Developing the Adolescents and Transition-Aged Youth volume of The ASAM Criteria®, Fourth Edition

The recently published Adolescents and Transition-Aged Youth volume of The ASAM Criteria, Fourth Edition, includes the Criteria's first dedicated set of substance use disorder (SUD) treatment standards tailored specifically to youth. Scott Hadland, MD, MPH, FASAM, a pediatrician and co-editor of the volume, says the new standards address the highly unique needs of young people impacted by SUD.

Dr. Hadland was one of five members of the editorial subcommittee responsible for driving the development of the new volume. Led by Editor in Chief Corey Waller, MD, MS, DFASAM, the team worked with numerous writing groups, councils, and committees across ASAM to draft these new standards. A rigorous methodology for evidence review and consensus development guided the process.

"Our goal was to create developmentally appropriate treatment standards for adolescents and transition-aged youth with substance use disorders, and to fully account for the developmental and family context of youth," said Dr. Hadland, who also serves as chief of Adolescent and Young Adult Medicine at Mass General Hospital for Children. "We aimed to provide a practical framework clinicians can use to match young people to the right level of care."

Previously, standards for adolescents were interwoven with those for adults in the Third Edition of The ASAM Criteria. Since its 2013 publication, there have been significant advances in research related to the prevention and treatment of SUD in young people. This led ASAM to dedicate an entirely separate volume to comprehensively address the unique considerations of adolescents (under 18) and transition-aged youth (16-25).

"Youth experience substance use disorders in a unique developmental context that shapes treatment engagement and recovery," explained Dr. Hadland. "Their care often involves families, schools, and pediatric health systems in ways that differ from adult care…a dedicated volume allows these developmental factors to be addressed directly."

Production of the volume kicked off in 2021. ASAM began by surveying key stakeholders to understand what worked well with implementation of The ASAM Criteria, Third Edition, assess challenges, and determine areas for improvement. This feedback was analyzed and combined with research advances, clinical experiences, and knowledge of evolving systems of care. According to Dr. Hadland, collaboration was key.

"The process was highly collaborative and unfolded over a long period of time. The writing committee included a range of experts who brought perspectives from pediatric and addiction medicine. We reviewed the literature, examined how adult criteria could or could not apply to youth, and debated how recommendations would work in real-world settings. Multiple rounds of drafting and revision helped refine the final standards."

Stakeholder input also shaped the new criteria. In 2024, ASAM released an initial framework for public comment and review. Given that The ASAM Criteria is implemented in different ways in systems across the country, it was important for members of the editorial team to receive diverse stakeholder feedback. Dr. Hadland noted that this feedback process was important to ensure the standards reflected day-to-day clinical practices and realities.

"We invited comments from clinicians, researchers, and treatment programs," added Dr. Hadland. "Many comments helped clarify language, strengthen developmental considerations, and ensure recommendations were feasible. The committee reviewed this feedback carefully and incorporated revisions where appropriate, which strengthened the final document."

Supporting Young People and Families Impacted by Addiction

Substance use disorder is a pediatric-onset illness. Initiating substance use in one's adolescent years, or experiencing an adverse childhood event, can lead to the development of an SUD.

Dr. Hadland witnessed this firsthand in his medical training, setting his addiction medicine career in motion.

"During my pediatrics training, I saw how profoundly substance use disorders affect young people and their families," recounted Dr. Hadland. "Many adolescents struggled to access effective treatment despite strong evidence that treatment works. That gap between need and care drew me toward addiction medicine. It offered a way to combine clinical care, research, and policy to improve treatment for youth."

Dr. Hadland's work remains focused on promoting adolescent and young adult access to treatment and recovery services, which can set young people up for health and success into adulthood.

"My vision is a system where every young person with a substance use disorder can access timely, evidence-based treatment," added Dr. Hadland. "That includes medications, behavioral care, and services that involve families. We also need stronger universal prevention, and integration of addiction care into pediatric and primary care settings. This new volume of The ASAM Criteria provides a framework to help clinicians assess youth and match them to appropriate levels of care across this full range of needs."

On March 25, Dr. Hadland presented the new standards to a crowd of adolescent SUD treatment professionals at the Joint Meeting on Youth Prevention, Treatment, and Recovery held in Baltimore.

"I feel grateful to have worked with such a dedicated group of colleagues," said Dr. Hadland, reflecting on the development of the volume. "The process was demanding but grounded in a shared commitment to improving care for youth. It is rewarding to see the volume completed and available to clinicians. I hope it helps strengthen treatment systems and improve outcomes for young people and families."

The ASAM Criteria, Fourth Edition, Volume 2: Adolescents and Transition-Aged Youth, is available in print and digital formats here.