Introduction

In this chapter we examine the relationship between the etiology and course of substance use problems among adolescents and our societal responses to those problems. A thorough review of this topic is a large task, one that could fill several volumes if completed comprehensively. Our review is selective. We argue that the treatment of adolescents with substance abuse problems must be sensitive to, if not specifically designed for, the psychological and social contexts of adolescent lifestyles. Unfortunately, many current treatment efforts are based on methods and rationales developed with adult populations. A new perspective on the treatment of adolescent substance abuse would begin with an understanding of the manner, rates, and predictive factors for adolescent substance abuse. Further, a new perspective would go beyond refining a model originating in adult psychopathology to developing a new model based on the specific developmental challenges of adolescence. For this effort, the assessment of variability in developmental trajectories of substance use is critical. Variability of substance use course suggests that not all adolescent use is problematic and that problematic use among adolescents is not often chronic. Different psychological factors are associated with different trajectories, suggesting the need for treatment of comorbid conditions as well. Essentially, we argue for a version of patient–treatment matching, but one that is sensitive to developmental issues in adolescents.

To make this case, we first describe the specific nature of adolescent substance use and related problems.