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When Your Teen Has an Addiction: What Works?
When parents discover their kids are abusing drugs or alcohol, their knee-jerk reaction may be to send them to rehab, often an over-reaction fed by the media with its focus on extreme cases like the heroin-addicted teens featured in this week’s U.S. News & World Report’s article, “Teens with Addiction Have Few Recovery Programs.” Then, parents go about choosing a program for all the wrong reasons. It may be to “scare them straight,” get them off their own hands, or perhaps to send them to the lap of luxury.
What really works when your teen has a bona fide substance use disorder?
Is it group treatment, the 12 steps, and/or sending them away for a month or more – removing them from the family environment and their current friends? Unfortunately, there’s not much research on adolescent treatment, and most programs are adaptations of adult versions without much evidence supporting their value. This and my next column will explore what we do know about helping young people with substance use disorders.
The Big Picture on Teens and Addiction
According to the latest National Survey on Drug Use and Health (NSDUH, 2012), just over 6 percent (1.5 million) of young people aged 12 to 17 had a diagnosable drug or alcohol problem within the past 12 months, and only 7.3 percent (111,000) received treatment at a specialty facility. Somewhat more were diagnosed with abuse rather than dependence (addiction). Do all of these kids need treatment in a program?
I saw a lot of kids who drank and smoked weed too many times and their parents overreacted and sent them to rehab where they were told they had a disease.When I was writing Inside Rehab, one young person who had spent much of his youth in and out of rehab told me, “I saw a lot of kids who drank and smoked weed too many times and their parents overreacted and sent them to rehab where they were told they had a disease.” There’s no question that it’s difficult to know what’s normal teen experimentation and when it crosses the line for concern. That’s why it’s important to seek out a professional assessment to help determine the extent of the problem. And for that, you don’t need to go to a treatment facility, unless the problem is obviously really serious.
After conducting an extensive review of scientific studies on teen alcohol problems, published in Addiction in 2004, Duncan Clark, M.D., Ph.D., at the University of Pittsburgh Medical Center, estimated that about half of teens in the general population with an AUD, will continue to have a problem in young adulthood, but half will not. (Dr. Duncan’s review didn’t address drug problems.) Of those who do have an AUD, about 30 percent will go on to drink without having problems, while fewer than 20 percent will become and remain abstinent through young adulthood.
Some experts believe that rather than go the formal rehab route, the place to start is with individual help from a mental health professional who has expertise in substance use disorders to get both an assessment of the drug or alcohol problem and a thorough psychological evaluation. Young people may benefit from continued one-on-one work with such specialists.
John Cacciola, Ph.D., a psychologist at Treatment Research Institute in Philadelphia who studies adolescent drug and alcohol treatment told me, “Some studies show that as many as 95 percent of teens with a substance use disorder have some other mental health disorder. Substance abuse is often the overt thing that gets them into treatment, but it’s an underlying problem, such as depression or sexual trauma, that’s really the issue.” Addiction programs, on the other hand, tend to see the substance use disorder as the primary problem.
Substance abuse is often the overt thing that gets them into treatment, but it’s an underlying problem, such as depression or sexual trauma, that’s really the issue.-John Cacciola
Does Teen Programming Square with What Science Shows Works?
As with adult rehabs, most programs that treat young people involve the 12 steps in some way, as well as group treatment. One young man who went to a prominent residential facility told me, that despite his own positive experience with the 12 steps, “Most kids aren’t ready or willing to grasp recovery and, as a result, counselors end up talking to a wall for twenty-eight days and then letting them out with a renewed zeal to get fucked up.”
Psychologist Ken Winters, Ph.D., a leading expert on adolescent substance problems and treatment, based at the University of Minnesota, added that when programs put a great deal of time and energy into the 12 steps, they may not adequately emphasize approaches that help young people change behavior – that is, helping them with decision-making, dealing with triggers, and negotiating life better.
Carrie Wilkens, Ph.D., co-founder of the Center for Motivation and Change in New York, believes that many young people often play along with the 12 steps because they realize that it’s the key to getting out of rehab, adding that expecting young people to “sign on to and embrace the 12 step, lifelong commitment [to abstinence] for the rest of their lives is a ridiculous expectation.”
It’s tough to know where older teens should be placed, and some programs have special tracks for young adults.
Nineteen-year-old Jordan G., whose parents sent him to an exclusive adult rehab after he got in trouble with the police, affirmed, “When you’re in rehab, you play along – I needed a letter for the court. But you almost start to believe the AA stuff, when deep down you know you’re going to do what you want when you get out.”
As for research supporting the 12 steps for teens, there isn’t much. Reviews of the scientific literature on what works for drug and alcohol problems for adolescents mention the 12 steps little, if at all. No randomized controlled trials have ever been conducted comparing 12 step interventions with other approaches. When it comes to having teens attend AA and NA meetings in the community, a number of studies suggest that those who get involved after treatment and stay involved are much more likely to remain abstinent than those who don’t. However, most teens don’t affiliate with AA, and most who do, drop out over time.
It’s quite clear that teens are more likely to attend 12 step meetings aimed at young people, but they can be difficult to find.
It’s a Family Affair
Instead of programs trying to get me to work the steps… I wish I could have had more family therapy and talked with my parents about why I was using, why I was upset.One young person put her finger on what teens really need to overcome substance abuse when I interviewed her for my book and she said, “Instead of programs trying to get me to work the steps and throw these drastic lifestyle changes at me, I wish I could have had more family therapy and talked with my parents about why I was using, why I was upset. I kind of felt like a leper being in rehab. I needed to get closer to my family.”
Yet, as with adult rehabs, teen programs tend to rely on “psycho educational” family weeks rather than true family therapy, despite the fact that two recent reviews of scientific research suggest that the most effective approach for teens with substance problems is family therapy, which requires special training that most addiction counselors don’t have. I was surprised to find that none of the programs I visited for Inside Rehab used the most effective type of family therapy according to research studies – done in individual, not group, sessions, and held at least weekly.
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