Consultation with the specialist
Drug Abuse
Robert L. Johnson MD
The wide array of therapeutic responses to substance use/abuse suggests that there is not one best approach to solve the problems of any one adolescent or young adult. Indeed, most young people require a variety of therapeutic interventions, which may include inpatient treatment, ambulatory therapeutic groups, and individual counseling, as well as self-help groups.
In choosing a therapeutic program, the physician must be circumspect when interpreting the reported success or "cure" rates of any of these modalities. Such citations often are misleading because frequently they fail to reflect accurately the therapeutic influence of several important patient population variables that distinguish the programs. For example, an outpatient program may report better "cure" rates than an inpatient program because the ambulatory program may have enrolled clients who have more limited substance use patterns and who are more committed to abstinence. Furthermore, there is no standard methodology for reporting "rates of success." Some programs simply report a compliance rate for clients who attend meetings or scheduled therapeutic sessions, some report the numbers of clients who complete the program without any reference to recidivism, and some report the numbers of clients who are "drug-free" after 1 year.
Given these caveats, the experience of most clinicians suggests that many adolescents who experiment with the traditional "gateway" drugs (eg, tobacco, alcohol, marijuana) respond well to outpatient group and individual therapy, those adolescents committed to a substance use/abuse pattern respond best to inpatient or residential programs, and adolescents who have a psychiatric/behavioral problem complicated by substance use/abuse require formal psychiatric treatment. Single-drug programs such as methadone maintenance or Alcoholics Anonymous have limited applicability for treatment of most adolescents who suffer from substance abuse.
