Moderators and mediators of treatments for youth with substance abuse

Adolescence is a period when substance use problems often emerge. Accordingly, efficacious, empirically valdated interventions, which can arrest the development of substance abuse by targeting etiologically relevant risk, promotive, and protective factors, are critically important. Enhanced understanding of factors that qualify intervention effects and the mechanisms by which interventions affect behavior is necessary to maximize effectivness. This chapter provides an overview of the developmental progression from substance use to disorder during adolescence and the etiologic foundations upon which current treatment efforts are based. A review of the literature regarding moderating factors that may contribute to the individual variability seen in adolescent treatment outcomes, and the mechanisms by which treatment change is hypothesized to occur, is presented. Special emphasis is given to randomized clinical trials conducted with selective and indicated preventive interventions for early (beginning at age 13) to late (age 18-21) adolescents.