What is a Substance Use Disorder?
In the United States there is a growing prevalence of substance use disorder (SUD) diagnoses among the general population. However, it is has been identified that there are certain populations that might be predisposed to this condition. According to the Center for Disease Control and Prevention (CDC), substance use disorders is considered to be a treatable, chronic diseases that can lead to impairment in a person’s health, social functional, occupational, academic performance or other facets of life. The hallmark of a substance use disorder is the inability to have control over the drug and a person is unable to reduce intake or completely cease intake. In 2022, it was reported that 20.4 million people in the United States were diagnosed with SUD with only 10.3% of people seeking treatment for this diagnosis. The prevailing drugs of abuse include prescription opioids, fentanyl, heroin, methamphetamine, and cocaine.
Signs and Symptoms of Substance Use Disorder
A substance use disorder or drug addiction is viewed as a disease that has the capacity to influence a person’s brain function and behavior. While the use of a particular substance can begin as an experimental use but for others it can lead to more frequent use. The risk of developing a substance use disorder can differ depending on the person and the associated drug. Some of the notable signs and symptoms can include the following:
- Feeling that one have to use the drug regularly — daily or even several times a day
- Having an intense urge for the drug that block out any other thoughts
- Over time, needing more of the drug to produce the same effect
- Taking larger amounts of the drug over a longer period of time than you intended
- Engaging in risky activities or behaviors that one would not normally do
Substance Use Disorder in Adolescents
The presence of substance use disorder among adolescents represents a unique and complex process, because at this stage of life there is a tendency to engage in risk taking behaviors that can include substance use. Adolescence is a fragile time during which a person can experience changes in physical, emotional, and social development so the therapeutic approach that is applied to this group has to be reflective of their developmental development and be distinct from the treatments of their adult counterparts. The therapeutic interventions that are applied to adolescents need to be tailored to each person’s development and have potential contributors for the behavior such as childhood trauma or family issues. It is important that screening is performed on an adolescent in order to determine the severity of the condition and the types of services that may be required to help the person get back to their previous functioning. If a determination is made that the adolescent is a severe risk then steps need to be taken to receive treatment. There are various levels of treatment for adolescents, but at the core it should seek to address both the physical and mental health needs of the adolescent
Pharmacotherapy Treatments for Substance Use Disorder in Adolescents
The treatment of adolescent substance abuse can primarily occur as an outpatient treatment with psychotherapy being viewed as first line. The implementation of behavioral approaches allows adolescents to become engaged in their own road to recovery and improve their ability to resistance the use of substances in the future. Examples of some of the behavioral approaches to therapy that can be applied to adolescents include cognitive behavioral therapy, adolescent community reinforcement approach, contingency management, and motivational enhancement therapy.
While pharmacotherapy can be used to treat tobacco, alcohol, and opioids in adults there are few medications that are currently approved for adolescent use. The Association of Academic Psychiatry released a policy statement in 2016 supporting the use of medications to support adolescents that are diagnosed with SUD. An example of an approved medication is buprenorphine (a partial agonist) for opioid use disorder in individuals who are 16 years and older. In addition, longer courses of treatment (2-3 months) of buprenorphine/buprenorphine-naloxone are considered to be more effective when compared to shorter courses in an effort to decrease the days of opioid use and achieve and maintain abstinence. The presence of opioid treatment programs for adolescents is becoming more common which provide a combination of medications and behavioral therapy for this disorder. As it currently stands more research is required in the area of medications for the treatment of alcohol and cannabis use disorders among adolescents. There have been some promise in naltrexone for alcohol use, N-acetylcysteine for cannabis use, and bupropion for nicotine use but there have not been published studies that demonstrate the effectiveness of these pharmacotherapies being used along for the treatment of adolescent SUDs.
The decision to initiate pharmacotherapy in an adolescent should be justified through the performance a careful evaluation of the diagnosis to determine if the benefit greatly outweighs the risk. There are few controlled clinical trials that have examined the effectiveness of substitution or replacement therapy (e.g, methadone, buprenorphine), antagonists(e.g., naltrexone), aversive therapies(e.g.disulfram) or anti-craving medications (e.g., bupropion, naltrexone) in adolescents so if these medications are to be used it is to be done through careful monitoring and consideration for the distinctive characteristics that set adolescents apart from adults.
Risk versus benefit of Pharmacotherapy in Adolescents
The use of pharmacotherapy in adolescents is still considered to be fairly new that requires further research to fully understand but if an adolescent appears to be refractory to all applied interventions it is ultimately up to the provider to determine the best course of action to take regarding the case. If an adolescent demonstrates significant impairment and is unable to function from day to day the assessment for pharmacotherapy should be considered in this case. The potential improvement in quality of life in comparison to the adverse outcomes of pharmacotherapy should be evaluated on a case by case basis in order to reach a decision that is in the best interest of the adolescent.
The examination of pharmacotherapy for substance use disorder in adolescents is still a new and requires ongoing research to determine the therapeutic outcomes. Given the high rate of adolescent substance abuse in the United States it is imperative that effective treatment approaches are in place and should be viewed as a priority. The early identification and treatment of SUD can prove to be critical when it comes to prevention and abstinence in the future. Further research is needed in the areas of pharmacotherapy for substance use disorders in adolescents but in the interim there are behavioral interventions that can be applied and medication initiation should be performed on an individual basis.
Agency for Healthcare Research & Quality. (2020). Interventions for substance use disorders in adolescents: A systematic review. https://effectivehealthcare.ahrq.gov/products/substance-use-disorders-adolescents/research
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SAMSHA. (2023). Screening and treatment of substance use disorders among adolescents. SAMSHA Advisory. https://store.samhsa.gov/sites/default/files/pep20-06-04-008.pdf
Mayo Clinic. (2023). Drug addiction (substance use disorder). https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112