Substance Use Disorder (SUD)
Must meet at least 2 of the 11 criteria for the diagnosis:
- Continuing to use opioids despite negative personal consequences
- Repeatedly unable to carry out major obligations at work, school, or home due to opioid use
- Recurrent use of opioids in physically hazardous situations
- Continued use despite persistent or recurring social or interpersonal problems caused or made worse by opioid use
- Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount
- Withdrawal manifesting as either characteristic syndrome or the substance is used to avoid withdrawal
- Using greater amounts or using over a longer time period than intended
- Persistent desire or unsuccessful efforts to cut down or control opioid use
- Spending a lot of time obtaining, using, or recovering from using opioids
- Stopping or reducing important social, occupational, or recreational activities due to opioid use
- Consistant use of opioids despite acknowledgment of persistent or recurrent physical or psychological difficulties from using opioids
- Craving or a strong desire to use opioids
About Substance Abuse in Children & Adolescents from the Office of Adolescent Health (OAH):
"Alcohol is the substance abused most frequently by adolescents, followed by marijuana and tobacco. In the past month, 39 percent of high school seniors reported drinking some alcohol, almost 23 percent reported using marijuana, and 16 percent reported smoking cigarettes.
"More adolescents drink alcohol than smoke cigarettes or use marijuana. Within the past month, almost four out of 10 high school seniors report drinking some alcohol and more than one in five have engaged in “binge drinking” in the past two weeks. Drinking endangers adolescents in multiple ways including motor vehicle crashes, the leading cause of death for this age group. Nearly one in four adolescents has ridden in a car with a driver who had been drinking. Genetic factors and life stressors influence adolescents’ alcohol abuse, but parents and guardians can help by monitoring adolescents’ activities and keeping channels of communication open.
"Cigarette smoking among adolescents has declined dramatically in the last 15 years. Today, most adolescents do not smoke, but about one in five has smoked within the past month and the use of smokeless tobacco increased between 2008 and 2010, but has remained fairly steady since 2010. Tobacco use harms nearly every organ in the body, and more than six million children born between 1983 and 2000 will die in adulthood of smoking-related illnesses. Multiple factors influence whether an adolescent becomes a regular smoker, including genetics and having parents or peers who smoke. Many adolescents start trying tobacco products at a young age, so prevention efforts in schools, in communities, and in homes, can help and should begin early.
"Illicit drug use—which includes the abuse of illegal drugs and/or the misuse of prescription medications or household substances—is something many adolescents engage in occasionally, and a few do regularly. By the twelfth grade, about half of adolescents have abused an illicit drug at least once. The most commonly used drug is marijuana but adolescents can find many abused substances, such as prescription medications, glues, and aerosols, in the home. Many factors and strategies can help adolescents stay drug free: Strong positive connections with parents, other family members, school, and religion; having parents present in the home at key times of the day; and reduced access in the home to illegal substances."
"Alcohol is the substance abused most frequently by adolescents, followed by marijuana and tobacco. In the past month, 39 percent of high school seniors reported drinking some alcohol, almost 23 percent reported using marijuana, and 16 percent reported smoking cigarettes.
"More adolescents drink alcohol than smoke cigarettes or use marijuana. Within the past month, almost four out of 10 high school seniors report drinking some alcohol and more than one in five have engaged in “binge drinking” in the past two weeks. Drinking endangers adolescents in multiple ways including motor vehicle crashes, the leading cause of death for this age group. Nearly one in four adolescents has ridden in a car with a driver who had been drinking. Genetic factors and life stressors influence adolescents’ alcohol abuse, but parents and guardians can help by monitoring adolescents’ activities and keeping channels of communication open.
"Cigarette smoking among adolescents has declined dramatically in the last 15 years. Today, most adolescents do not smoke, but about one in five has smoked within the past month and the use of smokeless tobacco increased between 2008 and 2010, but has remained fairly steady since 2010. Tobacco use harms nearly every organ in the body, and more than six million children born between 1983 and 2000 will die in adulthood of smoking-related illnesses. Multiple factors influence whether an adolescent becomes a regular smoker, including genetics and having parents or peers who smoke. Many adolescents start trying tobacco products at a young age, so prevention efforts in schools, in communities, and in homes, can help and should begin early.
"Illicit drug use—which includes the abuse of illegal drugs and/or the misuse of prescription medications or household substances—is something many adolescents engage in occasionally, and a few do regularly. By the twelfth grade, about half of adolescents have abused an illicit drug at least once. The most commonly used drug is marijuana but adolescents can find many abused substances, such as prescription medications, glues, and aerosols, in the home. Many factors and strategies can help adolescents stay drug free: Strong positive connections with parents, other family members, school, and religion; having parents present in the home at key times of the day; and reduced access in the home to illegal substances."
Assessment & Screening Tools
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Clinician-Rated
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Caregiver-Rated
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Self-Rated
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Position Papers & Practice Parameters
- US Preventive Services Task Force Recommendations for Screening and Behavioral Counseling Interventions for Unhealthy Alcohol Use in Adolescents (released 11/2018) indicate that the current evidence is insufficient to assess the balance of benefits and harms of recommending for universal counseling for youth ages 12-17. The Task Force found that evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined; however, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and American Academy of Pediatrics (AAP) continue to recommend the CRAFFT screening instrument for identifying risky substance use in adolescents. The NIAAA also recommends asking patients about their own alcohol use as well as their friends’ alcohol use.www.integration.samhsa.gov/clinical-practice/sbirt/CRAFFT_Screening_interview.pdf
- Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians (American Academy of Pediatrics, 2011)
- Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: U.S. Preventive Services Task Force Recommendation Statement (Moyer, 2013)
- Practice Parameter for the Assessment and Treatment of Children and Adolescents with Substance Use Disorders (AACAP, 2005)
Articles
General
- Treatment of Adolescent Substance Use Disorders (Belendiuk & Riggs, 2014), which includes psychosocial/behavioral interventions and pharmacologic treatment)
- Advances in Adolescent Substance Abuse Treatment (Winters, Botzet, Fahnhorst, 2011)
- Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and six months (Madras, Compton, Avula, Stegbauer, Stein & Clark, 2009)
- Systems-level Implementation of SBIRT (US Department of Health and Human Services)
- Adolescent Alcohol and Substance Use and Abuse (Bright Futures)
- Validity of the CRAFFT substance abuse screening test among adolescent clinic patients (Knight, Sherritt, Shrier, Harris, Chang, 2002)
Research Ethics and Planning
- NACDA Guidelines for Substance Abuse Research Involving Children and Adolescents (National Advisory Council on Drug Abuse)
Resources
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For Professionals
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For Families
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Organizations
- Center for Treatment Research on Adolescent Drug Abuse
- American Academy of Addiction Psychiatry (AAAP)
- American Academy of Addiction Psychiatry
- American Society of Addiction Medicine