Clinical Manual of Adolescent Substance Abuse Treatment

This comprehensive volume, edited by Yifrah Kaminer and Ken Winters, addresses issues related to the treatment of adolescent substance use. As noted by many researchers and clinicians, substance abuse during adolescence has adverse effects on many aspects of psychosocial development, including relationships with others, psychosexual development, growth of independence and maturity, separation from parents, and development of academic and vocational skills (1). Adolescent substance abuse is recognized as a risk factor for substance abuse and addiction later in life, and substance abuse and addiction are related to comorbid psychiatric and medical illnesses (2). Substance abuse during adolescence is connected to risk-taking behavior, which may be related to conduct disorder, self-destructive behaviors, aggression, and sexually transmitted diseases. This book usefully presents major approaches to evaluation and treatment and encompasses research and interventions of use to clinicians in the treatment of these young patients.

The book is organized into 16 chapters, starting with an overview of epidemiological issues, including the trajectories of substance use during adolescence. The next chapter focuses on the role of risk and protective factors in the prevention of substance use and substance use disorders. Two chapters focus on assessment issues, including screening and brief interventions and biomarker testing for substance use in adolescence. Therapeutic processes of change in adolescence are addressed, and there are useful chapters on pharmacotherapy as well as club and prescription drug use and over-the-counter medication abuse. Several chapters focus on specific interventions, including brief motivational interventions, cognitive-behavioral therapy, and contingency management; approaches to relapse are illustrated using examples from the Adolescent Community Reinforcement Approach and multidimensional family therapy. Twelve-step programs for adolescents are discussed. Several chapters focus on specific disorders seen in adolescent substance abuse, including attention deficit-disruptive disorders, internalizing disorders, suicidal behavior, and comorbid psychotic disorders. A final chapter addresses adolescent substance use disorders in the juvenile justice system.

A particularly interesting and important chapter is written by Marc Fishman, entitled Placement Criteria and Treatment Planning for Adolescents with Substance Use Disorders. This chapter briefly summarizes how the American Society of Addiction Medicine patient placement criteria might be applied in the field of adolescent addiction treatment. As Dr. Fishman notes, the goal of such guidelines is to find the best fit between the needs of the patient and the treatment that is available. Data are organized into six categories of assessment dimensions with treatment implications, and a consensus picture is given of the levels of care available for treatment of the adolescent. The American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders, 2nd Edition is “a prescription for the adolescent continuum of care” (p. 114). The general principals of treatment planning and placement are discussed, and the six assessment dimensions are outlined as well as the levels of care, from 0.5 (early intervention) through level IV (hospital treatment). Each dimension is briefly discussed, with a focus on the particular symptoms and treatment issues relevant to that dimension. For example, the section on dimension 1 discusses intoxication and withdrawal potential and also briefly mentions subacute psychiatric intoxication and withdrawal symptoms. There is a brief discussion pertaining to treatment matching and placement, and a case vignette is presented to illustrate the utilization of patient placement criteria and treatment planning. There is a useful table that outlines treatment services and placement relevant to each assessment dimension. This useful summary alerts the clinician to a standardized approach and practical organization for treatment planning. It emphasizes the need to improve treatment by broadening the continuum of care and utilizing that continuum more fully to include coordination between episodes of treatment at different levels of care.

A number of chapters have useful tables and figures as well as case illustrations and clinical examples. However, the book would benefit from the inclusion of more illustrative case vignettes and tables. The chapters are written in a very readable style by experts in their fields. In a brief format, the book presents a summary of material that should be helpful to all clinicians as well as to those focused on the treatment of adolescents. Particularly useful examples of methods of dealing with relapse in the course of treatment are given in Chapter 10, which offers two methods of dealing with relapse, the first based on the Adolescent Community Reinforcement Approach and the second based on multidimensional family therapy. Both examples give details of sessions, and both offer specific suggestions to address issues around relapse. Although the Adolescent Community Reinforcement Approach is primarily cognitive-behavioral while multidimensional family therapy is family-based and uses an integrated treatment approach, both have certain similarities, including a view of relapse as an opportunity for growth and learning, the collaboration of the therapist with the adolescent, and the utilization of family and other social systems. Another useful case vignette is given in the chapter entitled Assessment and Treatment of Internalizing Disorders. Although brief, this case vignette of a teenager who uses marijuana on a daily basis also includes a useful case discussion, which examines treatment goals, the treatment setting, treatment strategies, and the need to address comorbid depression, offering a useful view of an integrative treatment approach.

Clinical Manual of Adolescent Substance Abuse Treatment reflects current views on the treatment of adolescent substance abuse. It includes many of the treatment interventions now in widespread use. (However, it lacks a separate section on adolescent group psychotherapy, which is in widespread use throughout the country.) The four appendices also contain useful information. The comprehensive nature and clear presentation of the clinical issues discussed in this book make it a useful source of information and interesting to read. I recommend this book highly for clinicians with an interest in the treatment of adolescent substance use.