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

25. Adolescent Substance Abuse 575be rare in adolescents (Martin et al., 1995), there is little rationale for using differentdetoxification protocols than those used for adults. The use of agents to blockthe reinforcing effects of various substances, as aversive agents (e.g., disulfiram) orto relieve craving during and after acute withdrawal, has been studied in adultsbut has received scant attention in adolescents. Kaminer (1992b) described theuse of desipramine in an adolescent with cocaine dependence. Aversive pharmacologicaltreatment with agents such as disulfiram is rare in adolescents. In twocase studies, Myers, Donaue, and Goldstein (1994) expressed caution in usingdisulfiram in adolescents. The opiate antagonist naltrexone, used safely and effectivelyin adults to reduce cravings for alcohol, may hold promise for the treatmentof adolescents with alcohol use disorder according to a case study reported byWold and Kaminer (1997).The high prevalence of coexisting psychiatric disorders in adolescents withSUD presents additional targets for pharmacological agents (Bukstein &Kithas, 2003; Bukstein et al., 1989). Potential targets for pharmacological treatmentinclude depression and other mood problems, ADHD, severe levels ofaggressive behavior, and anxiety disorders. Unfortunately, few data in the literaturedemonstrate the efficacy of pharmacological agents prescribed for adolescentswith a SUD and comorbid psychiatric disorders. Preliminary data suggestthat selective serotonergic reuptake inhibitors may reduce problem drinking inadult drinkers (Naranjo, Kadlec, Sanheuza, Woodley-Remus, & Sellars, 1990),and both depression and drinking behavior in depressed adult alcoholics(Cornelius et al., 1993). However, a recent study indicates that these agentshave a limited clinical utility (Kranzler et al., 1995). In general, cliniciansshould use the same caution in considering pharmacological treatment for adolescentswith a comorbid SUD and psychiatric disorders, as they do in youthwith psychiatric symptoms alone.Only more recently has there been research evaluating the efficacy andsafety of any psychotropic medication in the treatment of adolescents withSUDs (Bukstein & Kithas, 2003; Kaminer, 2001). Open trials with pemolineand bupropion for ADHD, and fluoxetine for depression, in a population ofdrug-dependent delinquents have shown promise (Riggs, Milkovich, Coffman,& Crowley, 1997; Riggs, Leon, Mikulich, & Pottle, 1998). More recently, adouble-blind, placebo-controlled trial of a stimulant medication demonstratedthe efficacy of medication improving ADHD symptoms in adolescents withcomorbid ADHD and an SUD. This study also demonstrated that medicationtreatment of ADHD alone, without specific SUD or other psychosocialtreatment, did not decrease substance use (Riggs, Hall, Mikulich-Gilbertson,Lohman, & Kayser, 2004). Lithium, in a randomized controlled trial (Geller etal., 1998), and serotonergic reuptake inhibitors, in open trials (Cornelius et al.,2001; Riggs et al., 1997), have produced significant improvements in adolescentswith an SUD and comorbid mood disorders.An SUD may increase the potential for intentional or unintentional overdose.Some pharmacological agents may have inherent abuse potential. Critical