Treatment Options and Approaches for Youth Substance Abuse

Common treatment approaches include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Motivational Interviewing, and the Twelve-Step Approach, among others. Often, a multidisciplinary clinical team works together to implement more than one approach. Each modality has its advantages and its limitations.

A relatively newer approach to mitigating the risks associated with substance use is the Harm Reduction Model.

“Harm reduction is an approach that emphasizes engaging directly with people who use drugs to prevent overdose, improving the physical, mental, and social wellbeing of those served, and offering low-threshold options for accessing substance use disorder treatment and other health care services.”
SAMHSA 2022

Rather than focusing on complete abstinence from substance use, harm reduction places the agency of change on the individual and acknowledges that some degree of drug use (both licit and illicit) in society is likely. Harm reduction focuses on reducing adverse consequences while prioritizing safety. It emphasizes one’s physical and mental health along with their social and economic well-being over the measurement of drug usage.

This article presents a brief overview of youth substance use data to understand its prevalence, and then explores the harm reduction model as one approach to mitigating and reducing risks associated with youth substance use.

Prevalence of Youth Substance Use

The number of youth experiencing the negative impacts of substance misuse and abuse is significant. Here are a few key data points from the National Center for Drug Abuse Statistics to get a sense of the prevalence of youth substance use.

More than 2 million youth aged 12-17 report using drugs in the past month
Nearly 12 million youth aged 18 to 25 report using drugs in the past month
Nearly half (46%) of youth report having tried illicit drugs by the time they reach 12th grade
Alcohol is (by far) the most commonly abused substance among teens and young adults
Overdose deaths due to opioids have increased 500% among 15-to-24-year-olds since 1999

Research – and experience – teaches us that drug use has the potential to harm every aspect of one’s life, including:

School attendance
School performance
Mental health
Physical wellbeing
Peer relationships
Family system
Motor vehicle safety

Risk Factors that Contribute to the Likelihood of Youth Substance Use

So, what makes one youth choose to experiment with e-cigarettes, alcohol, marijuana, or opioids? What makes another youth avoid it altogether, and still another end up addicted and in need of intensive treatment?

The answers are complex and multi-faceted. Research does show, however, that the presence of certain risk factors leads to a greater likelihood of substance use:

Early aggressive behavior
Lack of parental supervision
Academic problems
Undiagnosed mental health challenges
Peer substance use
Drug availability in the environment
Poverty
Peer relationships/peer rejection
Child abuse or neglect

The presence of one or more of these risk factors is associated with increased likelihood of youth substance use and abuse. The earlier the risk factors occur in childhood, the greater the risk of youth substance abuse. Additionally, risk factors that occur for a prolonged period of time (e.g., from PreK through middle school), are also associated with an increased likelihood of youth substance abuse.

It is important to keep in mind that not all youth who experience one or more of these risk factors will develop substance abuse problems. Protective factors like strong parental support and involvement or caring adults can diminish the influence of strong risks (like having friends who abuse substances).

Harm Reduction Strategies Work Better Than Zero Tolerance in Youth

While the number of youth who use, misuse, or abuse substances is high and the risks associated with this behavior are significant, youth tend to tune out the familiar “zero tolerance” and “abstinence only” messaging. They are less likely to engage with parents/caregivers and with the professionals who care for them when they feel condemned by their choices.

A 2019 study from the University of British Columbia and the University of Calgary found that teens respond better to harm-reduction messaging than they do to zero-tolerance messaging.

“Youth were more receptive when their parents talked – in a non-judgmental way – about substance use or could point to resources or strategies to help minimize the harms of use. This approach seemed to work better in preserving family relationships and youth health,” said Emily Jenkins, Ph.D., a UBC professor of nursing who studies youth substance use.

So, what does that look like in practice, either as a healthcare professional who works with youth, a school-based practitioner, or a parent/caregiver? Often, it takes the form of motivational interviewing.

Harm Reduction and Motivational Interviewing

One of the most effective ways to put harm reduction into practice is through the use of motivational interviewing. Motivational interviewing is a counseling method, or approach to intervention, that helps people identify their internal motivation to change their behavior. Motivational interviewing recognizes how difficult it can be to change behavior and honors this challenge with empathy, active listening, and support of self-determination or self-efficacy.

There are 4 key principles associated with motivational interviewing:

Express Empathy

Empathy is foundational to motivational interviewing and effective work with youth. Professionals who seek to implement a harm reduction approach seek to understand the youth’s behaviors and situation from their point of view. It is not about judging, condemning, or moralizing the behavior, but creating a safe environment and expressing care and concern.

Develop Discrepancy

A youth develops discrepancy when they begin to see a mismatch between where they are and where they want to be. For example, when a 17-year-old identifies a goal of attending a 4-year university but chooses to spend time with friends vaping after school instead of completing homework or researching colleges. The professional who is working with the youth does not tell the youth what they ought to be doing, but rather helps them identify what their goals are and see how those goals are (or are not) connected to their behaviors.

Roll with Resistance

It’s the professional’s job to help the youth reach a new understanding of themselves and their behaviors. It is not the professional’s job to challenge, oppose, or criticize the youth. To help a youth develop a greater understanding of their substance use behaviors, a professional may reframe or offer a different interpretation of a situation.

Support Self-Efficacy

Supporting self-efficacy is helping the youth believe they have what it takes to make a change or perform a desired behavior. Professionals guide youth through the stages of change and reinforce their belief in the youth.

Substance Abuse Treatment Is Not Black and White

Like everything worth fighting for in life, mitigating the risk of substance use is hard work. It requires a committed, team-oriented, and long-term approach. It may also require being open-minded to the harm reduction model. Here’s why:

At one end of the continuum of consequences of youth substance use, the effects may be minimal. Consider a 21-year-old adult who consumes 1 glass of wine while at home. There is not likely to be significant risk associated with this one action.

At the other end of the spectrum, youth substance use may be detrimental and life-threatening. Think of any youth who unknowingly takes an opioid laced with fentanyl, or a newly minted 16-year-old driver who gets in the car to drive while intoxicated. The risk associated with either of these two behaviors is huge.

The line between these two ends of the continuum of consequences is not as clear as we might think. Rather than adopting a blanket zero-tolerance approach to all substance use, professionals who care for youth ought to fold in messaging and strategies that prioritize safety and education, the reduction of harm, and connection to resources.

There is not one, single correct way to care for youth who are using, misusing, or abusing substances. The harm reduction model is a relatively newer approach to treatment, and many professionals who work with youth are still navigating the nuances of how it works (especially with adolescents). Sometimes our own discomfort can interfere with our ability to effectively intervene with youth. So remember this: it’s not black and white. Recovery and the journey toward health exist along a continuum. Each step toward safety and health count.

Substance Use Prevention and Intervention

FARMINGTON High School