Alternative Treatments for Adolescents

Alternative Treatments for Adolescents

Description: 
Describes alternatives to buprenorphine treatment for adolescents, both medication and medication-free options.

Alternate Treatments for Adolescents

If an adolescent patient is not a suitable candidate for buprenorphine maintenance, there are a number of alternative therapies from which to choose.

Brief Intervention

In a brief intervention, the healthcare provider educates the patient about substance use and motivates the patient to reduce or eliminate use. Brief intervention is usually delivered in the context of a short (15-minute) office visit.

Brief intervention is recommended as a first-line treatment for adolescents who are experimenting with opioids but who do not meet criteria for opioid dependence (SAMHSA, 1999).

Methadone Maintenance Therapy

It has been suggested that methadone is an appropriate intervention for adolescents with opioid dependence (Hopfer et al., 2002), and doing so is legal under federal regulations, provided the patient meets certain criteria. However, methadone programs that will accept adolescents are extremely rare (Weill Medical College of Cornell University, 2004), so this treatment modality is not ordinarily an option for adolescent patients.

Medication-Free Treatments

Psychosocial treatment should be a component of any buprenorphine maintenance program. However, medication-free treatment modalities (also often called drug-free treatments) rely on counseling and therapy, using opioid agonists or other medication almost exclusively during detoxification (SAMHSA, 1999). Some examples of these treatments include 12-step–based programs, residential therapeutic communities, and family therapy.

Research shows that, for adolescent patients who complete them, medication-free treatments are as or more effective than opioid agonist treatment at preventing future opioid misuse (Hopfer et al., 2002). However, treatment retention is lower for psychotherapeutic treatments than it is for opioid agonist treatment (Hopfer et al., 2002).

Psychosocial, medication-free treatment is indicated for adolescent patients who

Have a short history of opioid dependence (less than one year) (Hopfer et al., 2002) Have made no or few prior treatment attempts (Hopfer et al., 2002)
Want to eventually become opioid-free, regardless of prior treatment or addiction histories (SAMHSA, 2001) Are highly motivated and engaged in treatment, regardless of prior treatment or addiction histories (Broome et al., 2001)

Key points to consider when placing an adolescent in a psychosocial treatment program:

  • The intensity of the program selected should be determined by the severity of the patient's opioid use problem (SAMHSA, 1999).

  • The program should be especially tailored for adolescents. Adolescents fare very poorly if they are treated in a program designed for adults (Etheridge et al., 2001; SAMHSA, 1999).

  • Referral to the program should be prompt. Also, the referring physician should personally contact the program to maximize the likelihood the patient will use it (SAMHSA, 1999).

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