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This webinar provided an interactive learning experience for attendees to explore adolescent substance use and new paths for research. Presenter Niranjan Karnik, MD, PhD, director of the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN) Great Lakes Node, reviewed recent data trends related to the prevalence of substance use among teens, described current treatment approaches, and talked about the pros and cons of social media and digital mental health interventions.

Adolescent substance use (SU) presents a distinct public health challenge, as this developmental stage carries heightened vulnerability for progression to problematic use. Early SU—before age 18—is a major risk factor for later Substance Use Disorders (SUD), with long-term neurobiological and psychosocial consequences. National surveillance data show a continued decline in alcohol and cigarette use, yet persistent concerns around cannabis (including synthetic variants) and sharp increases in vaping. The frequent occurrence of polysubstance use further complicates prevention and intervention efforts.

The intersection of SU and mental health conditions, such as anxiety and depression, compounds these challenges. The 2024 National Survey on Drug Use and Health data reveal that nearly one-third (27.9%) of adolescents aged 12–17 with both SUD and a Major Depressive Episode receive no treatment for either condition. Despite promising evidence-based interventions, their implementation remains limited, revealing a critical translational gap between research efficacy and real-world effectiveness.

To close this gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) is leveraging its multi-site research infrastructure to conduct pragmatic clinical trials that emphasize the inclusion of adolescents from all backgrounds. The CTN’s agenda identifies six priorities to advance scalable, impactful solutions:

• Implementation Science and Real-World Effectiveness – embedding interventions into existing systems of care.
• Precision Medicine and Personalized Interventions – integrating biological, psychological, and social data to tailor treatments.
• Family and Environmental Contexts – expanding family-based and peer-supported models.
• Digital Innovations and Technology Integration – evaluating technology-assisted and AI-driven interventions.
• Longitudinal Outcomes and Lifespan Perspective – assessing developmental, academic, and quality-of-life outcomes over time.
• Community-Led and Co-Designed Research – engaging community partners and individuals with lived experience as co-researchers.

Through this coordinated agenda, the CTN aims to build an equitable, evidence-informed framework that bridges discovery and practice, drives innovation, and informs policies that foster resilient, healthy futures for adolescents nationwide.

This presentation delved into implications of basic emotion science for innovative, mechanistic research on substance use prevention, treatment, and harm reduction. Informed by psychology, neuroscience, and addiction science, Dr. Shiota highlighted distinct research questions revealed through this lens, as well as opportunities for intervention.

Incidence, prevalence, and persistence of substance use differ by
generation and by substance. Understanding how each generation
uses alcohol and other drugs, why, and how health is implicated is
critical for public health. The presentation will overview what we
know about current trends in substance use, how rates are organized by age, period, and cohort, and how these trends are shaping public
health overall.

Compared to the general population, persons entering addiction treatment are three to four times more likely to be tobacco dependent and even addiction treatment staff members are two to three times more likely to be tobacco dependent. In these settings, tobacco use continues to be the norm; however, addiction treatment programs are increasingly aware of the need to assess for and treat tobacco dependence. The problem is a cultural issue that is so ingrained that assumptions about tobacco use and dependence in addiction treatment are rarely questioned. Denial, minimization, and rationalization are common barriers to recovery from other addictions; now is the time to recognize how tobacco use and dependence must be similarly approached. This article describes the Addressing Tobacco through Organizational Change (ATTOC) model, which has successfully helped many addiction treatment programs to more effectively address tobacco use. The article will review the six core strategies used to implement the ATTOC intervention, the 12-step approach guiding the model, and describe a case study where the intervention was implemented in one clinic setting (at Willamette Family Treatment Services, part of the CTN Oregon/Hawaii Node). Other treatment programs may use the experience and lessons learned from this CTN platform study about the ATTOC organization change model to better address tobacco use in the context of drug abuse treatment.

This presentation highlights the role of primary care setting as a conduit for evidence-based intervention access for families. In addition, attention will be given the need to focus on system level interventions to reduce the need for families and youth to be “resilient.”

Dr. Kaliamurthy’s presentation examines a case involving an adolescent who sought treatment within a pediatric health care system for fentanyl use. The focus is on the challenges identified in delivering care to adolescents with opioid use disorder. He also highlights barriers to treatment that must be overcome to deliver the minimum necessary care to ensure engagement in medication treatment for opioid use disorder and reducing overdose risk.

Dr. Graham’s presentation describes the development of the first
vaping cessation intervention for adolescents and young adults,
presents the results of two randomized clinical trials evaluating the
effectiveness of the program, and discusses ongoing work to disseminate the program to young people across the U.S.

In their complementary presentations, Drs. Hammond and Hinckley discuss the association between cannabis use and suicide-related outcomes among youth and young adults. Dr. Hammond presents findings from a study that used 20 years of national mortality data to examine the impact of medical and recreational cannabis legalization on suicide-related mortality among US 12-to-25-year-olds, focusing on variations by age, sex, race, and ethnicity. These findings are discussed within the context of current medical literature on cannabis policy effects and health disparities, with an emphasis on mechanisms, vulnerable
subgroups, and legislative reform. Dr. Hinckley presents data from a secondary analysis of the National Comorbidity Survey-Adolescent Supplement, involving youth aged 13-18. This study explores the association between cannabis use, major depressive disorder, and suicidal behavior. Findings are considered within existing literature to further understand how cannabis use and depression together may increase suicide risk among youth.

The objectives of this talk include 1) Describe the unique risk and protective factors
for substance use among Black adolescents; 2) Examine the evidence for culturally sensitive interventions for substance use prevention among Black adolescents; and
3) Identify opportunities for culturally tailored digital interventions for substance
use prevention among Black adolescents with a specific focus on family-based
interventions.

The purpose of this study, part of NIDA-CTN-0117, was to examine changes in addiction medicine treatment utilization during the COVID-19 pandemic among adolescents (aged 13–17 years) and differences by race/ethnicity.

Researchers compared treatment initiation (overall and telehealth), engagement, and 12-week retention between insured adolescents with substance use problems during pre-COVID-19 (March to December 2019, n = 1,770) and COVID-19 (March to December 2020, n = 1,177) using electronic health record data from Kaiser Permanente Northern California.

Compared to pre-COVID-19, odds of treatment initiation, overall (adjusted odds ratio [95% confidence interval] = 1.42 [1.21–1.67]), and telehealth (5.98 [4.59–7.80]) were higher during COVID-19, but odds of engagement and retention did not significantly change. Depending on the outcome, Asian/Pacific Islander, Black, and Latino/Hispanic (vs. White) adolescents had lower treatment utilization across both periods. Changes in utilization over time did not differ by race/ethnicity.

Conclusions: Addiction medicine treatment initiation increased among insured adolescents during the pandemic, especially via telehealth. Although racial/ethnic disparities in treatment utilization persisted, they did not worsen.

Related protocols: CTN-0117

Transition Age Youth (TAY), aged 18-25 years, face barriers to medication treatment for opioid use disorder (MOUD) resulting in lower retention. We evaluated OUD prevalence and MOUD receipt comparing TAY to adults aged 26 or older residing in rural settings.

Electronic Health Records (October 2019 – January 2021) for 36,762 patients across six primary care clinics involved in a large feasibility trial (CTN-0102) in US rural communities were analyzed. All clinics implemented a standardized intervention. Mixed effects logistic/linear regression estimated odds of OUD diagnosis among all patients; and among those with OUD, the odds of receiving MOUD and days prescribed MOUD during the 15-month study period, comparing age categories (TAY=18-25 years vs. adults 26 or older). Covariates included gender, race, ethnicity, mental health comorbidities, and insurance status.

OUD prevalence was 2.82% among TAY (n=3,122) and 3.24% among adults aged 26 or older (n=33,208). After adjusting for covariates and clustering, TAY had significantly lower odds of OUD diagnosis compared to adults 26 years or older (OR=0.58, 95% CI 0.45 to 0.73). There were no significant differences in MOUD receipt between age groups. Compared to adults 26 or older, TAY with OUD had significantly fewer MOUD days during the study, -43.81 days (-76.85 to -10.77).

Conclusions: While no differences were observed in MOUD prescription receipt between TAY and adults 26 or older, TAY with OUD had fewer total days prescribed MOUD indicating lower retention. Further research generalizable to rural communities is needed to assess retention among rural TAY with OUD.

Related protocols: CTN-0102

This presentation reviews the role of Community-Based Participatory Research (CBPR) principles and practices in the implementation of evidence-based and/or community-informed practices. It will include illustrations from current and recent studies of community engagement in identification of barriers and facilitators, co-design of implementation strategies, and conduct of formative evaluations of implementation process and outcomes using the RAPICE (Rapid Assessment Procedures-Informed Community Ethnography) methodology.

This presentation focuses on barriers faced by youth involved in the legal system to access treatment, ongoing efforts going across Indiana to improve training in evidence-based treatment, as well as implementation strategies to improve treatment.

Efficient screening tools that effectively identify substance use disorders (SUDs) among youths are needed. The objective of this study, part of CTN-0060-A-1, was to evaluate the psychometric properties of 3 brief substance use screening tools (Screening to Brief Intervention [S2BI]; Brief Screener for Tobacco, Alcohol, and Drugs [BSTAD]; and Tobacco, Alcohol, Prescription Medication, and Other Substances [TAPS]) with adolescents aged 12 to 17 years.

This cross-sectional validation study was conducted from July 1, 2020, to February 28, 2022. Participants aged 12 to 17 years were recruited virtually and in person from 3 health care settings in Massachusetts: (1) an outpatient adolescent SUD treatment program at a pediatric hospital, (2) an adolescent medicine program at a community pediatric practice affiliated with an academic institution, and (3) 1 of 28 participating pediatric primary care practices. Participants were randomly assigned to complete 1 of the 3 electronic screening tools via self-administration, followed by a brief electronic assessment battery and a research assistant-administered diagnostic interview as the criterion standard measure for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnoses of SUDs. Data were analyzed from May 31 to September 13, 2022.

The main outcome was a DSM-5 diagnosis of tobacco/nicotine, alcohol, or cannabis use disorder as determined by the criterion standard World Mental Health Composite International Diagnostic Interview Substance Abuse Module. Classification accuracy of the 3 substance use screening tools was assessed by examining the agreement between the criterion, using sensitivity and specificity, based on cut points for each tool for use disorder, chosen a priori from previous studies.

This study included 798 adolescents, with a mean (SD) age of 14.6 (1.6) years. The majority of participants identified as female (415 [52.0%]) and were White (524 [65.7%]). High agreement between screening results and the criterion standard measure was observed, with area under the curve values ranging from 0.89 to 1 for nicotine, alcohol, and cannabis use disorders for each of the 3 screening tools.

Conclusions: These findings suggest that screening tools that use questions on past-year frequency of use are effective for identifying adolescents with SUDs. Future work could examine whether these tools have differing properties when used with different groups of adolescents in different settings.

Related protocols: CTN-0060-A-1