Aaron Hogue

Significant developmental changes in adolescence typically lead to increased risky behavior, including substance use. Survey data indicated that adolescent alcohol and drug use has declined in recent years, with the exception of marijuana use, which has remained consistent, and e-cigarette use, which is on the rise. This chapter provides a summary of prevalence rates, trends, and maladaptive consequences of adolescent substance use. Etiological models of adolescent substance use are discussed, including dual-process and biopsychosocial models. Current literature on evidence-based screening, comprehensive assessment, and treatment is also reviewed. Despite the recent advances made regarding our ability to screen, assess, diagnose, and treat adolescent substance use, a significant treatment gap persists, which has significant individual and public health impacts. This chapter therefore concludes with a call for research that aims to increase patient awareness of effective treatment via strategies such as technology-delivered assessment and intervention and usage of direct-to-consumer marketing.

This article introduces neurodevelopmental and clinical considerations for treating adolescents with co-occurring attention deficit hyperactivity disorder (ADHD) and adolescent substance use (ASU) in outpatient settings. We first describe neurobiological impairments common to ADHD and ASU, including comorbidity with conduct disorder, that evoke a profile of multiplicative developmental risk. We then present two evidence-based options for targeting ADHD-related problems during ASU treatment. Medication integration interventions utilize family ADHD psychoeducation to prompt decision making about ADHD medication and integrate medication management into behavioral services. Clinic-based academic training interventions utilize family interventions to improve the home academic environment and boost organization skills. We conclude with recommendations for ADHD assessment and intervention sequencing.

Although attention-deficit/hyperactivity disorder (ADHD) is prevalent among adolescents in outpatient behavioral care, one of the few evidence-based treatment options, stimulant medication, is significantly underutilized. The Medication Integration Protocol (MIP) is a family-based intervention designed to help behavior therapists assume a lead role in educating clients about ADHD in adolescents, promoting family-centered decisions about medication initiation, and integrating medication management activities within behavioral treatment planning. This pilot study evaluated treatment fidelity and medication utilization for inner-city teens receiving MIP (n = 14) compared with a matched Historical Control (HC) group (n = 21) in a community clinic. Observational analyses revealed that in comparison with HC, MIP demonstrated basic protocol fidelity with regard to adherence to the MIP protocol, therapeutic alliance with the adolescent, and clinical focus on ADHD in session. MIP showed greater psychiatric evaluation completion and ADHD medication initiation than HC. Next steps in the ongoing development of MIP are outlined.

This study investigated baseline client characteristics that predicted long-term treatment outcomes among adolescents referred from school and community sources and enrolled in usual care for conduct and substance use problems. Predictor effects for multiple demographic (age, sex, race/ethnicity), clinical (baseline symptom severity, comorbidity, family discord), and developmental psychopathology (behavioral dysregulation, depression, peer delinquency) characteristics were examined. Participants were 205 adolescents (52 % male; mean age 15.7 years) from diverse backgrounds (59 % Hispanic American, 21 % African American, 15 % multiracial, 6 % other) residing in a large inner-city area. As expected, characteristics from all three predictor categories were related to various aspects of change in externalizing problems, delinquent acts, and substance use at one-year follow-up. The strongest predictive effect was found for baseline symptom severity: Youth with greater severity showed greater clinical gains. Higher levels of co-occurring developmental psychopathology characteristics likewise predicted better outcomes. Exploratory analyses showed that change over time in developmental psychopathology characteristics (peer delinquency, depression) was related to change in delinquent acts and substance use. Implications for serving multiproblem adolescents and tailoring treatment plans in routine care are discussed.

Attention-Deficit/Hyperactivity Disorder (ADHD) is prevalent among adolescents enrolled in behavioral health services but remains undertreated, and the first-line treatment option, stimulant medication, is underutilized. To address this gap, this article introduces the Medication Integration Protocol (MIP): ADHD Assessment and Medication Consult; ADHD Psychoeducation and Client Acceptance; ADHD Symptoms and Family Relations; ADHD Medication and Family Decision-Making; and Medication Management and Integration Planning. The article concludes by highlighting what behavior therapists should know about integrating medication interventions into primary care; managing medication priorities for adolescents with multiple diagnoses, including substance use problems; and the compatibility of MIP with everyday practice conditions.

Although the science of disseminating empirically supported behavioral treatments has made remarkable advances, the ultimate goal of dissemination—sustaining the implementation of evidence-based practices (EBPs) in usual care with a high degree of fidelity—remains challenging. This article presents a rationale and guidelines for transitioning from conventional purveyor-driven dissemination methods to intramural quality assurance procedures that can be maintained with routine agency resources. Three innovations for localizing EBP quality assurance are described: adaptation of observational fidelity methods for therapist self-report and supervisor observation of EBPs, process control benchmarking methods for continuous tracking of EBP fidelity strength and consistency, and development of intramural clinical expertise grounded in local management of EBP implementation and outcome data. These innovations exemplify a fundamentally empirical approach to sustaining quality EBP implementation in frontline settings.

Objective: This study investigated adolescent and caregiver reports of ADHD symptoms in a sample of clinically referred inner-city adolescents. Method: Participants (N = 168) included youth ages 12-18 (54% male, 98% ethnic minority) and their caregivers who each completed diagnostic interviews of ADHD symptoms and assessments of perceived need for ADHD treatment and correlated behavior problems. Results: Informants showed poor agreement on DSM-IV diagnostic categories and also dimensional scales, Inattention/Disorganization (I/D) and Hyperactivity/Impulsivity (H/I). Both caregiver and adolescent reports of I/D symptoms, but not H/I symptoms, were related to perceived need for ADHD treatment. Caregiver reports were linked to behavioral correlates typically associated with ADHD: I/D symptoms correlated with planning/organization and socioemotional deficits, and H/I symptoms correlated with externalizing and behavior regulation deficits. In contrast, adolescent reports of I/D were related to internalizing and externalizing problems, and their reports of H/I correlated with externalizing only. Few gender effects were found. Conclusion: Study results underscore the developmental salience of I/D symptoms and have implications for ADHD diagnosis and treatment planning for adolescents.