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EXECUTIVE SUMMARY AND RECOMMENDATIONS. This document, Treatment of Adolescents With Substance Use Disorders, is a revision and update of Treatment Improvement Protocol (TIP) 4, published in 1993 by the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA). Like TIP 4, this document aims to help treatment providers design and deliver better services to adolescent clients with substance use disorders. In 1992, CSAT convened a Consensus Panel of experts on adolescent substance use disorder treatment to produce guidelines for treatment programs on designing and delivering effective services to adolescent clients. The clients addressed in the TIP included, among others, young people involved with the juvenile and criminal justice systems. CSAT also intended for the Panel's guidelines to help governmental agencies and treatment providers establish, fund, operate, monitor, and evaluate treatment programs for substance-using adolescents. The result of that Panel's work was TIP 4, Guidelines for the Treatment of Alcohol- and Other Drug-Abusing Adolescents. In July 1997, CSAT convened a small Revision Panel to review TIP 4. The Panel recommended changes and developed content for this revised TIP. Since the publication of TIP 4, the understanding of substance use disorders and its treatment among adolescents has advanced. More is known today about the immediate and long-term physiologic, behavioral, and social consequences of use, abuse, and dependency. New research attention has begun to examine the effectiveness of various treatment methods and components that meet the specific treatment needs of substance-using adolescents, and this literature is reviewed. However, the literature is small. Fortunately, a large multisite, national study on the effectiveness of treatment for adolescent substance users is underway with funds from the National Institute on Drug Abuse. CSAT is also conducting studies on adolescents, focusing on marijuana treatment, diversion programs in the juvenile justice system (JJS), and exemplary treatment programs. The field will likely mature greatly by the knowledge advanced from these studies. The structure of the earlier TIP of separate inpatient and outpatient treatment chapters, which represented a continuum of service intensity, was viewed by the Revision Panel to be less central to treatment decisions than a continuum based on the severity of the substance use disorder. This shift in focus better reflects clinical experience, extant treatment research, and the recent changes regarding reimbursement by health care payors for treatment. However, the Revision Panel retained a broad definition of treatment. Treatment is defined in this TIP as those activities that might be undertaken to deal with problem(s) associated with substance involvement and with individuals manifesting a substance use disorder. Although the Panel recognizes that primary or secondary prevention of substance use are included in expanded definitions of treatment, the Panel limited the continuum of interventions to what is traditionally viewed as acute intervention, rehabilitation, and maintenance. The elements of the continuum primarily reflect the treatment philosophies of providers, with less emphasis on settings and modalities. In addition to defining the treatment needs of adolescents and providing a full description of the use of the severity continuum, the Revision Panel focused attention on three common types of treatment for adolescents today: 12-Step-based treatment, treatment in the adolescent therapeutic community, and family therapy. The 12-Step model lies at the heart of many adolescent treatment programs. Therapeutic communities (TCs) are an intensive type of residential treatment that is attracting attention as a preferred approach for substance-using juveniles incarcerated in the justice system. Clinicians have found that effective treatment of the adolescent almost always involves the family, and the effectiveness of family therapy has been documented extensively, particularly among those substance-using adolescents who are normally the most difficult to treat. This revision of the earlier TIP, then, offers guidelines for using the severity continuum to make treatment decisions and for providing three common models of treatment for adolescents with substance use disorders. Recommendations of the Revision Panel, supported by extensive clinical experience and the literature, are summarized below. The organization of this TIP reflects the core facets of initiating, engaging, and maintaining the change process for youths with substance use disorders. Chapter 1 details the scope and complexity of the problem. Chapter 2 covers factors considered in making treatment decisions, and Chapter 3 details the features of successful programs. Chapters 4, 5, and 6 introduce and describe the treatment approaches used in 12-Step-based treatment, therapeutic communities, and family therapy, respectively. Chapter 7 discusses adolescents with distinctive treatment needs, such as youths involved in the juvenile justice system, homeless and runaway youth, and youth with coexisting disorders. Chapter 8 describes the legal and ethical issues that relate to diagnosis and treatment of adolescents. This new TIP derives from CSAT's intention to provide protocols that reflect the work now being done by providers of high-quality treatment. As with other TIPs, this document brings the best knowledge from the field to State and local treatment programs. In order to avoid awkward construction and sexism, this TIP alternates between "he" and "she" for generic examples. The companion document, TIP 31, Screening and Assessing Adolescents for Substance Use Disorders, a revision of TIP 3, has also been published (CSAT, 1999).
