Abstract
Most substance use begins in adolescence. Both childhood trauma and associated post-traumatic stress disorder (PTSD) increase risk for early substance use, which is associated with greater eventual severity of substance use disorders (SUDs). When co-occurring, PTSD and SUD can reinforce and exacerbate each other, necessitating integrated treatment approaches. To systematically review existing literature on interventions for prevention or treatment of SUDs among adolescents (aged 10–24) with a history of trauma, with or without PTSD, we searched databases (PubMed, PsycInfo, CINAHL, Cochrane CENTRAL) using search terms related to substance use, trauma, adolescents, and interventions. Searches identified 8134 unique articles, 68 of which prompted full-text screening. Authors extracted data, applied the Effective Public Health Practice Project Quality Assessment Tool to evaluate the evidence, and synthesized findings. Thirty three articles met eligibility criteria, including 13 RCTs. Twenty studies (10 RCTs) evaluated interventions for substance use and co-occurring problems among youth with a history of trauma, predominantly via individual therapy based on cognitive-behavioral principles, although group therapy, case management, and other approaches have also been studied. Interventions with exposure-based components were infrequent but had robust results and minimal adverse outcomes. Thirteen studies examined differential response of youth with a history of trauma to standard SUD treatments, compared to youth without a history of trauma, with mixed findings. Youth with a history of trauma face elevated risk of SUDs and may respond differently to SUD treatments. Several promising interventions have been recently developed.
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The authors thank Lily Martin, medical librarian, for her assistance with the search strategy.
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This project was supported by the Resident Training Award in Substance Use Disorders, sponsored by the American Academy of Child and Adolescent Psychiatry (AACAP) and National Institute on Drug Abuse (NIDA). Views expressed do not reflect positions of AACAP or NIDA.
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T.D.B. conceived and designed the study, collected the data, performed analysis, prepared tables and figures, and wrote the main manuscript text. S.C.R., A.B.B., and A.L. collected data and performed analysis. T.R.R. and I.I. supervised design and data collection and revised the manuscript. All authors reviewed the manuscript.
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Becker, T.D., Castañeda Ramirez, S., Bruges Boude, A. et al. Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature. Eur Child Adolesc Psychiatry (2023). https://doi.org/10.1007/s00787-023-02265-x
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DOI: https://doi.org/10.1007/s00787-023-02265-x