Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

CHAPTER 25Treating Adolescent Substance AbuseYIFRAH KAMINEROSCAR G. BUKSTEINThe consequences of substance use, as well as substance use disorders (SUDs),continue to present a major public health concern. Level of substance use isassociated with leading causes of adolescent morbidity and mortality in theUnited States, including motor vehicle accidents, suicidal behavior, violence,delinquency, drowning, and unprotected sexual behavior. Adolescent SUDs,which include substance abuse and substance dependence as defined in thefourth edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-IV-TR; American Psychiatric Association, 2000), are also associatedwith drug-related chronic problems in several life domains, including psychiatriccomorbidity, school or employment performance, family function, peersocial relationships, legal status, and recreational activities.Regional studies reveal that between 7 and 10% of adolescents are inneed of treatment (Harrison, Fulkerson, & Beebe, 1998; Lewinsohn, Hops,Roberts, & Seeley, 1993; Reinharz, Giaconia, Lefkowitz, Pakiz, & Frost, 1993;Ungemack, Hartwell, & Babor, 1997). However, due to limited resources, onlya small segment of the adolescent subpopulation with alcohol and other substanceuse disorders (AOSUDs), in particular, those with high severity ofAOSUDs, comorbid psychiatric disorders, and legal problems, usually end up intreatment (Kaminer, 2001).Our objectives in this chapter are to review the trends in adolescent substanceuse, nosology, etiology of substance use and its transition to adolescentSUDs, psychiatric comorbidity, prevention, assessment, and the treatment–aftercare continuum. As a point of clarification, the generic term “substanceuse” refers here to nonpathological use of any licit drug (tobacco, alcohol, and559