Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide
Addiction Medications

Several medications have been found to be effective in treating addiction to opioids, alcohol, or nicotine in adults, although none of these medications have been approved by the FDA to treat adolescents. In most cases, only preliminary evidence exists for the effectiveness and safety of these medications in people under 18, and there is no evidence on the neurobiological impact of these medications on the developing brain. However, despite the relative lack of evidence, some health care providers do use medications “off-label” when treating adolescents (especially older adolescents) who are addicted to opioids, nicotine, or (less commonly) alcohol. Newer compounds continue to be studied for possibly treating substance use disorders in adults and adolescents, but none other than those listed here have shown conclusive results.

Note that there are currently no FDA-approved medications to treat addiction to cannabis, cocaine, or methamphetamine in any age group.

Opioid Use Disorders

Buprenorphine reduces or eliminates opioid withdrawal symptoms, including drug cravings, without producing the “high” or dangerous side effects of heroin and other opioids. It does this by both activating and blocking opioid receptors in the brain (i.e., it is what is known as a partial opioid agonist). It is available for sublingual (under-the-tongue) administration both in a stand-alone formulation (called Subutex®) and in combination with another agent called naloxone. The naloxone in the combined formulation (marketed as Suboxone®) is included to deter diversion or abuse of the medication by causing a withdrawal reaction if it is intravenously injected.65 Physicians with special certification may provide office-based buprenorphine treatment for detoxification and/or maintenance therapy.66 It is sometimes prescribed to older adolescents on the basis of two research studies indicating its efficacy for this population,67,68 even though it is not approved by the FDA for pediatric use.*

Adolescent drug abuse treatment is most commonly offered in outpatient settings.

Methadone also prevents withdrawal symptoms and reduces craving in opioid-addicted individuals by activating opioid receptors in the brain (i.e., a full opioid agonist). It has a long history of use in treatment of opioid dependence in adults, and is available in specially licensed methadone treatment programs. In select cases and in some States, opioid-dependent adolescents between the ages of 16 and 18 may be eligible for methadone treatment, provided they have two documented failed treatments of opioid detoxification or drug-free treatment and have a written consent for methadone signed by a parent or legal guardian.69

Naltrexone is approved for the prevention of relapse in adult patients following complete detoxification from opioids. It acts by blocking the brain’s opioid receptors (i.e., an opioid antagonist), preventing opioid drugs from acting on them and thus blocking the high the user would normally feel and/or causing withdrawal if recent opioid use has occurred. It can be taken orally in tablets or as a once-monthly injection given in a doctor’s office (a preparation called Vivitrol®).70

Alcohol Use Disorders

Acamprosate (Campral®) reduces withdrawal symptoms by normalizing brain systems disrupted by chronic alcohol consumption in adults.

Disulfiram (Antabuse®) inhibits an enzyme involved in the metabolism of alcohol, causing an unpleasant reaction if alcohol is consumed after taking the medication.71

Naltrexone decreases alcohol-induced euphoria and is available in both oral tablets and long-acting injectable preparations (as in its use for the treatment of opioid addiction, above).

Nicotine Use Disorders

Bupropion, commonly prescribed for depression, also reduces nicotine cravings and withdrawal symptoms in adult smokers.72

Nicotine Replacement Therapies (NRTs) help smokers wean off cigarettes by activating nicotine receptors in the brain. They are available in the form of a patch, gum, lozenge, nasal spray, or inhaler.73

Varenicline reduces nicotine cravings and withdrawal in adult smokers by mildly stimulating nicotine receptors in the brain.74

* According to the FDA label, “SUBOXONE and SUBUTEX are not recommended for use in pediatric patients. The safety and effectiveness of SUBOXONE and SUBUTEX in patients below the age of 16 have not been established.”

Medication-assisted therapies are rarely used to treat adolescent alcohol use disorders.