This report is available in PDF only (Draft Report [2 MB]; Draft Evidence Summary [177.9 KB]; Draft Appendixes [2.2 MB]). People using assistive technology may not be able to fully access information in these files. For additional assistance, please contact us.
Purpose of Review
The review aims to inform health care providers, policymakers, and a clinical practice guideline update from the American Academy of Child and Adolescent Psychiatry (AACAP) about the currently available evidence on interventions for adolescents to reduce or cease substance use. The review addresses both behavioral and pharmacological interventions used for adolescents or young adults with problematic substance use or a diagnosis of a substance use disorder (SUD), excluding tobacco.
- Brief behavioral interventions (that involve 1 or 2 encounters only)
- Motivational interviewing decreases days of heavy alcohol use and overall alcohol use.
- Motivational interviewing has not been found to decrease cannabis use. Further research is needed to identify if any other brief interventions may decrease cannabis use.
- Motivational interviewing decreases problems associated with substance use.
- Intensive behavioral interventions (that involve more than 2 encounters)
- Family-focused therapies reduce alcohol use.
- None of the interventions have been found to decrease cannabis use.
- Motivational interviewing decreases combined alcohol and other drug use.
- Combined cognitive behavioral therapy and motivational interviewing decrease illicit drug use.
- Treatments for problematic alcohol use in the college setting
- Behavioral interventions, in general, reduce alcohol use for up to 6 months.
- Mandated alcohol programs decrease alcohol use in the medium-term, regardless of intervention. Four commercially available interventions are more effective in the short term than no intervention.
- Brief behavioral interventions, particularly those based on motivational interviewing, reduce alcohol use compared to no intervention in college students with heavy or hazardous alcohol use.
- Pharmacological interventions
- In opioid use disorder, longer courses (2 – 3 months) of buprenorphine/buprenorphine-naloxone are more effective than shorter courses (14 – 28 days) to reduce days of use and achieve abstinence.
- More research is needed to understand the role of medications in treatment of alcohol and cannabis use disorders and of pharmacological treatments typically used for comorbid psychiatric illnesses.
Objectives. This systematic review (SR) synthesizes the literature on behavioral, pharmacologic, and combined interventions for adolescents ages 12 to 20 years with problematic substance use or substance use disorder. We included interventions designed to achieve abstinence, reduce use quantity and frequency, improve functional outcomes, and reduce substance-related harms.
Data sources. We conducted literature searches in MEDLINE, the Cochrane CENTRAL Trials Registry, Embase, CINAHL, and PsycINFO to identify primary studies meeting eligibility criteria through April 11, 2019.
Review methods. Each study was extracted by one methodologist and confirmed by at least one other methodologist. Data were extracted into customized forms in the Systematic Review Data Repository (SRDR) online system. We categorized interventions into one or more of seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation (Educ), contingency management (CM), peer group therapy (PeerGroup), and intensive case management (ICM). We conducted random effects meta-analyses of comparative studies where feasible and appropriate. We evaluated the strength of evidence (SoE) for each finding. The PROSPERO protocol registration number is CRD42018115388.
Results and conclusion. The literature search yielded 29,688 citations, from which 117 studies, in 222 citations, were included. Overall, the evidence suggests that brief MI reduces heavy alcohol use (low SoE), alcohol use days (moderate SoE) and substance use related problems (low SoE). In the college setting, prior SRs support at least short term benefits from behavioral interventions. Brief MI does not reduce cannabis use days (moderate SoE). Amongst non-brief interventions, limited evidence suggests that Fam may be most effective in reducing alcohol use (low SoE). More research is needed to identify other effective intensive behavioral interventions for alcohol use disorder. Intensive interventions did not appear to decrease cannabis use. Some interventions (CBT, CBT+MI, and CBT+MI+CM) were associated with increased cannabis use (low SoE). Both MI and CBT reduce combined alcohol and other drug use (low SoE). Combined CBT+MI reduces illicit drug use (low SoE). Longer courses of buprenorphine (2 – 3 months) are more effective than shorter courses (14 – 28 days) to reduce opioid use and achieve abstinence (low SoE). SRs in the college settings support use of brief interventions for students with any use, heavy or problematic use. More research is needed to identify the most effective combinations of behavioral and pharmacologic treatments for opioid, alcohol, and cannabis use disorders.