For adolescents whose substance use escalates into substance use disorders (SUDs), receipt of formal treatment services is rare.

Use of illicit drugs, misuse of prescription medications, and alcohol consumption are common among adolescents (Johnston et al., 2009; Miller et al., 2007). Data from the Monitoring the Future study shows rates of past month illicit drug use of 7.6%, 15.8%, and 22.3% among eighth, tenth, and twelfth graders, respectively (Johnston et al., 2009). Rates of having "been drunk" in the past month were 5.4%, 14.4%, and 27.6% in these three grade-based groups.

Recent research about the relationship between early onset of substance use and the development of substance use disorders (SUDs) heightens concerns about substance use during adolescence (Hingson et al., 2006; Lynskey et al, 2003; Volkow & Li, 2005). In their analysis of data from the National Survey on Drug Use and Health (NSDUH), Winters and Lee (2008) found that the risk of developing a SUD after recent onset of use is particularly acute for adolescents when compared to young adults. While substance use should not be conflated with substance abuse, this research demonstrated that the relationship between recent onset of use and developing an SUD was stronger for adolescents than for adults. Furthermore, individuals who begin drinking early in adolescence are more likely than their peers to hurt themselves or others unintentionally after drinking even as adults (Hingson & Zha, 2009).

For about 10% of American adolescents, substance use escalates into the development of an SUD. In 2007, 5.4% of adolescents met criteria for past-year alcohol abuse/dependence, and 4.3% of adolescents reported past year abuse of/dependence on illicit drugs (SAMHSA, 2008). SUDs pose risks to both physical and mental health for adolescents (Delaney et al., 2001; Dennis et al., 2003; Diamond et al., 2002). There is an extremely high rate of co-occurrence between SUDs and mental health conditions, with 76-90% of youth having an SUD also having at least one co-occurring psychiatric disorder (Kandel et al., 1999; Chan et al., 2008).

Although SUD treatment is associated with clinical improvements in a range of outcomes (Azrin et al., 2001; Brown et al., 2001; Dennis et al., 2004; Henggeler et al., 1999; Hser et al., 2001; Liddle et al., 2001; Muck et al., 2001; Winters, 1999; Winters et al., 2000), there is a treatment gap between the number of teens with SUDs and the relatively small number who actually receive treatment services. Just 11.3% of adolescents needing drug treatment actually receive treatment services, and the rate of treatment for alcohol use disorders (8.1%) is even lower (SAMHSA, 2008).