Introduction to a Special Series on Substance Use Disorder

Adolescent substance use is common with 11% to 31% of adolescents in 8th through 12th grade reporting illicit substance use.¹ Of particular concern is the increasing rate of overdose deaths among adolescents.² The likelihood of developing a substance use disorder (SUD) is linearly associated with frequency of use and inversely associated with age, such that young people with early onset of use are the most susceptible for later dependence.^3,4 This is of concern as early regular substance use is associated with psychosocial consequences that increase burden of illness and decrease functional outcome, including increased likelihood of other illicit drug use, poorer academic outcomes, justice and medical system involvement, psychiatric comorbidity, and unemployment.⁵ This is especially true for the 60% to 88% of adolescents with an SUD who have a comorbid psychiatric illness.⁶ Of concern, rates of comorbidity are highest among adolescents younger than 15 years of age. These youth with dual diagnoses are at even greater risk of dependence and poor health and psychosocial outcomes related to substance use.⁷ While current government initiatives highlight the reduction of adolescent substance use as a priority, data on consistently efficacious interventions that lead to maintained abstinence are lacking. Further, adolescent-focused interventions for SUD are scarce, and very few, if any, target the varied methods and modes of use, which may be linked to different patterns of use, types of users, and outcomes.⁵ As such, approaches to increase intervention dissemination and effectiveness are needed. Only about 7% of youth with substance use receive treatment, and only about 50% of adolescent mental health programs offer substance use-specific treatment.⁸ Further, randomized controlled trials of interventions for adolescent SUD show moderate effect sizes for motivational enhancement therapy, cognitive-behavioral therapy, contingency management, and others,⁹ but few maintain abstinence through follow-up, which is especially true for adolescents with psychiatric comorbidities, who demonstrate the highest rates of relapse.