Main Points

• Adolescents, 12 to 20 years of age, with problematic alcohol and/or cannabis use or use disorder:
  • 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.
• Adolescents, 12 to 25 years of age, with substance use disorders:
  • 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 opioid 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.
• College students with problematic alcohol use:
  • Behavioral interventions:
    • 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.

Structured Abstract

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 November 1, 2019.

Review methods. Studies were extracted into the Systematic Review Data Repository. We categorized interventions into seven primary intervention components: motivational interviewing (MI), family focused therapy (Fam), cognitive behavioral therapy (CBT), psychoeducation, contingency management (CM), peer group therapy, and intensive case management. We conducted meta-analyses of comparative studies and evaluated the strength of evidence (SoE). The PROSPERO protocol registration number is CRD42018115388.

Results. The literature search yielded 33,272 citations, of which 118 studies were included. Motivational interviewing reduced heavy alcohol use days by 0.7 days/month, alcohol use days by 1.2 days/month, and overall substance use problems by a standardized mean difference of 0.5, compared with treatment as usual. Brief MI did not reduce cannabis use days (net mean difference of 0). Across multiple intensive interventions, Fam was most effective, reducing alcohol use days by 3.5 days/month compared with treatment as usual. No intensive interventions reduced cannabis use days. Pharmacologic treatment of opioid use disorder led to a more than 4 times greater likelihood of abstinence with extended courses (2 to 3 months) of buprenorphine compared to short courses (14 to 28 days).

Conclusions. Brief interventions: MI reduces heavy alcohol use (low SoE), alcohol use days (moderate SoE), and substance use–related problems (low SoE) but does not reduce cannabis use days (moderate SoE). Nonbrief interventions: 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 (low SoE). 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). Subgroup analyses of interest (male vs. female, racial and ethnic minorities, socioeconomic status, and family characteristics) were sparse, precluding conclusions regarding differential effects. Pharmacological interventions: 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.

Journal Citations

• Steele DW, Becker SJ, Danko KJ, et al. Brief behavioral interventions for substance use in adolescents: a meta-analysis. Pediatrics. 2020;146(4):e20200351. DOI: 1542/peds.2020-0351.
•  Adelman WP. The need to focus research on adolescent cannabis use interventions. Pediatrics. 2020;146(4):e2020012336. DOI: 10.1542/peds.2020-012336.

Citation

Suggested citation: Steele DW, Becker SJ, Danko KJ, Balk EM, Saldanha IJ, Adam GP, Bagley SM, Friedman C, Spirito A, Scott K, Ntzani EE, Saeed I, Smith B, Popp J, Trikalinos TA. Interventions for Substance Use Disorders in Adolescents: A Systematic Review. Comparative Effectiveness Review No. 225. (Prepared by the Brown Evidence-based Practice Center under Contract No. 290-2015-00002-I.) AHRQ Publication No. 20-EHC014. Rockville, MD: Agency for Healthcare Research and Quality. May 2020. Posted final reports are located on the Effective Health Care Program search page. DOI: 10.23970/AHRQEPCCER225.