How do you determine the appropriate level of care for an adolescent with a substance use disorder?

This is a very timely question, as the use of substances in childhood and adolescence is an often-overlooked issue. A recent survey of high schoolers revealed that 11% of 8th graders, 21.5% of 10th graders, and 32.6% of 12th graders have engaged in substance use in the past month. (Miech et al, NIDA 2023) Regarding adolescents 12 – 17 years of age, over 5% need treatment for drug use, and over 6% need treatment for alcohol use. (Substance Abuse and Mental Health Services Administration (SAMHSA), 2023 National Survey on Drug Use and Health)

The initial phase of clinical management of adolescent SUD is to efficiently identify SU and related problems, psychiatric comorbidity, and psychosocial maladjustment. I start by using the American Societ...

Like all treatment decisions, this depends on a comprehensive evaluation of risk vs. benefit. Much of this answer depends on where you are practicing and what adolescent substance use treatment programs are reasonably available for a particular patient. Considerations include what programs are available in your area, coverage/family's ability to pay, the youth's willingness to enter treatment, the need for medication management, whether or not there is legal involvement, the specific pattern of substance use, prior levels of treatment trialed, and psychiatric comorbidity. In some areas, residential adolescent substance use treatment is limited to youth who are court-ordered or involved in the foster care system, and coverage for PHPs or IOP...