Summarise the key points of this article [URL].

Key Points: Revised Principles and Practice Recommendations for Adolescent Substance Use Treatment and Policy

Overview and Purpose

This 2025 narrative review updates the 2014 National Institute on Drug Abuse principles for adolescent substance use disorder (SUD) treatment, condensing 8 original treatment modalities into 5 evidence-based practices and revising 13 core principles to reflect current evidence. 1

The review addresses a critical public health need, as approximately 2.2 million (8.5%) of US adolescents aged 12-17 met criteria for SUD in 2021, with nearly one-third of 12th graders reporting past-year substance use. 1

Core Assessment Principles

Confidentiality and Trust-Building

• Explaining consent and confidentiality early in the visit is fundamental to adolescent care, as it builds trust and encourages honest disclosure about sensitive topics including substance use, mental health, and trauma history. 2
• Introducing confidentiality during early visits decreases both parent/caregiver and adolescent reluctance about time alone with providers. 2
• Clinicians must clearly explain the limits of confidentiality, including mandated reporting requirements for abuse/neglect or acute safety concerns. 2

Family Relationship Assessment

• Exploring the adolescent's relationship with family is essential, including documenting family strengths and limitations and observing the adolescent's interaction with caretakers. 2
• Most evidence-based services for adolescent problems involve family members, making family relationship assessment critical for treatment planning. 2
• Clinicians must balance family involvement with adolescent confidentiality, allowing the adolescent choice in involving parents or trusted adults when legally permissible. 2

Updated Treatment Principles

Integrated Care for Co-occurring Disorders

• Integrating care for co-occurring mental health disorders and SUDs is a key recommendation, as the majority of adolescents with SUDs have comorbid psychiatric conditions. 1
• Adolescent substance use is associated with increased risk of lower academic performance, development of mood disorders, social difficulties, and is a risk factor for suicidality and overdose death. 1

Service Accessibility and Engagement

• Improving service accessibility through the educational system is recommended to reach adolescents where they spend most of their time. 1
• Maintaining engagement throughout treatment is critical, as adolescents are particularly vulnerable to treatment dropout. 1
• Addressing tension between agencies when collaborating with other youth service systems (juvenile justice, child welfare) is necessary for comprehensive care. 1

Five Evidence-Based Treatment Practices

1. Screening, Brief Intervention, and Referral to Treatment (SBIRT)

• Adoption of SBIRT is recommended as a systematic approach to identify and intervene early with adolescents who have or are at risk for SUDs. 1

2. Social Programs and Family Involvement

• Investment in social programs and family involvement in treatment is essential, as family-based interventions have the strongest evidence base for adolescent SUD treatment. 1

3. Behavioral Therapies and Medications

• Expanding access to both behavioral therapies and medications for adolescent SUDs is critical, as pharmacological interventions remain underutilized in this population despite evidence of efficacy. 1

4. Harm Reduction Services

• Increasing funding to harm reduction services is recommended to reduce substance-related morbidity and mortality in adolescents who continue to use substances. 1

5. Continuing Care Services

• Supporting reimbursement for continuing care services is necessary, as SUDs are chronic relapsing conditions requiring long-term management beyond acute treatment episodes. 1

Policy and Research Implications

Funding and Policy Support

• Policymakers and funding agencies must provide necessary support to implement these principles and practices to improve the standard of care for adolescent SUD services. 1
• Increased investment in research is needed to further develop and refine evidence-based interventions for this population. 1

Research Priorities

• The review identifies areas of treatment in need of further research, particularly regarding optimal implementation strategies and long-term outcomes. 1

Common Pitfalls to Avoid

• Failing to establish confidentiality early creates barriers to honest disclosure about sensitive topics. 2
• Ignoring family dynamics is a critical error, as family factors are often pivotal in adolescent problems and treatment success. 2
• Not listening for indirect communication is problematic, as adolescents may not directly state concerns and require active listening for cues. 2
• Overlooking future orientation misses critical insight into developmental stage and risk assessment. 2