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elements of effective treatment were identified: (1) assessment and treatment matching; (2) comprehensive, integrated treatment approach; (3) family involvement in treatment; (4) developmentally appropriate programs; (5) strategies to engage and retain teens in treatment; (6) qualified staff; (7) gender and cultural competence; (8) continuing care; and (9) treatment programs. It is important for treatment programs to conduct ongoing evaluations of their effectiveness. At this point, research has not yet confirmed each of these elements, but they represent our best understanding of what works in teen treatment (CSAT, 2000c; Drug Strategies, 2003).

Assessment and Treatment Matching

Assessment (pretreatment screening) is an important first step to determine need for treatment. Unlike adults who often begin treatment once dependence or life-challenging problems emerge, youth may be referred to treatment primarily because of trouble at school or with the justice system. Understanding the extent to which youth have developed problems is a key to bringing appropriate resources to bear. Matching adolescents to appropriate treatment is based on considerations of age, gender, severity of problem (which is distinct from frequency and quantity of use), financial status, psychiatric comorbidity, cognitive functioning, and legal mandates (Jenson, Howard, and Yaffe, 1995; Brown, Tapert, Granholm, and Delis, 2000; Tarter, 1990; Tapert and Brown, 1999).

Distinguishing between use and abuse among adolescents is often more challenging than among adults. For example, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for substance use disorders were developed for adults and have significant limitations when applied to adolescents (Martin and Winters, 1998). Prematurely labeling teens as abusers can be harmful and may actually promote their progression from use to abuse. Those in need of treatment are also likely to have co-occurring psychiatric and psychological conditions.

Assessment is important to determine the type of treatment approach to which an adolescent may respond (Pickens and Fletcher, 1991; Bergmann, Smith, and Hoffman, 1995; Jainchill, Bhattacharyo, and Yagelka, 1995; Werner, 1995). If a program has a family component, there should be a thorough assessment of the family as well as an assessment of the multiple contexts in which the young person lives (e.g., family, peer, school). Treatment services provided to children of alcoholics and other drug users may be distinctly different from treatment services provided to those who do not have a situation in which other family members abuse and are dependent on substances.

Many adolescents experience academic problems and developmental delays as a result of alcohol and drug abuse and dependence. For these



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