Age-Appropriate Program Development

Adolescents with opioid use disorder (OUD) are developmentally different from older adults, and programs seeking to develop outpatient medication for addiction treatment (MAT) should include evidence-based, age-appropriate counseling and behavioral therapy as adjuncts. Additionally, patients of this age group may also have family and other social support that can be an asset to recovery. Incorporating family - Biological or chosen - into treatment is recommended when it is in the best interest of the young person.

Youth/Family Engagement/Recovery Supports

Collegiate Recovery Programs

Some colleges and universities may offer collegiate recovery programs (CRP) on campus. These are supportive environments within the campus culture that reinforce the decision to engage in a lifestyle of recovery from substance use. They are designed to provide an educational opportunity alongside recovery support to ensure that students do not have to sacrifice one for the other. More information can be found at: https://collegiaterecovery.org/ 

Recovery Housing

Recovery Home, frequently referred to as a "Sober home," is a broad term describing a substance-free, safe and healthy living environment that promotes recovery from alcohol and other drug use and associated problems. Residents are expected to abstain from alcohol and illegal drug use. For additional information: https://mashsoberhousing.org/ 

Anti-Stigma Message

Addiction may be the most stigmatized health condition in the United States. Person-first language that emphasizes the individual over the health condition and medically accurate terminology helps to reduce stigma. Several considerations may impact treatment decisions by youth. Patients may exhibit a hesitancy to initiate medications for opioid use disorder given the negative attitudes expressed by trusted adults (parents, caregivers, state agencies, treatment providers, teachers, etc.) or because they believe these medications will be required for the rest of their lives. A lack of information regarding the pharmacology of MAT may result in negative sentiments that question whether a patient on medication is "truly sober" or trading one drug for another. Young adults may get mixed messaging from primary care providers or other trusted adults about the efficacy or use of MAT - a situation compounded by the common separation of addiction treatment and primary care. It is essential that clinicians provide accurate information to dispel myths that patients may have about starting a medication for their opioid use disorder.

Behavioral Health Treatment with MAT

In general, all adolescents and young adults benefit from developmentally appropriate services tailored to meet their unique social, emotional, cognitive, and physical stages of development. Adolescents with OUD are developmentally different from older adults, and programs seeking to develop outpatient MAT should include evidence-based, age-appropriate counseling and behavioral therapy as adjuncts.

While medications can help manage cravings and withdrawal symptoms of OUD, counseling helps adolescents and young adults address life domains that may have been impacted by their use and/or address underlining issues or trauma that contributed to their initiation of substance use. Adolescence and young adulthood are a developmental phase focusing on identity formation and autonomy. For young people with SUD or OUD this can be especially challenging to navigate when treatment for their disease may mean separating from or reducing interactions with their existing peer group, relying more on parent or guardians instead of separating from them, and possibly not mastering certain developmental tasks that would promote long-term recovery capital such as education, employment, or romantic relationships.

Developmentally appropriate MAT care models must include behavioral health services and be relentless in their efforts to increase engagement and retention in treatment for this population. Prescribers, clinicians, and support staff should be trained in developmentally appropriate
SUD treatment modalities that are rooted in motivational interviewing. Programs should offer
flexible meeting times and days for young people, and whenever possible, flexibility in meeting location for actual counseling sessions. If possible, programs should utilize contingency management, incentivizing for attendance at sessions in varying denominations and at varying stages of treatment.

Some young people and/or families may be reluctant to engage in behavioral therapy. It is
recommended that providers do not discontinue MAT when a young person is not engaging in
behavioral therapy. Rather, providers may need to continue to provide education on the role of adjunctive behavioral therapy and explore the reasons why a young person and/or family is not following up with this recommendation.

If outpatient MAT programs are not positioned to offer evidence based, developmentally
appropriate behavioral health services, they can contract with trained providers in the community
such as Adolescent Community Reinforcement Approach (A-CRA) clinicians and agencies. Provider information may be found at: https://helplineMA.org/ or 800–327–5050.

Clinical service providers employ evidenced-based practices shown to be effective in engaging with
and treating adolescents and young adults with SUD and their families, such as:

Adolescent Community Reinforcement Approach (A-CRA)
A behavioral intervention that seeks to increase family, social, and educational reinforcers of an adolescent to support recovery
(http://ebtx.chestnut.org/Treatments-andResearch/Treatments/A-CRA)

Multidimensional Family Therapy (MDFT)
Family-centered treatment for youth
(http://www.mdft.org/)

Multisystemic Therapy (MST)
Intensive family and community-based treatment
(http://www.mstservices.com/)

Adolescent-Focused Family Behavior Therapy(Adolescent FBT)
Includes over a dozen treatments, including treatment planning, behavioral goals, job-skills training, stimulus control
(http://familybehaviorther.wixsite.com/familytherapy)

Functional Family Therapy (FFT)
An interventional program for families aimed at youth with different behavioral issues, including
substance misuse
(www.fftllc.com)