John has been a resident at Sober College three times in the past three years for addiction treatment. Prior to that, he was a client of five other facilities, including a long-term therapeutic boarding school. John has been on depression medication for several years, and despite the excellent care he has received, he has relapsed a dozen times and attempted suicide twice.

My career in Addiction Medicine began more than 40 years ago when I founded the Haight Ashbury Free Medical Clinic during the “Summer of Love” following my training at the University of California at San Francisco. As “Young Doctor Smith,” I dealt with young people who came for the Bay Area counterculture seeking “Drugs, Sex and Rock & Roll” and “Better Living through Chemistry,” only to see my neighborhood go from fantasy of psychedelics to a nightmare of speed. We dealt primarily with bad trips and methamphetamine psychosis with its associated medical and psychiatric problems (Brokaw, 2008; Owen, 2006).

Group therapy has been the most commonly employed treatment modality for adolescents with substance use disorders (SUD). Evidence has been accumulating in support for the efficacy of diverse forms of group therapy that have been utilized with adolescents, such as 12-step (Winters et al., 2000), psychoeducation (Kaminer et al., 2002) and cognitive behavioral therapy (Dennis et al., 2004; Kaminer et al., 1998; 2002; Waldron et al., 2001). However, it has been argued that aggregation of youths who display problem behavior in group interventions may, under some conditions, produce clinically induced negative effects on all participants (Dishion et al., 1999).

It is important for clinicians, therapists, substance abuse counselors, mental health workers, and criminal justice workers who are encountering and working with adolescent girls who present with comorbid disorders to recognize and address several issues to ensure these girls will achieve success in treatment.

Research seems to indicate that early substance use is predictive of more severe abuse later on. Though most research studies have only looked at the youth group between 8th and 12th grades, regarding first use, continued use, etc., anecdotal information from treatment professionals indicates that many children first use alcohol, tobacco, or drugs during preadolescence. Some report being exposed even earlier.

There has been dramatic growth in the study and treatment of adolescent substance use disorders in the past decade. Accumulating clinical experience and research findings reveal the critical need for more rigorous approaches to post-treatment continuing care services for adolescents (White & Godley, 2003). This article: 1) provides a brief summary of the available data relevant to the continuing care needs of adolescents, 2) describes the Assertive Continuing Care (ACC) model and its preliminary outcomes, and 3) offers recommendations related to the future of continuing care services for adolescents treated for substance abuse and substance dependence.