Treatment for Adolescent Alcohol Use Disorders

by National Institute of Health

(Page 5 of 6)

Prevalence data on binge and heavy drinking, collected in the 2002 U.S. National Survey on Drug Use and Health (NSDUH), indicate a public health problem of considerable dimensions in youth ages 12 to 17. Binge drinking is well established by midadolescence, as reported by 12 percent of 15-year-olds, 18 percent of 16-year-olds, and 25 percent of 17-year-olds. Not only are these youth at high risk for serious accidents and adverse social, health, and academic consequences related to their alcohol use, but some also may be at risk for developing multiple behavioral disorders including alcohol abuse and alcoholism. At the same time, as already discussed, alcoholism treatment researchers who specialize in youth diagnosis and treatment believe that DSM-IV criteria are inadequate to identify youth who have AUDs. They conclude that diagnosis of youth substance use disorders needs to be developmentally specific, to meet fewer criteria than required by DSM-IV, and to add criteria salient to youth drinking practices.

An Unmet Need

Nonetheless, the NSDUH data indicate a major unmet need for effective health services to prevent and treat alcohol and other associated behavioral problems. Among youth these ages, 1.4 million met DSM-IV criteria for alcohol abuse or dependence, but only 227,000 actually received any treatment for alcohol use disorders in 2002. Further, current services are not optimally designed for youth access or engagement. Youth prefer easy access, low threshold approaches that accentuate strategies adolescents normally use to stop drinking, and treatments that do not remove them from their primary home or academic settings. Youth perceive traditional services as less helpful than brief interventions tailored to salient adolescent concerns. Consequently, alternative formats, attention to developmental transitions, and social marketing are needed to more adequately address alcohol problems emerging in adolescence.

Heterogeneity in Adolescents With Alcohol Use Disorders

According to 2002 NSDUH data, nicotine use and illicit drug use are much higher among drinking youth ages 12 to 17 who reported they were binge drinkers or heavy drinkers in the past 30 days than they were among those who reported drinking less. Research on adolescents in treatment for alcohol use disorders reflects a similar pattern; these youth typically use cigarettes, are likely to have more than one substance use disorder, and may manifest psychiatric comorbidities as well. Alcohol-dependent adolescents with psychiatric comorbidities fare more poorly after treatment: These youth have lower abstention rates, relapse more rapidly, and show deterioration in their mental health symptoms following relapse to alcohol or other drugs. Also, adolescents in substance abuse treatment who have combined heavy alcohol use and drug disorders manifest a more severe problem profile and less successful treatment outcomes. Thus, by the time many youth reach treatment, they are already on a developmental pathway that ultimately, unless deflected, could lead to even more harmful behavioral lifestyles, medical disorders, and social consequences.

It is important to keep in mind, however, that adolescents in addiction treatment are a heterogeneous group and follow multiple pathways of change post-treatment, including successful ones. Results from several studies of alcohol-dependent youth consistently demonstrate that although a portion of adolescents abstain and others quickly return to problematic use after treatment, the majority of adolescents change their use patterns over time, both improving and deteriorating as they face new developmental challenges. Among treated youth, alcohol use following treatment also plays a significant role in relapse to other drugs, as well as in functioning in school, with peers and family, and in physical and mental health. See Chung and colleagues, "Course of Alcohol Problems in Treated Adolescents," for analyses of 1. four longitudinal, alcohol-focused treatment outcome studies that cover 1 to 8 years post-treatment and 2. how these treatment outcomes vary by subtypes of patients, settings, and trajectories.

NIAAA Research on Adolescent Treatment

Out of concern over the emerging evidence on the nature and magnitude of alcohol use and associated problems in underage youth, in 1997 NIAAA formally initiated a program of research to develop effective treatment interventions for adolescents with alcohol disorders. Prior to this, adult addiction treatments were extended to adolescents and rarely had been rigorously evaluated in youth. A total of 20 clinical projects have been funded under this NIAAA program, 14 of which were cofunded by SAMHSA's Center for Substance Abuse Treatment. The majority of these clinical studies are randomized controlled clinical trials. The objective of this initial wave of studies is to design and test innovative and developmentally tailored interventions and, in so doing, provide evidence-based knowledge to improve treatment outcomes for adolescents who have primary alcohol use disorders or manifest at least one or two symptoms of alcohol dependence. The results of these projects will be forthcoming over the next few years and will provide new information on the potential efficacy of family-based, cognitive-behavioral, brief motivational, and guided self-change interventions in a range of settings. They also will provide information on the efficacy of these treatments in subgroups of adolescents, including homeless and runaway youth, high school students, juvenile justice-involved youth, and minority youth. This treatment research also will shed light on distinctive features of adolescent treatment including processes of change and factors contributing to post-treatment success.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.