Agenda for Future Research and Concluding Comments

This concluding chapter highlights issues we see as especially important next-step agendas for the field. The issues we have highlighted concern (a) the implications that a developmental frame of reference provides in characterizing and parsing the etiology and course of addictive behavior; (b) the relevance of event-level predictors occurring in microtime and the extent to which they will supercede the more summative indicators that currently dominate the substance abuse field; (c) the increasing awareness, and characterization of drug-specific influences, and the degree to which these influences are useful in evaluating the vulnerability potential of drugs of abuse; (d) the differences in characterization of clinical symptomatology and course that have the potential to occur when evaluation of psychopathology and the details of intervention methods are unpacked with a specifically developmental lens; (e) the insights that new big data collection programs will create in understanding the cross-domain causal structure of substance abuse.

Development of Sexual Relationships and Substance Use

Sexual relationship development in adolescence can be affected by substance use. Substance use and risky sexual behavior frequently co-occur, and their co-occurrence is associated with short- and long-term negative consequences. The relationship appears to be bidirectional in nature, with substance use acting as a risk factor for risky sexual behavior and risky sexual behavior acting as a risk factor for substance use. Proposed mechanisms to explain this relationship include personality traits such as impulsivity or sensation-seeking tendencies, expectancies about how substances will affect sexual experiences, and effects of media messages that normalize substance use and sexual behavior for adolescents. Peer influence, family factors, and a constellation of problem behaviors that reinforce one another can also play a role. However, there are no integrative models to explain the relationship between substance use and sexual relationship development.

Effective Inpatient and Outpatient Models of Treatment for Adolescents With Substance Use Disorders

This chapter provides an overview of the physical, psychological, and brain development of the adolescent, establishing the need for treatment tailored to their unique developmental needs. It also defines the goals and phases of treatment, describes the continuum of care and contextualizes the body of effectiveness treatment research. The chapter reviews the evidence based literature on inpatient and outpatient settings including short-term detoxification, acute and long-term residential care, sober houses, therapeutic schools, day hospitals, intensive outpatient as well as outpatient approaches. Overall, studies indicate that treatment in youth has small to moderate effects. The chapter concludes with recommendations for what professionals and parents should look for in treatment programs for adolescent clients and discusses future research and policy recommendations.

Introduction to the Field and the Issues

This volume provides a comprehensive overview of the origins, development, and course of substance use as it emerges and unfolds in adolescence, a period where great change at genetic, neurobiological, behavioral, and social-environmental levels is taking place. The volume also provides reviews of clinical symptomatology and the multiple methods for intervention that have developed to address this major set of public health problems. This chapter provides a brief overview of these areas; it includes sections on epidemiology, similarities and differences among the different drugs of abuse, etiology and course, clinical symptomatology and comorbidity, intervention methods, and social policy. These summaries, covering multiple levels of analysis, provide a comprehensive description of a field that is still developing, but that has already achieved a substantial level of maturity.

Application of the Expectancy Concept to Substance Use

This chapter provides an introduction to, and overview of, substance use expectancy theory, which offers one framework to explain why individuals approach and engage in substance use behaviors. We begin with an overview of basic behavioral science models of expectancy, noting that the capacity to anticipate outcomes of behaviors, and hence choose to engage in behaviors from which one expects benefits or rewards, is central to adaptive functioning. We note the importance of the insight that this anticipation/expectancy principle can be applied to substance use. We then review models of the development of learned anticipations or expectancies of reward from substance use and consider factors that influence substance use expectancy development. We observe that longitudinal data, documenting expectancies’ prediction of subsequent addictive behaviors, and experimental data, documenting reductions in both drinking and eating disorder symptoms following expectancy reduction, speak to the functional role of expectancies in addictive behaviors.

A Developmental Perspective on Substance Involvement From Adolescence to Emerging Adulthood

Substance use is a developmental disorder, with clear age-graded trends reflecting initiation in adolescence, increased use through emerging adulthood, and a decline thereafter. A developmental framework places substance use behavior both within the context of normal development and in relation to the interplay between environmental and person-specific characteristics, where underlying risk may manifest as a substance use problem in the face of an enabling environment. Individuals have changing vulnerabilities to substance use and related problems that are due to chronological aging as well as attributable to the normative developmental tasks and role transitions that may serve as a turning point directing an individual toward or away from substance use. Against the backdrop of normative patterns are distinct developmental trajectories that are likely linked to different etiological pathways and that, through valid testing of developmental theory, can inform the content and timing of prevention programs targeted to reach high-risk subgroups.

Self-Regulation and Decision Making

Adolescence involves a complex interplay of biological, cognitive, emotional, and psychosocial changes when normative transitions in self-regulation, reward sensitivity, and decision making occur. As behavioral and cognitive systems mature at differing rates in adolescence, teens may be more vulnerable to the emergence of emotional and behavioral problems in the context of greater autonomy, independence, and responsibility. Youth develop more complex association networks pertaining to alcohol and other drug use across childhood and adolescence in concert with the development of more nuanced decision-making capabilities. As such, self-regulation of alcohol and other drug use behaviors may be particularly challenging for teens. In this chapter, we review the literature on the growth of self-regulation and decision-making abilities, their influence on the initiation and maintenance of alcohol and drug use in adolescence, and potential implications for prevention and intervention.

Twelve-Step Approaches

Twelve-step approaches to addressing substance use disorder (SUD) are unique in the treatment field in that they encompass professionally led, as well as peer-led, intervention methods. Also, in contrast to most professional treatments that have emerged from scientific theories and empirical data (e.g., cognitive-behavioral treatments), 12-step approaches have been derived, in large part, from the collective addiction and recovery experiences of laymen. Despite this, 12-step approaches have become influential in tackling SUD, with research demonstrating the clinical utility of employing such approaches among adults, and increasingly, among youth. Findings among adolescent samples indicate community 12-step mutual-help organizations, in particular, may provide a beneficial recovery-supportive social context during a life stage where such support is rare.

Cultural Variations and Relevance to Etiology

This chapter begins with a description of the role of culture on the etiology of substance use, misuse, and disorders among youth in the United States. This is followed by a discussion of how present constructions of majority-minority groups oversimplify the tremendous diversity individuals experience and how they tend to negate individual agency and fail to critique the structural forces that impact individuals’ drug-using behaviors. The chapter concludes with the thesis that a critical intersectionality framework is necessary to understand how substance use disorders vary as a function of individuals’ multiple dimensions, including how these are manifested and impacted by societies’ social and structural forces.

Targeted Prevention Approaches

This chapter reviews the current literature on targeted prevention approaches for adolescent alcohol and other drug (AOD) use. We open the chapter by examining both the historical and current use of the term “targeted prevention” in regard to teen AOD use. We then provide a review of existing targeted prevention work from a health communication perspective and offer recommendations for future areas for research on targeting in health campaigns. This is followed by a review of existing targeted prevention work from a clinical intervention perspective, with attention to both selective and indicated prevention strategies. This includes recommendations for future areas for research on targeting in early intervention programs. We conclude the chapter with a brief recapitulation of its contents.