This is a continuation of When Your Teen Has an Addiction: What Works?
You’d think that a recent “special issue” of a leading magazine for addiction counselors focused on adolescents and young adults would mention at least one teen program shown in scientific studies to have sound research backing.
The issue has articles on spirituality and wilderness therapy, approaches not even mentioned in a summary of the most comprehensive review (a meta-analysis) ever of studies on teen substance use disorder treatment published in the same magazine. The review – published in 2013 in the Journal of Substance Abuse Treatment – found that family therapy approaches were the most effective treatment, followed by cognitive-behavioral therapy and motivational interventions. (For a description of these approaches, see my article, “What Is Working in Addiction Treatment”.)
The following are three adolescent drug and alcohol treatment programs that measure up, using approaches shown to be effective in research studies:
Multidimensional Family Therapy (MDFT)
As a program designed for teens who struggle with substances and also have psychological or behavioral problems, MDFT helps them with coping, problem-solving skills, regulation of emotions, social skills, and alternatives to using drugs and alcohol.-Anne FletcherAt their main website it’s stated, “MDFT believes parents are the best medicine for adolescent problems…Interventions and treatment programs that focus solely on the adolescent are too often ineffective.” As a program designed for teens who struggle with substances and also have psychological or behavioral problems, MDFT helps them with coping, problem-solving skills, regulation of emotions, social skills, and alternatives to using drugs and alcohol. The parent component helps with decreasing family conflict, teamwork, family communication, and encouraging parents to take better care of themselves. If the parents have drug, alcohol, or psychological problems, they get help, too.
With a growing number of programs available both nationally and internationally, MDFT has been put to the scientific test for 25 years in numerous, well-designed studies, including randomized controlled trials. It’s also been shown to be more cost-effective than residential treatment and many traditional outpatient treatments. Although designed for one-on-one (not group) outpatient treatment, MDFT has been tested in a few residential settings with favorable outcomes.
A teen candidly stated in a video at their website, presumably after participating in MDFT, “I communicate better. I’m getting along a lot better with my brother. [The therapist] helped me communicate better with my father.” He also talked about how he used to “hold in” so many things and then how, with the help of his therapist, was able to “let it out.”
To see if there is an MDFT program near you, visit their website.
Adolescent Community Reinforcement Approach (A-CRA)
A-CRA has teens and trained therapists working individually, recognizing at the outset that teens use because they get something out of it. The therapy helps replace that “reward” with alternative means of having fun and finding ways to have a meaningful life without using. Young people also learn how to cultivate friendships and activities that are more likely to lead to a non-using life, but the focus isn’t always on substance use.
There is also evidence that for teens with substance problems, A-CRA helps reduce symptoms of co-occurring mental health problems, such as anxiety and depression.-Anne Fletcher
Parents are involved in a number of the sessions – sometimes with the teen and sometimes without – learning such skills as more effective problem solving and better communication. Randomized clinical trials have shown A-CRA to be effective, and long-term follow-up of young people who participated in A-CRA in these studies revealed that they were just as or more likely to decrease use of alcohol or drugs than those who participated in other, more expensive treatments. There is also evidence that for teens with substance problems, A-CRA helps reduce symptoms of co-occurring mental health problems, such as anxiety and depression. Although usually an outpatient approach, A-CRA has been used in residential settings, helping staff reward kids for positive behavior rather than use punitive approaches.
A-CRA and CRAFT (see You Can Motivate Your Loved One to Get Help) have the same underpinnings, having grown out of the well-researched Community Reinforcement Approach that’s been around for decades. CRAFT, too, has been pilot-tested for teens already in treatment and the results were promising. I spoke with Elizabeth Helton, MSW, the residential unit coordinator of the adolescent substance use disorder treatment unit at Chestnut Health Systems in Bloomington, Illinois, where this study took place. She said, “I love CRAFT and A-CRA because they are empowering approaches for both young people and their families.” In the past, they used a traditional education/counseling program that was lecture, then group discussion with a facilitator.
With CRAFT and A-CRA, they now teach young clients specific skills each week in the context of their life situations and then practice using them. She noted that with the old approach, “Parents didn’t get much that was helpful. The new focus is on better communication skills and helping parents increase their children’s positive behavior, which in turn decreases negative behavior. Elizabeth said, “If you take everything away from a kid – their cell phones, time outside, money – they have no incentive to do better. So we connect all of these things to positive behavior. If you come home on time, you get money for a movie, you get to use your cell phone, your curfew may get extended the next night.”
Find more information about A-CRA here. To find out if there’s a location near you that’s using A-CRA, contact Susan H. Godley, Ph.D., at Chestnut Health Systems; firstname.lastname@example.org; (309) 451-7802.
The Seven Challenges
The Challenges meets kids “where they are,” helping them to talk honestly about themselves and substances they use, examining why they’re using them and the impact on their lives.-Anne FletcherThe Seven Challenges was developed by Robert Schwebel, Ph.D., a psychologist, who set out to develop a more developmentally appropriate model than 12-step programs that tend to require immediate abstinence from drugs and alcohol, as he said, “before they’ve decided they want to be abstinent.” The Challenges meets kids “where they are,” helping them to talk honestly about themselves and substances they use, examining why they’re using them and the impact on their lives. They also help teens accept responsibility, think about what they want to accomplish, address where they’re headed in life, and examine how substances play a role in decision-making. An important aspect of the Challenges is understanding the “benefits” of drug and alcohol use for teens and coping with urges to use. Independent government-funded studies published in peer-reviewed journals showed that the Seven Challenges program significantly decreased adolescent substance use and improved mental health.
When I interviewed her for my book, Elizabeth B. was just finishing up a Seven Challenges program after having attended many other kinds of treatment facilities where they “did the twelve steps” and she said she didn’t pay attention. She told me, “The message was, ‘Don’t do drugs, it’s bad for you.’ It doesn’t work when adults tell you that. We all know it’s bad. At the Seven Challenges, they don’t tell you, ‘You need to stop using.’ They help you figure that out for yourself. And if a teen does use, it’s not the end of the world… The Seven Challenges really makes you realize what to look for right before you’re falling. They help you think through why you’re doing what you’re doing. You have to want to change for yourself, and the Seven Challenges helps you do that.”
For more information, visit their website. To locate a program, contact the director of program services, Sharon Conner, who can be reached at (520) 405-4559 or at email@example.com.
Why Don’t Things Change?
Sadly, not a single adolescent program I visited for my book, Inside Rehab, offered any of these approaches. All of them included the 12 steps. National surveys indicate that most facilities that accept teens use the 12 steps during treatment and link them to community-based 12-step meetings after treatment.
So why is it so difficult to find the most effective treatment for teens with substance problems?
Parents need to educate themselves and advocate for research-based approaches. If your child had a medical problem like diabetes, wouldn’t you want him or her to be treated based on the latest science?-Susan Godley
Susan Godley, Ph.D., co-developer of A-CRA, told me that she believes part of the reason is the natural human tendency to resist change. “Also, staff have a strong belief that what they’re already doing is effective because they’ve been doing it for a long time and some people have improved with the approaches they’ve used.” She also talked about how research-based approaches require more supervisory oversight and feedback than traditional ones and that training and supervision of drug and alcohol counselors needs to be improved. In the end, she maintains, “Parents need to educate themselves and advocate for research-based approaches. If your child had a medical problem like diabetes, wouldn’t you want him or her to be treated based on the latest science?”
Also Read: When Your Teen Has an Addiction: What Works?
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