Editorial

Publisher: Bentham Science Publishers

E-ISSN: 2210-6774|1|2|94-96

ISSN: 2210-6766

Source: Adolescent Psychiatry, Vol.1, Iss.2, 2011-04, pp. : 94-96

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Abstract

The lead article in this issue is an essay by Joseph Noshpitz on the Shakespeare play “Love's Labor's Lost,” in which Noshpitz analyzes the play in terms of what it reveals about pubertal development. Although written sometime before 1997, when Noshpitz died, it was never published. In it Noshpitz also reminds us of how endlessly fascinating normal pubertal development is. I won't say more here, other than to say how enjoyable it was to read and edit Noshpitz's work (and remember that he was my first editor) as I have a commentary on this article immediately following it.Several articles in this issue deal with substance abuse related disorders and treatment in adolescents. According to the American Psychiatric Association, 7%-10% of adolescents are in need of treatment for substance use disorders (Kleber et al., 2007) and:Alcohol and other psychoactive substance use, abuse, and dependence in children and adolescents continue to present a serious public health problem in the United States. Alcohol and other substance use are among the leading causes of morbidity and mortality from motor vehicle accidents, suicidal behavior, violence, drowning, and unprotected sexual activity in this population.The Substance Abuse and Mental Health Services Administration (SAMHSA), has called substance abuse treatment for teenagers “A major unmet need” (2002). Among youths in the U.S. aged 12 to 17, there were 1.1 million (4.5 percent) who needed treatment for an illicit drug use problem in 2009. Of this group, only 115,000 received treatment at a specialty facility (10.5 percent of youths aged 12 to 17 who needed treatment), leaving 983,000 youths who needed treatment but did not receive it at a specialty facility. In 2009, there were 1.2 million youths (4.8 percent) aged 12 to 17 who needed treatment for an alcohol use problem. Of this group, only 96,000 received treatment at a specialty facility (0.4 percent of all youths and 8.2 percent of youths who needed treatment), leaving almost 1.1 million youths who needed but did not receive treatment (Substance Abuse and Mental Health Services Administration, 2010).Traditionally, many psychiatrists who treated adolescents were not knowledgeable about or comfortable treating substance abuse problems, and those psychiatrists who provided treatment for substance abuse were not comfortable treating adolescents. I had no formal training in addiction psychiatry during my residencies in general and child and adolescent psychiatry in the 1970s. I learned what I did through a moonlighting job at a substance abuse treatment program in a local community hospital. Although today, formal training in the treatment of substance use disorders is a required part of general psychiatry residency training in the US, only one month is required. There is no stipulation of how much time in child and adolescent psychiatry training programs must be devoted to substance use disorders.1If one looks at the manpower numbers they are not encouraging. The American Academy of Addiction Psychiatry's website (www.aaap.org) indicates that there are 1,000 AAAP members (membership is open to any psychiatrist who has an interest in addiction medicine, so not all members have had fellowships). Following the completion of general psychiatry training, residents may take advanced training in the form of fellowships. To be formally trained in child and adolescent psychiatry and in addiction psychiatry requires two fellowships, adding a minimum of 3 years of training to general psychiatry training. While undoubtedly there are many psychiatrists without formal training in addiction who are qualified to treat adolescents with substance use problems, it is clear that even if the total number were 5,000 there would not be enough to treat the million plus adolescents who need treatment.Leaving aside the issue of manpower, most substance abuse treatment programs are not tailored for adolescents. Such approaches as Twelve Steps, therapeutic communi