Breaking the Cycle: Preventing and Treating Addiction in Youth

Virtually all addictions begin during adolescence. And nearly 4 million 12-25 year olds in the United States have a substance abuse problem, according to the U.S. Department of Health & Human Services. Substance abuse in adolescents is not restricted to opioids, but in the midst of this national crisis, too many young people are finding themselves in the grips of opioid addiction.

In 2016, 3.6 percent of adolescents aged 12-17 reported misusing opioids over the past year. Among 18-25 year olds, that number was even higher: 7.3 percent. Between 1999 and 2016, 56,428 adolescents and young adults (ages 15-24 years) died from a drug overdose.

These staggering statistics underscore the need for effective treatment programs. At Nationwide Children’s Hospital, members of the Adolescent Medicine Substance Abuse Program and Medication-Assisted Treatment for Addiction (MATA) Program have found that medication-assisted treatment (MAT), combined with behavioral health interventions and a focus on patient retention, results in more patients who enter and stay in recovery.

Despite the growing body of evidence showing the effectiveness of MAT in the treatment of opioid use disorders, providers – and even patients and parents – have been hesitant to embrace it. For some, treating opioid addiction with an opioid seems counterintuitive. They see the goal of recovery as being substance-free. For those for whom MAT has been life-saving, however, the understanding that medication can be part of a recovery process that enables them to live healthy, productive lives has made all the difference.

Relapse without MAT is high. According to the National Institute of Drug Abuse, MAT decreases the incidence of opioid use, opioid-related overdose deaths, criminal activity and infectious disease transmission. It also increases social functioning and retention in treatment.

Unfortunately, the adolescents and young adults are among those most likely not to receive MAT. According to a study recently published in JAMA Pediatrics, a majority of adolescents and young adults diagnosed with opioid use disorder are not receiving the recommended MAT. In fact, only 24 percent of youths aged 13-22 years receive one of the three FDA-approved medications – methadone, buprenorphine and naltrexone – within 3 months of diagnosis. For those under age 18, only 1 in 21 receives medication.

“There are far too few pediatric providers who prescribe medications for addiction, and stigma is still playing a role in deterring many patients and families from using these evidence-based medications,” said Scott Hadland, MD, MPH, MS, pediatrician and researcher at the Grayken Center for Addiction at Boston Medical Center in a press release.

In the MATA Program at Nationwide Children’s, the team uses buprenorphine/naloxone (brand names Suboxone^® and Zubsolv^®) as part of the comprehensive program. But that’s not the case everywhere. Among all treatment programs for youth listed by the Substance Abuse and Mental Health Services Administration, only 37 percent offer MAT. In some cases, programs may deny admission to young people who are already on a maintenance medication.

“We use buprenorphine for three main purposes: first, to suppress withdrawal; second, to block or decrease the euphoric effect of illicit opiates; third, to titrate doses to minimize or even eliminate the craving for opioids. In combination with talk therapy and meeting other health needs, this approach gives our young patients the best chance at recovery,” says Steve Matson, MD, medical director of the Adolescent Substance Abuse Program at Nationwide Children’s.

Patients in the MATA Program face a wide variety of challenges in addition to addiction, including pregnancy, sexually transmitted infections, hepatitis C, depression and anxiety. Integration into a primary care clinic supports coordinated care and reduces intake times. “We treat the whole patient, not just the withdrawal issues,” Dr. Matson says.

The key components of the MATA Program at Nationwide Children’s include:

• Point-of-care urine testing
• Narcan^® overdose kits provided to every patient
• Weekly visit to the Adolescent Medicine Clinic
• Mental health assessments at 3 and 6 weeks

And now, the team can add integrated behavioral health support to the list. In the summer of 2018, Ashley Garrett, LISW-S, LICDC, became the MATA outpatient clinician. The position is partially funded by a grant from the Nationwide Children’s Foundation. “Therapy for patients with addiction is incredibly important,” she says. “Many have a trauma history that has impacted their self-efficacy, and an appropriate therapeutic relationship is instrumental in demonstrating healthy relationships, improving one’s self-concept and developing skills needed for life.”

Some people are reluctant to participate in therapy, she adds. They don’t want to “talk feelings.” But getting a feel of the emotional landscape that contributed to addiction is essential for recovery.

Even so, therapy as part of treatment for addiction isn’t all talk about feelings.

“One of the things that we work on in addiction recovery therapy is answering these questions: What does a life in recovery look like for you? What does a recovered life look like? Once we know where we’re going, we can talk about strategies to support and sustain that recovered life,” Garrett says.

Treatment and prevention have a lot in common from the behavioral health perspective. Preventing a teenager from abusing drugs starts long before they hit adolescence. And it requires more than scare tactics, “just say no” campaigns, and a parent’s watchful eye. So does treatment.

Building resilience and making sure behavioral health needs are met is crucial to helping people at risk for addiction disorders. In fact, the U.S. Department of Health & Human Services lists “building strong relationships with adolescents” as the first step to connecting with youth on drug prevention. It’s also the first step to connecting with them on treatment.

“Historically, I thought one of the biggest challenges to treatment for patients with addiction from the behavioral health side was managing the externalizing behaviors – the opposition and aggression,” says Garrett. “After being in the field for several years, I see that it really comes down to love and belonging. The behaviors are a defense mechanism and a means of self-preservation.”

“We can teach skills and techniques to manage substance use triggers and support recovery,” she continues. “But it’s more difficult to help find loving and supportive people to help them feel worthy to pursue recovery.”

Those relationships can come from support groups and by destigmatizing addiction disorders.

In his visit to Nationwide Children’s in March 2018, National Institutes of Health Director Francis Collins, MD, PhD, toured the MATA Program. He acknowledged the difficulties that youth with addiction face and how the program can help.

“These kids, who virtually all come from difficult circumstances, feel it is safe to come and have a warm embrace from a care team that really wants to get to know them and isn’t going to stigmatize them,” he said.