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Developmental Appropriateness Program models specifically designed for adolescents are more effective than programs based on adult regimens. Adolescent treatment needs to emphasize maturational issues, psychological issues, and emotional and sexual issues. Treatment programs should be tailored to the different cognitive abilities of older and younger adolescents and deal differently with concrete versus abstract styles of thinking.

Retention Underage drinkers are often less motivated than adults to participate in treatment. They are often referred through delinquent acts at school or through the criminal justice system; they rarely self-refer. Programs need to develop strategies that engage and retain teenagers in treatment. Retaining underage abusers in treatment often requires the application of age-appropriate sanctions and rewards.

Gender and Cultural Issues It is important to recognize issues that are particular to some groups. For instance, there is a correlation between childhood trauma and substance abuse for girls and women. Often, female substance abusers have been sexually abused. For these reasons, it is contraindicated to put girls in a coed setting for treatment. Other differences along race and ethnicity must also be considered and attended to as a part of treatment. Alcohol use is often defined as part of a cultural context and certain cultural attitudes may affect use patterns as well as how an adolescent understands his or her alcohol use. Treatment programs that can attend to these differences may have greater potential to produce successful outcomes compared to those that do not.

Continuing Care Continuing care is crucial to achieving positive long-term outcomes (McKay et al., 2002). Underage drinkers who require intense treatment will also require intense continuing care. Currently, continuing care for adolescent drug and alcohol problems is rarely available. There is little research on continuing care to provide guidance regarding what kinds of continuing care are the most effective for these adolescents. Additional research in this area would be useful.

Assessment of Outcomes Most adolescent treatment programs have not been rigorously evaluated, though many keep track of outcome data and are able to provide statistics that suggest the effectiveness of the treatment and recovery strategies (SAMSHA, 2000; Pickens and Fletcher 1991; Bergmann et al., 1995; Jainchill et al., 1995; Werner, 1995). One of the challenges for treatment providers is that evaluation of treatment programs is costly and difficult (Kaminer and Bukstein, 1989; Milby, 1981). However, evaluation not only validates effective approaches, it also provides



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