Journal of Coloproctology

Winters K.C., Botzet A.M., Stinchfield R., Gonzales-Castaneda R., Finch A.J., Piehler T.F., Ausherbauer K., Chalmers K., Hemze A.

Significant progress has been made since 1990 in the development and evaluation of treatments for adolescent drug abuse. This body of research reflects a greater focus on varying interventions using different theory-based psychotherapies, as well as a recognition of the unique developmental milestones specific to adolescents. Several modalities and approaches meet standards of evidence-based treatments, and that, in general, they are comparable in terms of outcomes.

Lichvar E.K., Stilwell S., Ajmera T., Alexander A.L., Plant R.W., Panzarella P., Blau G.M.

The rate of alcohol and drug abuse among adolescents and the number of youth at risk for the development of substance use disorders later in life remain a serious, national health concern. Deeper end services, such as residential treatment, may be indicated for youth with severe substance use disorder. Residential substance abuse treatment for adolescents has continued to lack adequate research regarding its practices and outcomes. However, separately, there are best practices, principles and strategies in both residential treatment and in adolescent substance abuse treatment. In this chapter both are summarized to outline the best possible care for adolescents with substance use disorder. Also explored are the prevalence rates of commonly used substances among adolescents (e.g., alcohol, marijuana), population parameters, theoretical background of principle interventions, interventions that work, interventions that might work, interventions that do not work, policy changes pertaining to health care, and treatment recommendations.

Baumer P.C., Dennis M.L., Estrada B.

This chapter examines the characteristics and needs of substance misusing adolescents (ages 12–17) and young adults (ages 18–25), as well as implications for improving practice. The chapter begins with a review of the literature on prevalence, course, and correlates of substance misuse. It then uses a large treatment data set to provide a detailed description of the different demographics, substance use, and comorbidity characteristics of youth (ages 12–25) presenting to substance use treatment and explores how they vary by three demographic groups, type of substance problem, systems from which they could be recruited, and levels of substance use treatment. The chapter then focuses on using more detailed data on 16,361 youth from 208 Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT) grantee treatment programs in the United States who were interviewed with a standardized biopsychosocial assessment called the Global Appraisal of Individual Needs (GAIN). The chapter concludes with implications for assessing risk and assigning treatment.

Biermann S.L., Leukefeld C.G.

Self-help, also called mutual help, is an intervention for everyone who misuses substances. In this chapter, adolescent self-help/mutual help is defined as a safe no cost group process, including 12 steps, spiritual or other grounding, in which peer youth involved in substance misuse along with sponsors and/or mentors mutually support recovering youth to deal with cravings, life stressors, and to promote change. After presenting selected data on substance use, the US treatment utilization data are presented to highlight the limited adolescent self-help information, which is supported by the literature reviewed. Based on the literature review it is suggested that self-help/mutual help can be a promising approach for adolescents. Further research and controlled trials are recommended to add to understanding adolescent and youth self-help.

Imm P.S., Chinman M., Kulesza M., Hunter S., Acosta J.

This chapter is a literature review highlighting effective community-based prevention initiatives for reducing and preventing adolescent substance use and misuse. Findings are presented from the research literature on multicomponent prevention initiatives and environmental strategies/policies implemented by communities that have a consistent evidence base of positive results. For these sections, the authors integrate findings from two recent publications, (1) Planning Alcohol Interventions Using NIAAA’s College AIM Alcohol Interventions Matrix (National Institute on Alcohol Abuse and Alcoholism (NIAAA). Planning alcohol interventions using NIAAA’s College AIM Alcohol Interventions Matrix (NIH Publication No. 15-AA-8017). Bethesda, MD: National Institutes of Health, 2015), and (2) Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health (U.S. Department of Health and Human Services, Office of the Surgeon General. Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: U.S. Department of Health and Human Services, 2016). This update also includes a brief review of research literature on positive youth development (PYD), a holistic approach that focuses on developmental characteristics that can lead to positive outcomes including a reduction in negative behaviors among youth such as substance use. The chapter concludes by providing several recommendations to promote high-quality implementation to increase the likelihood of positive results. As funding for comprehensive evaluation efforts of community-based efforts becomes scarce, a communities’ capacity to ensure high-quality implementation should be prioritized.

Marks K.R., Leukefeld C.G.

This chapter provides an overview of selected factors related to adolescents recovering from substance use, a framework for thinking about recovering, a critical overview of definitions of adolescent recovery, and factors that can support recovering. Recovering is an active and ongoing engagement in change over time rather than an endpoint and relapse is a part of the recovering process. However, specific recovering definitions and outcomes (e.g., abstinence, personal growth, wellness) for adolescents have not been established. This reflects that lack of research on adolescents more broadly, as well as the broader focus on treatment outcomes rather than long-term recovering outcomes. Recovering supports include recovery community centers, sober living environments, education, transportation, and life-skills development. Recovering support groups and self-help groups are promising practices, but additional data is needed to rise to the level of evidence based. Gender contributes to the risks and resiliencies that impact recovering outcomes, although the effects are complex and variable. As such, recovering supports which are not gender-responsive do not work. For recovering adolescent females, strength-based, trauma-informed recovery support is often indicated. More adolescent-centered research is essential to better understand the unmet needs of recovering adolescent and identify evidence-based recovering supports. Such research needs to be grounded in the experiences of adolescents and validated with instrumentation designed for adolescents.

Gullotta T.P., Leukefeld C.G.

This second edition of Adolescent Substance Abuse updates the progress made in treatment and prevention interventions for the misuse of substances since the first edition. It adds specific new treatment and prevention chapters in addition to examining the social, behavioral, and biological factors contributing to misuse. The applauded standardized chapter format used in the first edition that identifies evidenced-based approaches that work, might work, and do not work is maintained when appropriate. This second edition of Adolescent Substance Abuse is a thoughtful thorough distillation of the research on substance abuse treatment and prevention that offers clear guidance to students, practitioners, researchers, and policy-makers in the treatment and prevention of substance abuse.

Strickland J.C., Stoops W.W.

Stimulant (e.g., cocaine, amphetamine, and methamphetamine) misuse poses a significant public health concern for adolescents given the potential impact on developmental trajectories during a period of dramatic physiological and psychological growth. High-risk behaviors already prominent in adolescents, such as violence, aggression, and unprotected sexual encounters, are also likely to increase following illicit stimulant use. This chapter provides an overview of the current primary prevention and treatment approaches targeting adolescent stimulant misuse. The history and characteristics of stimulant use and misuse, the pharmacology and clinical effects of stimulants, and expected clinical outcomes for stimulant-using adolescents are also provided. A review of the extant literature indicates that stimulant use has received little attention in the primary prevention and treatment literature when compared to adolescent alcohol, tobacco, and cannabis use. Those studies that do exist suggest that many of those prevention and treatment efforts developed for other substance use may help deter the initiation and reduce the misuse of stimulants in adolescents. Clinically useful prevention and treatment for adolescent stimulant use will likely require multiple approaches tailored to the patient and address factors at the level of the individual, peer, family, and community. More work is needed, however, to develop and test novel evidence-based methods for preventing and treating adolescent stimulant use disorder.

Bloom M., Gullotta T.P.

After setting a historical context and defining primary prevention, the technologies for primary prevention are discussed within the framework of evidence-based practice. Prevention’s technology tools embrace education, competency promotion, self-help, community organization, and systems change to reduce adolescent substance misuse. Theoretical grounded applications of these technologies are presented.

Sloboda Z.

The school has long been an appropriate setting for prevention strategies over the past 40 years as it is where children spend their most time after the home. For this reason, much of the research on evidence-based prevention interventions and strategies has focused on the school. This chapter reviews this history and discusses findings from this research as they pertain to three aspects of the school environment: (1) school climate or culture, which includes norms, beliefs and expectancies, and school bonding, by which the student is connected to the school experience and community; (2) school policy or social control; and (3) classroom curriculum, which comprises lessons that emphasize a cognitive approach to prevention. Reference is made to the International Standards on Drug Use Prevention, a guide published by the United Nations Office on Drugs and Crime that summarizes findings from rigorous international research.

Gullotta T.P.

The social history of alcohol, tobacco, marijuana, prescription and opiate drugs is overviewed. This history presents the context of current difficulties in solving the abuse of substances. The sequence of substance use, misuse and abuse is examined as stepping-stones as a continuum of use. A multifaceted prevention approach is proposed which incorporates harm risk reduction.

Kelly T.H., Harvanko A., Pierce M.E., Rayapati A.O., Martin C.A.

Exposure to psychoactive drugs presents a significant health risk during human development, particularly during critical periods of organ and system development. Exposure to psychoactive drugs of abuse can occur postnatally through passive exposure from environmental sources (e.g., tobacco smoke). Developmental exposure to drugs of abuse among children and adolescents has escalated as drugs have become increasingly accessible. This chapter will examine the health risks associated with developmental exposure to psychoactive drugs of abuse. The epidemiology of caffeine, nicotine, alcohol, marijuana, opiates and therapeutic stimulants exposure will be summarized, and research examining the neurodevelopmental and other health consequences of developmental drug exposure will be reviewed. While it remains difficult to isolate direct causal influences and disentangle the direct effects of drug exposure from indirect effects associated with environmental, social, and cultural influences that are often closely associated with drug exposure, compelling evidence suggests that developmental exposure to drugs of abuse can have both subtle and dramatic effects with important behavioral and societal consequences.

Calix S.I., Garrett K.C., Fine M.A.

Adolescence is a crucial period of individual development. Some degree of risk-taking and externalizing problem behaviors are common during this stage as youth explore and assert their independence. Learning from the negative consequences of these behaviors is important in their cessation by the time youth reach the latter stages of adolescence and adulthood. Problematic behaviors may however be perpetuated by youth who develop within the contexts of unhealthy family systems, peer systems, and who start using substances at an early age. The extant literature posits that the most effective treatment approaches are those that include the adolescent, the family system, and other systems with which the youth interacts and is involved. In this book chapter, the authors elucidate the contemporary empirically-supported treatments for adolescent substance abuse. Each of the empirically-supported treatment models, including important components and stages of each treatment, is summarized and discussed. Other promising treatment models also are highlighted.

Lofwall M.R., Yule A.M.

The United States is in the midst of ongoing opioid epidemic that is in large part, iatrogenic, meaning that it is associated with overprescribing of opioid analgesics by health care providers (Nelson et al., JAMA 314:1453–1454, 2015). Simultaneously, there is increasing prescribing of benzodiazepines and together, the increasing availability of these medications in American homes is adversely affecting all age groups, including adolescents (i.e., ages 12–21 years old) (Bachhuber et al., American Journal of Public Health 106:686–688, 2016). This chapter will review terminology including the pharmacological effects on persons using these substances, how effects change over time and characteristic withdrawal syndromes, epidemiology of adolescent opioid and benzodiazepine misuse, use disorder, treatment admissions, and associated morbidity such as overdose. Relevant risk factors will be reviewed followed by discussion of effective preventative, harm reduction and treatment approaches. Along the way, we will discuss common myths and misconceptions about prescription opioids and benzodiazepines, and heroin.

Crowley M., Green L.C.

Social capital, which includes the meaningful connections individuals have in their families, schools, and communities, has implications for education, labor, health, and criminal outcomes, in addition to potential economic and fiscal benefits for society. The Serve Here CT implementation is presented as a possible model for interventions aimed at increasing social capital.