Treatment professionals have only recently recognized that substance-abuse treatment programs for adolescents cannot simply be scaled-down versions of adult programs. Adolescents are not simply “little adults.”
Unlike their adult counterparts, adolescents in treatment have more family difficulties, are more likely to have psychological problems, and are more likely to have attempted suicide. Their alcohol and drug-use patterns are also different. Teens tend to abuse multiple substances, while adults are more singular in their focus.
The path to hitting a “bottom” is also different. For adults, entry into treatment is usually heralded by loss of job are family, chronic medical problems, and/or encounters with the law. The “red flags” for adolescents are more subtle and revealed in school performance, peer relationships, and interactions within family of origin, as well as involvement with the judicial system.
For most teens, referral to treatment is involuntary and is usually mandated by family, school, or the judicial system. When asked in Intake what the problem is, the most common answers are “Don’t know” or “Somebody (family, teacher, policeman) just overreacted.” When pressed, most say they are doing nothing different from their peers who were not “caught.”
Once they finally get into treatment, youth seek out and respond to different treatment modalities (favoring group therapy over individual), need to have their family included in treatment, and must have a school-based component if in inpatient or residential treatment.
Finally, most adult treatment programs are not set up to deal with the oppositional or acting-out behaviors characteristic of adolescent substance abusers. Fortunately, most residential facilities do not mix teen and adult recovery programs.
Implications for Treatment Programs:
While adults in treatment are free to make geographical and personal changes in their environment by relocating and choosing either solitude or different significant others to reside with, adolescents do not have this freedom.
Because of this, if there is family dysfunction – either addiction or mental health issues – it is much harder for a recovering teen to stay clean and sober from alcohol or drugs. Effective treatment requires that family members must also be helped to achieve health. If this does not happen, an alternative home environment must be found for the youth.
Successful adolescent treatment programs must not only address substance use but help an adolescent navigate the normal developmental tasks of identity formation that are often neglected while using chemicals. This means that:
- Effective problem solving and social skills need to be learned in order to build self-esteem. Basic trust must be built or rebuilt. Often this is done through the use of physical exercise such as navigating ropes or falling backwards into the arms of a peer.
- Verbal skills also need to be learned, such as how to ask for help. Basic feelings must be identified and a language of emotional communications must be established. Many substance-abusing teens cannot name three different feelings.
- Coexisting mental health issues such as depression, anxiety and post-traumatic stress disorder (PTSD) must be evaluated. Very often substance abuse masks these disorders and they only emerge in early recovery. Left untreated, they become triggers for relapse.
The importance of a quality and accessible aftercare system cannot be overemphasized. Such a program must be within easy travel from home. If a teen is dependent upon a parent’s driving, or has a long mass-transit commute, the likelihood of treatment being continued is small.
Without such support through the creation of a new peer group, the return to substance-abusing friendships is inevitable.
Adolescents present a unique challenge to treatment professionals. Creative and effective strategies must be developed within the context of limited Insurance-based treatment and ever decreasing government support for treatment.
We have no choice but to rise to the challenge.