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

25. Adolescent Substance Abuse 577discharge from the Cannabis Youth Treatment study (Dennis et al., 2004) or tomanifest at least some form of substance abuse (Kaminer, Burleson, et al.,2002). Lack of continuity of care or aftercare programs for adolescents withAOSUDs is the rule rather than the exception.Partially overlapping terms such as “aftercare,” “continued care,” or “transitionof care” have been used in the literature interchangeably to describeinterventions used in the postacute treatment period. The Continuity of CareGuidelines for Addiction Services developed by the American Academy ofAddiction Psychiatry (AAAP) defined “continuity” as follows: “Transitionsshould incorporate relevant elements of any preexisting treatment plan. Treatmentplans should be relevant to the entire course of an episode of illness/disabilityso that they can provide a degree of continuity in the context of change”(Sowers, 2003, p. 2).The timing and level of therapeutic services in important. The more ancillarycommunity therapeutic services received during treatment, the better theshort-term outcome (Burleson & Kaminer, in press). The more therapeutic servicesreceived posttreatment, however, the poorer the short-term outcome.Godley, Godley, and Dennis (2002) reported that adolescents referredfrom residential treatment to continuing care services were significantly morelikely to initiate and receive more continuing care services, to be abstinentfrom marijuana 3 months postdischarge, and to reduce their 3-month postdischargedays of alcohol use when assigned to an assertive continuing care protocolinvolving case management and the adolescent community reinforcementapproach as compared to usual continuing care. Because of the statedimportance of aftercare, we need continued exploration of how to improveengagement and retention in aftercare. One of the most prominent aftercareoptions is school-based interventions. Most patients return to school; therefore,school-based tertiary prevention in the form of counseling, peer-led groups, andsupport group for “recovered” adolescents is warranted (Wagner, Kortlander, &Morris, 2001). Adolescents enrolled in these programs may also be instrumentalas role models in school-based primary and secondary prevention groups forhigh-risk youth. Also, continued participation in self-help groups, follow-upwith an outpatient clinic, and rigorous maintenance of a contingency dischargecontract are helpful for relapse prevention.Parents/caretakers should be encouraged to support the recovery processand to maintain a risk-free lifestyle for the adolescent (e.g., be aware of ominoussigns of relapse, keep curfew hours, and avoid enabling behavior).CONCLUSIONDespite the progress achieved in the understanding of different aspects of SUDsin adolescents, more research is needed to advance the field. Among the priorityareas for further research are interventions including prevention, and effec-