Pharmacotherapy interventions for adolescent co-occurring substance use and mental health disorders: a systematic review
Open accessAbstract
Background: Co-occurring mental health and substance use (SU) disorders among adolescents are common, with two-thirds of adolescents who seek SU treatment also requiring support for mental health. Primary care physicians play a key role in the pharmacological treatment of mental health disorders among adolescents, however, little is known about the impact of these treatments on SU outcomes. Objectives: This systematic review summarizes the evidence regarding commonly used pharmacotherapy interventions for mental health and their impact on adolescent SU. Methods: Literature searches were conducted across five databases as part of a larger systematic review of adolescent SU interventions. Studies were screened for eligibility by two researchers, and study data were extracted regarding study design, patient and treatment characteristics and results. Risk of bias analyses and qualitative syntheses were completed to evaluate the strength of the evidence and the impact of pharmacotherapy on SU outcomes. Results: Ten randomized controlled trials exploring seven pharmacotherapies met criteria for inclusion. All studies had low to moderate risk of bias. Four studies evaluated pharmacotherapy for co-occurring depression and SU, three evaluated attention deficit hyperactivity disorder and SU, and three evaluated bipolar disorder and SU. Five of the 10 studies also included a behavioural intervention. We found no evidence that pharmacotherapy for co-occurring mental health diagnoses impacted SU. Conclusion: Family medicine clinicians prescribing pharmacotherapy for mental health should be aware that additional interventions will likely be needed to address co-occurring SU.
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Solely intervening with medications for non-substance related psychiatric concerns is insufficient to treat adolescent SUD.
“solely intervening with medications for non-substance related psychiatric concerns is insufficient to treat adolescent SUD (66)”
From Initial insights from a quality improvement initiative to develop an evidence-informed young adult substance use program (2022) · cites this paper as [66]
Cites
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,577 · see citing works
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
Hu, R. J. (2003) · Elsevier eBooks · doi:10.1016/b0-12-226870-9/01070-4 · Cited by 9,167 · see citing works
Sobell, L. C., & Sobell, M. B. (1992) · Measuring Alcohol Consumption · doi:10.1007/978-1-4612-0357-5_3 · Cited by 4,110 · see citing works
A Children's Global Assessment Scale (CGAS)
Shaffer, D. (1983) · Archives of General Psychiatry · doi:10.1001/archpsyc.1983.01790100074010 · Cited by 3,716 · see citing works
Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998) · Journal of Abnormal Child Psychology · doi:10.1023/a:1022602400621 · Cited by 1,772 · see citing works
Geddes, J. R., & Miklowitz, D. J. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60857-0 · Cited by 848 · see citing works
Cipriani, A., Zhou, X., Del Giovane, C., Hetrick, S. E., Qin, B., Whittington, C., Coghill, D., Zhang, Y., Hazell, P., Leucht, S., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30385-3 · Cited by 734 · see citing works
GELLER, B., COOPER, T. B., SUN, K., ZIMERMAN, B., FRAZIER, J., WILLIAMS, M., & HEATH, J. (1998) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199802000-00009 · Cited by 526 · see citing works
The Hamilton Rating Scale for Depression
Hamilton, M. (1986) · Springer eBooks · doi:10.1007/978-3-642-70486-4_14 · Cited by 463 · see citing works
Chan, Y.-F., Dennis, M. L., & Funk, R. R. (2008) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2006.12.031 · Cited by 443 · see citing works
Zhou, X., Teng, T., Zhang, Y., Del Giovane, C., Furukawa, T. A., Weisz, J. R., Li, X., Cuijpers, P., Coghill, D., Xiang, Y., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30137-1 · Cited by 367 · see citing works
der Oord, S. V., Prins, P. J. M., Oosterlaan, J., & Emmelkamp, P. M. G. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.10.007 · Cited by 337 · see citing works
Grading the strength of a body of evidence when assessing health care interventions: an EPC update
Berkman, N. D., Lohr, K. N., Ansari, M. T., Balk, E. M., Kane, R., McDonagh, M., Morton, S. C., Viswanathan, M., Bass, E. B., Butler, M., et al. (2015) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2014.11.023 · Cited by 279 · see citing works
Self-citationChildren's Depression Rating Scale--Revised
Poznanski, E. O., GROSSMAN, J. A., BUCHSBAUM, Y. Y., Banegas, M., Freeman, L., & Gibbons, R. D. (1984) · PsycTESTS Dataset · doi:10.1037/t55280-000 · Cited by 253 · see citing works
Trends in Office-Based Mental Health Care Provided by Psychiatrists and Primary Care Physicians
Olfson, M., Kroenke, K., Wang, S., & Blanco, C. (2014) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.13m08834 · Cited by 221 · see citing works
Adolescent heavy episodic drinking trajectories and health in young adulthood.
Oesterle, S., Hill, K. G., Hawkins, J. D., Guo, J., Catalano, R. F., & Abbott, R. D. (2004) · Journal of Studies on Alcohol · doi:10.15288/jsa.2004.65.204 · Cited by 199 · see citing works
Hogue, A., Henderson, C. E., Becker, S. J., & Knight, D. K. (2018) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2018.1466307 · Cited by 197 · see citing works
Self-citationImpact of psychiatric comorbidity on treatment of adolescent drug abusers
Rowe, C. L., Liddle, H. A., Greenbaum, P. E., & Henderson, C. E. (2004) · Journal of Substance Abuse Treatment · doi:10.1016/s0740-5472(03)00166-1 · Cited by 184 · see citing works
O'Neil, K. A., Conner, B. T., & Kendall, P. C. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.08.002 · Cited by 166 · see citing works
Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions
Anderson, L. E., Chen, M. L., Perrin, J. M., & Cleave, J. M. V. (2015) · PEDIATRICS · doi:10.1542/peds.2015-0807 · Cited by 166 · see citing works
Hogue, A., Henderson, C. E., Ozechowski, T. J., & Robbins, M. S. (2014) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2014.915550 · Cited by 151 · see citing works
Riggs, P., Mikulich‐Gilbertson, S. K., Davies, R. D., Lohman, M., Klein, C., & Stover, S. K. (2007) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.161.11.1026 · Cited by 147 · see citing works
Hanwella, R., Senanayake, M., & de Silva, V. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-176 · Cited by 137 · see citing works
Antidepressants for the treatment of people with co-occurring depression and alcohol dependence
Agabio, R., Trogu, E., & Pani, P. P. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008581.pub2 · Cited by 131 · see citing works
Riggs, P. D., Winhusen, T., Davies, R. D., Leimberger, J. D., Mikulich-Gilbertson, S., Klein, C., Macdonald, M., Lohman, M., Bailey, G. L., Haynes, L., et al. (2011) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2011.06.010 · Cited by 124 · see citing works
Shane, P., Jasiukaitis, P., & Green, R. S. (2003) · Evaluation and Program Planning · doi:10.1016/s0149-7189(03)00055-7 · Cited by 113 · see citing works
Double-blind fluoxetine trial in comorbid MDD-CUD youth and young adults.
Cornelius, J. R., Bukstein, O. G., Douaihy, A. B., Clark, D. B., Chung, T. A., Daley, D. C., Wood, D. S., & Brown, S. J. (2010) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2010.05.010 · Cited by 105 · see citing works
Brief Behavioral Interventions for Substance Use in Adolescents: A Meta-analysis
Steele, D. W., Becker, S. J., Danko, K. J., Balk, E. M., Adam, G. P., Saldanha, I. J., & Trikalinos, T. A. (2020) · Pediatrics · doi:10.1542/peds.2020-0351 · Cited by 99 · see citing works
Self-citation2015 Recommendations for Preventive Pediatric Health Care
(2015) · Pediatrics · doi:10.1542/peds.2015-2009 · Cited by 97 · see citing works
Thurstone, C., Riggs, P. D., Salomonsen-Sautel, S., & Mikulich-Gilbertson, S. K. (2010) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2010.02.013 · Cited by 96 · see citing works
Medication Use in US Youth With Mental Disorders
Merikangas, K. R., He, J.-P., Rapoport, J. L., Vitiello, B., & Olfson, M. (2012) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2013.431 · Cited by 93 · see citing works
Riggs, P. D., Hall, S. K., Mikulich-Gilbertson, S. K., Lohman, M., & Kayser, A. (2004) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200404000-00008 · Cited by 89 · see citing works
Cornelius, J. R., Bukstein, O. G., Wood, D. S., Kirisci, L., Douaihy, A. B., & Clark, D. B. (2009) · Addictive Behaviors · doi:10.1016/j.addbeh.2009.03.008 · Cited by 79 · see citing works
Treating Mental Health and Substance Use Disorders in Adolescents: What Is on the Menu?
Brewer, S., Godley, M. D., & Hulvershorn, L. A. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0755-0 · Cited by 79 · see citing works
Pharmacological treatment of attention deficit hyperactivity disorder with co-morbid drug dependence
Cunill, R., Castells, X., Tobias, A., & Capellà, D. (2015) · Journal of Psychopharmacology · doi:10.1177/0269881114544777 · Cited by 78 · see citing works
Self-reported health problems and physical symptomatology in adolescent alcohol abusers
Arria, A. M., Dohey, M. A., Mezzich, A. C., Bukstein, O. G., & Thiel, D. H. V. (1995) · Journal of Adolescent Health · doi:10.1016/1054-139x(94)00066-n · Cited by 56 · see citing works
Onset of alcohol or substance use disorders following treatment for adolescent depression.
Curry, J., Silva, S., Rohde, P., Ginsburg, G., Kennard, B., Kratochvil, C., Simons, A., Kirchner, J., May, D., Mayes, T., et al. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0026929 · Cited by 51 · see citing works
Findling, R. L., Pagano, M. E., McNamara, N., Stansbrey, R. J., Faber, J. E., Lingler, J., Demeter, C., Bedoya, D., & Reed, M. D. (2009) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-3-11 · Cited by 44 · see citing works
Integrating Substance Use Treatment Into Adolescent Health Care
Sterling, S., Valkanoff, T., Hinman, A., & Weisner, C. M. (2012) · Current Psychiatry Reports · doi:10.1007/s11920-012-0304-9 · Cited by 42 · see citing works
Zhou, X., Qin, B., Giovane, C. D., Pan, J., Gentile, S., Liu, Y., Lan, X., Jia, Y., & Xie, P. (2014) · Addiction · doi:10.1111/add.12698 · Cited by 38 · see citing works
2021 Recommendations for Preventive Pediatric Health Care
Hackell, J. M., Abularrage, J. J., Almendarez, Y. M., Boudreau, A. D. A., Berhane, A. M., Cantrell, P. E., Kafer, L. M., Schafer, K. S., Skatrud, A., Warner, R., et al. (2021) · PEDIATRICS · doi:10.1542/peds.2020-049776 · Cited by 36 · see citing works
Interventions for Substance Use Disorders in Adolescents: A Systematic Review
Steele, D. W., Becker, S. J., Danko, K. J., Balk, E. M., Saldanha, I. J., Adam, G. P., Bagley, S. M., Friedman, C., Spirito, A., Scott, K., et al. (2020) · doi:10.23970/ahrqepccer225 · Cited by 34 · see citing works
Self-citationDelBello, M. P., Kadakia, A., Heller, V., Singh, R., Hagi, K., Nosaka, T., & Loebel, A. D. (2021) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2021.03.021 · Cited by 34 · see citing works
Treatments for Adolescents With Comorbid ADHD and Substance Use Disorder: A Systematic Review
Zaso, M. J., Park, A., & Antshel, K. M. (2020) · Journal of Attention Disorders · doi:10.1177/1087054715569280 · Cited by 31 · see citing works
Pharmacotherapies for co‐occurring substance use and bipolar disorders: A systematic review
Coles, A. S., Sasiadek, J., & George, T. (2019) · Bipolar Disorders · doi:10.1111/bdi.12794 · Cited by 20 · see citing works
Effectiveness of medication for opioid use disorders in transition-age youth: A systematic review
Becker, S. J., Scott, K., Helseth, S. A., Konnyu, K. J., Balk, E. M., Saldanha, I. J., Adam, G. P., & Steele, D. W. (2021) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2021.108494 · Cited by 19 · see citing works
Self-citationFluyau, D., Revadigar, N., & Pierre, C. G. (2020) · American Journal on Addictions · doi:10.1111/ajad.13133 · Cited by 13 · see citing works
Integrated Care Key for Patients With Both Addiction and Mental Illness
Kuehn, B. M. (2010) · JAMA · doi:10.1001/jama.2010.597 · Cited by 12 · see citing works
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Hogue, A., Porter, N., Henderson, C. E., Ozechowski, T. J., Wenzel, K., Fishman, M. J., & Becker, S. J. (2025) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2025.2521855 · Cited by 9 · see citing works
Self-citationHalladay, J., Stead, V., McCarron, C., Kennedy, M., King, K., Venantius, M., Carter, A., Syan, S., Matthews, M., Khoshroo, S., et al. (2022) · medRxiv · doi:10.1101/2022.10.21.22281362 · Cited by 5 · see citing works
“Although it is important to simultaneously treat psychiatric disorders with medications where indicated, solely intervening with medications for non-substance related psychiatric concerns is insufficient to treat adolescent SUD (66) and other psychological and pharmacological interventions for SUDs should be delivered…”
BackgroundInfluentialFamily Practice substance use disorder theme issue: commentary
Spigt, M., & Scherrer, J. F. (2022) · Family Practice · doi:10.1093/fampra/cmac008 · Cited by 3 · see citing works
- Authors
- Scott, K., Becker, S. J., Helseth, S. A., Saldanha, I. J., Balk, E. M., Adam, G. P., Konnyu, K. J., & Steele, D. W.
- Affiliations
- Brown University (US)
- Corresponding author
- Scott, Kelli
- ORCID
- Venue
- Family Practice
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-08-27
- Volume
- 39
- Issue
- 2
- Pages
- 301-310
- ISSN
- 0263-2136 (ISSN-L)
- 1460-2229
- PMC
- PMC9126201
- OpenAlex
- W4229031669
- Cited by
- 3
- References
- 49
- Citations by year
- 2025: 1 · 2022: 2
- FWCI
- 0.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Family Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (K23DA050729, K23DA048062)
- U.S. Department of Health and Human Services
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- adolescent substance use, co-occurring mental health disorders, pharmacotherapy, depression, attention deficit hyperactivity disorder, bipolar disorder, primary care prescribing, general practice, substance use outcomes, behavioral interventions
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Behavior Therapy, Mental Disorders, Bipolar Disorder, Humans, Mental Health, Substance-Related Disorders
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