Adolescent substance use — structured clinical viva

This is a polysubstance adolescent presentation with dual mental health risk (low mood, NSSI) and parental demand for coercive residential care. Minimise neither cannabis potency/frequency nor family distress.^[5][6]

Assessment framework. Confidentiality-with-safety; private interview; CRAFFT then full pattern (high-THC daily, alcohol binges, methamphetamine); dual screen (mood, self-harm, psychosis, ADHD, trauma); family monitoring capacity; school interface; toxicology as adjunct not alliance test.^[1]

Evidence-based care. MI for ambivalence; family-based therapy as core psychosocial (Waldron); name MDFT (Rigter) and CYT packages; brief alcohol intervention evidence; harm reduction goals (driving, binge reduction, school) per Stockings; concurrent dual care not sequential exclusion.^{[2][3][4][6][7]}

Family communication. Validate fear; reject pejorative "boot camp only" as first step when outpatient family work is appropriate and home is safe; escalate intensity if risk high.^[7]

Pharmacotherapy context. Limited for cannabis/stimulants; if opioid OUD were present, cite Woody extended BUP/NX vs short detox — not the main pathway here.^[8]

Difference from adult topics. Developmental brain context, family therapy primacy, school/Gillick/confidentiality, CAMHS–AOD interface, and youth trial evidence (CYT/MDFT/CRAFFT) rather than adult AUD pharmacotherapy algorithms.^[1][2][6]