Foreword 1

Alcohol and drug abuse continue to be perceived as extremely serious problems by all Americans. In volume alone, substance use disorders are daunting problems. For example, in 2001 (the latest data available in the US National Survey of Substance Abuse Treatment Services [2001]), 1.1 million US youth aged 12–17 were estimated to need substance abuse treatment. However, it seems clear from research in the UK and Europe that young people with substance abuse problems are not being identified accurately. Therefore, this very large prevalence figure may be a substantial underestimate. Finally, there is also indication that the situation may be getting worse. Surveys in the USA and a variety of other countries documented alarming increases in adolescent substance use throughout the 1990s and rates have remained steady and consistently high in the early years of this decade (see Ch. 6).

It is disturbing that of the 1.1 million identified adolescent abusers, fewer than 100 000 actually received treatment, leaving a significant “treatment gap” nationwide. Even worse, there is also concern regarding the effectiveness and worth of the treatment that is available. Indeed, a significant proportion of Americans – even those who work within healthcare settings – feel that “nothing works” for substance abuse. For instance, the Services Research Outcomes Study found in 1998 that while adult patients improved significantly in drug abuse programs, adolescents actually increased their alcohol and drug use in the years following treatment.