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Treatment For Adolescence with S ubstance Abuse

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  1. Treatment For Adolescencewith Substance Abuse By Matthew Dahlin

  2. Introduction • Many kinds of treatment • Boarding schools • Wilderness Programs • Outpatient Treatment • Residential Treatment Centers • Small Residential Treatment Centers • Transitional Independent Living • In 2003: 42,000+ living in RTCs (1, 7)

  3. Treatment Centers • Outpatient • Inpatient • Short term (more time doing therapy, 50-70 days) • Long term (6-12 months) (7,9)

  4. How Youth Get to a RTC • Have problem and high risk behavior (substance abuse, depression, ODD • Parents look for help • Transporters • Wilderness Program (sometimes) • Ed Consultant • RTC (7)

  5. Main StudyThe Relative Effectiveness of 10 Adolescent Substance Abuse Treatment Programs • 10 Treatment Centers • 3 Inpatient Long Term • 4 Inpatient Short Term • 3 Outpatient • Measured almost everything (strategy, and income) • Show stats of most effective of each (5)

  6. Main Study (5)

  7. Main Study Results (5)

  8. Potential to Change (statistically) Out of 10studies (3 LTR, 4 STR, 3OP) • Recovery was highest among 17 year olds in LTR who lived in a house with family prior to treatment, (not friends, or others) and were white or Asian (SES is high) • Theories • LTR cost more, kid isn't going back to ghetto • 17 years old, realize its time to be an adult • More time received in drug therapy • More time to stay sober • Family has much lower substance use in home (5)

  9. What Treatment Components Work • Tailor to specific Sex • Placement in proper program • Stay Longer • Staying extra 30 days improve odds as much as 15% • Understanding Treatment Plan • Increased odds of substance abstinence by 138%-200% • Group • Most effective in short term (2,6,8)

  10. What Treatment Components Work (continued) • Match clients to counselors that will “click” is key for short term, helpful in long term • Improving Self Image – Psycho-Social Moratorium • Involvement in community • Learning new hobbies • Doing well in School (3,6,8,10)

  11. What Treatment Components Work (continued) • Family involvement • Family being trained how to be supportive (especially in Aftercare) • Parents learning new Skills • Family/Home Visits (6,8)

  12. What Treatment Components Work(continued) • Aftercare!! • Must start as soon as Child is put in treatment • Training Parents • Needs to be looked as being as important as the treatment • Placement in school completion programs, vocational training, peer support groups, KEEP BUSY! • In the last 30-45 days, putting strong emphasis on the next stage of life (both parents and child) • At minimum, periodic follow up (3,8)

  13. What Doesn’t Help (much) • AA/NA/CA were not significant, but positive. • Unsupported values from parents • Lack of continued services after leaving the initial treatment • Being placed in foster home right after leaving treatment • Allowing kids to “go through the motions” instead of really making them get involved (6,8)

  14. Personal Findings • W.S. – Clean (8months+) • A.W. – Clean (8months+) • M.C. – Relapse • A.B. – Relapse 2 months after, 2 more to get clean. Now clean 4 months. • S.C. – Relapse (left early) • G.L. – Relapse (left early) • P.H. – Relapse (left early) • C.Z. – Relapse (left early) • A.V. – Clean (4months+)

  15. Opposing View • May have no real contact with family for up to 2 years • Usually far away from home (many in UT) • Lack of family involvement • Parents choice of Program is often based on brochure • Child is traumatized by method of getting to treatment (transporters) (1)

  16. Opposing Views (continued) • Some adolescents learn more antisocial behavior • Many cases of: • Physical abuse • Sexual abuse • Neglect • Inadequate monitoring for safety and progress • Inadequate training of staff (1)

  17. Opposing Views (continued) • Annual cost can exceed $120,000 • No Guarantee this will help your kid • A community based program would make a bigger change • Cost less • Saw 60% decline in residential treatment (done in Milwaukee) (1)

  18. Response to Opposing Views • Wouldn’t you give your kid the chance • Never seen the abuse • Far away is good • Plenty of family involvement • Parents choice of program is based on: Recommendation, visit, phone, and interview of staff and kids

  19. Difficulties in Research • Figuring out what specific components really make the change (would need a controlled experiment)

  20. Future Research • How to make aftercare more available • How to properly train under-educated staff • Better follow up with questionnaire to our departed clients • For those who do relapse, is it better or worse? • Specifically what kinds of Therapy helped the most? • Find out what made the client “Want” to make changes in their life

  21. Get Involved • Many RTC’s and Wilderness programs all over Utah • Not having experience abusing substances will NOT negatively effect your involvement (4)

  22. References 1)Bazelon, D. Fact Sheet: Children in Residential Treatment Centers. Judge David L. Bazelon Center for Mental Health Law. 2)Cunningham, W., Duffee, D., Huang, Y., Steinke, C., Naccarato, T. (Jan, 2009). On the Meaning and Measuremnt of Engagement in Youth Residentail Treatment Centers. Portland State University. University of Albany. 3)De Maeyer, J., Vanderplasschen, W., Broekaert, E. (Sept, 2008). Exploratory Study on Drug Users’ Perspectives on Quality of Life: More than Health-Related Quality of Life? Springer Science+Business Media B.V. 4)Machell, D. Counselor Substance Abuse History, Client Fellowship, and Alcoholism Treatment Outcome. Department of Justice and Law Administration. Western Connecticut State University. 5)Morral, A., McCaffery, D., Ridgeway, G. Mukherji, A. and Beighley, C. (2006). The Relative Effectiveness of 10 Adolescent Substance Abuse Treatment Programs. RAND Drug Policy Research Center. 6)Orwin, R., Ellis, B. (Jan, 2000). Treatment Components and Their Relationships with Drug and Alcohol Abstinence. Nation Evaluation Data Services. 7)Program Descriptions for Teens with Emotional or Behavioral Disorders. Independent Educational Consultants Association. www.IECAonline.com 8)Roley, J. (1995). The Design of an Effective Family Reintegration and Aftercare Program for Youth Successfully Leaving Residential Care. Nova Southeastern University. 9)Nelson, C.A., Thomas, K.M., & de Hann, M. (2006). Nerual bases of cognitive development. Handbook of Child Psychology (6thed). 10)Erikson. E. H. (1950). Childhood and Society. New York. W.W. Norton.