Youth Addictive Disorders: A Call for a Developmentally Informed Approach

Addictive disorders including substance use disorders (SUDs) and behavioral addictions are the most prevalent psychiatric disorders. Yet, among our country’s young people—including adolescents aged 12 to 18 years and young adults aged 18 to 25 years—only about 10% of those who need treatment for addictive disorders receive it, and resources for assessment, prevention, and treatment are inadequate. Why?

Inadequate screening and treatment for SUD stems from our medical school education system as well as subspecialty training, which have not properly addressed addictive disorders. Unfortunately, many health care professionals don’t realize that youth with addictive disorders require a developmentally informed perspective (DIP) to treatment.

What is DIP? The common denominator of the youth subpopulation is its neurocognitive and socioecological developmental stage. Youth are not “miniature adults.” In fact, their brains are under construction until their mid-20s, when the prefrontal cortex finally matures. DIP emphasizes the importance of understanding both the onset of substance use and the pathways (trajectories) to substance use disorders and behavioral addictive disorders (such as gambling and internet addiction). Drug use and nonsubstance addictive behaviors in youth have been characterized by elevated sensation seeking and impulsive behavior that is devoid of effective use of executive functions and inhibitions. This has been attributed to developmental dysregulation, particularly in the prefrontal cortex. These findings underscore the importance that clinicians know the risk factors that predict progression from substance use to SUD as well as the challenges of developing age-appropriate prevention and treatment strategies to postpone, reduce, and/or eliminate substance use and prevent SUD.

Developmentally, not all adolescents who use substances escalate to levels of abuse or dependence as defined in DSM-IV or to an SUD, as defined in DSM-5. For those adolescents who show escalating use, several full cycles spanning many years may be the norm rather than the exception. Nonetheless, emerging research on developmental psychopathology and adolescent development has implications for how we view current prevention, intervention, and treatment paradigms. The field can benefit from a greater understanding of how varying levels of substance use severity are viewed within etiological paradigms and optimally treated with varying levels and intensities of prevention, intervention, treatment, and after/continued-care strategies.

The rapid expansion of knowledge in the youth addictive disorders field is of great importance for clinicians because of new drug delivery systems (for example, e-cigarettes), concentration and variability of products (for example, cannabis), and the confusion and ignorance regarding the harmfulness of cannabis use. The following domains should be included in curricula on the treatment of youth with addictive disorders:

The newly published book Clinical Manual of Youth Addictive Disorders edited by myself and Ken Winters, Ph.D., provides expert reviews of the most updated clinical and research information of these crucial domains. ■