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Research Agenda for Substance Use Disorders 

Research Agenda for Substance Use Disorders
Chapter:
Research Agenda for Substance Use Disorders
DOI:
10.1093/9780195173642.003.0021
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date: 16 August 2018

For a variety of reasons, little research has been conducted among adolescents with substance abuse problems. We operate as though data obtained from studies in adults applies to adolescents, but we know that there are critical differences. Thus assumptions about adolescents must be empirically tested. The following are a series of questions compiled by the Commission on Abuse of Alcohol and Other Drugs that we believe should be given high priority.

    What We Know

  • Substance abuse will often progress to addiction and become a lifelong illness, if not treated.

  • Long-term treatment is usually required to arrest addiction.

  • Motivation is an important ingredient for successful treatment.

    • Changes in lifestyle are required.

    • Drug use is a pleasure-reinforced compulsion.

    • Drug craving may lead to relapse.

  • Adolescents are different from adults.

    • There are differences in brain development and plasticity.

    • Specialized treatment approaches are necessary, including:

      • Age-appropriate interventions

      • More focus on family treatment

      • Longitudinal continuation of treatment.

  • Heredity affects the vulnerability to addiction.

  • Availability of drugs is a key variable in developing drug abuse.

    What We Do Not Know

  • Which psychosocial treatments are most effective? All of the following show some promise:

    • Individual therapy (cognitive-behavioral therapy, maturation enhancement therapy)

    • Family therapy

    • Group therapy

    • Twelve-Step rehabilitation

  • Is group therapy an effective modality for adolescents?

    • If so, how should it be structured?

    • Should adolescents always be segregated from adults in group treatment?

  • What is the neurobiology of adolescent addiction?

    • Initiation of addictive patterns

    • Progression of addiction

    • Vulnerability to specific agents

  • Is it necessary to require complete abstinence in adolescents attempting recovery?

    • Does this mean ceasing use of all addicting drugs?

    • Does nicotine use impede recovery?

  • How can we enhance perceived risk for experimenting with drugs?

  • How can we best match patients with treatments?

    • Matching problems to treatments has been found effective in small studies, but rarely used in practice.

  • How can the judicial system positively influence outcome?

    What We Urgently Need to Know—The Priorities

  • Prevention programs: which ones are most effective or ineffective?

    • Mass media campaigns?

    • Drug Abuse Resistance Education (DARE)?

    • Urine testing?

    • Other approaches?

  • Which specialized treatments for adolescent addiction provide the best outcomes?

  • Which specialized programs can prevent binge drinking in college?

  • Which pharmacological treatments work best for adolescents with substance use disorders?

    • Pharmaceutical companies have shown little interest in developing medications for adult addictions and none for substance abuse in adolescence. How can we recruit the pharmaceutical industry into the area of prevention and treatment?

  • What are the best means of identifying adolescents at risk for addiction?

  • How can we recruit scientists into the area of addiction research?

    How Can We Improve the Treatment System?

  • How can we obtain adequate reimbursement for treatment providers?

    • Adolescent treatment programs are scarce and underfunded.

  • How can we provide an accessible continuum of care with age-appropriate expertise?

    • Medical and psychiatric evaluation capability

    • Inpatient facilities

    • Partial hospitalization and intensive outpatient programs

    • Outpatient treatment with long-term capability

  • How can we integrate substance abuse treatment with other mental health treatment?

    • Comorbidity of substance abuse with other mental disorders is very common.

    • Few treatment programs are equipped to treat dual diagnosis.

  • How can we disseminate scientific evidence supporting the disease concept of addic-ion?

  • How can political initiatives secure appropriate resource allocation?