Summary: Substance use disorders (SUDs) in youth are strongly associated with aggression, delinquency, and involvement with the juvenile justice and mental health systems. This article reviews the relationship between aggression and SUDs and discusses evidence-based approaches to assessment and intervention, with a focus on youth in secure settings. While evidence indicates etiological overlap, SUDs also confer risk for aggression and delinquent behavior. SUDs and aggression are each influenced by executive functions that develop as youth transition toward adult roles. Additionally, the effects of substance use on the adolescent brain impair neurocognitive function and increase the risk for aggression and further substance use. In terms of assessment, it is important to identify function and form of aggression in order to understand motives and associations with substance use and to select appropriate interventions. Evidence-based screening and assessment of aggression, substance involvement, and related domains is also critical. In terms of treatment, youth with SUDs tend to be underserved, particularly when they are also involved with the juvenile justice system. Multiple modes of evidence-based treatment for substance use are available. Approaches that address risk factors common to SUDs and aggression across multiple domains (e.g., family therapies) have been found to be most effective but may be difficult to adapt for use in secure settings. Individual therapy approaches also have empirical support and may generally be more practical in secure settings.
