Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide
Behavioral Approaches

Behavioral interventions help adolescents to actively participate in their recovery from drug abuse and addiction and enhance their ability to resist drug use. In such approaches, therapists may provide incentives to remain abstinent, modify attitudes and behaviors related to drug abuse, assist families in improving their communication and overall interactions, and increase life skills to handle stressful circumstances and deal with environmental cues that may trigger intense craving for drugs. Below are some behavioral treatments shown to be effective in addressing substance abuse in adolescents (listed in alphabetical order).

Group Therapy for Adolescents

Adolescents can participate in group therapy and other peer support programs during and following treatment to help them achieve abstinence. When led by well-trained clinicians following well-validated Cognitive-Behavioral Therapy (CBT) protocols, groups can provide positive social reinforcement through peer discussion and help enforce incentives to staying off drugs and living a drug-free lifestyle.

However, group treatment for adolescents carries a risk of unintended adverse effects: Group members may steer conversation toward talk that glorifies or extols drug use, thereby undermining recovery goals. Trained counselors need to be aware of that possibility and direct group activities and discussions in a positive direction.

Adolescent Community Reinforcement Approach (A-CRA)

A-CRA is an intervention that seeks to help adolescents achieve and maintain abstinence from drugs by replacing influences in their lives that had reinforced substance use with healthier family, social, and educational or vocational reinforcers. After assessing the adolescent’s needs and levels of functioning, the therapist chooses from among 17 A-CRA procedures to address problem-solving, coping, and communication skills and to encourage active participation in constructive social and recreational activities.54

Cognitive-Behavioral Therapy (CBT)

CBT strategies are based on the theory that learning processes play a critical role in the development of problem behaviors like drug abuse. A core element of CBT is teaching participants how to anticipate problems and helping them develop effective coping strategies. In CBT, adolescents explore the positive and negative consequences of using drugs. They learn to monitor their feelings and thoughts and recognize distorted thinking patterns and cues that trigger their substance abuse; identify and anticipate high-risk situations; and apply an array of self-control skills, including emotional regulation and anger management, practical problem solving, and substance refusal. CBT may be offered in outpatient settings in either individual or group sessions (see "Group Therapy for Adolescents") or in residential settings.55

Contingency Management (CM)

Research has demonstrated the effectiveness of treatment using immediate and tangible reinforcements for positive behaviors to modify problem behaviors like substance abuse. This approach, known as Contingency Management (CM), provides adolescents an opportunity to earn low-cost incentives such as prizes or cash vouchers (for food items, movie passes, and other personal goods) in exchange for participating in drug treatment, achieving important goals of treatment, and not using drugs. The goal of CM is to weaken the influence of reinforcement derived from using drugs and to substitute it with reinforcement derived from healthier activities and drug abstinence. For adolescents, CM has been offered in a variety of settings, and parents can be trained to apply this method at home. CM is typically combined either with a psychosocial treatment or a medication (where available). Recent evidence also supports the use of Web-based CM to help adolescents stop smoking.56

Motivational Enhancement Therapy (MET)

MET is a counseling approach that helps adolescents resolve their ambivalence about engaging in treatment and quitting their drug use. This approach, which is based on a technique called motivational interviewing, typically includes an initial assessment of the adolescent’s motivation to participate in treatment, followed by one to three individual sessions in which a therapist helps the patient develop a desire to participate in treatment by providing non-confrontational feedback. Being empathic yet directive, the therapist discusses the need for treatment and tries to elicit self-motivational statements from the adolescent to strengthen his or her motivation and build a plan for change. If the adolescent resists, the therapist responds neutrally rather than by contradicting or correcting the patient. MET, while better than no treatment, is typically not used as a stand-alone treatment for adolescents with substance use disorders but is used to motivate them to participate in other types of treatment.57

Twelve-Step Facilitation Therapy

Twelve-Step Facilitation Therapy is designed to increase the likelihood that an adolescent with a drug abuse problem will become affiliated and actively involved in a 12-step program like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Such programs stress the participant’s acceptance that life has become unmanageable, that abstinence from drug use is needed, and that willpower alone cannot overcome the problem. The benefits of 12-step participation for adults in extending the benefits of addiction treatment appear to apply to adolescent outpatients as well, according to recent research. Research also suggests adolescent-specific 12-step facilitation strategies may help enhance outpatient attendance rates.58

Behavioral interventions help adolescents to actively participate in their recovery from drug abuse and addiction and enhance their ability to resist drug use.