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Treatments for adolescent substance use disorders (SUDs) in the community use a variety of modalities and settings and almost always reflect a psychosocial approach. In recent years, the use of medications (pharmacotherapy) has increased. This chapter will explore the current situation for pharmacotherapy as a treatment for adolescents with SUDs, particularly the rationale and empirical basis for pharmacological treatment in this population. The goal is to understand the limited scope of the current literature, and the broad potential for empirically based pharmacological therapies to assume a more prominent role in the treatment of adolescents with SUDs.
Current status of pharmacotherapy
Pharmacotherapy can be used to target the symptoms or behaviors directly or indirectly related to SUDs. Unlike psychosocial treatments, which may target a host of different individual and family processes underlying adolescent SUDs, pharmacological treatments usually focus on a more specific target, such as comorbid psychiatric disorders or neurophysiological processes underlying addictive behavior (e.g., the reinforcing properties of substances of abuse on the brain). The ample evidence pointing to the role of neuropsychiatric factors in the etiology and development of SUDs in adolescents supports serious consideration of pharmacological strategies in SUD treatment (Bukstein & Tarter, 1998). The dependence liability of psychoactive compounds is indicated by the propensity of laboratory animals to self-administer the substance (Brady & Lucas, 1984). Drug reinforcement involves activation of the dopaminergic system subserving reward centers of the brain (Gardner, 1992; Wise & Rompre, 1989). Different substances may have different mechanisms of activating or influencing dopaminergic systems.
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