Changing Assumptions in Treating Adolescents for Addiction

Never Treat your Adolescent Addict as an Adolescent

These days just making the journey from adolescence to adulthood is hard enough. Mix in alcoholism and other addictions and it can seem impossible. Despite this, many programs have heroically attempted to treat adolescent addicts, often with disappointing outcomes. Whereas treatment in general reduces drug use by 21 per cent overall, recent SAMHSA studies found that treatment for adolescents actually increased their chemical use by an average of 13 per cent! (SAMHSA, 1993). To exacerbate these dismal findings, adolescent programs for addiction require longer stays, a higher staff to patient ratio and cost significantly more then the familiar 28 day program (NDATUS, 1989).

The news is not all bad, however. Although treatment for adolescents doesn't appear to give the desired results, the ones who do find their way to recovery from addiction are more likely to have gone through treatment than not. Therefore it becomes our job as treatment professionals to identify what assumptions don't work in the old model of adolescent treatment, what does work, and learn how to treat an adolescent in a setting that is most likely to lead him or her to long-term abstinence from mind affecting chemicals. The difficulties with the old model of adolescent addiction treatment have emerged with time and experience. They include:

Too Much Emphasis on Family Therapy

The first problem with our assumptions in treating adolescents is the unrelenting focus on the parents and family structure as the key to recovery. Even though family participation in treatment has never really been able to predict continued abstinence (Fiorentine and Anglin, 1996), reviews of studies do state that family involvement in treatment for substance abuse is effective (Diamond, Serrano, Dicky, and Sonis, 1996). Yet, an analysis of the reviews reveal studies that are not well controlled and that most findings are correlational in nature. They state findings that say things like: when the family conflict is reduced, the drug addict uses less drugs. One could just as easily say that when the user uses less, family conflict decreases. It's a mistake to base treatment on weak correlations like this. McCrady makes a great point when he explains that well controlled research in this area is scarce and "there are notable discrepancies between the popularity of clinical practices and the empirical bases of practice" in family-involved alcoholism treatment (McCrady, 1989).

Not Enough Emphasis on Abstinence

Another reason for the failure of adolescent only centers may be a lack of emphasis on total abstinence. Even though it is known that long-term abstinence is associated with 12-step meeting attendance in the first year following treatment (Thurstin, Alfano, and Nervivano, 1987), staff members on adolescent units tend to recommend fewer 12 step meetings to their younger clients then they do with adult clients. They also have an average of only 23 per cent recovering staff as compared to multigenerational units that have 50 to 60 per cent of staff in recovery (Marshall and Marshall, 1994). This may in part explain the lack of emphasis on 12 step meeting attendance because recovered alcoholic counselors also recommend significantly more 12 step meetings for clients then nonalcoholic counselors. In addition, adolescent treatment is less likely to use abstinence as a measure of treatment success then multigeneraltional units. Presumably, abstinence may not be their treatment goal (Rush, 1986).

High Risk Youth are Vulnerable to Peer Aggregation

The third and most important reason that the old model and its inherent assumptions doesn't work well is that it places a young person in a peer environment that makes it practically impossible to recover. This is the single most important point to understand in treating adolescents. Kids are socialized by their peer groups--not by their parents and not by the professional. They gain their attitudes, behavior, likes and dislikes, and propensity for change from their peers. This has startlingly strong therapeutic implications.

By placing young people in a contextual framework of drug addicted maladjusted same age peers (that will, by definition, become their reference group), the only way to embrace recovery within this context, would be to be abnormal. They would have to go against the normal and innately powerful process of group socialization to align themselves with the staff. The consequences would be the negative judgment of their peers and non assimilation into the group they prefer. Although not unheard of, kids don't turn their back on their reference group very often.

Components for Motivating the Adolescent

Motivating an adolescent to want recovery has several important components: