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Substance Abuse and Addiction 395a decrease in IQ, and the main risk, apart from overdose, is infection from nonsterileneedles (McLellan, Woody, & O’Brien, 1979).TreatmentStudies of treatment for addictive disorders among adolescents are scarce. Thereare ethical issues concerning how to obtain consent from a minor and how to involveparents. There is also the difficulty in getting adolescents to accept the needfor treatment and to volunteer for a study. Currently the first randomized clinicaltrial of a medication for opiate addiction (buprenorphine) among adolescent opiateaddicts is underway, but recruitment of volunteers has been difficult (G. Woody,personal communication, May 2006). Most treatment programs tailored to the needsof adolescents use the same psychotherapeutic approaches and medications that havebeen found effective in adults. We know, however, that psychoactive medicationsas well as drugs of abuse have different effects on the adolescent brain as comparedto the adult. Thus randomized controlled clinical trials in the adolescent populationwill be necessary. A review of the literature concerning treatments for substanceabuse in adolescents has recently been published (O’Brien et al., 2005).PreventionSome degree of risk taking and thrill seeking is normal in adolescence. (Steinberg,2004). School-based programs aimed at primary prevention of substance abusehave had variable success. Evaluations of drug education programs such as DAREhave generally found them to be ineffective (Becker, Agopian, & Yeh, 1992;Ennett, Tobler, Ringwalt, & Flewelling, 1994). In contrast, there have been welldesignedprograms teaching social resistance skills in junior high school that haveproduced significant results. In well-controlled outcome studies using similarcomparison groups, the adolescents exposed to the training and 2 years of boostersessions showed significant reductions in nicotine, alcohol, and marijuana use atfollow-up (Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995; Griffin, Botvin,Nichols, & Doyle, 2003). For an extensive review of adolescent substance abuseprevention programs See O’Brien et al, 2005.ConclusionsAdolescence is a vulnerable period for initiating substance abuse. Progression fromuse to abuse to addiction is influenced by multiple, simultaneous variables categorizedin the medical model as agent, host, and environment. Happily, the