure a smooth transition and to track their progress. The peer group also should be addressed as conformity to peer pressure reaches its peak during adolescence; programs designed specifically for adolescents often concentrate on building new peer groups. Teens rarely think they have a problem, and as a rule, do not go into treatment voluntarily. Young people tend to come to treatment while dependence is in its nascent stages, before hardcore addiction has developed. They have not been exposed to the negative consequences of addiction, decreasing the motivation to seek treatment. This can require creative programming, including engaging activities designed to get adolescents involved in the therapeutic process.

Additionally, materials and curricula used in treatment programs should be adolescent-specific. Because so many treatment materials were originally designed for adults, examples often pertain to situations involving work, spouses, and children. Adolescents tend to be concrete rather than abstract thinkers, which may make it difficult for them to translate these examples to school or girlfriend/boyfriend.

Further, young people entering treatment are often less verbal than adults; games and other hands-on activities can be useful.

For example, one program designed specifically for adolescents gives patients disposable cameras and asks them to document their lives. Another program gives adolescents plastic CD cases and asks them to decorate the cases as if they were doing the cover art for their life album. The program asks adolescents to imagine they are rock stars and to write the title track of their life album. Activities such as these are likely to generate more meaningful discussions in therapy.

While the overarching goals of treatment for adolescents are similar to those for adults, the distinct needs and developmental issues involved require unique treatment approaches. Family issues, co-existing disorders, denial that treatment is needed, and negative peer influences are some of the critical issues that must be addressed in adolescent treatment.

Unfortunately, the lack of treatment for adolescents combined with the urgency of finding treatment makes it difficult for parents and other caretakers to shop around for the most appropriate programs. As the treatment field continues to progress, it is essential that the particular needs of adolescent substance abusers be addressed.

Mathea Falco, an attorney, is president of Drug Strategies. She served as Assistant Secretary of State for International Narcotic Matters from 1977-1981.