Clinical practice guideline: Assessment and treatment of adolescents and young adults with substance use disorders and problematic substance use (excluding tobacco) (2026)

Objective: To enhance the quality of care and clinical outcomes for adolescents with Substance use disorder (SUD) and problematic substance use (PSU). The aims are twofold: 1) to summarize empirically-based guidance about the psychosocial, behavioral, and psychopharmacologic treatment of SUDs and PSU in adolescents and young adults; and 2) to summarize expert-based guidance about the assessment and clinical management of these disorders.
Method: Statements about the treatment of SUD / PSU are based upon empirical evidence derived from a critical systematic review of the scientific literature conducted by the Brown Evidence-Based Practice Center under contract with the Agency for Healthcare Research and Quality (AHRQ). To update the AHRQ/Brown findings, a subsequent literature search of meta-analyses was conducted and critically reviewed by the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Evidence that each studied intervention resulted in benefits that outweighed the harms was assigned a Strength of Evidence (SOE) rating - A (high), B (moderate), C (low), or insufficient. Interventions with an SOE rating of C or higher were eligible to be assigned a category of Recommendation (1) or Suggestion (2). Guidance about the assessment and clinical management of treatments for SUD / PSU was informed by expert opinion and consensus as presented in previously published clinical practice guidelines, chapters in leading textbooks of child and adolescent psychiatry, the DSM-5-TR, and government-affiliated prescription drug information websites.
Results: Suggested (2C) safe and effective short-term treatments for SUD / PSU in adolescents and young adults include brief (1-2 session) motivational interviewing for alcohol use; non-brief (>2 sessions) motivational interviewing, family therapy, or cognitive behavioral therapy for alcohol use or disorder with or without other drug use; motivational interviewing plus cognitive behavioral therapy for illicit drug disorders; behavioral interventions for college students with problematic alcohol use; and longer-term buprenorphine treatment and slower buprenorphine taper for opioid use disorder. The SOE was insufficient to support suggestions or recommendations for the pharmacological or behavioral treatment of any other adolescent SUD / PSU.
Conclusion: Substance use in adolescents and young adults is known to cause dependence, overdose, accidents while intoxicated/under-the-influence, physical and mental health problems, academic and vocational failure, and premature death. This document highlights four empirically-supported treatment suggestions for SUD / PSU in youth. Despite the magnitude of the problem, there is a paucity of safe and effective treatments for adolescents and young adults with SUD / PSU, suggesting the urgent need for additional research. [Author's abstract]