Pharmacotherapy for Adolescents with Substance Use Disorders

Substance use disorders (SUD) are among the most prevalent and serious mental disorders occurring in adolescents. Though significant gains have been made in evidence-based psychosocial therapies for the treatment of adolescent SUD, pharmacotherapy studies are scarce. Psychosocial treatment should most often be considered as the first-line treatment for adolescent substance use disorders. These may include such SUD-specific therapies as motivational enhancement therapy (MET), cognitive-behavioural therapy (CBT) and family-based interventions. We advocate for widespread availability of such treatments. Many patients will continue to struggle with their addictions despite high-quality psychosocial treatment. Comorbid mental disorders are quite common and may limit gains from such treatments. Many adolescents with severe SUD and mental disorders or disorders refractory to psychosocial interventions may benefit from pharmacotherapy in their road to recovery. The evidence for this approach is quite limited, and so any implementation of medication prescription for the treatment of SUD in adolescents needs to be carefully monitored. Potential benefits and risks need to be evaluated in light of the clinical presentation. Patients and families should be made aware of the limited degree of evidence for such an approach and should also be made aware of any off-label use of medications.