From the Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA (AS, NR, ALB); and Department of Research, VA San Diego Healthcare System, San Diego, CA (ALB).
J Addict Med. 2024;18(2):97-102. doi: 10.1097/ADM.0000000000001249. Epub 2024 Jan 10.
The high prevalence of tobacco/nicotine use among youth, including e-cigarettes, is a public health problem in the United States. Early exposure leads to an increased risk of dependence and health consequences in adulthood. We reviewed the literature on current treatment approaches for nicotine/tobacco use in adolescents/young adults and highlighted underexplored areas of treatment research. There are no current Food and Drug Administration-approved medications for treatment of nicotine/tobacco use disorders in adolescents. However, in research settings and on a case-to-case basis, clinical practice medications (including nicotine replacement therapy, bupropion, and varenicline) have been prescribed to this population with consideration of risk-benefit analysis when behavioral treatments are not sufficient to address dependence. Among the nonpharmacological interventions, there is evidence to support the potential for expanded use of contingency management in youth. Neural differences predisposing adolescents to substance use, along with higher attentiveness to value of options in decision making (flexible reward system) may enhance the effectiveness of reward-based approaches for treatment of substance use disorders in this population. The overall high rates of nonresponders across psychosocial and pharmacological treatments highlight the importance of considering novel strategies to improve existing interventions. We suggest that future research be done that considers unique characteristics of today's adolescents, such as high social activism and engagement with digital rewards to tailor contingency management for this age group and assess its effectiveness. Adolescents could potentially benefit from rewards administered through digital media (eg, video games, computer-based apps, and social media influencers).
在美国，青少年（包括电子烟）普遍存在使用烟草/尼古丁的问题，这是一个公共卫生问题。早期接触会增加成年后患依赖和健康问题的风险。我们回顾了关于青少年/年轻人尼古丁/烟草使用当前治疗方法的文献，并强调了治疗研究中未得到充分探索的领域。目前，没有经食品和药物管理局批准的药物可用于治疗青少年的尼古丁/烟草使用障碍。然而，在研究环境中和根据具体情况，在行为治疗不足以解决依赖问题时，会考虑风险效益分析，向该人群开具临床实践药物（包括尼古丁替代疗法、安非他酮和伐尼克兰）。在非药物干预措施中，有证据表明扩大使用条件强化管理的潜力。使青少年容易产生物质使用的神经差异，以及在决策中对选项价值的更高关注度（灵活的奖励系统），可能会增强基于奖励的方法在该人群中治疗物质使用障碍的有效性。心理社会和药物治疗的总体高无反应率强调了考虑新颖策略来改进现有干预措施的重要性。我们建议未来的研究考虑当今青少年的独特特征，例如高度的社会积极性和对数字奖励的参与，以针对该年龄段调整条件强化管理，并评估其有效性。青少年可能会从通过数字媒体（例如视频游戏、基于计算机的应用程序和社交媒体影响者）管理的奖励中受益。
