M42 Treatment of Adolescents with Substance Use Disorders - Comprehensive Notes

Executive Summary

This document is a revision and update of Manual 4 (1993) by CSAT/SAMHSA aimed at helping treatment providers design and deliver better services to adolescent clients with substance use disorders.
Origin: CSAT convened a Consensus Panel in 1992 to develop guidelines for treatment programs, including youths involved with juvenile/criminal justice systems.
Advances since 1993 include better understanding of immediate/long-term physiologic, behavioral, and social consequences of use, abuse, and dependency; and emerging evidence on effectiveness of treatment components. A large multisite national study on adolescent treatment effectiveness is underway (funded by NIDA). CSAT studies focus on marijuana treatment, juvenile diversion programs, and exemplary programs.
Key shift: move from a continuum based primarily on inpatient/outpatient settings to a continuum based on the severity of the adolescent’s substance use disorder. This reflects clinical experience, research, and reimbursement trends. Treatment is defined broadly to include activities addressing problems associated with substance involvement and with individuals manifesting a substance use disorder; prevention is acknowledged but the continuum emphasizes acute intervention, rehabilitation, and maintenance.
Three core treatment models highlighted: 12-Step-based treatment, adolescent therapeutic communities (TCs), and family therapy. The 12-Step model is central in many programs; TCs offer intensive residential treatment sometimes for justice-involved youth; family therapy engages families as active treatment partners.
Structure of the manual: sections on scope/needs, decision factors for placement, general program features, three treatment modalities, distinctive needs, legal/ethical issues, and appendices (bibliography, medical management, field reviewers).