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There are two general developmental paths for adolescent AOD use. For most adolescents various patterns of AOD use begin in adolescence and decline substantially with the transition to young adulthood suggesting that some adolescent AOD use patterns are a normal part of adolescent exploration of adult behaviors.

However, a small percentage of adolescents continue their AOD abuse into young adulthood and these problems that are maintained can usually be predicted by adolescent problem behavior and not necessarily by the patterns of AOD use during adolescence. The initial use, continuance, and possible AOD abuse are typically the result of a complex interaction of biological vulnerabilities including psychiatric disorders and different pharmacological responses, psychological vulnerability to the effects or the perceived effects of AOD use, parental and peer influences, life events, and other socio-cultural and environmental factors.

Substance use among adolescents is particularly dangerous because adolescence is a period of critical physical, mental, emotional, and social development. The challenge in working with adolescents is to distinguish between normal transitional risk-taking behaviors that are non-problematic and those same behaviors that, by their frequency, and intensity, are problematic expressions both now and possibly in the future.

Without effective treatment many adolescents can experience significant dysfunctional behavior that can not only seriously compromise their physical, psychological, and social development, but these adolescents are at high risk for the development of significant physiological, psychological, and social problems as adults and their AOD use can affect the people around them. The many transitions that occur during adolescence represent windows of opportunity to intervene to change courses of behavior that are already changing, away from problem behaviors and redirecting them to more positive adjustment (Schulenberg, Maggs, Steiman, & Zucker, 2001).

Traditionally, treatment for adolescent AOD use problems was based upon adult diagnostic and treatment models. However, research has shown that adolescent AOD users have unique characteristics that are different from adult AOD users. As a result, new programs have been developed that take into account the unique characteristics of adolescent AOD users and the role their families can play in recovery.

Therapy and treatment for adolescent AOD users is further complicated by the fact that most adolescents are in treatment as a result of external requirements or pressure by families, school officials, the court system, and other authorities. As a result, many of them are reluctant, if not resistant, to fully participating in the treatment process.

The research and clinical experience has shown that these intervention efforts can be successful especially if attention is paid to motivating the adolescent for treatment, involving the family in the treatment and long-term recovery process, and treating any related psychological and social problems. While the challenges of working with adolescents are great, the rewards can also be significant for the adolescent, the family, counselors and treatment personnel, the school system, the courts system, and the community.