017 - Substance Use Disorders in Children and Adolescents - An A.I. Generated Overview

This is a general overview that highlights common features of substance use disorders in youth and discusses in more detail substances like alcohol, nicotine, cannabis, and opioids.  It is a curated A.I. generated podcast.

Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com

Feedback can be emailed to feedback@psydactic.com OR submitted via a form at https://psydactic.com.

This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Transcript

Substance Use Disorder Overview

Resources:

Beckmann, David, Kelsey Leigh Lowman, Jessica Nargiso, James McKowen, Lisa Watt, and Amy M. Yule. 2020. “Substance-Induced Psychosis in Youth.” Child and Adolescent Psychiatric Clinics of North America 29 (1): 131–43.

Crowley, Daniel Max, Janet Welsh, Sarah Chilenski-Meyer, Jochebed Gayles, Elizabeth Long, Damon Jones, Mary McCauley, Michael Donovan, and Taylor Scott. 2024. “Integrated Prevention Infrastructure: A Framework for Addressing Social Determinants of Health in Substance Use Policy Making.” Focus (American Psychiatric Publishing) 22 (4): 483–91.

Gau, Susan S. F., Mian-Yoon Chong, Pincheng Yang, Cheng-Fang Yen, Kung-Yee Liang, and Andrew T. A. Cheng. 2007. “Psychiatric and Psychosocial Predictors of Substance Use Disorders among Adolescents: Longitudinal Study.” The British Journal of Psychiatry: The Journal of Mental Science 190 (January): 42–48.

Gray, Kevin M., and Lindsay M. Squeglia. 2018. “Research Review: What Have We Learned about Adolescent Substance Use?” Journal of Child Psychology and Psychiatry, and Allied Disciplines 59 (6): 618–27.

Green, Rejoyce, Bethany J. Wolf, Andrew Chen, Anna E. Kirkland, Pamela L. Ferguson, Brittney D. Browning, B. E. Bryant, et al. 2024. “Predictors of Substance Use Initiation by Early Adolescence.” The American Journal of Psychiatry 181 (5): 423–33.

Harrop, Erin, and Richard F. Catalano. 2016. “Evidence-Based Prevention for Adolescent Substance Use.” Child and Adolescent Psychiatric Clinics of North America 25 (3): 387–410.

Hasin, Deborah S., Charles P. O’Brien, Marc Auriacombe, Guilherme Borges, Kathleen Bucholz, Alan Budney, Wilson M. Compton, et al. 2013. “DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale.” The American Journal of Psychiatry 170 (8): 834–51.

“Howlett-et-al-2012-Understanding-and-Treating-Adolescent-Substance-Abuse-a-Preliminary-Review.” n.d.

Imperio, Caesar G., Frances R. Levin, and Diana Martinez. 2024. “The Neurocircuitry of Substance Use Disorder, Treatment, and Change: A Resource for Clinical Psychiatrists.” The American Journal of Psychiatry 181 (11): 958–72.

Iqbal, Muhammad N., Charles J. Levin, and Frances R. Levin. 2019. “Treatment for Substance Use Disorder with Co-Occurring Mental Illness.” Focus (American Psychiatric Publishing) 17 (2): 88–97.

Jegede, Oluwole, Srinivas Muvvala, Emmanuel Katehis, Saad Paul, Ayorinde Soipe, and Ayodeji Jolayemi. 2021. “Perceived Barriers to Access Care, Anticipated Discrimination and Structural Vulnerability among African Americans with Substance Use Disorders.” The International Journal of Social Psychiatry 67 (2): 136–43.

Leza, Leire, Sandra Siria, José J. López-Goñi, and Javier Fernández-Montalvo. 2021. “Adverse Childhood Experiences (ACEs) and Substance Use Disorder (SUD): A Scoping Review.” Drug and Alcohol Dependence 221 (108563): 108563.

Schneider, Sophia, Jan Peters, Uli Bromberg, Stefanie Brassen, Stephan F. Miedl, Tobias Banaschewski, Gareth J. Barker, et al. 2012. “Risk Taking and the Adolescent Reward System: A Potential Common Link to Substance Abuse.” The American Journal of Psychiatry 169 (1): 39–46.

Simon, Kevin M., Sion Kim Harris, Lydia A. Shrier, and Oscar G. Bukstein. 2020. “Measurement-Based Care in the Treatment of Adolescents with Substance Use Disorders.” Child and Adolescent Psychiatric Clinics of North America 29 (4): 675–90.

Simon, Kevin M., Sharon J. Levy, and Oscar G. Bukstein. 2022. “Adolescent Substance Use Disorders.” NEJM Evidence 1 (6): EVIDra2200051.

Squeglia, Lindsay M., Matthew C. Fadus, Erin A. McClure, Rachel L. Tomko, and Kevin M. Gray. 2019. “Pharmacological Treatment of Youth Substance Use Disorders.” Journal of Child and Adolescent Psychopharmacology 29 (7): 559–72.

“Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57).” 2022. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report.

Tervo-Clemmens, Brenden, Alina Quach, Finnegan J. Calabro, William Foran, and Beatriz Luna. 2020. “Meta-Analysis and Review of Functional Neuroimaging Differences Underlying Adolescent Vulnerability to Substance Use.” NeuroImage 209 (116476): 116476.

Waligoske, Kate, Shawn Van Gerpen, and Vivek Anand. 2022. “Empirically Validated Screening Tools for Adolescent Substance Use Disorders.” South Dakota Medicine: The Journal of the South Dakota State Medical Association 75 (4): 176–80.

Welsh, Justine W., Alex R. Dopp, Rebecca M. Durham, Siara I. Sitar, Lora L. Passetti, Sarah B. Hunter, Mark D. Godley, and Ken C. Winters. 2025. “Narrative Review: Revised Principles and Practice Recommendations for Adolescent Substance Use Treatment and Policy.” Journal of the American Academy of Child and Adolescent Psychiatry 64 (2): 123–42.

West, Michelle L., and Shadi Sharif. 2023. “Cannabis and Psychosis.” Child and Adolescent Psychiatric Clinics of North America 32 (1): 69–83.

Wilkins, Jeffery N. 2019. “Management of Adolescent Substance Use Disorders, with an Emphasis on Cannabis Use Disorders.” Focus (American Psychiatric Publishing) 17 (2): 141–42.

Transcript:

Welcome to PsyDactic - CAPs board study edition.  I am your host, Dr. O'Leary, a child and adolescent psychiatry fellow in the national capital region.  This is a podcast I designed to help myself and other Child and Adolescent Psychiatry fellows study for their boards.  Anyone interested in human development and mental health will likely also get something out of it.  I am using AI to assist me with the content creation.  The tool that I used to create this episode allows me to do a literature search on a topic and pick peer reviewed and reputable sources to feed into the AI.  Then I create a prompt to guide the discussion.  I usually have to create 2-3 different prompts and explore the output of each, then pick the best parts, edit out problem parts, and paste it all together.  Even though I am using AI, all the content in the podcast should be considered my opinion and no one else's.  At the very least, it is compiled by me and released to you, so I take responsibility for that. If you find errors in the content or have suggestions for improvement, I would love it if you could go to PsyDactic.Com and fill out a form there to let me know.  You can also email me at feedback@psydactic.com.

Today, I am releasing a discussion about substance use disorders.  This is a general overview that highlights common features of substance use disorders and discusses in more detail substances like alcohol, nicotine, cannabis, and opioids.  In future episodes I hope to release more detailed discussions of each of these separately.  Until then, enjoy this AI generated discussion with your friendly A.I. hosts Ranai and Kai,or maybe you can call them Sarai and Malakai, but whatever you call them, they won’t care.  They are an illusion.

A.I hosts:

So today, based on the sources we've got, we're going to go through a few key things. First, uh we'll look at how substance use problems actually begin and develop in young people.
Yeah. The roots of these issues.
Then we'll uh move on to get a sense of how common these disorders are. That's the epidemiology,
right? The big picture.
And then we'll um unpack all those different risk factors that can contribute. You know, things like early experiences and genetics, uh that kind of stuff. And then we'll dive into what's actually happening in the brain when it comes to addiction, the neurobiology of it all.
The nuts and bolts.
Exactly. And then uh we'll move on to how professionals actually screen and assess for these disorders.
Yeah. The identification piece.
And finally, we'll uh touch on some general treatment approaches that have, you know, proven to be effective.
All right. Sounds like a pretty comprehensive roadmap.
Yeah. So, let's uh jump right in. So, you know, when we talk about substance use disorders in children and adolescence, I mean, where do these problems actually start? Like, what's the journey that leads young people down this path?
Yeah. Well, you know, right off the bat, it's super important to recognize that substance use problems are a global thing and they come with some pretty significant health, personal, and economic costs. Not everyone's equally vulnerable,
right?
It's a whole combination of factors that ultimately put someone at increased risk.
So, it's it's not as simple as just saying, well, if someone has access to alcohol or drugs, they're going to develop a problem.
Oh, definitely not. There are a lot of pieces to this puzzle.
Like, what what are some of the the things that we know can increase someone's risk? Well, for starters, certain personality traits can be a factor, you know, like uh things like impulsivity.
You know, acting without really thinking things through or having a hard time controlling impulses, what researchers call behavioral disinhibition or even having a strong drive for uh seeking out new and intense experiences, like always needing that next thrill. That's often referred to as sensation seeking.
Oh, yeah. I've definitely seen that. Um how certain personality types can make it harder to resist uh using substances.
It's definitely a piece of the puzzle. And then you have co-occurring mental health conditions,
right? Like dual diagnosis kind of.
Exactly. So young people with ADHD or anxiety disorders, uh they might be at a higher risk.
And of course, you can't forget about the whole developmental stage of adolescence itself, right?
I mean, it's a time of of massive brain development, a lot of changes, and you know, a lot of experimentation,
a lot of hormones.
This period of life can be a a time of increased vulnerability. That makes a lot of sense, right? It's it's a time of trying new things and and pushing boundaries and figuring out who you are.
Yeah. And social influences, those are those are huge, too,
right? The peer pressure piece.
Yes. So, peer pressure, the feeling that substance use is just, you know, normal and accepted among your friends and even just uh you know, how easy it is to actually get those substances,
right? Accessibility. So, really, it's that environment. The environment they're in can have such a huge impact.
And unfortunately, you know, You can't forget about the family environment either, correct? Because that can play a big role too, right? Like uh if there's substance abuse within the family or if a child has experienced abuse or neglect, those kinds of things, they create a much more vulnerable situation,
right? It's it's almost like the the foundation isn't as stable, so they're they're more likely to kind of reach for something to cope. So, it sounds like like we're talking about a pretty complex interplay of of different influences here. I mean, are there are there any particular factors that kind of stand out as as being especially important, like red flags to look out for.
Yeah. I think one of the biggest takeaways here is that the age at which substance use begins. That's really crucial.
Oh, yeah.
Starting to use substances before the age of 14, that really ramps up the risk of developing a full-blown substance use disorder later on. It's it's almost like the earlier the exposure, the higher the stakes.
Wow.
And and this just really underscores how important prevention efforts are in early adolescence, right? We need to catch it early.
Yeah. Yeah, makes sense. Um, and what about family history?
Family history, that's another big one. So, having a family history of substance use disorder, that also makes someone more vulnerable,
right? So, it's it's almost like there's a a genetic predisposition or at least, you know, maybe some learned behaviors or patterns.
It's definitely a combination of factors, but yeah, family history is is definitely something to pay attention to.
So, if if there's a pattern of substance use in the family or if someone starts using really young, I mean, those those are big red flags. Right. Those are things that that should really raise our awareness.
Yeah. Big time.
Okay. So, now we have a little bit of a picture of of how these issues can start, but to really get a grasp on the scope of the problem, you know, what do the numbers tell us about how common substance use disorders actually are among young people?
Yeah. Well, the epidemiology, it definitely paints a concerning picture. So, looking at data from the US,
um, back in 2017, the SAM HSA data, um, it estimated that around 19.7 million people aged 12 or older had a substance use disorder.
Wow. That's that's a huge number. I mean, that's a lot of people.
It's a significant portion of the population.
Yeah.
And uh breaking it down, about 14.5 million had alcohol use disorder and 7 and a half million had a disorder related to uh illicit drug use. And of those illicit drugs, marijuana was the most common affecting around 4.1 million people.
Wow. So, I mean, this isn't just a US problem, right? I mean, this is happening all over the world.
No, definitely not. It's a global concern and and you know a big chunk of this burden falls on young people between the ages of 15 and 24 which you know as we were talking about earlier that's such a crucial developmental period.
Yeah. You're you're just starting out your life and to have that kind of impact so early on that's that's really really concerning.
It is and and it often gets even more complicated because among adolescents who have a substance use disorder a large percentage of them somewhere between 37% and 80% they also have at least one other mental health disorder.
Wow. these issues they tend to go hand in hand which you know it really emphasizes the need for treatment approaches that look at the whole picture
right it's not enough to just treat the substance use you have to look at the underlying mental health issues as well
exactly
okay so so we've talked about some of those general risk factors you know family history early initiation but let's dig a little deeper into that whole idea of adverse childhood experiences or ACEs because I know that came up a lot in the research we looked at what what exactly is the link there
so ACEs. Those are things like uh you know abuse, neglect or just major dysfunction in the household. And there was this big scoping review where they specifically looked at the connection between ACEs and substance use disorders. And what they found over and over again was that there was a much higher prevalence of ACEs in people who also had SUD compared to the general population.
So I mean the research is pretty clear there's there's a connection there.
Yeah, it seems like the more ACEs someone's had, the more likely they are to struggle with substance use. They also found pretty strong link between ACEs and both the development and the severity of substance use disorders. And this wasn't just in adolescence, it went all the way into adulthood. So, it's it's like those early experiences can really cast a long shadow.
That's that's really powerful and kind of sad, too, to think that those early traumas can have such a such a long-lasting effect.
It really highlights how important it is to address childhood adversity and and to provide support for for kids who are going through those tough experiences. There isn't a totally standardized way of defining and measuring ACEs yet,
right?
And the specific substances that were looked at varied a lot across different studies. So, while the link is definitely there and it's a big concern, we need more research to really get a handle on exactly how ACEs increase risk. And as we talked about before, co-occurring mental health conditions, those are a major factor, too. So, depression, for example, and anxiety disorders and ADHD, those are also, you know, big risk factors and we also see higher rates of substance use in young people who might be at risk for developing psychosis.
So it sounds like like mental health and substance use are are pretty intertwined for a lot of young people.
Definitely.
Okay. So let's shift gears a little bit and and talk about what's happening in the brain. What do we actually know about the neurobiology of substance use disorders in general? Like what are the the underlying mechanisms that contribute to addiction?
Yeah, this is uh this is a pretty complex area, but it's really crucial for understanding how addiction takes hold,
right?
So, addiction is a chronically relapsing disorder,
right?
So, it's characterized by this this compulsive drive to seek out and use the substance. You lose control over how much you use, how often you use,
and then there's that that negative emotional state like withdrawal or what we call negative affect. Yeah.
That pops up when the substance isn't available.
So, it's it's not just about chasing pleasure.
Goes way beyond that. It's more about avoiding those negative feelings.
Exactly.
So, so what's actually happening in the brain when someone uses drugs or alcohol?
They break it down into uh a few key stages. In the beginning, there's this binge intoxication stage.
Okay?
And that involves a lot of activation in the brain's reward pathways.
Uhhuh.
And this is primarily the messocortical dopamine system and a specific area called the nucleus encumbent
with the pleasure center.
Yeah.
Yeah.
So, think of this pathway as like Like the brain's main pleasure highway gets activated by things that we find naturally rewarding like you know food, social connection, that kind of stuff,
right?
But addictive drugs, they essentially hijack this pathway. They cause this this surge of dopamine which creates this really powerful learning signal to brain. It's like, hey, this feels good. Let's do it again.
So the brain learns to associate the substance with pleasure.
Yeah. And dopamine and opioid peptides, those are those are key players in these reinforcing effects. They're the ones that really make you want to keep using.
So I I'm curious, do different drugs affect this system in the same way or is there some variation?
Well, it's it's not exactly the same across the board. So stimulants, nicotine, alcohol, opioids, cannabis, they all increase dopamine release, but they do it through different mechanisms.
Okay?
They interact with different receptors and neurotransmitter systems in the brain.
So So what happens when someone uses substances repeatedly over a long period of time? Does the brain start to adapt.
Oh yeah, definitely. The brain's always trying to maintain some kind of balance. And with chronic substance use, it definitely starts to adapt in some pretty significant ways.
Like how?
Well, for example, research has shown that in people who drink heavily, the nucleus encumbent, remember that's the pleasure center, it actually becomes less responsive to alcohol over time.
It's like the brain gets kind of numb to the effect.
It's desensitized.
Yeah. There are actually lower levels of dopamine type 2 receptors in the nucleus. incumbents of people with alcohol dependence.
So, so fewer receptors, so less dopamine combined and that leads to less of a reward response.
Yeah, basically. And that's actually led to the idea of a reward deficit syndrome,
right?
Where the brain just becomes less sensitive to those natural everyday rewards that we all experience.
I mean, I guess that explains why so many people with addiction have a hard time finding pleasure in things that they used to enjoy.
It could be part of it. Yeah.
And and I guess it also kind of explains why As we were talking about earlier, so many adolescence with SUD don't think they need treatment, right?
Because the substance has kind of become their main source of reward.
It kind of takes over their whole reward system
and it overshadows everything else. Absolutely.
But it's it's not just the reward system that's affected, right? I mean, there are other parts of the brain involved, too.
Oh, yeah. Definitely. There are a lot of moving parts.
So, what else is going on?
Well, stress related systems in the brain, they get involved too. So, things like the cappa opioid receptor and dinorphine,
right? These have been implicated in both alcohol consumption and the likelihood of relapse.
And then the prefrontal cortex which is you know that part of the brain that's responsible for decision- making, planning, controlling impulses, you know the executive functions, right? That often shows impaired function. And this can contribute to why people make those, you know, those choices to keep using substances even when they know it's causing problems.
It's like the part of their brain that should be saying, "Hey, this is a bad idea isn't working properly.
Yeah. It's like the brakes aren't working as well.
Wow. So, it's it's really a double whammy in terms of brain function. You've got the reward system that's all messed up and then the control center is also compromised.
Exactly. It's a recipe for trouble.
And what about other substances like cannabis? I mean, what are the neurobiological effects there?
Well, cannabis that exposure to THC, you know, the main psychoactive component of cannabis, it can actually change the connections between neurons in the prefrontal cortex. Interesting.
Like it messes with the synaptic density and efficiency.
Yeah.
Okay. So, it's it's not just affecting the reward system. It's it's impacting how different parts of the brain are communicating with each other.
Exactly. And you can't forget about the endockinabonoid system which has receptors all over the brain including the CD1 receptors. This system is involved in a ton of different functions like regulating mood, appetite, pain, and cannabis directly affects it.
And THC, that's the main active ingredient in cannabis. Right.
Yeah. THC acts as what we call an a at the CB-1 receptors, meaning it activates them and this leads to those increased dopamine levels in the stryatum and other reward related pathways.
So it's it's kind of hijacking the reward system in a similar way to other drugs
in a way. Yeah. But each substance has its own unique effects too.
Right. Right. It's so fascinating how how complex all of this is.
It really is.
So okay, we've talked about all these brain changes and risk factors, but thinking about, you know, how to actually identify these issues early on,
especially with them not always admitting there's a problem.
Early identification is key. Absolutely. And sadly, a lot of adolesccents who could use treatment are missed. Healthcare providers, they often rely on informal observations instead of using those standardized screening tools.
Is that because they're hard to use or
partially providers say they don't have enough time, not enough training on the tools or just aren't familiar with them?
Right. So, even if they have good intentions, it's not happening as often as they should.
Exactly. And then on the teen side, they might not even see it as a problem. So, they don't think they need help.
But I read that teens self-reporting in a confidential setting is pretty accurate.
That's true. They do might be a little hesitant at first, but overall they appreciate being asked by someone they trust and those self-reports pretty reliable.
Good to know. So, that brings us to ESERTS screening, brief intervention, and referral to treatment. Can you break that down for us?
Sure. Espert, it's a whole public health approach. The goal is to Find those who are using substances in a risky way or who already have an SUD. So you screen everyone, catch it early, then you do brief interventions to get them motivated to change and if needed, refer them to specialized treatment.
Got it. And we saw a few specific screening tools mentioned. Craft FT comes up a lot. What is that exactly?
Yeah, CRAF FT is popular. It's validated specifically for adolescence and it's an acronym so easy to remember the questions.
C is for car. Have you ever ridden in a car driven by someone? including yourself, who is high or who has been using drugs or alcohol? R is for relax. Do you ever use alcohol or drugs to relax, feel better about yourself, or to fit in? A is for alone. Do you ever use alcohol or drugs while you are by yourself? F is for forget. Do you ever forget things you did while using alcohol or drugs? The next F is for friends. Do your family or friends ever tell you that you should cut down on your drinking or drug use? T is for trouble. Have you ever gotten into trouble while you were using drugs or alcohol?
Two or more yes answers that suggests a possible problem needs further assessment.
Clever way to remember it. What other tools did they mention?
There's Posit, that's the problem oriented screening instrument for teenagers. S2BI, screening to brief intervention. That one's all about how often they use different substances and it's pretty accurate. Then there's Bastad, brief screener for tobacco. alcohol and other drugs, the NIA youth alcohol screen that's specific to alcohol, and the Audi alcohol use disorders identification test, the cage questionnaire, that's used for adults a lot, but it's not as good for teens.
So, there's no shortage of options. Key is to actually use them, right? And it sounds like the screening should be quick, easy to do during a regular visit.
Exactly. It doesn't have to be this big ordeal. Even single item questions can be a good start, like the ones from NIA and NAIDA. For alcohol, it's in the past year, how many times have you had five or more drinks in a day? Four or more for women. Any answer more than zero, that's a positive screen, needs followup. For drugs, it's in the past year, how many times have you used an illegal drug or prescription meds for non-medical reasons? Again, any use is a positive screen.
Simple and to the point. Beyond the screening, what else is important when assessing a teen?
Clinical interviews are crucial. You got to get the whole picture, their use patterns, the context, what problems they're facing, all that. and a physical exam that can show physical signs of substance use too.
How do we how do clinicians really get like a deep understanding of someone's substance use?
So, one key technique is called a functional analysis of substance use.
It's basically looking at what happens before the substance use. Okay. Like what are the triggers, what are the antecedants and then what happens afterwards? What are the consequences?
Short and long term.
Exactly. Both short and long term. You know, are there positive consequences? Are there negative consequ consequences.
Understanding these patterns can really help in tailoring treatment.
That makes sense. It's not just about the behavior itself. It's like why
exactly? It's about understanding the function of the behavior,
right? What other like areas should we be covering in a really thorough assessment.
Okay. So, you want a detailed medical history, right?
Mhm.
Looking for things like has there been any trauma?
Okay.
Pregnancy,
sexually transmitted infections, any signs of liver disease, You also want to assess how the adolescent is functioning in school or at work. You know, their peer relationships. What's the substance use like in their family? And and finally, you want to ask about any positive activities they're involved in like sports, hobbies, anything pro-social,
right? Protective factors.
Exactly. Protective factors.
Okay, makes sense.
Yeah.
Then there's the biological testing, the drug tests. What are the options there?
So, most common is urine testing. Easy to collect, cost effective. Often they use amino acids. days. Those quick tests you can do right there in the office. Detection time varies. Cannabis a few days to weeks. Cocaine 2, three days. Amphetamines, similar. Opioids, PCP, a few days, too. Blood testing, that's more definitive. Or if you need the exact concentration of the drug. Less tampering, better at finding the original drug. Oral fluids, saliva, that's an option, too. The drug levels there match up with blood pretty well. Got to wait 2 hours after eating or drinking, though, to collect the sample. Then there's hair testing that goes way back weeks or even months.
Wow. So many choices. Any potential problems with these tests, false positives, things like that?
Oh, yeah. Definitely got to be aware of that. False positives and false negatives can happen. Like puppy seeds can make a urine test positive for opiates. Some cough meds can show up as PCP. Benzoipene tests, sometimes they don't catch all the types because the molecules are so similar. Even nicotine replacement like patches that can give a positive for nicotine.
So you can't just blindly trust the test.
No. Got to look at the whole picture. If there's a positive, screen, best to confirm it with a more specific test.
Makes sense. One more thing our source mentioned, and it seems obvious once you think about it, but cultural factors in assessment.
Oh, yeah. Super important. The DSM5 actually includes this cultural formulation interview, the CFI, to help clinicians learn about the person's background, how it might be impacting their mental health and substance use.
So, it's not one-sizefits-all.
Nope. Got to tailor the approach. And that's important for diagnosis and for treatment planning, too. You want a plan that's going to work for that specific person taking their background into account.
And I know this is a really sensitive area, especially with teens. Confidentiality
huge.
Our sources really emphasize how crucial this is.
It's absolutely paramount.
Yeah.
Yeah.
So, why is it so important, especially when we're talking about substance use?
Well, adolescence, they're they're often hesitant to seek help. Yeah.
You know, to share sensitive information about, you know, substance use, mental health, trauma, if they're worried that it's going to get back to their parents without their consent. So, when they know know that what they share is confidential
when they understand the legal and ethical protections,
right?
They're way more likely to actually seek help and to be honest,
open and honest.
Exactly.
So, it builds trust.
It's all about trust.
Yes.
But, and this is important.
Okay.
State laws regarding a minor's right to confidential substance use treatment,
they can vary quite a bit.
Okay.
Some states minors can consent to their own SUD related care. Other states have different regulations. There are also some federal laws that offer certain protections.
Sounds complicated.
Yeah, it can be tricky for providers to navigate.
So, what what should they do?
The key is to be really clear. Explain your confidentiality policy upfront at the beginning of the assessment at every visit.
Okay?
And and ideally have that conversation with both the adolescent and their parent or guardian present. Okay?
So, everyone's on the same page.
All right? What happens next? What about treatment options? Yeah. So, it sounds like there's no magic bullet. Our sources stress that it needs to be individualized, tailored to each person's needs.
That's it. Exactly. Teens are still developing their experiences, their challenges. They're different from adults. So, you got to make sure the treatment plan makes sense for their age, their situation, all of that.
Right. Let's start with the psychosocial interventions. One that came up was brief intervention. What does that usually look like?
So, brief interventions, those are usually short counseling sessions. The focus is encouraging health choices, getting them to cut back or stop the risky behavior,
like giving them info on the risks.
Yep. That giving them feedback on their own use, helping them set goals for change, sometimes connecting them with more intensive treatment if they need it. And what's cool is it's been shown to work, reduces alcohol and cannabis use in teens who end up in the ER for substance related reasons. Plus, it's cost effective.
So, short, but impactful potentially. Then there's motivational interviewing. MI and motivational enhancement therapy meti those seem to be about helping the person find their own reasons to change
you got it mi it's a way of talking with them helping them strengthen their own motivation and commitment to change you focus on what we call change talk statements they make about wanting to change feeling able to having reasons needing to being committed
sounds very empowering
it is yeah and it's got a lot of research backing it up for all sorts of addictions including in adolescence works in different settings too and there's evidence that training family members and MI can help them support the teen better.
Wow. So, it's not just for therapists. It can be a tool for families, too. Cool. What about cognitive behavioral therapy, CBT? What does that bring to the table?
CBT. It's based on the idea that our thoughts, feelings, actions, they're all linked. So, it teaches skills to first achieve abstinence and then maintain it. That involves spotting and challenging those negative thought patterns that lead to drinking, coping with cravings, and stress without alcohol. All that. It's proven effective for a bunch of SUDs including stimulants and cannabis. Often used alongside meds too when appropriate. Typically, it's structured assessment, skills training, then planning for the future, how to stay on track. It's collaborative, tailored to each person.
Very practical skill focus. We also saw family therapy. You mentioned multi-istic therapy, functional family therapy, stuff like that. How do those fit in?
Those are programs that work with the whole family, trying to address all the factors contributing to the teen's use. They've shown promise in treating existing problems, but also improve preventing them.
So, getting the whole family on board, working together.
Yeah. And family support. It's huge for teens entering treatment, sticking with it, succeeding long term.
Makes sense. Then there's integrated care.
Integrated care means you're addressing both at the same time, usually by the same clinician or a team that's working closely together. Super important when someone's got psychosis along with substance use. The old way, treating each separately, it's not as effective because they impact each other so much. Right. They're not isolated problems. Okay. And I know for for adults with substance use disorders,
we often hear about like mutual support groups. Yeah. Like 12step programs. Are those
are those used for adolescence and are they effective?
So there's some encouraging data that suggests adolescent involvement in these groups can be helpful. You know, some studies have shown that attending these groups is linked to lower rates of substance use and more access to recovery resources, right?
But it's important to that meetings that are specifically designed for adolescence are not as common. And you know, going to a meeting that's mostly adults may not feel as relatable or supportive to a teenager,
right?
And then you also have the issue of, you know, some of those 12step principles might not really resonate with with, you know, the developmental stage of an adolescent, right? Or their beliefs.
Okay, so that's the psychosocial side. What about meds?
But you got to be really careful with teens. weigh the risks and benefits very carefully.
Right. They're still developing. So specific situations like tobacco use disorder, there seem to be some options there.
Yep. Nicotine replacement therapy. So patches, gum, lozenes, inhalers, nasal spray, all that. Those have good evidence to help teens quit smoking. And meds work best with counseling, too.
Now, bupropion, that's a different story.
Okay?
It works in a different way. It's a norepinephrine and dopamine reuptake inhibitor.
Okay?
And it also acts as a nicotinic receptor antagonist.
Okay.
So, it can also help with those withdrawal symptoms.
Lots of choices there. What about opioid use disorder? Anything for teens struggling with that?
Yeah, buprenorphine often with nlloxxone that can be used for outpatient detox and for longerterm maintenance. Gradual tapering off buprenorphine seems to lead to better outcomes in this age group. Nrexone, that's another one. Pill or injection, it's an opioid antagonist. They've even done studies comparing buprenorphine to clonine for managing withdrawal symptoms. in teens.
Interesting. So, focusing on alcohol use disorder itself.
Any meds specifically for that in adolescence?
Benzoazipines, those are usually the first choice for managing alcohol withdrawal because they're effective good safety profile in terms of preventing seizures and stuff. They boost GABA activity in the brain. Which benzo you use depends on the team, age, liver function, seizure history. Anti-vulsants are sometimes used too for withdrawal. The FDA approved meds for AUD and adults snrexone, a camper ate dulfuram gabapentin those have mostly been studied in adults but sometimes a doctor might use them off label in teens but that's always with caution weighing the risks and benefits monitoring closely nrexone that one's to reduce the good feelings alcohol gives a camper helps balance brain chemicals dulfurum that's a deterrent makes you feel awful if you drink gabapentin that might help with anxiety sleep problems mood stuff during that longer withdrawal
sounds like more research is needed for the medication side of things especially in teens what about canc Cannabis stimulants anything proven effective there
for cannabis use disorder no FDA approved meds yet they're looking at adrenopolone and acetylcysteine CBD but results are mixed so far so it's mostly psychosocial interventions for now stimulant use disorder no FDA approved meds there either research is ongoing a lot of it focused on meds that target those reward pathways the stimulants used for ADHD those might help reduce cravings for other stimulants in some cases but It's tricky. Got to be very careful about misuse potential.
So, a lot of wait and see in those areas. Our sources also mentioned medication for managing detox in general.
Yeah, like we said, benzo and anticonvulsins are key for safe alcohol withdrawal and lockxone. Can't forget that one. It's a lifesaver. Reverses opioid overdoses quickly. Getting that out there and accessible, that's a public health priority.
Absolutely. Last question on treatment. Actually getting teens into treatment in the first place. That can be its own hurdle, right?
It can. Referral to the right service. services is essential. Providers got to know what's available in their community and often it takes family support, even sometimes mandates from the juvenile justice system to get teens engaged and keep them in treatment until it's done.
Wow. So, it's a whole system, not just the teen themselves,
right? Takes a village.
And the last source we touched on, the importance of having good prevention in place, too. It's not just about fixing problems. It's about stopping them before they start.
100% strong community initiative. getting different groups working together, using proven strategies to address those social factors that contribute to substance use. That's how you prevent it in the long run.
Prevention is key. Well, this has been a really deep dive, I'd say. So, for you listening, here's something to chew on. Given how fast the brain develops during those teen years and how much harm alcohol can do during that time, what are some new innovative ways we could prioritize prevention? How can we make sure that young people who are struggling or might at risk can get the support they need. Support that's based on evidence that's easy to access. Think about what resources are in your community. Stay informed about the research happening in this area. It's important stuff. Thanks for joining us for this deep dive.
Thanks for having me. Beat down.