Evidence-Based Reviews

Crossing the line: When does teen substance use become abuse or dependence?

Current Psychiatry. 2003 July;2(7):31-41

References

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23. Deas DV, Randall C, Roberts J, Anton R. A double-blind, placebo-controlled trial of sertraline in depressed adolescent alcoholics: a pilot study. Human Psychopharmacology Clinical and Experimental 2000;15:461-9.

24. Geller B, Cooper T, Sun K, et al. Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependency. J Am Acad Child Adolesc Psychiatry 1998;37:171-8.

Depression. Deas et al²³ randomized 10 adolescents with alcohol use disorders and depression to 12 weeks of group CBT plus sertraline or placebo. Sertraline was started at 25 mg/d and titrated to a maximum of 100 mg/d. Drinks per drinking day, percent of days drinking, and Hamilton Rating Scale for Depression scores declined similarly in both groups.

Drinking decreased significantly from baseline (by an average 4.7 drinks), and adolescents in both groups no longer met DSM-IV criteria for depression at the end of treatment. CBT’s effectiveness in treating alcohol use disorders and depression might have concealed any difference in effect between sertaline and placebo.

Bipolar disorder. Geller et al²⁴ randomly assigned 25 adolescents with bipolar disorder and substance dependence to lithium or placebo for 6 weeks. Lithium was started as an evening dose of 600 mg and titrated to achieve a lithium blood level of 0.9 to 1.3 mEq/L. Among the 21 adolescents who completed the trial, those receiving lithium had significantly fewer positive urine toxicology screens and higher clinical global assessment of function scores.

Related resources

National Clearinghouse for Alcohol and Drug Information, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. www.health.org/govpubs/bkd306/31k.aspx
National Institute on Alcohol Abuse and Alcoholism (assessment instruments). www.niaaa.nih.gov/publications/instable.htm
Deas D, Thomas SE. An overview of controlled studies of adolescent substance abuse treatment. Am J Addict 2001;10:178-89.

Drug brand names

Sertraline • Zoloft

Disclosure

Dr. Deas receives grant support from Pfizer, Inc. and the National Institute of Alcohol Abuse and Alcoholism.

Dr. Upadhyaya receives grant support from the National Institute of Drug Abuse and GlaxoSmithKline.

Acknowledgment

The authors wish to thank Alva Blair for assistance with preparing this manuscript and Natalie Johnson, MA, Kess Mughelli, BS, and Lakeleia Middleton-Robinson, MA, for technical support.