Adolescent drug and alcohol abuse is a major public health issue that has been gaining national attention recently as more and more young people die from opioid overdoses. The prevalence of adolescent drug use is staggering. Imagine a classroom of high school seniors. Using national data, we can estimate that in a class of 30, about 12 adolescents used alcohol and seven used marijuana in the past month. Five adolescents abused prescription drugs in the past year. This is especially troubling given that 90 percent of adults with drug or alcohol dependence began using before age 18.
There are many efforts under way to address this epidemic. The latest is a guide from the National Association of State Alcohol and Drug Abuse Directors (NASADAD) to help state agencies enhance the adolescent addiction treatment and recovery systems, maximizing the opportunities afforded by the Affordable Care Act (ACA). The ACA expands coverage for behavioral health treatment, promotes prevention efforts, and encourages the integration of physical and behavioral health. This generates new opportunities for providers to tackle adolescent substance use; but providers can’t do it alone.
The State Adolescent Substance Use Disorder Treatment and Recovery Practice Guide outlines principles of good care, specific guidance for providers on delivering treatment, and considerations for decision makers who coordinate services for adolescents. Treatment standards and guidelines from 24 states were used to craft these recommendations. Though targeted to the state agencies that oversee substance abuse treatment, the underlying principles are relevant for state officials, providers and advocates alike.
Most importantly, we need to catch adolescents upstream, before a problem begins. Simple, quick screenings can be conducted by a wide range of people, from school counselors to community outreach workers to pediatricians. One specific approach that fulfills the recommendations from the report is called SBIRT (screening, brief intervention, and referral to treatment). SBIRT is an effective prevention tool that can be used in a variety of medical and nonmedical settings. It involves asking young people a few questions about their drug and alcohol use and providing guidance or referring to treatment, if a problem exists. Community Catalyst is leading a national project to promote SBIRT for youth.
For young people who require treatment, we need to recognize that the available treatments for addiction are largely designed for adults. Adolescents benefit the most from specialized services geared toward their emotional and physiological development.
States should adopt systems of care that are recovery-oriented and promote best practices for reaching and treating young people. Services provided using this philosophy are person-centered—the young person directs their treatment as they draw on their own priorities and personal goals for recovery. This approach often employs peer support and mentors, which are key ingredients in a young person’s recovery.
It’s also important to remember that adolescents with addiction often receive fragmented services through multiple state systems (e.g., child welfare and juvenile justice). States can address this through better coordination of services across youth agencies, and a more streamlined continuum of care.
These are just a few key takeaways from the report, which provides a roadmap to addressing adolescent substance use statewide. Only with a coordinated approach, supported by best practices from the field, can we begin to tackle this epidemic. The ACA means that more young people will have insurance coverage, access to screening and expanded and improved behavioral health treatment. States should seize this opportunity to build comprehensive, state of the art systems of care, which will protect young people now and head off future addiction among this generation.
— Melissa Ough, policy analyst