How Good Are the Best Adolescent Substance Abuse Treatments?

October 1, 2004

Drug and alcohol abuse dependence are the most prevalent causes of adolescent illness and death in the United States, and treatment for adolescents with substance abuse problems is urgently needed. But researchers who set out to evaluate some of the most highly regarded treatment programs now in place found that many of them lack some or all of the elements considered essential for successful outcomes.

To determine exactly what a good adolescent substance abuse program should include, the researchers surveyed the literature and talked to an advisory panel of 22 experts in the field. They came up with nine characteristics to look for in a program, including:

Assessment and treatment matching. Programs should conduct comprehensive assessments that cover psychiatric, psychological, and medical problems; learning disabilities; family functioning; and other aspects of the adolescent's life, and treatment should then be matched with the needs that have been identified;
Comprehensive, integrated treatment approach. Program services should address all aspects of an adolescent's life;
Family involvement in treatment. Research shows that involving parents in the adolescent's drug treatment produces better outcomes;
Developmentally appropriate program. Activities and materials should reflect the developmental differences between adults and adolescents;
Engaging and retaining teens in treatment. Treatment programs should build a climate of trust between the adolescent and the therapist;
Qualified staff. Staff should be trained in adolescent development, co-occurring mental disorders, substance abuse, and addiction;
Gender and cultural competence. Programs should address the distinct needs of adolescent boys and girls, as well as cultural differences;
Continuing care. Programs should include relapse prevention training, aftercare plans, referrals to community resources, and follow-up;
Treatment outcomes. Rigorous evaluation is required to measure success, target resources, and improve treatment services.
Research on the effectiveness of treatment for adolescents is a relatively new field, the researchers point out, with few standards to guide program developers or users. As to the seriousness of the need to identify and implement good programs, they cite the fact that only 10 percent of the 1.4 million adolescents (ages 12 to 17 years) with illicit drug problems currently receive treatment, compared with one in five adults with similar problems.

Using sophisticated survey techniques, the researchers came up with a list of 144 "highly regarded" adolescent-only substance abuse treatments currently in use. The treatments were broadly distributed by region, program age, setting, approach, and accreditation status. Of those programs, only 19 satisfied more than two-thirds of the program characteristics identified by the researchers as essential for successful outcomes. The worst overall performance was in the category of assessment and treatment matching; fewer than half of the programs reported using a standardized substance abuse instrument or a clinical interview.

Of equal concern, the researchers said, was the poor performance of most programs in engaging and retaining teens in treatment. "Denial among adolescents about their drug problems is high, and few seek treatment on their own. Programs need creative techniques to engage and retain adolescents in treatment by providing activities relevant to their concerns; treatment for adolescents should have tangible, concrete stages of process and outcomes."

Their study showed, the researchers concluded, that the one characteristic of treatment programs most often relied upon by parents, physicians, juvenile court judge, and school counselors when referring teens for substance abuse treatment?accreditation?is no guarantee that the programs have the qualities necessary for good treatment outcomes.