• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Pharmacotherapy for Substance Abuse

Pharmacotherapy for Substance Abuse

October 1, 2012
From The Carlat Child Psychiatry Report
Issue Links: Learning Objectives | Editorial Information
Caroline Fisher, PhD, MD
Treating substance abuse is difficult whether the patient is young or old. Although one might hope that the shorter period of abuse seen in teens would make the disorder less entrenched, the data shows otherwise: addiction is a stubborn disorder with a long term, relapsing, and remitting course (Simkin DR and Grenoble S, Child Adolesc Psychiatric Clin North Amer 2010;19(3):591–608). Treatment needs to address the complex needs of the adolescent patient: identification and treatment of comorbid psychiatric disorders, behavioral interventions, family and environmental supports, individual therapy, and at times, medication.

Adolescents with substance use disorders often struggle with skill deficits (eg, social, academic) that may need to be addressed, as well as other adversities. We need to remember to treat the whole patient, not just the substance abuse. Don’t forget to screen for common diseases associated with drug abuse, including hepatitis, HIV, and tuberculosis, and educate your patient on how to avoid the risky behaviors that lead to them.

We should monitor for drug use throughout treatment (urine screens, for example), but don’t get frustrated if the tests sometimes come out positive. Relapse is the rule for substance abuse treatment. Instead of the “detox-and-done” approach, plan on a long treatment course with frequent assessments and revisions of the overall treatment plan as the needs of the adolescent change. Use the adolescent’s need for autonomy and get the patient involved in planning contingencies for relapse and identifying treatment goals. Make small steps into victories, even if the adolescent is not voluntarily seeking treatment. Many people who abuse substances do not tolerate failure, so relapses (and “failures” of any kind) need to be reframed and normalized.

Medications have been helpful in adults and in what few studies of adolescents that have been done. If you think that a medication might help, the table “Medications for Substance Abuse in Adolescents” summarizes the available evidence.

Table 2: Medications for Substance Abuse in Adolescents

Click here to open pdf



There are currently no drugs FDA-approved for treatment of marijuana dependence. There have been small pilot studies of buspirone (Buspar), divalproex (Depakote), the Parkinson’s disease drug entacapone (Comtan), gabapentin (Neurontin), mirtazapine (Remeron), and the oral tetrahydrocannabinol Dronabinol. A small randomized controlled trial showed benefit for N-acetylcysteine (Acetadote).

Medications for cocaine dependence have not been well-studied in adolescents. Amphetamine (Adderall), baclofen (Gablofen, Lioresal), desipramine (Norpramin), and methylphenidate (Ritalin, Concerta) have shown some success in treating adults with cocaine dependence.

Studies have been small and meta-analyses have not detected any effect of medications for smoking cessation in adolescents, however buproprion (Wellbutrin, Zyban); the nicotine replacements, Commit, NicoDerm CQ, Nicorelief, Nicorette, Nicotrol, and Thrive; and varenicline (Chantix) are FDA-approved for adults.
Child Psychiatry
KEYWORDS child-psychiatry substance-abuse
    www.thecarlatreport.com
    Issue Date: October 1, 2012
    SUBSCRIBE NOW
    Table Of Contents
    New Drugs, Legal Highs, and Big Risks: A Review of Novel Intoxicants
    Pharmacotherapy for Substance Abuse
    Trends in Adolescent Substance Abuse
    Hoarding and ADHD Linked
    Study of Cortisol Looks at Youths at Risk for Psychosis
    Featured Book
    • CMFB2e_Cover.png

      Child Medication Fact Book for Psychiatric Practice, Second Edition (2023)

      All the important facts covering child and adolescent psychopharmacology.
      READ MORE
    Featured Video
    • therapist_canstockphoto9201097.jpg
      General Psychiatry

      Using SAMe In Clinical Practice with Garrett Rossi, MD

      Read More
    Featured Podcast
    • canstockphoto17326101.jpg
      Child Psychiatry

      Recognizing Developmental Trauma Disorder in Children and Adolescents

      Whether due to COVID, conflict, climate, or common car crashes, children often lose their caregiver at the same time they experience trauma. Our podcast with Julian Ford will...

      Listen now
    Recommended
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report

    Contact

    info@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.