REVIEW OF: Lee D et al, JAMA Health Forum 2025;6(8):e252647

STUDY TYPE: Cross-sectional study

Adolescent mental health and substance use problems are rising, but treatment access hasn’t kept pace. Using 2021–2022 National Survey on Drug Use and Health data, this study examined more than 32,000 youth ages 12–20 to see who actually receives care for substance use disorders (SUDs), major depression, and suicidality.

The gaps were wide. Only 10% of adolescents with an SUD received any treatment in the past year. For mental health conditions, 51% received care. Youth with both an SUD and depression were somewhat more likely to get treatment, but most still went untreated.

Turning 18 appeared to make things worse. Compared with younger teens (12–17), young adults (18–20) were less likely to receive mental health treatment (51% vs 63%) and SUD treatment (8% vs 11%). Buprenorphine use was rare: Just 11% of teens with opioid use disorder received medication treatment, compared to 25% of young adults. Medicaid coverage dropped sharply after age 18, and uninsurance increased.

CARLAT TAKE
The most striking statistic here is 1 in 10. That’s how few teens with SUDs receive treatment. Even for depression and suicidality, only about half get care. This study occurred in the wake of the COVID-19 pandemic, which may have impacted the results. Still, the transition to adulthood is a danger zone, likely driven in part by insurance loss and fragmentation of services. In your practice, aggressive screening matters, and so does planning ahead. When treating a 17-year-old with an SUD or severe depression, plan early for care continuity after 18. System failures are real, but continuity planning is within your control.

For more information on substance use disorders in youth, see:

• Teen Drinking: Risks and Responses (in CCPR Jul/Aug/Sept 2021)
• Addressing the Hazards of Performance-Enhancing Substances (in CCPR Jul/Aug/Sept 2021)
• Vaping and Nicotine Addiction in Children and Adolescents (in CCPR Jan/Feb/March 2025)
• Managing Substance-Induced Psychosis in Teens (in CCPR Apr/May/Jun 2025)