Hogue A, Porter NP, Henderson CE, et al. Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, Update 2018-2023: Current Status, Best Practices, and Opportunities for Advancing the Science. J Clin Child Adolesc Psychol. 2025:1-25. doi:10.1080/15374416.2025.2521855
This systematic review examined the latest evidence on outpatient behavioral treatments for adolescent substance use (ASU). The review had two main goals: to update findings from a major 2018 review and to address growing public health concerns about marijuana and opioid use among young people. The authors reviewed randomized comparative studies published since 2018 that evaluated behavioral treatments for adolescents with substance use problems. Despite the importance of the topic, only five new studies met the rigorous research standards required for inclusion. As a result, the overall conclusions remained largely unchanged from the earlier review. The strongest evidence continues to support family-based treatments, which actively involve family members in the recovery process. Cognitive Behavioral Therapy (CBT), which helps people identify and change unhelpful thoughts and behaviors, also remains well supported in both individual and group formats. Motivational Interviewing/Motivational Enhancement Therapy (MI/MET), which aims to strengthen a person’s motivation to change, shows mixed results when used alone. Contingency Management (CM), which uses rewards to encourage positive behaviors, remains a useful component of broader treatment programs. Other commonly used approaches, such as twelve-step and disease-centered programs, still lack sufficient research evidence. The review highlights increasing concerns about adolescent marijuana and opioid use. Although marijuana use rates have not risen dramatically among adolescents, perceptions of risk have declined, and negative consequences have increased. Opioid-related overdose deaths among adolescents are also rising. No approved medications currently exist for adolescent cannabis use disorders, and there is very limited high-quality evidence on treatments for adolescent opioid use disorder. The findings emphasize the need for continued research, especially on treatments tailored to marijuana and opioid use, digital treatment approaches, and strategies that improve access to care. The authors also stress the importance of developing and implementing treatments in partnership with local communities, particularly those that have experienced unequal access to substance use services.