Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, Update 2018-2023: Current Status, Best Practices, and Opportunities for Advancing the Science.

OBJECTIVE This systematic review (1) updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Hogue, Henderson, Becker, and Knight (2018); and (2) addresses public health concerns related to youth marijuana and opioid use. METHOD We first summarize the earlier updates, along with those from recent literature reviews and meta-analytic studies, of ASU treatments. We then present study design and methods criteria used to identify five comparative studies subjected to JCCAP level of support evaluation. We detail these five studies in terms of their sample characteristics, quality of evidence, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach. RESULTS These cumulative designations are identical to those of the previous review: ecological family-based treatment, individual cognitive-behavioral therapy, and group cognitive-behavioral therapy are Well-Established; behavioral family-based treatment and motivational interviewing are Probably Efficacious; drug counseling is Possibly Efficacious; and five multicomponent treatments (three of which include contingency management) are Well-Established or Probably Efficacious. CONCLUSIONS To address pressing issues in ASU treatment, we discuss best practices and promising research on behavioral and medication interventions for marijuana use and opioid use. We conclude with opportunities for advancing ASU treatment science in the areas of technology-based intervention, co-occurring disorders, addiction recovery, and access to and delivery of evidence-based approaches.