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Minnesota Health Technology Advisory Committee  SAMHSA/CSAT Treatment Improvement Protocols32. TIP 32: Treatment of Adolescents with Substance Use Disorders Title Page Treatment of Adolescents With Substance Use Disorders Treatment Improvement Protocol (TIP) Series 32 Ken C.
Winters, Ph.D. Revision Consensus Panel Chair U.S.
DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Rockwall II, 5600 Fishers Lane Rockville, MD 20857 DHHS Publication No. (SMA) 99-3283 Printed 1999 Link to the National Guideline Clearinghouse This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. All material appearing in this volume except that taken directly from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated. This publication was written under contract number 270-95-0013 with The CDM Group, Inc. (CDM). Sandra Clunies, M.S., I.C.A.D.C., served as the CSAT government project officer. Rose M. Urban, M.S.W., J.D., C.S.A.C., served as the CDM TIPs project director. Other CDM TIPs personnel included Y-Lang Nguyen, production/copy editor, Raquel Ingraham, M.S., project manager, Virginia Vitzthum, former managing editor, Mary Smolenski, Ed.D., C.R.N.P., former project director, and MaryLou Leonard, former project manager. The opinions expressed herein are the views of the Consensus Panel members and do not reflect the official position of CSAT, SAMHSA, or the U.S.
Department of Health and Human Services (DHHS). No official support or endorsement of CSAT, SAMHSA, or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized client care and treatment decisions. Treatment Improvement Protocols (TIPs) are best practice guidelines for the treatment of substance use disorders, provided as a service of the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT). CSAT's Office of Evaluation, Scientific Analysis and Synthesis draws on the experience and knowledge of clinical, research, and administrative experts to produce the TIPs, which are distributed to a growing number of facilities and individuals across the country. The audience for the TIPs is expanding beyond public and private treatment facilities for substance use disorders as substance use disorders are increasingly recognized as a major problem. The TIPs Editorial Advisory Board, a distinguished group of substance use disorder experts and professionals in such related fields as primary care, mental health, and social services, works with the State alcohol and drug abuse directors to generate topics for the TIPs based on the field's current needs for information and guidance. After selecting a topic, CSAT invites staff from pertinent Federal agencies and national organizations to a Resource Panel that recommends specific areas of focus as well as resources that should be considered in developing the content of the TIP. Then recommendations are communicated to a Consensus Panel composed of non-Federal experts on the topic who have been nominated by their peers. This Panel participates in a series of discussions; the information and recommendations on which they reach consensus form the foundation of the TIP. The members of each Consensus Panel represent treatment programs for substance use disorders, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A Panel Chair (or Co-Chairs) ensures that the guidelines mirror the results of the group's collaboration. A large and diverse group of experts closely reviews the draft document. Once the changes recommended by these field reviewers have been incorporated, the TIP is prepared for publication, in print and online. The TIPs can be accessed via the Internet on the National Library of Medicine's home page at the URL: http://text.nlm.nih.gov. The move to electronic media also means that the TIPs can be updated more easily so that they continue to provide the field with state-of-the-art information. Although each TIP strives to include an evidence base for the practices it recommends, CSAT recognizes that the field of substance use disorder treatment is evolving, and published research frequently lags behind the innovations pioneered in the field. A major goal of each TIP is to convey "front-line" information quickly but responsibly. For this reason, recommendations proffered in the TIP are attributed to either Panelists' clinical experience or the literature. If there is research to support a particular approach, citations are provided. This TIP, Treatment of Adolescents With Substance Use Disorders, updates TIP 4, published in 1993, and presents information on substance use disorder treatment for adolescent clients. Adolescents differ from adults both physiologically and emotionally as they make the transition from child to adult and, thus, require treatment adapted to their needs. The onset of substance use is occurring at younger ages, resulting in more adolescents entering treatment for substance use disorders than has been observed in the past. In order to treat this population effectively, treatment providers must address the issues that play significant roles in an adolescent's life, such as cognitive, emotional, physical, social, and moral development, and family and peer environment. This TIP focuses on ways to specialize treatment for adolescents, as well as on common and effective program components and approaches being used today. Chapter 1 details the scope and complexity of the problem; Chapter 2 presents factors to be considered when making treatment decisions; and Chapter 3 discusses successful program components. Chapters 4, 5, and 6 describe the treatment approaches used in 12-Step-based programs, therapeutic communities, and family therapy respectively. Chapter 7 discusses adolescents with distinctive treatment needs, such as those involved with the juvenile justice system. An explanation of legal issues concerning Federal and State confidentiality laws appears in Chapter 8.Appendix B is a table on the medical management of substance intoxication and withdrawal, which will appear in a forthcoming publication. Other TIPs may be ordered by contacting the National Clearinghouse for Alcohol and Drug Information (NCADI), (800) 729-6686 or (301) 468-2600; TDD (for hearing impaired), (800) 487-4889.
1997-98 Revision Consensus Panel Chair
The Treatment Improvement Protocol (TIP) series fulfills SAMHSA/CSAT's mission to improve treatment of substance use disorders by providing best practices guidance to clinicians, program administrators, and payors. TIPs are the result of careful consideration of all relevant clinical and health services research findings, demonstration experience, and implementation requirements. A panel of non-Federal clinical researchers, clinicians, program administrators, and patient advocates debates and discusses their particular area of expertise until they reach a consensus on best practices. This panel's work is then reviewed and critiqued by field reviewers. The talent, dedication, and hard work that TIPs panelists and reviewers bring to this highly participatory process have bridged the gap between the promise of research and the needs of practicing clinicians and administrators. We are grateful to all who have joined with us to contribute to advances in the substance use disorder treatment field.
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Tailoring Treatment to the Adolescent's Problem